Ed. Note: Excobedo is a family physician in Santa Monica who spent seven days in Baton Rouge as a volunteer shortly after it was savaged by Hurricane Katrina. What follows is part II of her “reflections and observations documenting the magnitude of the damage and ineptitude of the response.” P.C.
My Issues with the Red Cross…
American Red Cross is there and has been from the first days. They have done a lot of good, but their mistakes are becoming enormous as the days go on and their quasi-governmental penchant for bureaucracy and incompetent appointees magnify the social trauma inflicted upon those they are charged with serving. It was the Red Cross that was running the River Center where they used volunteer time inanely to hand out three diapers at a time to refugees, and it was the Red Cross that was so hard to communicate with that people stayed up all night in the shelter try to reach them by phone.
They somehow could not have adequate volunteers so refugees could have face-to-face contact. I guess the volunteers they turned away left and right every day just did not have the “right training” in cultural sensitivity or had not been beaten into submission through the Red Cross training process.
The work performance evaluations they hand out list the first criteria as “supports the objectives of the supervisor, relief operation and the organization” and nowhere seeks feedback about a Red Cross staff ability to engage someone in need, identify those needs, and then meet them. I witnessed Red Cross staff treated abusively by shelter administration who also expressed contempt for the sheltered population.
Dental absesses abounded and when several cases of small individual bottles of Scope were donated, Red Cross staff was told not to distribute it because “they will drink it and get drunk.” At the River Center, the Red Cross hoarded hygiene supplies and basic necessities on a giant loading dock while kids could not go to school because they had no pants or shoes, babies drank from dirty baby bottles, people slept on the floor, and donated clothes sat inaccessible. I tried for four days to get access to the Red Cross storehouse of hand sanitizer which was unfortunately off-site. They finally released two cases which were carried in by one of the two EMTs I sent in an ambulance to hopefully pick up a truckload. In someone’s mind, those two pitiful cases must be enough for the nearly 2,000 people living and working in the River Center for weeks. Other volunteers and I resorted to spending hours bringing materials in from the loading dock and handing them directly out before they could be shipped to the Red Cross storehouse where they would be impossible to get access to again.
Some Tips for Future Volunteers
If you are going into the Gulf area to assist with medical relief, try to make connections before you leave, but be prepared that basically any area code 225 number is going to be impossible to reach. You just have to show up and make it happen.
2. Keep a connection home so you can have friends next-day ship anything you find lacking –- Nextel cell phones work the best there but are still spotty. The chapel has several computers with internet access so you can email. Those little walkie talkies at K-Mart don’t work worth a darn so leave them at home.
3. Don’t go it alone. Poor communication means you always need to work as a team of two to four. Someone always needs to be able to be a runner. Psychologically, having a partner is a great way to avoid burnout and take care of yourself also. You automatically have someone to lean on and someone to talk to about what you experience.
4. Bring a sharpie pen – immensely useful for labeling supplies, meds, and you-name-it.
5. Recognize this ain’t medicine like we have ever practiced before. Your value as a physician is not in the number of cases you see or treat. Be prepared to start with the basics of food, water, shelter, and safety with everyone. From there, you move up the hierarchy. Remember that if patients are too afraid to leave their cots to go eat breakfast, that accucheck machine you just gave them and taught them to use is not going to keep them healthy.
6. Emphasize hand-washing, dental hygiene, and hydration. These are our most powerful tools.
7. Know yourself. Watch for signs of burnout. Talk to your fellows. Enjoy what creature comforts you can. Experienced disaster responders know the priority is 1) Self 2) The team and 3) The patient. You cannot help others if you let yourself get taken out by illness or injury. (www.aidworkers.net/personal/health.html)
8. Expect the first 36-48 hours to include lots of seemly useless waiting around as you get plugged in and try to network and get past the red tape. Expect it and accept it. Use the time to psychologically prepare and don’t fight it. The longer you hang out the more obvious the needs become.
9. If you can, bring your own ground transportation. There are no taxis or public transport.
10. Pack light, simple and be prepared to carry it all on you back — especially if you do not have your own transportation.
11. Pick up a copy of the “Emergency Referral Resource Guide” – the chapel had them when I was there… it lists all the referral numbers from the CDC to the Coroner’s Office to battered women’s shelters. Soon hopefully you will actually be able to get through to places by phone and these numbers will be useful.
12. Bring a pocket-sized notebook to keep notes and emails and names of those you meet.
13. Connect with http://www.thechapelnet.com/locations/lsu.aspx. They house medical volunteers in classrooms on cots and provide everything from transportation to clean underwear. Keep your “batteries charged” here and network with others struggling to get past the red tape.
