Ronnie Dufrene never cared much for coffee. That is, until the Lafitte native mostly lost his sense of smell after spending months working on the 2010 Deepwater Horizon disaster response.

Now, the waft of a fresh brew is one of the few scents he can pick up.

“Every now and then, I get a faint whiff of something,” said Dufrene, 55, a shrimper. “I can smell coffee, and that makes me crave it. I’d rather have a Diet Coke, but it’s one of the only things I can smell, so I go for it.”

Jack Jackson has a different problem. The 57-year-old crab fisherman from lower St. Bernard Parish says he was repeatedly splashed with oil mixed with chemical dispersants while handling containment boom, not far from where BP’s well blew out on April 20, 2010.

Before long, he began suffering migraines and developed a hacking cough that still wakes him up some mornings. “I’d be gagging out here like I smoked cigarettes for years, because I remember way back when I did,” Jackson said, recalling a two-pack-a-day habit he kicked after Hurricane Katrina in 2005. “It seemed like it brought that hack back again.”

Four years after the Deepwater Horizon drilling rig caught fire and exploded about 50 miles off the Louisiana coast, killing 11 men and causing one of the worst environmental disasters in U.S. history, many questions remain unanswered about the potential long-term impacts of exposure to the millions of gallons of sweet crude and large quantities of dispersants that were used to break up the oil as it poured into the Gulf of Mexico, into wetlands and onto beaches along the Gulf Coast.

A month into the $14 billion response effort in May 2010, the Environmental Protection Agency gave the British oil giant three days to find a less toxic alternative to Corexit, the dispersant it was using at and below the water’s surface. BP resisted, and the EPA backed off, instead telling the company to “significantly scale back the overall use of dispersants.”

Based on witness interviews, the Government Accountability Project, a whistleblower advocacy group, released a report last year that said coming into contact with Corexit could lead to a host of ailments, including abdominal pain, hypertension, kidney and liver damage, inability to withstand exposure to the sun, memory loss and respiratory problems. The report urged a federal ban on the chemical.

Still, the last four years — which included testimony from oil company executives, rig workers and drilling experts during a federal civil trial in New Orleans — have shed light only on what led to the disaster and the actions taken in its aftermath. Now, doctors and scientists are beginning to understand the short-term consequences faced by the potentially more than 200,000 cleanup workers and Gulf Coast residents who may face health problems related to the spill.

Increased Depression?

So far, much of what has been learned is in regard to mental health. The National Institute of Environmental Health Sciences began interviewing tens of thousands of people who played a role in the spill response for a long-term study in 2010. Preliminary observations from initial health exams found an approximately 30 percent increase in anxiety and depression among cleanup workers. Many workers also say they’ve experienced physical symptoms, such as respiratory problems, skin rashes and neurological issues.

BP, for its part, says some advocacy groups “refuse to acknowledge evidence of the region’s recovery.” The oil company shut down its last “active cleanup” operations in Louisiana last week.

“They cherry pick the findings of scientific reports or blithely mischaracterize them to support their agendas,” BP spokesman Geoff Morrell said in a statement.

But getting the kind of answers that people affected by the disaster seek will take time, experts say.

“We don’t know what those people were exposed to and if they’re going to be sick one day,” said Lafitte Mayor Timothy Kerner.

On one hand, Kerner said, he’s grateful to BP for putting so many local residents to work on the spill cleanup. At the same time, he doesn’t believe the company properly outfitted everyone for the job.

“To say that everybody had the proper gear on, that’s totally false,” he said.

In 2012, BP reached deals for sweeping settlements of private claims resulting from the oil spill, including medical claims, in order to avoid piecemeal litigation. BP also agreed to a multibillion-dollar settlement that compensates Gulf Coast businesses and residents for economic damages due to the spill.

The medical program, which began processing claims earlier this year, offers money for cleanup workers and coastal residents who lived in certain areas near the Gulf after the oil spill and suffered health problems potentially related to oil or chemical exposure. The deal also provides for comprehensive medical exams every three years for 21 years and reserves claimants’ rights to file suit against BP for damages if they develop a spill-related medical condition years later.

The money paid out depends on several criteria, such as whether the symptoms affect vision, breathing, ear, nose and throat, skin, the gastrointestinal system or the heart. Whether the symptoms are short- or long-term and whether they first appeared or worsened after the spill are also factors.

Efforts Paying Off?

Besides resolving individual claims, the class-action settlement also allocated $105 million toward four integrated, five-year projects to bolster access to health care in 17 Gulf Coast counties and parishes. That effort includes addressing behavioral and mental health needs, training community clinicians and expanding environmental health expertise so primary care doctors can recognize and treat conditions related to spill-related exposures.

Though it’s still early, some public health experts say the effort is already paying off.

“A disaster exposes all the fault lines of the community,” said Dr. Elmore Rigamer, medical director of Catholic Charities for the Archdiocese of New Orleans. Rigamer is a psychiatrist who helped treat victims of the oil spill in hard-hit St. Bernard and Plaquemines parishes.

The Baton Rouge Area Foundation, using funding from BP, awarded $15 million to Catholic Charities in 2011 to provide mental health services for coastal residents.

During his work, Rigamer found that many fishermen hired by BP to clean up after the spill were low-income people already living on the margins; many had not seen a doctor in years.

“The problem was really exacerbated by the spill,” he said, “and I think we made real progress in getting these people better health care.”

But more definitive conclusions about the spill’s impact are still years away. Since 2010, NIEHS has enrolled about 33,000 response workers and Gulf residents in its long-term study. The study, considered the largest of its kind, will be used in part to understand the relationships among cleanup work, exposure to oil-related chemicals and dispersants, and physical symptoms.

