Reflections from the field...

Stories from the Hurricane Katrina Recovery Efforts

In the devastation left by Hurricane Katrina and Hurricane Rita, Texas physicians rushed to provide urgent health care services to tens of thousands throughout the Gulf Coast region. They worked tirelessly in affected areas, makeshift medical clinics and in their own communities. As the magnitude of the tragedy wrought by Katrina started to become clear, TAFP staff began fielding calls from members wanting to know how they could help those in need. To avoid confusion, we coordinated efforts with the Texas Medical Association, which was working with the Governor’s Office to establish volunteer rosters for health care providers.

We know many of you added your names to those lists and we want to hear your stories so we can maintain a historical record of your efforts. We put out a call to the TAFP membership to send in descriptions of volunteer efforts. Here are some of the first responses we received.

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From:

Chen, George G. [ggchen@utmb.edu]

3rd-year medical student, UTMB Galveston

Sent:

Wed 9/15/2005 4:54 PM

Subject:

Student efforts to aid hurricane survivors

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My son Brendan was born just two weeks ago, so I took a month off to help my wife take care of him at our parents’ place in Sugar Land. Upon hearing about Katrina and seeing all those images on TV, we donated about 500 diapers (part of our stash in preparation for our bundle of joy).

I also went by the Astrodome Sunday morning (Sept. 4) to help see patients at the triage section of the big makeshift clinic at Reliant Arena right next door to the dome. Overall, everyone was happy and grateful to be seen by all the medical staff volunteering there. It was great to hear stories about how families had just been reunited just hours before coming to seek some medical attention for their ailments. The biggest concern there was outbreaks of diarrhea. About every other person I saw had some sort of diarrhea complaint. Nevertheless, it was good to see people in relatively good spirits. Most were looking ahead immediately to finding the rest of their loved ones and some were already thinking about restarting their lives.

It was great to see the number of volunteers just pouring in to help. When I went to the Astrodome again on Tuesday morning (Sept. 6), they turned me away because there were enough doctors already volunteering. I came away still feeling full of pity for all those left homeless, but I felt proud to be part of this community that was able to step up in a big way to ease the suffering of our neighbors.

Sincerely,

George Chen MSIII

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From:

Baumer, Joane, M.D. [JBaumer@JPSHealth.org]

Program Director, John Peter Smith Family

Medicine Residency Program

Sent:

Thu 9/15/2005 5:44 PM

Subject:

what a team can do

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Our health network was notified on the Wednesday after the hurricane [Katrina] that we would be receiving survivors and evacuees. The Area Emergency Operations Command set up 25 shelters to receive 4,000 – 4,500 in Tarrant County. Our administration notified the Chair of Community Health, Dr. [Wayne] Williams and myself, the Chair of Family Medicine, that we would be responsible for medical assessment and management. We agreed to staff the two existing community clinics near the largest shelters with volunteer physicians. The network agreed to provide registration, nursing, pharmacy staff and patient transportation. We agreed that our clinic experience and staffing model could be used to avoid flooding our own emergency services sites.

We had no further concrete information prior to the arrival of the survivors over the ensuing five days.

Buses began arriving at shelters Thursday evening from the Superdome. Survivors in wet clothes for four to five days disembarked. Onsite physicians, including many volunteer TAFP members began to triage survivors for medical care. Some of them, including David Lawson, M.D., provided from their own offices medications and tetanus immunizations at the shelters for some survivors. Most were transferred to a small shuttle to one of the clinics. There we met them, took their basic identification information, created a temporary chart and placed them into a quiet and comfortable exam room with a nurse, physician and pharmacist. We rapidly assessed their vital signs and needs and provided water, medications and a one-month supply of their medications from our formulary with refills for six months. We gave them information for follow-up if necessary and assisted them back to their shelter.

Sounds basic. It was anything but. Many were displaced without basic survival tools. Some end-stage renal patients were without dialysis for five days. Some HIV patients had no medications for a week or more. Patients with active TB had no meds for five days; diabetics had not had insulin for five to seven days; cancer patients had gone without chemotherapy for days or missed a scheduled dose; patients with psychoses had been without meds for several days and many had active untreated skin infections. At least once or twice a day we had to send a patient by ambulance to the hospital who was too ill for us to manage in the clinic.

We were very, very fortunate to have a team that knew what to do. I and the director of nursing and pharmacy and plant ops convened on site several times a day between patient bursts. We had all worked together before. We could assess and re-assess immediately and adjust our resources. Our pharmacists stood by our sides translating medications into our formulary for rapid deployment of medications to those in need. Community volunteers offered water and snacks to waiting patients. We placed teams of doctors, nurses and pharmacists on call — as buses came we called them in then. At one point we had as many as 12 physicians seeing patients simultaneously.

The opportunities abounded for onsite flexibility responses to the illnesses we encountered. On the third day, the public health nurses informed us that they could not give the tetanus shots in the shelters because of a lack of manpower — they transferred 500 doses to us and we delivered them in a rapidly deployed clinic space for that purpose over the next two days to all of the shelter and some walk-in survivors who had been in the “toxic gumbo.”

Many of the women had been standing or walking in water for hours up to their waists or higher. They had multiple complaints of vulvovaginal discharges and “yeast infections.” We soon realized that topical medications would be impractical to give them in shelter where they had no privacy. We developed the diflucan/metronidazole cocktail for management.

