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.
Some of the Stories We Heard
One night we baby-sat a cute little guy whose parents were drug addicted and burnt out. He was dirty and agitated and had been on Benadryl constantly for days to keep him quiet. His parents were not much better. He spent a night with us and got a bath, clean clothes, a playpen to sleep in and a good meal.
After a long sleep, he looked like a new boy and laughed and giggled with the Guardsman who stood watch over him all night. Our social worker on nights spent a ton of time speaking with the parents and assessing their situation. The child had bruises all over, but they were not inconsistent with surviving a category 4 hurricane. Social services were alerted but as the family left the shelter the next day it is impossible for them to follow him. I can only hope his parents had also metamorphosed into new people after a nights sleep and that he is kept safe.
During the night of the diarrhea mini-epidemic, my nurse responded to a National Guardsman who called for help in the bathroom where a patient was vomiting. After getting that gentleman transferred, he overheard load wheezing and respiratory distress in one other the stalls and found a 6’4” guy about 250 pounds in severe respiratory distress. We stabilized him with Po lasix and Albuterol and transferred him to a hospital. The social worker hanging out at night recognized him immediately as a chronic schizophrenic who was nearly catatonic when he came in. She called the ER and found out they had diuresed 3 L of fluid off him and were deciding whether he should be admitted. She left strict instructions to call her on her cell with an update but heard nothing until she called at 10 p.m. after we returned, then next when she called the hospital looking for him. She was told he had been discharged to the lobby at 10 a.m. All his meds and belongings were at the River Center and he barely would speak, so it was clear he would never find his way back to us. Thankfully, the hospital staff checked the lobby about 15 hours after his discharge and he was still sitting there quietly. They brought him back to the ER, gave him something to eat and called his social worker who picked him up and brought him back to the River Center where he was placed in a separate smaller group of people who could not safely be independent in such a large facility.
Blog From My Time in The Area…
Monday, September 12, 2005
Dr. Jodie Escobedo with our medical assistant Armando Hidalgo have left today for Louisiana with a group of prominent Santa Monica physicians as part of a relief effort for Hurricane Katrina. We will be posting her daily blogs here. On her way out, she sent us this description of the group and their purpose:
“We are traveling with a NGO, Doctors and Nurses of the World, along with several other local doctors and nurses. They cannot say where exactly we will be (as plans are fluid) but we will be flying in to Baton Rouge on a donated private jet. We will be the first of a series of local docs traveling to reach the as- yet-untreated and to relieve the docs who have been working around the clock for the past two weeks. Part of our job is to get a foothold and ground knowledge of the area so each successive rotation can build an increasingly more effective medical relief program.”
All of us here at Peak Health Medical Group are honored that Dr. Escobedo was asked to be a part of this important mission, and we thank all of our patients for understanding any inconvenience this may cause with her absence. Stay tuned for more updates!
– posted by Brian Madden MD @ 08:00 AM
Wednesday, September 14, 2005
Dr. Escobedo called about 12 hours ago after finishing her first shift, working overnight at the River Center shelter outside of Baton Rouge. She was exhausted and didn’t have time to write, so I’m paraphrasing our conversation on her behalf.
The first day was consumed by bureaucracy. They were initially told by FEMA authorities that they didn’t need any doctors and were sent away.
They knew this wasn’t true, so they finally found another group – not sure which – who was able to assign them to a location. Half of the group went away, Dr. Escobedo doesn’t know where, while her half was assigned to the River Center shelter. She hasn’t had contact with the others in her original group since.
Somehow in this process they are told they will need certification before they can report to their assignment — or they even found this out after arriving at their assigned place. They had to trek back to Baton Rouge and wait for another meeting, so they could receive this certification letter.
Finally upon making it to the assigned place with the proper paperwork, they were able to start.
And so far she has worked one shift and nobody has asked to see that piece of paper.
So the thinking goes it would be more efficient if volunteer physicians took the liberty of completing this form for themselves if they are assigned to a location to be part of the relief effort. Now it occurs to me to point out that if you do this you should actually be a physician with a prearranged assignment in Louisiana, but in this case I don’t think there’s much to be gained (if it could be pulled off at all) by being a volunteer doctor impostor. From Dr. Escobedo’s description, it seemed all the bureaucracy accomplished was to delay her ability to start treating patients.
On the patient side, already the trauma is evident. Perhaps this illustrates it best: when a patient’s oh-by-the-way moment as they walk out the door is, “And did I tell you I have a brain tumor?” you know that priorities have shifted. This particular patient was more concerned about the young orphan he adopted in lieu of his missing 14-year-old. Others had chemical burns over half their bodies from three days of search and rescue efforts. (Chemical!)
It was obvious from this conversation that there is an incredible amount of work left to be done. Her team was taking over for an intensivist from Boston who was here because he knew a friend from Tulane who asked him to come down; originally he was to help at the hospital but ended up working in a shelter. There are still more evacuees arriving daily to her location.
I later found out that Dr. Escobedo was interviewed by CNN, probably when she returned to start her shift at 7 p.m. We don’t know when it will air but we will keep watch for it!
– posted by Brian Madden MD @ 10:00 PM
Thursday, September 15, 2005
Here is an email from Dr. Escobedo sent this morning, I think it catches us up on the situation well:
“I am at a loss for words. Last night was our second time as night shift at the River Center in Baton Rouge. Diarrhea and vomiting broke out for the second time in the last two weeks and the “River Center Runs” brought about 50 people through the two medical clinics we staffed. We sent several to the ER, including a case of flash pulmonary edema and a gentleman who collapsed and was bagged by paramedics. He seemed to be having an MI.
