Dr. Littenberg in New Orleans: Part II
In this installment of Dr. Littenberg's report, which describes incredible resourcefulness and generosity while testifying in a very balanced manner to Red Cross and FEMA disarray and confusion. I am refraining from condemnation of the "higher ups" because Littenberg focuses on what the local people, volunteers, and the medical community both in and outside of New Orleans have been able to do in dire conditions.
Since my last e-mail, things have quieted down a bit. We admitted many hundreds of "special needs" refugees (those with medical or nursing needs beyond basic sheltering) to the field hospital in the abandoned K-Mart building. This unit started with nothing but 4 walls and a roof. Within 48 hours, we had 250 beds, nursing, doctors, electricity, hot food, bedside glucose monitoring, oxygen and a full-service pharmacy. We had Physical Therapists doing range of motion on the bed-bound patients and getting the ambulatory elderly out of their beds to prevent deconditioning. We never had reliable running water though. Three days later, we had placed all the patients in permanenet hospitals, nursing homes, or other more stable facilities. Nursing homes from all over the region literally sent buses and took as many as 15 patients at a time, no questions asked, no paperwork. Because of the inadequate plumbing, the unit was decomissioned as soon as possible.
After we closed the K-Mart, I was unable to get any clear information on where I was needed. All the official agencies wanted us to sit around the closed building and wait for a plan to be approved by higher-ups. I joined up with another Internist, a medical student, 5 nurses and a Pharmacist (all spontaneous volunteers). We found a bus and driver that FEMA had chartered but had not assignment to any task. We had a call from an Orthopaedist in Terrbonne parish who said they needed help, so we "borrowed" the bus and took it down to Houma, LA which is a major refugee center about 60 miles southwest of New Orleans. This town of about 100,000 had relatively little storm damage, but received many thousands of evacuees from New Orleans and the gulf coast. The civic center gymnasium has been housing up to 1,000 evacuees on cots and air mattresses. By this time, most of the acute event-related injuries and illnesses have been managed. I've seen little in the way of rash even among those walking in the water for days. We've had a handful of diarrhea cases that we placed in an isolation area and treated with antibiotics and anti-diarrheal agents. Most have resolved very promptly and appear not to represent an outbreak. We have been very busy with chronic conditions out of control: diabetes, hypertension, COPD, depression, etc. My little group also went down along the gulf copast to provide vaccines and deliver supplies. They have since returned to their homes around the country.
The mental illness situation has been interesting. We've had a modest number of acutely decompensated patients with acute traumatic stress reactions. We saw more than a few methadone maintenance patients who had lost their clinics and were truly suffering the tortures of the damned. And, lots and lots of lost and confused folks who were struggling hard to get oriented. Last night, we vaccinated a number of Red Cross volunteers who had not gotten their shots before leaving. This created a major storm as the Red Cross seems to have vaccination policies that are in conflict with CDC recomendations. Red Cross managers at the district level were all upset about this and threatened to "fire" the local Red Cross lead volunteer. The Red Cross volunteers here are supremely upset by this, especially since the Red Cross has supplied virtually no supplies, cash or staff, and seem to be busy polishing the organizational image while obstructing delivery of services. I can't tell if this is just a local political brou-ha-ha in this Red Cross district or evidence of more serious issues. The Public Health Service came through yesterday on an inspection, but they have provided no services or supplies. A local Navy Reserve unit assigned their medical corpsmen to us for their weekend drill so we have an NP and three excellent nurses. They also helped set up our syndromic surveillance system. Four medical students from the University of the Carribean have been very helpful. Yesterday and today they have been creating a vaccine registry for kids under 7 years so we can make sure they don't miss their shots. A local pediatrician will obtain the vaccines for us, (although the Red Cross wants us to withhold them). The locals continue to come through. The church groups are housing and feeding most of us (I'm staying at the local surgical center. At first, I was in the recovery room, but now I have a single patient room.) The local pharmacies have dispensed lots of stuff with no charge. We call in the presciption and send out a volunteer runner twice a day to get the meds and deliver them to the patient. Our in-house pharmacy is amazingly well-stocked with donations of everything from aspirin to Pro-graf (which we actually used!). Bon Secours hospital, an indigent-care hospital in Baltimore, sent down 50,000 doses of medications (antibiotics, insulin, blood pressure meds, inhalers, OTC, etc.) in unit of use vials and two pharmacy technicians to set it all up. Similar large acts of generosity are daily here. Local providers have been rounding with us once or twice a day after their regular hours or by phone to conult on pediatrics, psychiatry, surgery, neurology, infectious disease, etc. Some displaced mental health counselors have been providing services. All free of charge.
