Tomorrow marks the first anniversary of the landfall of Hurricane Katrina. coturnix and others are collecting strories from around the blogosphere on the aftermath in New Orleans and elsewhere; the cleanup effort (still ongoing, barely begun in some areas); rebuilding (likewise; lagging far behind where even many pessimists thought it would be by this time); and moving back into the area (not an option for many). The area, it seems, will never be the same.
I've discussed problems with disaster preparedness previously on this blog; therefore, I won't use this as another soapbox to discuss just how unprepared we are for even small disasters, much less something of this magnitude. Instead, I want to highlight something that has received somewhat less attention in the past year: what's become of medicine and health care in New Orleans post-Katrina.
An article in the New England Journal of Medicine addressed this head-on this past April.
Although many citizens have yet to return, area hospitals are scrambling to meet local needs. The population of metropolitan New Orleans is approximately 24 percent smaller than before the hurricane, but only 15 of 22 area hospitals are open, with 2000 of the usual 4400 beds. According to data from the Times-Picayune, before the storm, New Orleans had only 3.03 hospital beds per 1000 population, as compared with the average of 3.26 per 1000 for U.S. cities; today, there are 1.99 per 1000. "The number one current problem is total hospital capacity," says Joseph Uddo, chief of general surgery at East Jefferson General Hospital in neighboring Jefferson Parish. "Emergency department patients can't move into the hospital because beds aren't available. We have no surge capacity."
The situation is complicated by the fact that the doctors who've remained are doing double or triple-duty, taking on responsibilities for care that they generally didn't deal with pre-Katrina. Pediatricians become generalists, and everyone becomes a psychiatrist to some extent, as mental health care is sorely lacking.
Many believe that mortality has also increased substantially, although specifics are difficult to obtain -- the Louisiana Department of Health is still struggling to complete the compilation of 2005 data. As a crude indicator, there were 25 percent more death notices in the Times-Picayune in January 2006 than there were in January 2005. Stress exacerbating underlying health problems is blamed for some deaths. Post-traumatic stress disorder and suicide remain tangible public health issues. There are insufficient numbers of mental health facilities and care providers to deal with the crisis.
Approximately 40 of Ochsner's 600 physicians and 1500 of its 7400 other employees resigned after Katrina -- because their spouses no longer had local employment, children's schools were closed, or housing was not available, among other reasons. One New Orleans nurse who resigned her post in frustration explained that "the patient rooms are crowded, the staff is stressed, and there are serious supply shortages. Our standards of quality are tough to meet when the system is so strained." Staff shortages cause bottlenecks at many hospitals. Elective surgery has been postponed at some hospitals owing to a lack of anesthesiologists.
Hospitals have gotten creative, collaborating with each other and pooling resources to provide services, but it's still not enough. And today, several months after publication of the NEJM article, there's still much work to be done. A new article notes that health care systems in the region are "still fighting to get back on their feet," and an August 2 article in the Journal of the American Medical Association confirms that it's still a mess there, particularly when it comes to mental health, with large numbers still suffering from anxiety, depression, post-traumatic stress disorder, and other issues--and counselors and MDs with training in these areas are few and far between.
Certainly, there's no magic bullet here. Doctors are worried about returning to practices where patients have left, and to areas where their spouses may not have a job and their kids may not have a school. It has to be difficult to make a decision like that, and certainly doctors who have chosen not to return can't be faulted. But this highlights, again, how things can change in the blink of an eye, and how close we all are to disaster.
References
Berggren and Curiel. 2006. After the Storm -- Health Care Infrastructure in Post-Katrina New Orleans. NEJM. 354:1549-1552.
Weisler et al. 2006. Mental Health and Recovery in the Gulf Coast After Hurricanes Katrina and Rita. JAMA. 296:585-588.
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Wonder what the long term effects of wandering through that cess pool of toxic waste will be. Always wondered how the medical profession could separate what they were seeing from normal human emotions. I guess when you are right there in the disaster and your family is suffering its a lot harder - total respect to their efforts.
Wonder what the long term effects of wandering through that cess pool of toxic waste will be. Always wondered how the medical profession could separate what they were seeing from normal human emotions. I guess when you are right there in the disaster and your family is suffering its a lot harder - total respect to their efforts.
I wonder if university hospitals across the nation could each take 1 month 'shifts' in teams of 2 or 3 (thus not understaffing their own units) and send critical personell to support/relieve the exisiting medical staff. It would seem to me that the need is beyond doctors (nurses/receptionists/file clerks/dietary workers/janitors) and that the need for beds is partly staff and partly facility related. Clearly some staff are skilled and some are not. SUpplying skilled staff would seem helpful.