NOLA: Then and now
New Orleans, LA - The problems of the people of New Orleans are far from over. Eighteen months after Hurricane Katrina hit and the city flooded, many people are suffering posttraumatic stress disorder, and there is a desperate shortage of doctors and nurses in the area, the attendees of the American College of Cardiology (ACC) 2007 Scientific Sessions heard yesterday. ACC is the biggest meeting to be held in New Orleans since the hurricane, and physicians living and working here thanked the college for showing its support and returning to the city.

Recounting personal tales of their hurricane experiences, the healthcare workers explained what they think is needed to help medical services return to normal in the city. Many of the problems encountered in New Orleans pre-Katrina—including a high proportion of uninsured people—have been exacerbated by the disaster: "It's very difficult to rebound," Dr Kevin U Stephens, director of the health department of Louisiana, told the meeting.

But lessons have also been learned. The nurses and doctors who rode out the storm all stressed that personnel were the most valuable resource both in the immediate aftermath of the hurricane and during the following months. But despite careful disaster preparation, the best-laid plans often failed, and flexibility was all, they stressed.
Plan ahead, but be prepared to change plans
For the first few months after Katrina, one of the biggest problems was caring for those with chronic diseases, many of whom were cardiac patients. Emergency physician Dr Peter DeBlieux (Charity Hospital, New Orleans, LA) explained how he saw 75 to 100 patients a day in tents in his hospital's parking lot.

New Orleans Convention Center 2006

Then they moved to the convention center, which is currently hosting the ACC meeting, which operated as a makeshift hospital for six months after Katrina. "From November 2005 to March 2006, we saw 150 patients a day in tents in the convention center," he said. "These included transplant recipients and stage 4 heart-failure patients. We had no real consultants." After they left the convention center, DeBlieux and his team switched their tents to a former department store near the Superdome. It was November 2006—more than a year after the hurricane—before they were able to move back into the hospital, which is still not operating to full capacity.

"Our plans failed," he said, "but the outpouring of manpower was helpful, and the armed services were a godsend."

Jamie Blazek

Nurse practitioner Jamie Blazek, a transplant coordinator at Ochsner Clinic Foundation, New Orleans, which was one of the three hospitals in the city to remain open in the immediate aftermath of the disaster, described the plan that her institution devised and implemented. "We established a sister facility ahead of time to evacuate patients to, and we set expectations for our employees. We had an A team that was required to ride out the storm and a B team that had to be staged nearby to provide relief."

"Our most valuable resource was personnel," she said, stressing that flexibility was key. "We had clinicians in the cafeteria slinging hash. There were no job descriptions. You did what had to be done."

Another important aspect was communication, Blazek added. "For a few weeks, the area code 504 was difficult to call into. It was very important to get alternative numbers, including cell-phone numbers, and/or email addresses for patients and staff."

She said they have learned that patient instructions are vital, too. "Patients should have a four-week supply of their medication and a list of the drugs they are on and the doses." This is doubly important when patients are in clinical studies, she noted. "We had had people who were evacuated and who had no idea what their study drug was or even which company manufactured it." Patients should also write down the names and phone numbers of their healthcare staff and make sure their doctors have numbers for them: "Our instructions to patients were to plan ahead, pack ahead, and leave early."
What next, and how can you help?

Dr Hector O Ventura

Recounting the terrible toll of Katrina—1500 lives lost, 780 000 people displaced, 200 000 homes destroyed, and 200 000 jobs lost—cardiologist Dr Hector O Ventura (Ochsner Clinic Foundation) addressed the issue of what to do next: "We need to attract physicians to the region, and that is not easy. Training programs and medical schools are key."

And Ventura—a self-confessed skeptic of electronic medical records before Katrina—noted that a computerized approach is another vital component going forward. "I didn't like those things before, but now I realize we need them."

Reimbursement is also a big issue, he said. "The hospitals that are actually caring for the uninsured should be reimbursed." Currently, one of the foremost providers of healthcare to the population of New Orleans, including those who lack any insurance, is the St Thomas Community Health Center, a primary-care facility on St Andrew St.

Donations given by delegates at ACC to the Association of Black Cardiologists and to the Greater New Orleans Medical Foundation are going to St Thomas Community Health Center. People can also contribute online .

The heart-transplant patient's story Hugo Mejia and his wife Hugo Mejia—even now aged just 45—had a heart transplant on August 2, 2005 following five heart attacks. He was discharged 11 days later, and two weeks later Katrina hit New Orleans. The Mejia family tried to evacuate the city, as they had been advised, but their car broke down. They returned home to ride out the storm. Immediately after the hurricane, they thought things would be okay. There was some damage to the house, but it was not excessive. But then the floodwater rolled in, and the family had to use a table knife to cut through to the roof of their house to get to the only place they could be assured of safety. For three days they lived on the roof until they were rescued by boat. "I thought that was the end of it," said Hugo, "but my ordeal was just beginning." The family was taken to the Superdome, but Hugo's wife did not want to go in. Resigned to using diapers to replace the dressings that Hugo had run out of, she said: "The smell was awful, and the people there looked crazy." Eventually, they were evacuated by bus, and seven days after the storm, Hugo finally saw a doctor who said he was showing signs of rejecting the heart. In Houston, Hugo was admitted to the hospital, but on the third day, a doctor came and told them to leave "because Medicare would not pay." Around the same time, Hugo's wife tried to fill a prescription for his transplant medications in Houston, only to be told that because they were from Louisiana this was not possible. "We had no home. The desperation I felt, the homelessness, with three children in tow, in a different city, with no fallback, was very hard," said Hugo. "What we went through, no family in this country should have to endure." Fortunately, Hugo's wife had a sister in Ohio, and the family was eventually taken there, where Hugo received care at the Cleveland Clinic and where they managed to save the transplanted heart. Yet Hugo stresses that, despite being delighted with his new heart, "Our lives are still in turmoil. Our finances are devastated. But we have to look forward." Hugo's story was relayed to the ACC meeting in a video presentation entitled "In His Own Words." Hugo and his wife were then given a standing ovation by attendees.