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.
Friday, September 16, 2005
Last night was less busy. Armando and I “adopted” a few people and avoided crying by looking for ways to provide the basics for those who had really nothing but a cot and each other. At midnight I saw a lady in her 70s caring for three teenage grand nephews and their four year-old brother. She had a mild COPD exacerbation but shared that all four boys had asthma and they had no meds. The 13 year old also suffered from bad bipolar disease in addition to his asthma so getting those meds had been her first priority after arrival and she had accomplished that in the last 48 hours. Because of his medication he had surpassed all his brothers in size and now weighed 200 pounds at age 13 and had no pants to wear to school so he was refusing to go. She had waited to come in as unless they were asleep she really could not bring them all into our cramped little area and they would not behave long enough for her to get some help for herself. “Besides,” she said. “I have to call the Red Cross at 2 or 3 a.m. anyway as that is the only time you can get through to them.” The River Center is a Red Cross shelter. She is in their shelter and yet she has to be up at 2 a.m. to communicate with them. She left the “first aid” station with an uncommon and coveted cot that could elevate the head and she was asking for pillows so she could sleep because she could not lie flat. Her back was killing her so Armando set her up with one of the rare air mattresses. We got her spacers, Albuterol and Advair for each of them labeled with their names and set up in zip locks. We dug up incontinence supplies for her and the ever needed hand sanitizers and baby wipes. I took her back to the piles of donated clothes scattered all over the loading dock so she could find her boys underwear and herself a bra and something to use for PJs. Armando saw her four “boys” sleeping and as they walked to her area and she shared the problem of no pants for the boys so getting them to school was difficult and she was stuck. He found not only several second hand pants to fit each of them but also brand new cool T-shirts and even several pairs of new pants hidden under a table in a box with an “x” on it as a cryptic identification for Xtra large. I helped him carry the two boxes of clothing and a brand-new nebulizer and 4 boxes of Albuterol solution unit doses to set amongst their things about 3a.m. The boys were all asleep but her bed was empty. She was no doubt on the phone trying to get Red Cross to help her register with FEMA so she could get temporary housing and get out of the shelter. I hope the boys went to school because she is gonna need a nap. The baby bottle recycling is slowly becoming part of the system after 48 hours. We are running low on new ones and not getting so many dirty ones. People leave the shelter every day – we encourage them to have four bottles per kid per day. More families enter also every day and often come with nothing or only one or two bottles. The floors only got cleaned here and there. Everyone pointed at the six horsemen of the apocalypse: FEMA, Red Cross, City Admin, Louisiana state Administrators, independent contractors, the refugees for whom this is “working out just fine.” (… in Barbara Bush’s words). Oh, well a little is better than nothing.
When we showed up there was no additional hand sanitizer. I spoke with the dude who (at least unofficially manages) the piles in flux all over the loading docks. I asked him if he could help me out. 20 minutes later, eight cases of waterless hand sanitizer showed up in front of the pharmacy. Now when I walk through the floor I see many familiar faces. The rumor is when we leave they are no longer going to staff the night clinic so there will be no one to deal with the sick kids, people that can’t sleep, and those who have diarrhea in their beds and cannot change them. I suspect they will instead have EMIs sit “on call” for people who are decompensating. Despite dozens of MDs showing up at DHH headquarters they are turning them away because they do not want to staff a night clinic. All the nurses and doctors are volunteers. It costs them nothing to keep it open but probably by looking at the site tallies for number of patients seen they figure there is not enough need. They have never really looked around on their limited brief visits and seen people or imagined that even if people don’t come in for medical care we have plenty to do such as reaching out to them and cleaning up the mess from the previous day let alone working to improve systems modest step by modest step. I am gonna go take a shower and see you guys soon.