Dr. Dale Sandler, the study’s lead investigator, said interviews showed that oil-response workers were about 30 percent more likely to have moderate to severe depression than residents who did no cleanup work.

A second round of health exams, some to be conducted at LSU Health New Orleans, will focus on neurological, respiratory and additional mental health issues. Participants will receive blood pressure, cholesterol and diabetes screenings and will be referred to health care as needed.

Little Initial Clarity

In the months after the spill, Sandler said, many residents who visited a local primary care doctor for symptoms they thought were caused by the spill typically received little clarity.

Preliminary results from her study showed that response workers were more likely than others to suffer from wheezing and coughing, symptoms that some are still experiencing. But she also said it’s “a little bit early” to tell whether those same workers are at a greater risk of suffering from a major illness, like cancer, and whether short-term issues will persist or wane over time.

“The thing that people really want to know is not just, ‘Did this make me cough?’ ” she said. “They really want to know, ‘Did this make me sick? Is this going to give me chronic lung disease?’ ”

Further complicating matters, researchers say, is a natural urge by some residents to draw a direct link beyween newfound health problems and the spill. But pre-existing conditions or habits, like heavy smoking or excessive drinking, also can play a role.

“If you already have an existing disease — let’s say you are already a patient with hypertension — and on top of that, you have this impact on the kidneys, it’s difficult to say what came first or what contributed to the overall outcome,” said Dr. Maureen Lichtveld, who directs Tulane University’s Environmental Health Capacity and Literacy Project, a five-year, $15 million effort to address behavioral and mental health concerns and expand environmental health expertise along the Gulf Coast.

“Those are complex questions, because there’s so many things that come into play,” she added.

Lichtveld also received almost $4 million to fund a three-year evaluation of environmental health risks to seafood and Gulf Coast communities. The project is aimed at collecting baseline data about seafood consumption and environmental hazards in order to develop a risk assessment in case another disaster occurs.

A Boon for Researchers

Despite the long-term questions, one thing is certain: The 2010 disaster has been a boon for local medical researchers, as BP has provided an influx of money that doctors and other observers say is unprecedented in the area.

But not everyone is optimistic that the ramp-up in research will provide real answers on the long-term health impacts, particularly because most cleanup workers and residents did not have a baseline to see whether their toxicity levels changed after the accident.

“I have no anticipation that those guys are going to find anything,” said Clint Guidry, president of the Louisiana Shrimp Association. “Those guys couldn’t find anything when the goddamn oil was gushing out of the Gulf.”

Guidry said the local fishing community continues to struggle four years after the spill, with lower catches, smaller profits and some prolonged illnesses.

“I’ve never seen the kind of stress that happened during the oil spill,” he said. “It was unbelievable.”

Howard Nations, a Houston-based lawyer who says he represents thousands of boat captains and deckhands in greater New Orleans who became sick after the spill, laid the blame squarely on the chemical dispersants used to break up the oil.

“The people on the boats, especially, were consistently sprayed with dispersants from the planes,” Nations said. “They were just going overhead and they were spraying it over the water.”

Controversial Program

That’s the culprit that Lafourche Parish native Michael Robichaux, an ear, nose and throat specialist, has heard blamed over and over.

For more than a year after the spill, he operated a detoxification program from his Raceland home, treating more than 100 cleanup workers and others who said they got sick from the spill.

A former state senator, Robichaux saw patients for up to six hours a day for five weeks. They’d take vitamins and rotate between exercise and sweating in saunas. “There’s just no question that we have significant illnesses that have occurred,” he said.

The sometimes controversial detoxification concept has roots in a regimen developed by L. Ron Hubbard, the founder of Scientology; the church helped open a similar clinic in New York City that treated 9/11 first responders.

Robichaux has long been critical of BP’s medical settlement, which he contends fails to provide compensation for many of the symptoms he observed in his patients. He also believes the studies’ findings will be whitewashed to shield BP from blame.

“We’ve got all these problems, and if you’ve been in this playing field before, you realize that the industry is going to take control of all the studies,” he said. “You’re going to get nothing from the universities but what the industry wants you to hear.”

Though skeptical at first, Robichaux is impressed with what he was able to accomplish.

“We looked into it with a great deal of hesitation,” he said. “We got involved in it, and we opened up a detox clinic not knowing what was going to happen, but the results of this treatment were beyond anything I’ve ever seen before in my life.”

Little Protection

Jorey Danos is buying in. The 34-year-old father of three from Labadieville in Assumption Parish spent months doing oil spill cleanup work, often handling oil and dispersant with little protection, he said.

“I was grabbing that oil with my bare hands and getting dirty,” he said. “As far as I could see water, I could see oil.”

At the time, Danos was intrigued by the opportunity and couldn’t turn down the money, about $3,000 every 10 days.

“I thought I was doing something special,” he said. “I thought I was doing right by my family until a year later, when I went from a perfectly healthy body to losing weight and losing my mind, really.”

That’s when his health began to take a turn for the worse: He began having trouble concentrating and grappled with fatigue, paranoia and occasional seizures. Blisters cropped up on his back, face and neck, and he developed respiratory problems.

“The groceries are the most I can pick up,” he said.

Danos said he saw some improvement in his energy and his skin after undergoing treatment with Robichaux, who continues to treat his other symptoms.

Still, even as doctors and researchers continue studying the impact of the disaster, Kerner, the Lafitte mayor, said many of the health effects already are apparent.

“A lot of them use cough medicine and nasal spray and try to move on,” he said. “But, I think in a lot of cases, some of them are having problems.”