Hurricane Katrina Perspectives Detail Personal Drama and Public Tragedy

• Public Health • Oct 13, 05

Tales of heroes and hooligans will swirl through this storm-ravaged city for months and years to come, and the editors at the New England Journal of Medicine this week contributed seven compelling Hurricane Katrina stories.

Four of the seven are personal accounts of New Orleans physicians - three Ochsner Clinic physicians and an infectious disease specialist who was among the last evacuees from Charity Hospital.

Based on her experience at Charity, Ruth Berggren, M.D. wrote that “survival, functioning, and sanity” for providers and patients depended upon a number of “unexpected necessities,” none of which are mentioned in medical textbooks. Here is her list of crisis necessities:

Shoes, specifically good comfortable shoes.
NSAIDs because with no coffee or cold cola severe caffeine withdrawal headaches are a common complaint.
Clean underwear and fanny packs (packs to carry items usually carried in pockets of lab coats).
Flashlights and “D” batteries.
Toilets. Dr. Berggren said an enterprising nurse spent her off time setting up temporary latrines.
Shift work with adequate sleep. Nurses, according to Dr. Berggren, fared better than physicians because they adhered to a disciplined schedule - 7 a.m. to 7 p.m. or 7 p.m. to 7 a.m. with sleep in-between.
Morale-boosting activities, which she said can include song fests, talent shows or prayer services as long as everyone joins together.
“Strength of initiative to make your rescue needs known.” In this case, she contacted news organizations, including CNN to ask for help - and she got it.
Self-possession in the face of desperate, armed men - even men who are the designated rescuers.

Finally, a “team,” she said. “The most critical necessity is a team of professionals who care about their patients and one another.” While Dr. Berggren was struggling at Charity, three Ochsner clinic physicians were facing challenges in other areas of the city. Gregory S. Henderson, M.D., Ph.D., first led a team to a pharmacy, wading through thigh-high water on Canal Street. Along with a pharmacist and several police officers Dr. Henderson broke into the pharmacy, and they took as many supplies as they could stuff into plastic garbage bags. Those supplies were delivered to an ad hoc clinic at a Canal Street hotel. Andrew Cohen, M.D., meanwhile was manning the dialysis unit at Ochsner Clinic Foundation. He describes a patient who arrived by pirogue, a shallow-draft Cajun boat. The man, a rhythm and blues singer, arrived with serum potassium at potentially lethal levels because he had gone days without dialysis. Ochsner hypertension expert Edward D. Frohlich, M.D., was trapped with other evacuees in the exhibit hall in a large hotel adjacent to the Super Dome. “It was difficult, if not impossible, to obtain necessary medications—as I discovered first hand when I tried unsuccessfully to get an ophthalmic steroid for my corneal grafts,” Dr. Frohlich wrote. Other articles described the public health lessons to be gleaned from the Hurricane Katrina disaster. The take home message from Hilarie H. Cranmer, M.D., M.P.H., of the Brigham and Women’s Hospital in Boston sent to Baton Rouge to work at the American Red Cross field headquarters was that there was no shortage of physician volunteers in Louisiana, but in “the immediate aftermath of a disaster involving large, displaced populations, doctors, as difficult as it might be to accept, are one of the least useful commodities.” What is really needed, she wrote, is security and safety for the displaced population followed by water, sanitation, food and shelter. Primary source: The New England Journal of Medicine

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