In The Ruins, Angels Of Mercy
Without the barest necessities, doctors and nurses struggle to keep hurricane victims alive
April Fugere has discovered that it takes only about 36 hours to turn a modern American hospital into something more like a Civil War-era battlefield unit. "The stench is unbelievable," Fugere, an intensive care nurse, said from her post at flood-ravaged Charity Hospital last week, a few days after Hurricane Katrina battered New Orleans.
The hospital had no running water or working toilets. Food and bottled water were in short supply. The pain medication was long gone. When the emergency generators gave out, Fugere and her colleagues kept critically ill patients alive by squeezing their ventilator bags by hand. Rescuers had turned away after being fired upon, but by week's end, most of the patients had been evacuated. It was too late for some. "There are lots of patients who died," Fugere says. "They are laying them out in a hospital stairwell, in body bags."
From the flooded city of New Orleans and eastward along the Gulf Coast, doctors and nurses at dozens of hospitals and nursing homes last week struggled against enormous odds to keep thousands of seriously ill people alive without the most basic tools--food, water, medicine. The situation outside hospital walls was no better. Swarms of displaced residents with chronic health problems tried to make do without life-sustaining treatments like insulin and kidney dialysis. Even those who were healthy when the hurricane hit risked serious injury or death through dehydration, infection, or starvation as the week dragged on with no rescue or basic rations in sight. "We're seeing people who have been holed up in heated attics without food or water for days," says Christopher Guarisco, director of the emergency department at the Oschner Clinic Foundation in Jefferson Parish, La. At the New Orleans Convention Center, corpses lay abandoned amid throngs of people desperate to escape. A lucky few got out: Premature babies and other critically ill patients were airlifted to hospitals as far away as Houston. But most were left to suffer.
The healthcare crisis was exacerbated by the fact that hospitals weren't immune to the violence that erupted. "When the crowds tried to take the ambulances away from us, we just abandoned the ambulances and locked them up," says Richard Zuschlag, chief executive officer of Acadian Ambulance Service in Lafayette, La. In their second attempt to evacuate Charity Hospital, "we got shot at," Zuschlag says. But as National Guard troops began entering the city, the ambulance crews started moving again.
"It's utter chaos here," says Deano Bonano, chief deputy administrator for Jefferson Parish, just outside New Orleans. At midweek, the parish's hospitals were crammed with patients, most of them old or frail and in need of dialysis or oxygen, who were moved into the hospitals before the storm hit and had no place to go. "People are lined up in hallways, everywhere we can plug in a machine," Bonano says. "We're trying to relocate these special-needs patients to hospitals outside the area, but transportation right now is hard or impossible." Early in the week, he had taken to going out with the police or National Guard and raiding local supermarkets. "We are actually breaking into grocery stores," he says. By week's end, however, Bonano said Wal-Mart and Sam's Club had shipped in tractor-trailers with food, water, and ice, and power and water were being restored to the three open hospitals.
Bonano was hoping the federal government would step in, but it was having its own problems. The Federal Emergency Management Agency set up a triage station at the New Orleans airport for patients, but doctors there soon found themselves swamped, with enough aircraft to ship out only children and the sickest patients. Some nursing home patients waited a day and a half for transport, sleeping on luggage carousels or behind rental-car counters. "We did not have food and water to give patients for 24 hours," says Mona Khanna, a physician and medical reporter from Dallas who is part of a FEMA Disaster Medical Assistance Team. "This morning [Thursday] they got Saltines and Cheez-Its. Just now they got bottled water."
Farther east in Mississippi, Garden Park Medical Center in Gulfport and the Biloxi Regional Medical Center got their ER s back up despite flooding and roof damage; FEMA had set up tents in the hospitals' parking lots to give tetanus shots and treat less serious cases. "We are the only building that is anywhere near functional in this part of Biloxi," says director of marketing Lori Derouen. The hospital in Bay St. Louis was closed. So was Forrest General Hospital in Hattiesburg, which transferred its intensive care patients to Wesley Medical Center across town. "We've got cars on the side of the interstate who have been trying to get to us for medical care, but they've run out of gas," says Ron Seal, CEO of Wesley. Those hospitals that remained open are in critical need of electric power and water, says Sam Cameron, CEO of the Mississippi Hospital Association. Gas for ambulances, and for employees to drive to work, was also running out. Still, Cameron says, "it's not nearly as bad as the folks in Louisiana."