As we evolve away from acute crisis management to chronic needs management and Primary Care, the local systems will be increasingly stressed. I suspect the need for volunteer health professionals of all types will continue for months and months. However, the patients are wonderful, entertaining, grateful, and inspiring. They are appreciative, intelligent, and very rewarding to deal with. I plan to be home Monday evening.
Since my last e-mail, things have quieted down a bit. We admitted many hundreds of "special needs" refugees (those with medical or nursing needs beyond basic sheltering) to the field hospital in the abandoned K-Mart building. This unit started with nothing but 4 walls and a roof. Within 48 hours, we had 250 beds, nursing, doctors, electricity, hot food, bedside glucose monitoring, oxygen and a full-service pharmacy. We had Physical Therapists doing range of motion on the bed-bound patients and getting the ambulatory elderly out of their beds to prevent deconditioning. We never had reliable running water though. Three days later, we had placed all the patients in permanenet hospitals, nursing homes, or other more stable facilities. Nursing homes from all over the region literally sent buses and took as many as 15 patients at a time, no questions asked, no paperwork. Because of the inadequate plumbing, the unit was decomissioned as soon as possible.
After we closed the K-Mart, I was unable to get any clear information on where I was needed. All the official agencies wanted us to sit around the closed building and wait for a plan to be approved by higher-ups. I joined up with another Internist, a medical student, 5 nurses and a Pharmacist (all spontaneous volunteers). We found a bus and driver that FEMA had chartered but had not assignment to any task. We had a call from an Orthopaedist in Terrbonne parish who said they needed help, so we "borrowed" the bus and took it down to Houma, LA which is a major refugee center about 60 miles southwest of New Orleans. This town of about 100,000 had relatively little storm damage, but received many thousands of evacuees from New Orleans and the gulf coast. The civic center gymnasium has been housing up to 1,000 evacuees on cots and air mattresses. By this time, most of the acute event-related injuries and illnesses have been managed. I've seen little in the way of rash even among those walking in the water for days. We've had a handful of diarrhea cases that we placed in an isolation area and treated with antibiotics and anti-diarrheal agents. Most have resolved very promptly and appear not to represent an outbreak. We have been very busy with chronic conditions out of control: diabetes, hypertension, COPD, depression, etc. My little group also went down along the gulf copast to provide vaccines and deliver supplies. They have since returned to their homes around the country.
The mental illness situation has been interesting. We've had a modest number of acutely decompensated patients with acute traumatic stress reactions. We saw more than a few methadone maintenance patients who had lost their clinics and were truly suffering the tortures of the damned. And, lots and lots of lost and confused folks who were struggling hard to get oriented. Last night, we vaccinated a number of Red Cross volunteers who had not gotten their shots before leaving. This created a major storm as the Red Cross seems to have vaccination policies that are in conflict with CDC recomendations. Red Cross managers at the district level were all upset about this and threatened to "fire" the local Red Cross lead volunteer. The Red Cross volunteers here are supremely upset by this, especially since the Red Cross has supplied virtually no supplies, cash or staff, and seem to be busy polishing the organizational image while obstructing delivery of services. I can't tell if this is just a local political brou-ha-ha in this Red Cross district or evidence of more serious issues. The Public Health Service came through yesterday on an inspection, but they have provided no services or supplies. A local Navy Reserve unit assigned their medical corpsmen to us for their weekend drill so we have an NP and three excellent nurses. They also helped set up our syndromic surveillance system. Four medical students from the University of the Carribean have been very helpful. Yesterday and today they have been creating a vaccine registry for kids under 7 years so we can make sure they don't miss their shots. A local pediatrician will obtain the vaccines for us, (although the Red Cross wants us to withhold them). The locals continue to come through. The church groups are housing and feeding most of us (I'm staying at the local surgical center. At first, I was in the recovery room, but now I have a single patient room.) The local pharmacies have dispensed lots of stuff with no charge. We call in the presciption and send out a volunteer runner twice a day to get the meds and deliver them to the patient. Our in-house pharmacy is amazingly well-stocked with donations of everything from aspirin to Pro-graf (which we actually used!). Bon Secours hospital, an indigent-care hospital in Baltimore, sent down 50,000 doses of medications (antibiotics, insulin, blood pressure meds, inhalers, OTC, etc.) in unit of use vials and two pharmacy technicians to set it all up. Similar large acts of generosity are daily here. Local providers have been rounding with us once or twice a day after their regular hours or by phone to conult on pediatrics, psychiatry, surgery, neurology, infectious disease, etc. Some displaced mental health counselors have been providing services. All free of charge.
As we evolve away from acute crisis management to chronic needs management and Primary Care, the local systems will be increasingly stressed. I suspect the need for volunteer health professionals of all types will continue for months and months. However, the patients are wonderful, entertaining, grateful, and inspiring. They are appreciative, intelligent, and very rewarding to deal with. I plan to be home Monday evening.
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