Prologue

Upon completion of our whirlwind fact-finding mission in New Orleans, President William Winspear expressed his awe at the massive destruction of property, people, and emotions that we discovered there. He suggested that we devote an entire issue of Dental World to describe what we found. And to try to draw some conclusions as to whether PFA can be of any help, and where we can be involved.

I guess that presupposes that this is within the mission of PFA. The predominant feeling is that this is, and if not, should be. We are a dental honor service organization that has as its members some of the finest minds in the world. If we cannot find some solutions, who then has the brain power to be able to?

Several Board members commented that we are human beings first and dentists second. On that precept we should be involved. And as our Foundation tries to solve massive dental problems, one millimeter at a time, this is not any different. This just needs some creative thinking to do it.

Who is more creative than dental professionals who daily tweak a restoration to work; experiment in research and technology; find new ways to perform dentistry; invent new and better materials, instruments, ideas; have new methods of teaching our successors and colleagues? This is a great profession that is constantly re-inventing itself every day. So we have a new challenge now. We can do it!

The City of New Orleans

In this particular case we must start at the beginning to determine where this disaster started evolving.

The City of New Orleans, like the Pierre Fauchard Academy, had its origins in France. 17th-Century France was in an expansionist race for land in the Americas against its chief rivals Spain and England. Spain had already claimed Latin and South America; and the English had most of the eastern coast of North America. France, though, had a plan. They claimed the St. Lawrence River, the Great Lakes, the Mississippi River, and all the land those waters drain. This formed a semicircle of land around the English Colonies, effectively boxing them in with forts and settlements, anchoring their territories from Quebec to St. Louis to New Orleans. This was based mostly on the explorations of Rene Robert Cavelier de La Salle.

About this time, 1678, Pierre Fauchard was born in France.

The English victories in Canada during the French and Indian War secured Canada for Britain; however, St. Louis and New Orleans guarded the French claim to the Mississippi drainage lands.

But, the geography of the mouth of the Mississippi did not lend itself to an easy area to build a city, fort, or even a village. The closest high ground to do that on was Baton Rouge. That was some distance and meander from the mouth of the Mississippi, though. In 1699, with the help of the resident Choctaw Indians, the French were shown a way into the New Orleans area by going up the Mississippi, over to Lake Pontchartrain, and back down to Bayou St. John.

In 1693, Pierre Fauchard was a cabin boy in the French Navy apprenticing with the ship's doctor and experiencing various diseases and cures. By 1696, Fauchard had begun practicing a form of dentistry in western French villages.

In 1718, Jean Baptiste founded what was called ''Isle d' Orleans.'' In that time it was an island with Lake Pontchartrain to the north and the wandering Mississippi River to south, the swamp and delta to the east, and the western areas honeycombed with bayous and channels.

In 1718, Pierre Fauchard settled in Paris and practiced dentistry.

The declared City of New Orleans was laid out by the French engineer Adrien de Pauger. All this was but a false imagery for the maps of Europe. New Orleans was more firmly established on parchment maps than it was in the marshes of Louisiana.

The heat, humidity, mosquitoes, and disease made selling settlement difficult in Europe. Few wanted to live there. And there were no immediate natural resources, like gold, building stone, or any nearby farm acreage.

Fauchard published his first book, Le Chirurgien Dentiste ou Traite des Dents. It was an instant best seller thanks to the newly invented Gutenberg printing press.

Spanish New Orleans

When France lost the Seven Year 's War (1756-63), the Treaty of Paris ceded French Canada and all the land between the Mississippi River and the Appalachian Mountains to the English. New Orleans and the huge area called Louisiana (to the west of the Mississippi) went to the Bourbons of Spain from 1762 to 1802.

Pierre Fauchard died in 1761.

Spanish rule did not change anything. The English colonists brought their goods down river to New Orleans in greater numbers. The Mississippi was the waterway of life for the heartland of North America. This had worried the French and then the Spanish, but neither took effective action to colonize the city to any degree. The French Quarter, the Vieux Carre, is more Spanish in construction than French--having been wiped out by fire in 1788, three fol- lowing hurricanes, and another fire. That is why some of the old street signs are also in Spanish.