The patients with early spreading skin infections were going to be very difficult to follow-up. We agreed to combine ceftriaxone and clindamycin to cover for the most likely pathogens.

Halfway through the process the public nurse practitioner, Ms. Russell and I reviewed our first 500 charts to get a better idea of the public health risks. We could identify the few patients with TB, fevers and coughs and surprisingly only three patients with diarrhea. We adjusted accordingly and tracked the patients most at risk in the shelters.

Following the initial rush in the first three to five days, we continued to provide a hurricane survivors clinic over the next week as survivors transitioned out of the shelters. We provided services for the other survivors in hotels, friends’ and relatives’ homes and those living in their vehicles.

Our department of a 100 faculty, residents and visiting students responded without a whimper. Our staffs joined us at every site and time. We were joined by an army of volunteers including 20 community physicians, 55 nurses, 36 pharmacists, 57 business office volunteers, 26 transportation and law enforcement volunteers, 35 community citizens, 33 health care managers and 10 mental health specialists We felt so privileged to be a part of this effort.

In the end we saw almost 2,000 survivors in our special and our regular clinics. As a network we had 148 ER visits, 37 admissions, 350 lab tests, three babies delivered, over 500 tetanus vaccines given and over 4,000 prescriptions filled.

But, ultimately it was the survivors who will inspire us for years to come. After their unbelievable ordeals, we would treat them and ask, “Is there anything else worrying you?” Ninety percent of the time they would look back and say, “Thanks for all you have done for me. I just wish I could have saved that baby who died next to us;” “I wish I could have carried one more person to safety;” “I wish I could find my wife;” “I wish my children didn’t have to see those horrors;” “ I wish I could have done more to help.” They are our real heroes.

Reflections from the field —

Joane Baumer, M.D.

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From:

Anonymous

Family physician in Houston, Texas

Sent:

Wed 9/17/2005 12:18 AM

Subject:

Hurricane Relief Effort

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On Thursday night, Sept. 1, my husband and I were watching again the news reports on CNN and MSNBC where it seemed the reporters and newscasters could get to the Superdome and Convention Center in New Orleans, and yet there was very little to no evacuation or supply relief being reported. We watched people and children without food and water, and we decided that we could no longer wait for the government to step in.

On Friday, Sept. 2, we decided to take food and water into New Orleans, and try to bring people out ourselves. We couldn’t find any trucks to rent in Houston, so we bought three RVs (with a 90-day return policy of 75 percent of original price), attached three 16-foot trailers, and went to Costco and loaded up with food and water. I also took medical equipment.

We headed out at 11 p.m. Friday night with three other friends who helped us drive. All the signs on I-10 said “I-10 closed to New Orleans,” but when we got to Baton Rouge, we talked with a police officer we ran into and she said that with those supplies and a doctor, they wouldn’t keep us out, and that proved to be true.

It turned into quite an adventure and we felt like we were exactly in the right place at the right time. Livingston Parish had put out a call for a doctor and flagged me down on the highway as we headed to New Orleans. (The police officer had told them about our little convoy of RVs and trailers, and that I was a doctor.) The Director of OEP [Office of Emergency Preparedness] in Livingston Parish outfitted all three RVs with donated medical supplies, and we went into Washington Parish, St. Tammany Parish, and Jefferson Parish with supplies and doctors —- many places where there had been no communications and absolutely no Red Cross, federal or state visits or relief efforts. The Director of OEP in Livingston Parish was exactly the right guy to hook up with, and he made a plan to use the supplies, RVs and volunteers to maximum benefit for his parish and his neighboring parishes.

My husband and I returned to Houston on Sept. 5, the morning that 15 or so other doctors from around the country showed up in Livingston Parish to volunteer, but we left two RVs and the trailers to use for as long as they need them, and they are still there.

Additional note: We received a call from the Director of OEP in Livingston Parish last week (Sept. 29) and found that one of the medically-outfitted RVs, staffed with volunteer doctors, is now in Lake Charles, due to Hurricane Rita.

Anonymous, Family Physician in Houston, Texas

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From:

Martin, James, M.D. [james.martin@christushealth.org]

Program Director, CHRISTUS Santa Rosa Family

Medicine Residency Program

Sent:

Thu 9/15/2005 3:59 PM

Subject:

stories

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The CHRISTUS Santa Rosa Family Medicine Residency Program played a critical role in the more seriously ill evacuees who came to San Antonio. Dr. Todd Thames helped organize and coordinate the triage system utilized in the ED department of the hospital, and the residency program either admitted or coordinated the admission of approximately 80 patients. Many residents cancelled their Labor Day holiday plans, even when told by me to take their breaks. One chief resident commented, “Isn’t that what doctors are supposed to do?” (i.e. volunteer and respond to needs of community)

Jim Martin

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If you have a story you would like to add to the record, please send it via e-mail to jnelson@tafp.org. If you prefer to call, we have established an extension in our phone system that is set up to record your stories. Please call (512) 329-8666 ext. 39 and follow the recorded instructions.

To those of you who have volunteered or who plan to volunteer in any way to help those in need, thank you for your work and for your sacrifices.