Hundreds were killed, thousands are homeless and millions of lives have been turned upside down. The recent Gulf Coast hurricanes have been called the worst natural disasters ever to strike the United States.
News accounts have emphasized the massive failure of organizations, name-calling and finger-pointing among government officials, and misery compounded among the poor of Louisiana and Mississippi. Can any good be found in this suffering?
I was privileged to be on a team of 15 physicians and 25 nurses from the Scripps Health network in San Diego deployed to the George R. Brown Convention Center in Houston in early September. We were part of a U.S. Public Health Service pilot project to develop public-private partnerships to care for disaster victims. Our task was to relieve the physicians and nurses from the University of Texas Health Science Center at Houston, who had been working around the clock for 10 days and were experiencing battle fatigue.
Houston had opened its arms to about 150,000 evacuees from New Orleans and had placed about 50,000 of them in temporary shelters. Most were poor, and many were chronically sick. The University of Texas staff set up a clinic on the main floor of the convention center adjacent to where the evacuees slept on cots and blankets, and had been seeing nearly a thousand patients each day among arrivals from Louisiana. As the people left the shelters and were dispersed into apartments and hotels throughout the city, the number seeking medical care began to drop, and our group had to take care of a mere 600 patients each day.
Having inherited a well-designed patient flow system from the U.T. group, we simply ran the convention center clinic like we run the emergency departments at the Scripps hospitals. The nurses performed triage and directed patients to adult medicine, pediatrics or fast track for simple problems. Supporting X-ray, lab and pharmacy staffs were available to help us do our jobs better.
Scripps had committed to providing coverage for two weeks. Chris Van Gorder, Scripps’ CEO, wisely created two teams, each to stay one week. Those of us on the first week’s team expected to sleep on cots or in tents, but we were housed at the Hyatt Regency about a mile from the convention center. We teased each other about the rigors of hardship duty! Most of us on our 40-person squad knew and trusted one another. We were veteran nurses and seasoned doctors, the real first team. Those evacuees got the best care that could be given under those conditions.
In addition, several dozen individual volunteer physicians and nurses had come on their own from all over the U.S. We quickly became friends.
Many of the patients had rashes, skin infections from walking through contaminated water, and respiratory or gastrointestinal infections. Many had left their homes so quickly that they had run out of medicines, or had not had time to take their prescriptions and medical devices with them. Though it might be a skin eruption that brought them to us, most had underlying chronic problems, such as diabetes, hypertension and asthma that needed attention.
Caring for the patients was a pleasure and a privilege. They were universally polite and grateful. Nearly everyone thanked us for coming from California to help. We worked 12-hour shifts, with a skeleton crew on duty after midnight. After work we got a bite, we flopped in bed for a sound sleep, then started over again the next morning.
We sent four doctors each day to St. Agnes Baptist Church, which was being used by the Red Cross to distribute vouchers and offer counseling for jobs and housing. Four thousand people waited patiently every day in the hot south Texas sun to get help, and some would be overcome, or get sick while standing in line, and so there was plenty of work for the doctors.
A few patients were sick enough to be sent to the hospital to be admitted. Some patients had heart attacks, uncontrolled diabetes or pneumonia. I saw a pregnant woman at term with an elevated blood pressure, a woman with leg pains in whom I suspected blood clots, and an 80-year-old man with acute urinary retention, all of whom needed hospital-based care.
Grief and depression were present, though surprisingly infrequent considering how severely the people’s lives had been disrupted. Mental health counselors were on site to help care for these patients. I saw one woman who had paddled to safety in a rowboat through a flooded area and had seen multiple bodies floating in the water. One body was that of a child whose skin was not as bloated and discolored as the others, and the patient was having flashbacks about whether the child could have been alive, and should she have jumped into 10 feet of sewer water to attempt a rescue. I reassured her that she had done her best but referred her for counseling.
There were some light moments as well. Prescription drugs were free if a doctor wrote “Katrina Relief” on the top of the scrip. One afternoon the pharmacist stormed into the adult area and demanded to see a volunteer physician from Ohio who was working with us. I said he was probably in an examining area with a patient. He replied indignantly, “Well, tell him to stop writing prescriptions for Viagra. We’re not going to fill them.”
Houston Mayor Bill White and his staff epitomized competence. They organized the city to receive 150,000 evacuees, provided clean, sanitary shelters and were working hard to get the people out into the community. White headed a disaster meeting every morning in which the heads of various responsible agencies reported on progress and problems. There was no whining, no casting blame, just, “let’s get the job done as well as we can.” That week Houston set the standard in urban disaster management for the rest of the country.
After our week ended, we passed the baton to the second team. The last night we had a small party at the hotel, shared war stories with the incoming group and wished them success. The next morning we flew out of Bush Intercontinental Airport back to San Diego, not just a team, but comrades and friends. We had shared an adventure and felt proud and privileged to have had a chance to participate. We had no way of knowing that three days later our successors would be caught in the evacuation for Hurricane Rita. No doubt they have their own stories to tell.
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Dr. Kevin P. Glynn is a pulmonary disease specialist and former chief of staff at Scripps Mercy Hospital in San Diego.