Because the Mississippi River had a habit of jumping its basin and forming a new way to empty to the Gulf through the maze of swamps and marshes, large, thick earthen levees were built to contain the river. Eventually these levees reached the height of 10 to 15 feet above sea level, and ran for about two miles. In doing this, the river bottom also rose higher to accommodate its current flow and silt deposits. The end result was that, over time, the height of the river became 10 feet above sea level, and higher than Lake Pontchartrain. That made most of the city of New Orleans below the level of the river. This basin, for two hundred years of construction, was a known disaster waiting to happen. Worse, because the height and length of the levees formed the rim of the basin, if a levee was broken through anywhere, the water from either the river or the lake would rush in and fill the basin called New Orleans. And keep it in.

The garbage and sewage would also collect on the city side of the levees, fostering disease. You cannot drain anything by gravity from a lower basin.

American New Orleans

When the Army Corps of Engineers reinforced the levees and put in drainage pumps in the years after the Civil War, the dry land it drained became developed areas for low-income housing. This was not planned. It just happened that way.

In 1803, when President Thomas Jefferson bought Louisiana from France (including both St. Louis and New Orleans) the population was 8000 inhabitants. By 1860 it had grown to 170,000. By the 1960s the population had reached a little over 1 million people.

Often referred to as N.O., its nickname of the ''Big Easy'' reflects the residents' attitude toward life, very easygoing in nearly everything, even addressing its pressing problems.

In its earlier years, 1/3 of the population would annually leave the city for summer residences from June through October. This was to avoid the heat and humidity for sure, but also to miss the hurricane season and the disease epidemics that plagued this bottomland of the Mississippi. This ''evacuation'' was also a way of life for many residents, as are the Mardi Gras Festivals in February.

Katrina

Katrina was a Category 3 hurricane that hit the Gulf Seaboard of the United States on Monday, 29 August 2005. This was the most forceful hurricane in 100 years. While its intensity was not as great as others, its widespread area of impact was larger.

In a quick space of time, Hurricanes Rita and Tammy hit overlap areas as well, causing increased damage. In general, ''Katrina'' has become a noun covering all the damage and suffering resulting from the losses incurred that August/September and are still continuing today.

Rain began before the hurricane made landfall and resulted in 8-10 inches during the period. For three hours it fell an inch an hour. The rain pattern continued to affect areas as far north as the Ohio River Valley.

Wind was clocked at over 140 mph with a steady 100 mph over New Orleans. The wind pattern affected other southern States, even spawning tornadoes in Georgia.

Storm surges affected the coastlines everywhere along its path, but nowhere more devastating than in the basin of New Orleans. Some wave surges were 18 feet above normal and extended 500 yards inland. Remember that the levees were at best 15 feet above sea level. All buildings in its path sustained roof and floor damage with those under 15 feet above sea level, totally destroyed. Only the 1935 Florida Keys Hurricane and 1969 Hurricane Camille were more powerful.

Devastation

The loss of life, human and animal, is enormous and is still being counted. When the water started filling the houses, many people went to the second floor to escape, and then to the attic. When the water kept coming the people cut through their roofs to climb on top. Some were unable to cut through their roofs. One book on the disaster is called ''One Dead in the Attic'', and refers to the strange shorthand markings on the outside of the houses spray painted there by searchers looking for live survivors. They had to skip the dead to hurry on finding those alive. The markings were left to notify subsequent volunteers to take out the bodies.

Property loss is in the billions of dollars. And after the levees gave way, by 30 August, 80% of New Orleans itself was filled with water, with some areas 20 feet under.

The Gulf oil production was reduced by 95%, driving up gasoline prices all over the mid-United States. The electric service was interrupted for 1.7 million households and took weeks to restore. Drinking water was out due to a broken water main that served the city's water system. And food supplies were nonexistent. Phone lines and cell towers were down and took months to get back up to serve computers, handle bank accounts, business and personal communications, health records, etc.

