New Orleans Health Care Heads in New Direction

Post-Katrina New Orleans epitomized the adage that bad situations bring out the worst and the best in people. The worst received the most attention: looting, muggings, AWOL police officers, and public officials and private citizens alike behaving badly. The good received considerably less attention, especially outside of New Orleans and surrounding areas.

Despite the death (more than 1,800 people died) and destruction (an estimated $110 billion), Katrina brought out the very best in many people.

Doctors Reach Out

Upon returning to the city, resident physicians from Tulane University immediately recognized a huge health care void and set out to fill it as best they could, said Dr. Karen DeSalvo, vice dean and professor of medicine at Tulane.

Tulane residents fanned out over the city and set up makeshift clinics wherever they could find the space and resources: from street corners and tents to buildings that escaped the flood waters. Using whatever medical supplies they could obtain, they started dispensing free health care services.

Faculty, staff, and students at LSU Health Science Center worked side-by-side with clean-up crews to remove tons of trash, damaged equipment, and even human waste from Charity Hospital and other facilities.

The not-for-profit Ochsner Foundation hospitals accepted record numbers of indigent and uninsured patients.

Even as water filled the basements and ground floors of most buildings, patients remained in hospitals and required care. Dr. Lee Hamm, chair of internal medicine at Tulane, commandeered a resident's canoe to make rounds until the streets were passable.

"I didn't know how things were going [at the hospitals]," said Hamm. "We had heard rumors of things not going well, not at those hospitals, but elsewhere. One of the orthopedic residents had brought a canoe to the parking lot -- why I don't know. But it turned out to be useful."

The unorthodox manner for making rounds reassured Hamm and others that patients were being evacuated from the hospitals as well as could be expected.

The decision to celebrate Mardi Gras in 2006 left New Orleans residents bitterly divided, some seeing the celebration as totally inappropriate as thousands of citizens tried to cope with the disaster and others as an opportunity to interject some relief from the dreariness and to show the world that New Orleans would come back.

When city officials decided to let the good times roll, three downtown hospitals were open: Touro Infirmary, Children's Hospital, and Tulane (with a fourth of its bed capacity).

Both Tulane and LSU set up temporary facilities to handle medical emergencies from revelers who partied too hard. The three hospitals increased their staffing to the extent possible. The end result was a Mardi Gras that met or exceeded expectations.

New Models of Care and Training

Rising to meet the challenges posed by Katrina was the beginning of a transformation of health care services in New Orleans. Tulane has played a prominent role in creating a network of community clinics that allow residents to obtain care that is convenient, familiar, and affordable. Rotations at the clinics have been incorporated into the training of interns and residents.

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