Hurricane Katrina shattered the medical infrastructure for 47 Mississippi counties and 31 Louisiana parishes along the Gulf Coast. Mississippi's Harrison and Hancock hospitals lie in ruins. The storm destroyed clinics, damaged hospitals, decimated communications systems, wiped out the power grid, toppled trees and scattered debris across roads and highways.
"There was no organization, and that was our biggest handicap," said Beth Embry, executive director of the Mississippi AFP. "The (Mississippi) Department of Health was taking names of volunteers and requests for medication, but they were overwhelmed."
"Remember," she added, "we live three hours inland, and Hurricane Katrina was still a category 1 hurricane when it came through here."
In Katrina's wake, patients in Waveland, Pass Christian, Bay St. Louis, Gulfport and numerous other Mississippi towns required medical attention and medication. But no one knew exactly where those patients were and what they needed.
The resulting confusion and lack of information delayed medical responses, but creative solutions did, in the end, match health care needs to health care professionals.
In Mississippi, it was a Virginia family physician criss-crossing the rural back roads who became a point man for much of Embry's efforts to identify and help those in need.
That doctor, Mitchell Miller, M.D., of Virginia Beach had traveled to Mississippi with a patient whose extended family survived the storm. His goal was to join the medical teams in shelters who were providing care to the thousands of hurricane victims.
His problem was that few could tell him where those victims were.
"I first went to the hospital at Bay St. Louis, and FEMA (Federal Emergency Management Agency) people said it was self-contained and I wasn't welcome there," said Miller. "They referred me to local command at Stennis Airport (near Bay St. Louis). When I got there, I was greeted by guards who were locked and loaded. They didn't know where a medical facility was."
Likewise, those posted at a nearby command post established in a trailer by the state public health department didn't know where the American Red Cross had established shelters.
"There was no coordination between the entities," said Miller. "There was no way for physicians to get to areas in need because no one could identify where they were."
Miller's solution: Go to the small towns in Harrison and Hancock counties and ask local people directly about their need.
"I was lucky because I had local people as guides," he said. "We found shelters that the local people knew about but no one else in the state knew about."
His efforts paid off. In Long Beach, he found one doctor who was helping patients in a shelter that the local residents had established on their own. In Diamondhead, he learned about a physician whose practice survived intact and who needed only a generator to reopen. Throughout a region untouched by official relief efforts, residents banded together to establish shelters, pool resources and survive.
Miller contacted Embry to relay requests. With that initial cell phone call, he became the source of information between patients in need, the Mississippi AFP, and public health officials coordinating and sending medical teams to areas of need.
"Dr. Miller was my eyes and ears," said Embry. It was, she added, invaluable at a time when few had access to telephones, e-mail, the U.S. Postal Service or any other form of communication.
As he called in updates of people's needs, Miller also provided care. "We were like the 'Dr. Hook traveling medicine show,'" he said. "People would line up for acute care needs."
Most problems were minor. Miller administered tetanus shots, helped people get prescriptions for chronic conditions, and dressed minor wounds and lacerations. Other ailments, however, went far beyond what he could readily treat.
"These people were in shock. They were depressed," he said. "Their homes, their businesses, their vehicles were just gone. It was as close to seeing a nuclear disaster as I could imagine. They had no bank (to get to their financial resources) and no gasoline to leave town."
Such large-scale devastation starkly demonstrated that family physicians must contribute to and be part of the first-response plan for disasters, he said.
"Uniformly, for all of the people who were in this devastated region, what was not available to them was what they needed most. And that was basic primary care," said Miller.