Travel by all modes of transportation was interrupted. Roadways and train beds were underwater or blocked with debris. Bridges were washed out or badly damaged. Transportation vehicles were underwater, damaged, or unable to get fuel. The airports were flooded and closed. Water-borne vessels of all kinds were damaged, blown on land, or sunk. And the fishing industry was at an immediate halt.

Again, like for two centuries before, sewage, contaminated water, and disease became a factor along with the heat and humidity in the late summer swelter.

This was the greatest natural disaster to affect the United States, with well over several million people from Florida to Texas directly or indirectly affected.

The Human Factor

About 2/3 of the population did evacuate when told. One PFA Fellow sent his mobile home up to a relative's house a week before and then evacuated to that location. But many, for whatever reason, failed to leave. A few spent the time at a French Quarter tavern that was open and serving customers through the storm. Many who failed to leave were sent to the Super Dome or to the New Orleans Convention Center on the Mississippi River. This was the city government's Disaster Plan. But no supplies were there for them. No one realized the number of people that would show up and stay for what period of time. Hotels opened up their doors and rooms for those who did not leave. And many did not leave there until they were evicted to serve tourists for the 2006 Mardi Gras.

School buses were sent to the evacuation collection points, but were sent too late and became stranded in the flood waters. The bridges leading out of the city were underwater or damaged, and there are not that many routes leaving water-locked New Orleans.

The mentality of the remaining populace was that their government would provide for them. That did not happen for several reasons. One third of the police force (and other government personnel) left when told to evacuate. Many of the remaining police were busy fending for their own survival, as were many of the citizens. And there was no effective Disaster Plan in force to handle the massive wide-spread situation.

The City of New Orleans had nothing that was capable of dealing with this singular event in history. They were unprepared, and then too slow to act, once they realized the magnitude of the situation.

The federal government's FEMA and service organizations were on standby, but were hampered by an 1868 federal law that prohibits federal authorities from entering a State without permission of the State government. The Louisiana Governor was called directly by the President for such permission. She denied him access even though the State of Louisiana had no disaster plan in place. Blaming the federal government deflected the finger-pointing to avoid the spotlight of failure. The State militia was later sent in to restore order, after the fact. Again, too little, too late. The State relented and allowed federal authorities in to help.

Looters and the Lawless

With no police presence, looters ran rampant, robbing and ruining businesses. Some caught on camera looting were the police themselves. But many good citizens participated in getting essentials to survive.

Firemen claimed to be under gunfire attack in answering calls to put out fires and rescue missions. The city seemed to be in anarchy.

Crime was up everywhere.

Hurricane + Aftermath = Disaster

Hospitals and clinics were under water, without electricity, computers, or communications. They tried to evacuate by helicopter. Ambulances were unable to answer emergency calls due to the blocked or underwater roads. Of the 14 hospitals in New Orleans, only one has been able to open their doors since Katrina. The LSU School of Dentistry has closed and moved to the Baton Rouge Campus. Their Med Center is closed. Many dental offices lost their equipment, had damage to their buildings and records, had patients leave the area, and had to wait for banks to re-open their accounts to do business.

Driving was and still is a hazard. Even after the flood waters subsided and the roads cleared of debris, there were no street signs, no stop signs, few traffic lights, and missing street lights.

Shrubbery and trees were gone, along with the shade they provided. And there was the heat and humidity, mold and moss growing, standing water and the vermin it hatches. Some homes, even today, are just piles of rotting rubble. The worst hit were the poor and retired people who cannot afford to fumble through the insurance claims and the government permits necessary to get on their feet again.

With so many residents leaving and never returning, available manpower was reduced, particularly in the trades. Necessary city employees needed residences. Businesses, such as hardware stores--to supply building materials, were gone. Grocery stores--for food and bottled water; restaurants--to feed the remaining population, were gone; doctors--to serve the health needs; teachers--to reopen the schools; appliance stores--to replace the destroyed washing machines, stoves, and refrigerators, etc., were gone; gas stations--for fuel; and so many of the day-to-day essentials that we all take for granted were needed immediately. They were not there. Shopping malls were closed and damaged. Some are still not open today.