14. Plan to arrive in Baton Rouge on a weekday during business hours so you can go by the Jimmy Swaggert Center (the big building where the Louisiana Health Department a.k.a. DHH or Department of Health and Hospitals, rents space) to get “credentialed.” Someone will look at your license and a picture ID and then confirm via a web database that you are a doctor. If you are lucky, they will make an assignment, but do not be put off if they say they do not need you now and will call later. Just head over to the Chapel and see if you get a cot. Then hang out in the lounge and talk to people and get on the phone and find someplace you can help.
15. Keep getting the run around? No one seems to need you? Contact the Pastors Resource Counsel (PRC) and they will help get you connected with the people off the administration’s radar. (www.prccompassion.com.) Email email@example.com and you can find out about churches and smaller shelters no one is advocating for or providing services to.
16. Consider flying in to Jackson
Miss. and renting a car there, as there are few flights in and out of Baton Rouge and New Orleans. Jackson is only three hours from Baton Rouge and I expect rental cars will be more accessible there. Renting a car or a hotel room in Baton Rouge is basically impossible. Expect to have a long trip unless you live in the Southeast already. There are no direct flights to the Baton Rouge, New Orleans or Jackson from LAX or Long Beach or basically anywhere in the West.
For info on the Jackson Airport http://www.jmaa.com/AirportGuide/citiesserved.cfm.
Some of the many stories I heard…
One night at 2 a.m. an elderly white woman presented, complaining of cough. After talking with her for a few minutes, I uncovered she was the sole caregiver for her four grandnephews aged 4, 13, 14, 18. One had severe bipolar disease and her first priority had been to get him his medication.
She came in for cough and I learned all four boys had asthma to match her COPD. None of them had any medications. The kids had no clothes and she was up in the middle of the night to try to get through on the phone to the Red Cross and so she could get herself taken care of while the boys slept.
The last night we were there, one really funny old guy came in complaining of not being able to sleep. Before he left, he told us how he managed to survive. He and his wife, six months pregnant, stayed in New Orleans. He said they had about two hours after the worst of the storm before the floodwaters showed up. Winds were still well over 100 mi per hour. He saw water creeping up his street and yelled to his wife they had to get to high ground. As they gathered their basics, in a matter of minutes the water had reached their back yard. By the time they got out the door, it was up to their knees. As they reached a neighbor’s house it was up to their waists. As they reached the nearest two-story house, they were up to their armpits. By the time they got to the stairs, they were swimming. They spent a couple of days on the roof, until the men managed to dive into the water and locate a small submerged boat one of them had seen tied up before the flood. They cut it from its mooring and it floated to the surface and they all crammed in to escape.
A few hours before we were told to leave the River Center because night staffing was not necessary, I met a really nice lady who had arrived in the shelter that day after being discharged from the hospital. She was found cleaning a huge wound on her thigh that nearly went to the femur. She had been discharged that afternoon from a local hospital where she was admitted for wound debridement and antibiotics for several days. She had no money and was given prescriptions which she was going to try to get filled in the morning. My medical assistant saw her sitting on her cot cleaning the wound with a toothette. It was a gaping deep “V” in her anterior lower thigh. She stated it was nothing, she would be okay and that she had fallen trying to climb over a fence and impaled herself on a stump. She insisted it looked so much better as before it was “nasty.” She asked me if was right that the hospital had used charcoal packing to get it cleaned up. With a little cajoling, we got her to come in for a proper dressing and a wet-to-dry to clear the fibrinous exudates starting to build up again in the wound. We filled her antibiotics and made sure she did not miss the evening dose. We also learned she was chronically mentally ill but had no meds and in the hospital had been hiding the pills they had prescribed under her tongue and saving them for later. She showed them to us also and asked if we could give her something else as they made her feel funny.
I met a young woman, already a mother in her early 20s, who had multiple aches and pains and the typical cough and diarrhea. She never did open up but admitted to having sex in the shelter and had no access to birth control. Until I had a box of bulk condoms shipped to the medical clinic, NONE were on site. I gave her money, as my supply had not arrived yet, and got her to promise to buy some and start the birth control pills I taught her how to use and wrote a scrip for. Our interaction ended with a distinct feeling that there was more there that she was reluctant to share. I can plausibly consider things unspeakably horrible from missing family to sexual assault to the trauma of watching those around you die.I can only hope she finds someone willing to listen when she is ready get whatever it is out.