Counts as per the shelter director this morning, show nearly 1,900 people at a minimum. Add nearly the same number of volunteers and workers, who are all tired and stressed and often dealing with losses of their own. For the refugees’ care we write little quick notes that we keep in a rudimentary charting system of manila folders by name. The volunteers and workers we treat “paperlessly”. We have a collection of tables and we have nurses assess quickly and bring people back where we sit next to them and talk to them about their problem.
The stories are intense and unbelievable. At least 30% of people have no functional literacy. Medication confusion and compliance errors abound as does diarrhea and puke. The reserve guard troops equipped with their empty automatic weapons are angels. They alone withstand better complete chaos and a repeat of the superdome horror. They watch the bathrooms for us and bring us the patients who are so sick they move to the bathrooms where vomiting blood and passing out can then be done in semi-privacy and evade our volunteers and nurses who patrol the “floor” watching for sick people.
The majority of the professional staff are non-natives. California is very well represented. We have been alternating with a team from South Carolina who do the busy days. They are doing a bang-up job. A FNP from Northern California watches the “arena” – a second clinic near the second large floor that has about 500 of our refugees in cots and piles. We walk through the loading dock between the two areas through a massive amount of clothes, diapers, water, and supplies. Upstairs a group of nurses staff an area of 12-20 people who need TLC and to be protected from the general population. Demented and handicapped patients get to keep one caregiver with them in that area.
At night it is rather quiet for me, as they are sleeping. Last night Vicki Paterno, MD (pediatrics) hydrated a boy with a sickle cell crisis which we were able to avert for a 12 hours at least, though he and his mom were checking back in as we came “home” to “the chapel” – see http://www.thechapel.com. It is at LSU and here they house healthcare and mental health workers with cots, showers, food, and everything else from underwear to taxi service.
Pregnancy tests are not plentiful and birth control is not available for anyone. If you think sleeping on a cot in public would stop people from having sex, you are wrong. We are amazingly resourceful. That is why I called and left the voicemail to ship the promo condoms we bought here.
THEY ARE NOT AVAILABLE ANYWHERE.
Last night I contacted the emergency response center as I saw a couple of patients I am very suspicious of giardia. I realized that despite the fact no one was dangerously ill from the diarrhea/nausea I realized we could easily end up with 1,500 people shipping out with chronic giardia all over the US or worse yet the tip of a building iceberg of emerging cholera. We had no material to collect stool samples nor guidelines from the CDC regarding appropriate public health investigation. At 2 a.m. I paged the CDC epidemiologist and never heard back. Eventually we were able to speak with a doc from the public health department of LA. They are overwhelmingly frustrated as they had surveillance measures in place when the CDC came in and informed them they would take over. Not being comfortable just hydrating and scrounging Pedialyte, bananas and clean(er) sheets and cots for those who needed help, we started looking to improve the sanitation situation.
The floor was covered with puke and diarrhea and had kids walking through it in the bathrooms last night. The janitorial staff cleaned it up ASAP but still the traffic immediately assured effective distribution throughout the huge conference center. We knew the Red Cross was pushing hand sanitizer as people entered but once we started asking we realized that nearly everybody ill stated they had no personal supply available of hand sanitizer. Additionally we realized there had been no arrangements for parents to have access to clean bottles for their infants and they had been washing them in the bathroom with whatever soap they had. This was despite a few hundred new bottles on the loading dock. We started out just handing out fresh bottles and realized we would eventually run out and contacted the chapel this morning and got a volunteer to agree to pick up dirty bottles and return them then next day when she picks up more. Every parent with a toddler and below we have had to then approach and tell them to come pick up at least 4 bottles per kiddo and give us their dirty ones because we can’t have the babies getting ill. This alone is a huge accomplishment.
We handed out every bottle of hand sanitizer we could find and filled up several carts with trash bags (for vomit and dirty clothes and diapers).
Once we started circulating people began asking for diapers and baby wipes. It turns out they could get them from the Red Cross who were ever so slowly releasing them in packs of 3 diapers per child. The people are still coming in and many leave each day with the net increase in population supposedly 200 yesterday. Most people are finally getting in touch with family or friends and fleeing the center to crowd in friends and family homes. Unphased by the absolute insanity of only giving parents enough diapers for 6 hours or so we started just taking entire packs of the diapers and handing them out. Needles to say the public health doctor agreed with us when we explained that even though it was not organized and it risked some people taking a pack or two more than they needed immediately (they cannot carry more than that as they must carry everything they own) we cannot skimp on hygiene basics. Still he could do nothing to officially sanction them as the Red Cross technically “owned” the mountain of diapers which we did our best to make a molehill of and get every baby easy access to clean diapers. One day shift Red Cross manager repeatedly asked Armando to move the dolly he was continually filling and handing out for the three hours after our 12 hour shift ended. “You need to move that. It’s in my way” his response “YOU need to move. You are in my way!”
All the professional RNs and nurses aided and abetted our wanton generosity – with the assist of the health department we got a meeting with the Red Cross shelter “manager” where we reviewed the numerous hygiene problems and gained official sanction for our baby bottle exchange program. After putting out an emergency call for hand sanitizer for a shelter with about 3000 refugees and workers at about 3 a.m., by noon we had received three small cases despite sending a BLS ambulance to the Red Cross storehouse where by everyone’s account they have “mountains.” Hopefully by 9 p.m. the floor will have been piece by piece mopped with dilute bleach solution, we will have chlorox wipes to clean cots, and plenty of hand sanitizer. I am gonna sign off as I am exhausted. I have to go sleep before I go back on duty in six hours. Another quality productive agency is aww.prccompassion.com, also support www.thechapel.com. There is huge need here. We have to do email@example.com has a huge constantly updated list of small pockets of people in acute need!”To Be Continued