FEMA moved in hundreds of white mobile trailers to house the necessary employees required to rebuild the city. Individual businesses re-opened as soon as they were able to repair the damage and regain employees. Garbage pickup and destroyed homes were started to be hauled away, block by block--an enormous undertaking. And where do you remove it all to? Prices for labor, when available, soared; building materials were difficult to secure; money from frozen bank accounts hard to get loose; and insurance companies are just now settling cases 16 months later!

Even if you and your family and your home are all right, is your place of employment still there? Is it still operating? Do you have a job? Are your customers still around? Can your children go to school? Can you buy food, gas, water? Does your phone, electricity, gas, water still work? Are the streets clear?

The disaster actually was not the hurricane, as awful as that was. The disaster was the aftermath of trying to clear ground and rebuild; even the decision to rebuild in the New Orleans area and risk it all again was an important consideration for many.

The New Orleans Health Department

President William Winspear of Australia has an arm's length exposure to this disaster with a more objective viewpoint than those of us closer to the situation. His approach was to rationally discuss the situation with city government to determine where PFA could be of service. He talked with the PFA leaders in New Orleans about what considerations we could be doing to help. While many rallied to the hurricane damage and threw money at the problem, Dr. Winspear wanted a more thoughtful process, after the horror of the event had died down, to determine just exactly where PFA could be of service.

Dr. Winspear discussed this very topic for several hours with the New Orleans Health Department's Director, Dr. Kevin Stephens. Though it had been a year after Katrina, Dr. Stephens noted that we were the FIRST health organization to contact him offering help. In that time, only one hospital had re-opened; only one public dental health clinic was in operation; the dental school had moved out of the city; many of the students had suffered as well in losing books, equipment, and residences; and no one has a handle on how many private practitioners were back in business to serve New Orleans again. It is estimated that 20% are up and running. Reports are that many were under-insured for this ''once in a century'' disaster.

But as with any Katrina situation, all have multi-problems with convoluted roots. 80% of the homes were flooded or had major damage resulting in lower property taxes and a drastic loss in tax base revenue. Retail businesses have been slow to get stocked and re-opened for business, if at all, resulting in lower sales tax revenue. Since only an estimated 450,000 residents have returned (about half), sales are lower and likewise the sales tax revenue. This translates into less tax money to cover the budget and provide for needed services, such as police, fire, ambulance, administration, and public health needs. Dr. Stephen's Health Department has gone from 350 personnel to 60 to serve the city. They do have two mobile dental clinics but have had to restrict services only to the children and the elderly.

Servicing patients has become a nightmare. Closed businesses and lost jobs have also meant lost health insurance. Frozen personal bank accounts means there is not the access to money to pay bills. Out of work means no paycheck but for the essentials. Dentists face the same problems on the other side in lack of cash flow, fewer patients from a smaller population, difficulty getting to their own bank accounts to pay bills, and lost patients due to immigration to other areas. 30% of the work force has been uninsured migrant workers. The middle class is gone, or has not stabilized. The remaining poor have no money.

President Winspear talked about contacting dental manufacturers to solicit replacement dental equipment and supplies from discontinued stocks and last year 's equipment. Dr. Winspear also suggested that the April Dental Meeting in New Orleans be used for securing trade materials that manufacturers might donate rather than pay to move back to the factory.

The dental provider population is erratic. Some have moved away; several have decided to retire; many are waiting, rebuilding their offices and/or equipping them and getting staff. This depends on funding from re-opened banks and established accounts, loan approvals, and insurance reimbursement.

Dr. Stephens then went into discussing solutions to problems he had encountered in this disaster that would be of immense benefit in future situations. He mentioned establishing a Central Repository of Patient Records and DNA to recover lost files, forming a database for identification purposes (especially for their dead and decaying bodies), and aiding patients in taking their records to where many moved to.

Another conversation item was the establishment of a National Dental/Physician Base with regional/national licensure, or at the very least provisions for reciprocity in times of disaster. He had many semi-retired out-of-state dentists volunteer, but there was no allowance for their license in this time of stress to the system. Dr. Stephens went on to recommend a Standard Credentialing Certification that has worked well for the European Union: the organization of a dental/medical registry of available licensed practitioners and their locations, perhaps set up through the ADA/AMA. These are items that PFA can get behind and lobby for.

