In a single day, Hurricane Katrina pushed the lives of Gulf Coast residents back to the 19th century and earlier. Many had no water, no electricity, no roads and no communications.
The hurricane affected nearly 6,000 physicians along the Gulf Coast. Some doctors suffered the loss of their offices and their homes. Others could salvage their offices but few of their patients, who had scattered to more than 40 states across the nation or who wouldn't come for care because of lost jobs, incomes and employer-based insurance.
Despite such obstacles, family physicians from throughout the region and across the country converged on towns devastated by the storm to care for its victims.
Their experiences shine a light on some realities not readily recognized before the regionwide disaster. Among them: People who survive widespread disaster need the expertise of family physicians. Here are some of the stories of AAFP members' experiences as they responded to a disaster that tested the expertise, nimbleness and innovative thinking that family physicians brought to the care of hurricane survivors.
Hurricane Victims' Greatest Need: FPs' Skills
Even in Central Mississippi, residents bore the brunt of Hurricane Katrina. By the time the storm reached Kosciusko, the winds had died down to about 75 miles per hour -- still a Category 1 hurricane that was strong enough to rip up some trees by their roots and cut electricity for a week.
Timothy Alford, M.D., of Kosciusko rode out the storm at home with his family, including his father, who had evacuated from Ocean Springs, Miss. Five days later, Alford drove to Ocean Springs. There, he discovered five and one-half feet of water had sloshed through his father's home, pushing the freezer into the living room and setting the refrigerator on the kitchen counter.
Although Katrina demolished or seriously damaged 30 percent of the town's homes, the storm spared much of Ocean Springs' water, electrical and sewer infrastructure. Even so, the Ocean Springs Hospital was forced to operate essential services with a generator.
Alford made his way to the hospital two blocks from his father's severely damaged house.
"The emergency room was inundated with patients," he recalled. He dived into work alongside physicians who had lost their own homes and practices.
"The family doctors who had gone in and helped out were local physicians," said Alford. "Most of them were homeless. Most of them were living at the hospital at that point."
The number of patients appeared overwhelming, but the extent of injuries -- for most people -- was not, said Alford. Most complaints focused on minor lacerations, abscesses and other infections, spider- and snakebites, and mental health challenges.
Many came into the hospital and shelter clinics because "their medications had floated off, and they needed a new prescription," said Alford.
In fact, he added, "The thing that impressed me was that so much of what we were seeing in the disaster zone was family medicine-related. Most of the care that was needed was done by family doctors. They needed us for triage, to tell them who needed trauma care" or outpatient attention.
FP's Leadership Helped Prepare Community for Disaster
Michael O'Dell, M.D., director of the North Mississippi Medical Center Family Medicine Residency of Tupelo, wasted no time preparing for the expected onslaught of Hurricane Katrina evacuees. He knew that without coordination, individuals attempting to respond to the crisis would waste resources, fragment care and, likely, fail to meet the health needs of many. So he came up with a plan to meet those needs.
"If we had a bunch of people doing a bunch of different things, it would break the integrity of the system," he said. "Once the plan was developed, everyone was happy to work with it. The whole community coalesced around the plan."
He led a hastily formed group composed of representatives from the family medicine residency, the local chapter of the American Red Cross, the Good Samaritan Health Services Free Clinic and the county medical reserve corps as they planned for an influx of evacuees in need of health care.
Recognizing that available shelter space could not accommodate a health service, O'Dell and his committee established a fully functioning treatment center at the Good Samaritan clinic. Seven faculty and 22 residents from O'Dell's family medicine residency provided primary staffing for the facility. Their purpose: to address acute but nonemergent conditions, triage more serious problems to the hospital and link evacuees to the local health care infrastructure.
O'Dell and James Taylor, Pharm.D., the residency program's faculty pharmacist, contacted pharmaceutical representatives to request help with medications. In addition, O'Dell and Heather Taylor, the residency program administrator, spread word of the clinic through an e-mail to physicians at the North Mississippi Medical Center.
Most evacuees with acute needs checked in and settled at the Red Cross shelter, which does not provide health services, before seeking care at the clinic. Once they arrived at the clinic, faculty from the family medicine residency and other volunteer physicians identified and responded to their health care needs.
"It (the clinic) was set up to get people as quickly as we could into the local medical system to serve acute needs without overwhelming the emergency room," said O'Dell. "We treated more than 500 evacuees in the first two weeks."
As O'Dell expected, most evacuated patients needed help getting medications for chronic conditions. People with diabetes -- some using pumps -- needed insulin. Those with high blood pressure sought prescriptions for their antihypertensives.
"But we also had people with some significant illnesses" that are potentially life-limiting without continual medical attention, said O'Dell. Cancer patients had lost or run out of chemotherapy drugs; two people with sickle cell anemia needed intervention; and HIV-positive patients required prescriptions. Fifty people evacuating from the storm were admitted to the hospital.
The residency program's faculty and residents were key to meeting the patients' needs, said O'Dell. Though subspecialists, such as cardiologists and obstetrician/gynecologists, also offered key help, their expertise did not match patient need.
"A lot of people found out how valuable our primary care skills are," he said.
Loss of Electricity, Gasoline Supply Strains Hospital Capacity
Nearly 100 miles from the devastation of New Orleans, people in Magnolia, Miss., struggled with loss of electricity and water. The domino effect on the town's health care infrastructure rippled across the community.
Seriously ill patients who could live at home with electricity and water were flocking to the hospital, said FP Lucius Lampton, M.D., of Magnolia.
"A lot of people are on home oxygen or respirators," said Lampton. "People who have chronic pulmonary obstructive disease were scared because without electricity, they couldn't operate their nebulizers."
Meanwhile, doctors couldn't discharge patients who had been hospitalized before the storm and subsequently recuperated; to do so would send them into home environments that virtually guaranteed relapse, new infection or additional complications.
Physicians suddenly found themselves facing a dilemma: The hospital needed beds to accommodate the potential influx of seriously ill or injured patients from New Orleans and other Gulf Coast communities, but it also needed to provide space for local residents.
"We needed to assess which patients to give hospital beds to," said Lampton. "We had evacuees from New Orleans who needed oxygen, but we also had elderly patients who had gotten better but didn't want to go home because they had no electricity to operate their equipment."
However, three days after Hurricane Katrina, conditions at the hospital deteriorated, he said. The generators ran out of gasoline. Food ran low. Without air conditioning, temperatures hovered in the mid to upper 90s. Older patients became confused. Clinical conditions worsened. Initial symptoms of depression and post-traumatic stress disorder surfaced.
Equally difficult was ensuring that hospital staff could get to work.
"For one week, there was no way to get gasoline," said Lampton. "A lot of our nurses and physicians live 20 to 30 miles away, and they're very dependent on gas. The hospital ended up buying a van to carpool people in to work. They couldn't let them stay the night at the hospital because we needed the beds for the patients."
Over time, patients were evacuated to other states where facilities could provide temporary care. In late October, HHS launched its Medical Travel Program, described in a CMS fact sheet. (PDF file: 7 pages / 46 KB. More about PDFs.) The travel program provides transportation to hurricane evacuees from their current temporary health care centers to facilities in their home states or closer to caretakers or family.
