The tragedy after Hurricane Katrina

Tragedy continued, in the form of illness to aid workers, after Hurricane Katrina passed.

After the storm waters of Hurricane Katrina subsided, devastation remained: unsafe and waterlogged structures, with moldy, crumbling walls; unsalvageable fridges and soggy couches; indoor rivulets of mud. Local economies collapsed. A million people were displaced. Thousands of residents lost everything they had — their homes, their jobs, their communities, all underwater.

After the storm, the tragedies didn't stop. As people from around the country arrived — including thousands of migrant workers, many from Mexico and Honduras — the long process of cleaning up began. Displaced locals also joined the efforts. But, unbeknownst to many workers, this kind of clean-up and demolition involved numerous risks to their health and safety.

All that water caused the proliferation of mold and bacteria, which may have sparked allergic reactions, skin infections and lesions, and asthma attacks for the workersencountering standing water, scooping toxic mud or hauling moldy debris to landfills. As they took down some of New Orleans' famously colorful houses, workers were upping their chances of lead poisoning — old paint contains lead.

As they broke down and hauled away concrete, bricks and insulation, workers in Louisiana likely were exposed to silica and asbestos. Silica, a long-recognized serious occupational health hazard, causes silicosis, an irreversible, progressive lung disease and is also associated with lung cancer, chronic renal disease and autoimmune disorders. The World Health Organization estimates 107,000 people die worldwide each year from occupational asbestos exposure, which leads to mesothelioma, lung cancer, and other health issues. September 2005 was unusually hot in New Orleans, with 87 percent of the days at higher than average temperatures; heat stress is yet another exposure that can cause serious worker illness.

In addition, demolition workers face the same on-the-job risks that kill an average of more than 15 construction workers each week. Most die falling off of ladders, rooftops or unsafe structures. Others are struck by objects, electrocuted or caught or pinned by things like heavy machinery. These deaths make construction one of the most dangerous occupations in America.

The risks after natural disasters are high, but they can be reduced with proper training,work practices and equipment, like local exhaust ventilation and respirators. But a study by Tulane University and University of California, Berkeley on Hurricane Katrina demolition workers found that protective equipment was "available but insufficient, especially for undocumented workers," with 19 percent of all workers saying they were not given any protective equipment for dangerous work. Undocumented Latino workers — which made up roughly 25 percent of the study's subjects — had significantly less awareness of the health risks.

Few employers trained Katrina workers on the risks they were taking and how to protect themselves on the job. The limited health and safety regulations provided by OSHA and other agencies are often difficult to enforce, particularly during emergencies. Efforts to strengthen worker protections like OSHA's new silica regulations are facing serious pushback from industry, but these regulations are needed to prevent worker exposure.

Once sick or injured, migrant demolition workers encounter numerous barriers to receiving health care, in part due to their mobility, and compounded by cultural and language barriers, transportation issues, and lack of financial resources. Ten years later, some of the workers have settled in Louisiana, but others moved on. Where are the migrant workers from post-Katrina Louisiana, and, for those who are sick, or become sick, how will they access health care?

As clinicians, we recognize the importance of prevention. Across the country, migrant workers need preparation for future disaster clean-up work. Day laborer and migrant health organizations can provide ongoing health and safety training in culturally and linguistically appropriate ways. When disaster strikes, companies need to provide safety equipment and employ appropriate work practices to prevent exposures. Before a disaster — right now — we need stronger regulations to protect this segment of our workforce, to remove as many of the occupational risks as possible.

This weekend's tenth anniversary of Katrina is rightly focused on the people of New Orleans and environs who lost everything. An entire city of destroyed lives is heartrending. Compounded onto that tragedy were the unnecessary, unsafe exposures that clean-up workers endured for months after the storm. We cannot prevent future hurricanes, but we can take steps to assure that we limit the number of lives that are devastated in the aftermath of disaster, by ensuring the health and safety of clean-up and demolition workers.

Amy K. Liebman is the director of environmental and occupational health at the Migrant Clinicians Network's Salisbury office. Dr. Ed Zuroweste is Migrant Clinicians Network's chief medical officer and assistant professor of medicine at Johns Hopkins School of Medicine.

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