As New Orleans waited for over a century for the disaster to happen, it will happen again, somewhere, sometime in the future. One book entitled Hurricane Katrina says on the cover, ''The One We Feared.'' If we learn nothing from this natural and human disaster, we ought to make long-range, broad-based plans for its return in whatever form. It may not be possible to prevent the natural disaster from happening, but preparation can lessen the human error factor considerably. If we are to face such situations as ''national'' disasters, then we must have national programs on all levels to address them. We are no longer a secular society. As the oil industry and fishing industries proved, what happens in New Orleans affects the entire country.

We all were so concerned about the possible Y2K situation occurring and took preventative measures to head it off to the tune of millions of dollars. Why would we be so oblivious to confronting such natural disasters in the future, now; and solving the human problems that just increased the tragedy exponentially.

The Louisiana PFA Section

President William Winspear, Region III Trustee Karyn Stockwell, and Editor James Brophy met with Section Chair Guy Ribando and PFA leaders: past Chair Frank Martello, Mark Chenrey, Chuck McCabe, and Tony Celino along with New Orleans resident advisor Dr. Joseph Lago, and the PFA wives who all offered fascinating on-site stories, aftermath problems, and suggested PFA solutions. Dr. Winspear thanked everyone for attending and giving him a first-hand view point on the Katrina situation. He noted that his country, Australia, has been the only country to have stood with the United States in their conflicts around the world since WWII. ''Australians love the Yanks.'' And we feel hurt when you are.

President Winspear urged the PFA leaders to seek local solutions to their public dental problems, file for a PFA grant, and investigate what they can do to help the city and one another.

The conversations went on for some hours, with many of the participants following up by sending us their own personal pictures. Drs. Winspear, Stockwell, and Brophy then went to DuMont's Cafe on the levee for a personal interview with Dr. Lago about the New Orleans disaster. Nestled under a Mississippi River levee, DuMont's Cafe was crowded during another windy Autumn storm. You could never tell that just a year ago the city was almost wiped out.

In his fact-finding mission, President Winspear sent us all in different directions for information. He contacted local friends to get their stories. Photographer Shirley Brophy roamed the streets of New Orleans seeking out illustrative photographs of the city, then and now. Editor Jim Brophy interviewed residents on the street and in their businesses. Everyone was friendly and eager to talk about surviving. All of us took a tour of the afflicted area and Shirley amassed hundreds of photos as we went through St. Bernard's Parish (county in other states/countries), the infamous flooded 9th Ward, the Super Dome, the still mostly windowless Hyatt Hotel, the abandoned hospitals, the still-ruined homes, the empty shopping malls, and vacant lots filled with white FEMA mobile homes. Nowhere were we allowed to leave our vehicle because of the possibility of still-present disease. Our only rest stop was at the remote City Park, where a car racing along the signless street nearly hit us--running what had been a stop sign crossroads.

A weekend jazz festival was scheduled for City Park in their return to recovery.

New Orleans was established by the French for the political reason of holding the mouth of the Mississippi River for France. As a declared ''city,'' it appeared on maps throughout Europe and discouraged other countries from taking the land. But in reality it was hardly more than a village.

Today New Orleans is less than half the size it was in the summer of 2005, but is struggling to maintain its dot on the maps of the world. The French Quarter is in full swing filled with tourists once again. Mardi Gras was held in 2006 with parades and festivities. And when the Mayor told them not to parade in certain areas, the people did anyway. Jazz Festivals and every possible holiday is celebrated there. We followed a midnight wedding out of St. Louis Cathedral up to Bourbon Street where a parade was going on with balcony celebrants tossing beads to the street.

The Super Dome is now again hosting the Tulane University Green Wave football team, the New Orleans Saints football team, and the college Sugar Bowl. Only half the Riverwalk shops are open, but the ones that are open do not have the press of crowds to eat or shop. Antoine's, the Court of Two Sisters, and Pete Fountain's do not need a week lead time for reservations. Now is the time to visit New Orleans.