After sleeping a bit this p.m. I am going to try to run over to Jimmy Swaggart Center and make sure they have someone to follow me, and then hook up with a paramedic unit making runs into New Orleans and doing house to house visits/searches as a “freelance” ride along. Part of me is very afraid of seeing things that by all accounts look like an atomic blast hit. The other part of me, now painfully aware of the poverty hidden from my consciousness by distance and economic segragation, feels I cannot shrink from the front lines of this gigantic poopy diaper that must be changed. In areas, everything below the flood line is still dead weeks after the flood. Anyone from this area knows vegetation in humid climates grows rapidly. They just started requiring waders and respirators on anyone returning to the very poor and completely flattened St Bernard Parish. No one knows what all was spilled and the stench is unbelievable. According to those who have been there, don’t believe George Bush that things are getting better. The only area the authorities keep admitting the need for additional help with is morticians. That is telling. Be very afraid.
Everyone who can throughout the entire nation needs to plan to spend a week or two in the next year (if not more) physically in the gulf somewhere.
It is a third world country here for those displaced and I desperately hope this brings the horror of economic injustice home to our country.
This was our generation’s wake-up call. We must come to help bury the dead, assist in the healing, and learn how to demand/embrace economic justice for our own sake and our fellow men. The need is immense. Our generation will be judged and defined by the long-term response to this unbelievable, horrendous tragedy.
Saturday, September 17, 2005
Last night an hour before we showed up, we were called and told that the night clinic was cancelled. We of course showed up anyway “to get our last paychecks” (hearty chuckle by all) and ended up treating several dozen people, including at least four who would have required acute ER visits. When we arrived, the word was out that the clinic was closing… “because we need to transition to providing long term health care access. We are making these people too dependant on us. The middle class are holed up, eight and 12 people in a house, and they can’t get access to health care while these people are able to walk in and they can afford to go see their doctors.” Ok, I did not memorize her words but that is very close and was the ah-ha moment just before I got told to leave and not come back. You will be very impressed that not one curse word passed my lips. Not only have the Red Cross, OPH, EOC, FEMA and the CDC reached new heights of bureaucratic mediocrity in crisis, there is a clear underlying resentment that “these people” are in Barbara Bush’s words having this “work out very well for them.” To make a long long story short.
When we showed up for our shift that had been cancelled patients were waiting. We were told the “infirmary” on the second floor, which housed a few demented and schizophrenic patients as well as a developmentally disabled boy who is bedbound, had to be moved to the floor with the main population because “they do not have special needs” so we need to close the “special needs” infirmary. What are special needs, you ask? No one could tell me. They admitted that the patients in the infirmary would be at-risk and could not safely be placed on the “floor.”The nurse manager, a very burnt-out lady, Kim Scullen RN, insisted they would be fine because they were going to move all the people out of a corner of the conference center and move all the infirmary patients there and staff it with Red Cross volunteers who would bring them their food and help them to the public restrooms across the convention center floor. We were told the medical clinic was not going to be staffed after 9 a.m. in the morning and the upstairs room had to be emptied. Since the Red Cross was going to have to staff VOLUNTEERS either way and I promised I could have volunteer nurses cover the area why not just call it a board and care room instead of special needs. She had no answer to that and fell back on “because my boss says so.” We took a chance last night and tried to move the patients to a temporary hospital which the EMI dispatcher told us would accept them. Unfortunately, they sent them back to us, but the emergency disptacher agreed they could not go to the floor so at least I had an excuse to keep them in the upstairs until my shift “ended.” Nurse Kim Scullen then came in this a.m. and yelled at me, telling me I had no authority to transfer patients and who did I think I was and then laid into the Red Cross RN working with me tonight. As she insulted me again and accused me of “rabble rousing”… I think that’s a Southern way to say “talking back,” I guess it was a good thing I got credentialed after all, since she took my name and I expect to be forever blackballed by the Red Cross. If there is a riot or a serious disease outbreak in the River Center in Baton Rouge, we saw it coming and the bullies insisted everything was fine. I am going to go try to catch a ride to the storm destruction area. With so many authority figures saying things are business as usual I have to see for myself.