Part One
I am a family physician in Santa Monica. I have a garden variety family practice with three partners and two part-time physicians.
I recently returned from seven days in Baton Rouge as a volunteer. What follows are my reflections and observations documenting the magnitude of the damage and ineptitude of the response.
I can only hope this orientation will better equip anyone who follows me to the gulf or perhaps strengthen efforts to reform the current botched relief efforts.
First, I must paint my overall impression of the situation before I move on to the finer details. I am in awe and inspired by the strength and resilience of those displaced as well as the selfless dedication, support, and warmth expressed by most Louisianans. Unfortunately, I am also dumbfounded by the intense organizational deficiencies and resentment of those in need displayed by certain local Louisiana authority figures. The federal agencies clearly are not performing at the level expected, but from what I have seen, the local leadership is actively working to thwart a professional relief effort by denying the scope of the problems and creating dysfunctional policies and bureaucracies.
Local officials, including politicians, select Red Cross personnel and an especially well-placed but small segment of the Louisiana medical community have managed to get themselves into positions of power in which their prejudices have resulted in the hoarding of supplies, vilification of the needy and substandard treatment of volunteers and refugees alike.
We cannot wait for this select group with an agenda to pass on the call for help from those in need. We must continue to rush to the aide of the Gulf region, now and for months, if not years, to come. The small, but powerful minority who are manipulating this situation and facilitating continuing trauma and suffering have become a collection of bullies hiding behind procedure.
The suffering of those hit by the hurricane and the failed levies is enormous. There is and will be continued need for all forms of relief regardless of what officials report. There are well over one million people displaced with nothing but the clothes on their backs. There can be no spectators in this relief effort and we cannot wait to be asked for help to get busy.
The Extent of the Damage:
Devastation of Infrastructure
Social services and safety net services that were not resilient or effective before this event have basically completely fallen apart. Half the hospitals are now gone, the number of patients has gone up, and the percentage of the population now destitute is huge. Three weeks after the storm, communication systems are still barely beyond third world. I tried today to reach the Louisiana Academy of Family Physicians repeatedly only to get an all circuits are busy signal. EMS dispatchers have spotty communications and confessed fear that a rig and crew might get into trouble and they would have no way of knowing until they failed to check in by dark at the command center. According to the EMTs I spoke with all the hospitals are on diversion chronically.
Stunned Humanity
I saw people walking like zombies with a flat affect and glazed eyes. Many cannot connect at all but are instead on autopilot survival mode. The lucky ones can engage, if given supportive listening. The stories are horrific and need to be shared. I spoke with several women who clung to trees in the water for days until they were rescued, parents losing their children, elders being drowned in their beds as the waters rose, people surviving on their roofs or by luck and sheer willpower.
The chronically mentally ill are now walking about unmedicated and drug addicts are detoxing cold turkey in public shelters next to families with children, the elderly, and the traumatized able bodied survivors who spent the first days desperately trying to rescue those trapped. Busloads of men released by the Louisiana State Dept of Corrections are dropped off at shelter doors where no attempt is being made to transition them into this difficult living situation. They must walk in and find floor space amongst the frazzled and exhausted. The vocabulary of prison administration is creeping into the language used by Red Cross shelter staff.
I worked five nights with a pediatrician as essentially an urgent care doctor at the River Center in Baton Rouge. By the administration’s count, it housed between 1300 and1800 people, but I suspect it’s closer to 2000 when everyone was back from school and work at night. Each night we saw young healthy men with no tachycardia who presented with vomiting or diarrhea and who did not leave their cots to urinate until they had received three to four liters of fluid. Standard objective signs of serious illness are clearly blunted in this setting of overwhelming stress.
Burnt Out Helping Professionals With Inadequate Skills
Regardless of the body count, thousands have died, and those who survived have had their families and support systems scattered. Many were then traumatized by the violent few who were allowed to take over and terrorize those displaced to public spaces or the roofs of their houses.
The cost of living in the Baton Rouge area, especially for anyone trying to secure housing, has dramatically risen at the same time, jobs have vanished and quiet secure time is needed to heal. Housing for hundreds of thousands is simply gone. They have nowhere to return to and neither do their families who often lived in the same areas. Those lucky enough to have family/friends in the outlying areas are crammed into close quarters. The disruption of daily life and ongoing pain of being faced with the immense suffering appear to have hardened some, especially those responsible for local relief efforts, against the overwhelming need.
Whether it was a pre-existing condition or not, some of those in charge of helping now blame the victims and are convinced, as one nurse manager of the River Center yelled at me, “We have made these people dependant upon us. They just need to go home.” She refused to accept the fact that they had nowhere to go.
Unprecedented Environmental
Contamination
Not only are people’s homes gone but the environmental destruction is severe. We saw several men with chemical burns. Several ambulance
drivers spoke of areas where even after three weeks nothing had begun growing below the level of the storm surge. Misguided local officials who
continue to push for people to return to destroyed home sites are not being overruled by the federal government. FEMA instead is rejecting anyone entering the worst areas unless they have hip waders and respirators. The smell is horrendous in these outlying areas and debris is everywhere. Every day dozens of “chainsaw gangs” head out to cut the massive trees ripped up by the roots and the wreckage of buildings and boats strew about.
Inadequate Federal Response
Even as you read this, the stage is being set for another disaster. The same local officials who allowed inhuman poverty to fester and then failed to prepare for the expected hurricane are now urging people to return to their homes. Again the federal government is not stepping up to the plate and overruling these patently unrealistic actions. Plans are in the works in Baton Rouge to close all the major shelters by the end of this month so local residents can get their lives back to normal and keep their college and professional sports teams on schedule.
A major public health crisis is brewing as conditions are perfect for major outbreaks of everything from multi-drug resistant TB to West Nile to Cholera to impetigo. The one federal agency which appears to have taken control locally is the Center for Disease Control that swiftly moved in and kicked the Louisiana equivalent of the Public Health Department out of the large shelters and then disappeared, leaving no public health supervision or guidance in place at the River Center where I was. As it is the largest shelter in Baton Rouge, I cannot imagine they performed better elsewhere.To be continued.
