Reflections on Serving The Underserved

by Stephanie Lancaster, Assistant Professor, Department of Occupational Therapy

There’s been a lot of coverage in the news about hurricanes lately, something that strikes fear in the heart of even those of us who aren’t likely to be in the path of a storm of this magnitude because of where we live. Both of my daughters attended college in New Orleans, and even though they were there post-Katrina they learned a lot there about the long-lasting devastation of a hurricane, especially in the context of areas with demographics as there are in that city. I remember watching the news when Hurricane Katrina was being forecasted, with first the meteorologists and then rain-beaten reporters on the scene talking about the orders for mandatory evacuation of New Orleans and other areas predicted to be in the direct path of this monster storm. When Katrina hit two days later, I heard the news reporters on TV talking about the roughly 200,000 people in New Orleans who did not evacuate, and I couldn’t wrap my brain around their reasoning. Why did they stay when they had been ordered to leave, when the risk of staying had been widely broadcasted? All I could think of was maybe they were in denial, thinking they could literally weather the storm despite the warnings and mandate for evacuation.

I’ve done a lot of reading, listening, talking, and thinking about this subject since that time, and the things I have come to realize have changed my reaction when I have heard similar stories since then about people in the path of a hurricane who have not left their homes despite orders to do so by their cities or governmental agencies. I know now that leaving – getting out – was not nearly as much a move of agency as it was opportunity. I now know that more than a quarter of the people living in New Orleans before the storm hit were living below the poverty line. At least a quarter of those did not own or have access to a car. Many of the individuals who stayed behind had lived in that area their whole lives, with that often extending into generations far up the family tree, resulting in their being less likely to have family or friends outside of the area with whom they could shelter. Timing was not on the side of those who were living paycheck-to-paycheck or relying on government assistance as the storm hit at the end of the month; those with children in school had very likely had to spend extra money on school supplies as their kids went back to school after the summer break. At least two-thirds of those who did not evacuate had no money in the bank and no credit card to use as a back-up. Those living in poverty were much more likely not to be able to evacuate because they were dealing with poor health or disability, if not personally then in the role of a caregiver for a family member, neighbor, or friend. In essence, it wasn’t at all related to denial of what was happening that caused those who stayed to do so; in fact, it was just the opposite: it was their acute awareness of their circumstances that led to their staying.

This is something that relates in many ways to what goes on in the healthcare system in our nation. It sometimes appears that those who are underserved are in that category at least in
part because of the choices they have made, but in actuality it is the circumstances they are in – and sometimes the decisions made by others in political and other arenas, that is at the root.