Onslaught. Louisiana's Department of Health and Hospitals has had lots of practice with hurricanes over the years. As Katrina approached, public-health workers set up seven special-needs shelters at university arenas. But nothing had prepared them for the thousands of sick and injured who made their way north from the coast in cars, buses, helicopters, and ambulances, quickly filling the shelters. By midweek, the state had triaged more than 6,000 people, with thousands more coming. "Many of them are evacuees from hospitals," says Bob Johannessen, spokesman for DHH. "Many of them waited a very long time in the staging areas in New Orleans to get here. It's those existing medical conditions that are presenting the most challenges."
Survivors too ill to fend for themselves were ferried to hospitals and nursing homes hundreds of miles north by volunteer EMT s. By week's end, the state's hospitals were maxed out. "A lot of heart patients have been off their medications, and it's getting to a crisis situation with them," says Dave Miller, director of the emergency department at Summit Hospital in Baton Rouge. "We have a lobby right now full of people trying to get shelter. We've seen 'em, treated 'em, and discharged 'em, but they don't have anywhere to go."
The federal Department of Health and Human Services is now setting up 10 mobile medical shelters on military bases including Fort Polk in west central Louisiana, 200 miles away from the affected areas, and Eglin Air Force Base in Pensacola, Fla., 150 miles from New Orleans. They plan to treat people for dehydration, heat stroke, and other pressing needs. "The purpose of these shelters is to provide basic medical services only," says HHS spokesman Bill Hall. "We have identified hospitals with available beds all over the nation where seriously ill patients can be transferred." The department is also working with pharmaceutical companies and state health departments to figure out how to get donations of prescription drugs to hurricane refugees. "The details are being worked on now," Hall says.
The federal Centers for Disease Control and Prevention has sent more than 30 workers to the hurricane region to assess the situation and deliver basics such as tetanus shots; 8,000 doses of tetanus vaccine were dispatched to Mississippi. The CDC is also organizing two dozen 20-member teams that include experts in infectious disease and environmental health who are expected to be of more use in the weeks to come, as cleanup operations begin. "We're in a marathon, not a sprint," CDC Director Julie Gerberding said last week.
Future ills. Indeed, doctors and nurses in Louisiana and Mississippi have been so busy trying to keep people alive that they've scarcely acknowledged the medical problems more typical after a hurricane--hepatitis A, diarrhea, and other intestinal problems caused by drinking polluted water or eating spoiled food; infected cuts and scrapes; and chainsaw injuries from cleanup efforts. Those problems, along with animal bites from snakes, rats, dogs, and other displaced critters, as well as mosquito-borne diseases such as West Nile virus, usually demand more healthcare than the initial injuries caused by a hurricane. But with hundreds of thousands of residents evacuated and unable to return home anytime soon, that may not prove true for Katrina's victims.
Public-health officials also worry about the hundreds of thousands of people displaced by the hurricane who will need basic healthcare--doctors' visits, new prescriptions, dental care--and won't have anywhere to turn. "There's a whole range of people who have put off healthcare," says Georges Benjamin, executive director of the American Public Health Association. "You create a health debt that has to be caught up."
And in the weeks to come, people who are just grateful to have survived will find themselves struggling to patch together a new life for themselves and their families after losing their homes, jobs, schools, and churches. "The ultimate impact will be on mental health," says the CDC's Gerberding. That's why the CDC plans to provide mental health experts "at every single location" with refugees, she says. "The long-term consequences of this on the individual are just overwhelming."
With Helen Fields, Josh Fischman, Betsy Querna and Amanda Spake
This story appears in the September 12, 2005 print edition of U.S. News & World Report.