USA

LOUISIANA: Assessing Gustav's Impact on Partners
Direct Relief USA Program staff members Katie Lewis and Amy Fox visited Louisiana health centers and clinics following Hurricane Gustav to assess damage and existing needs. Below is there report from September 2008.

September 15
We spent our first day in New Orleans at the National Association of Community Health Centers (NACHC) annual conference. In addition to attending seminars, we met with our partners at NACHC and Cardinal Health. Thanks to John Lamb from NACHC, Lance Hengst from Cardinal, the technology of Blackberry and the Internet, and our headquarters staff we were able to send eight shipments of hurricane emergency aid to Texas and Louisiana.

September 16
We toured New Orleans’ Lower Ninth Ward in the morning, where much of the devastation from Katrina is still apparent. Crossing the Industrial Canal, we could see the newly constructed levees. It wasn’t hard to imagine how, with enough water, the canal could overflow into the nearby neighborhoods. We passed row after row of destroyed city blocks. Windows and doors were boarded up and spray painted with Xs, used as a marker during Katrina to identify the number of survivors and the number of deceased. Roofs were caved in and walls were completely missing as many of these homes have remained untouched since 2005. Every now and then we came across a home that had been rebuilt. Despite all the demolition, people remain in the Lower Ninth Ward as homes are renovated one by one.

Our next stop was the St. Gabriel Eastside Community Health Center, in St. Gabriel, outside Baton Rouge, where we met with Phyllis Adams, chief executive officer. St. Gabriel sustained minor wind damage from Hurricane Gustav; part of the roof was blown off, destroying some of their immunization stock. Luckily, insurance will cover the roof damage and the State of Louisiana will replace the spoiled medication. St. Gabriel closed for four days after Gustav due to lack of power. The center received a generator from a local church, and ran the clinic with minimal lights and no air conditioning. Most of the patients the clinic saw in those early days suffered from depression, hypertension, and asthma, and many needed medications for chronic conditions. A social worker and a psychologist on-site worked with the medical director and nurses to provide the care these patients needed. 

September 17
We traveled about 60 miles northeast of Baton Rouge to visit Ginger Hunt, CEO at the RKM Primary Care Clinic in Clinton, a very rural part of the state. RKM, which opened in March 1999, is one of the newer buildings in the area. It operates six clinics throughout four parishes and treats about 75 patients a day. With some minor roof leaks at two of their sites, RKM escaped major damage from Hurricane Gustav. Running on a generator, the clinics were able to stay open 24/7 following the hurricane.

Ms. Hunt says that RKM prides itself on its quick and friendly service. In the waiting room, we spoke with a mother and daughter in to see a doctor about a foot injury. Both mentioned that the staff was much nicer at RKM than at the private practice and that the service is always faster. Of the more than 20,000 patients RKM sees each year, 26 percent live below the federal poverty line, 7.4 percent are unemployed, and 32.9 percent don’t have a high school education. 

We moved on to St. Helena Community Health Center in Greensburg, another very rural, poor area. We spoke with Henrietta Spears, interim executive director of St. Helena, which serves more than 40,000 patients annually, 75 percent of whom are under- or uninsured. While the clinics weren’t damaged in the hurricane, they were closed for two days due to lack of power, water, and gas. A major obstacle for St. Helena is getting patients to come in to the office. Homes are sometimes more than 20 miles apart and residents are unable to afford transportation to the clinic. Many of St. Helena’s staff have lived in the area their whole lives and know the people they treat. Staff members often stop by patients’ homes after hours to make sure they have their medications or to bring food that patients wouldn’t be able to buy.   

RKM and St. Helena serve similar populations and see the same problems. At both, many patients post-Gustav came in seeking mental health treatment. Depression and anxiety are common but spike after hurricanes. Fortunately, both health centers employ psychologists and social workers to provide treatment.          

September 18
This morning we met with Emma Tanner at Capitol City Family Health Center in Baton Rouge. Capitol City moved into a beautiful new facility last December, where it offers primary care, dental services, HIV counseling/testing, immunization, mental health, lab testing, and nutrition education services. If a patient comes in for something like stitches, he can meet with a dentist, complete lab work, or talk with a social worker all in one visit. The clinic closed for a few days after Gustav and sustained minor roof leaks; most patients following the hurricane needed medication for chronic illnesses. Ms. Tanner said that Capitol City patients are often late to or miss appointments because they can’t afford transportation to the clinic.   

Back in New Orleans, we met with Mary Crooks at the Community Outreach Center at EXCELth, Inc, at its corporate office downtown. EXCELlth operates four clinic sites and four mobile units throughout New Orleans. Adequate facilities are the biggest challenge facing EXCELth’s clinics, which all experienced power outages after Gustav, though only the Algiers Clinic had roof leaks. With Ms. Crooks, we toured one of the mobile sites, a bus with one treatment room and a triage area. EXCELth sees many patients through its mobile clinics, which allow them to reach new patients. When a patient can’t make it to a clinic, EXCELth brings the clinic to the patient. 

At the end of the day, we visited St. Thomas Community Health Center, housed in a two-story brick building from the early 1900s. In a predominately poor, African American community, the clinic serves about 150 patients a day. This number grew significantly after Katrina. Dr. Donald T. Erwin, president and CEO, requires that all his staff attend a seminar titled “Undoing Racism,” because he feels that the only way to truly help the community is to understand its background.

St. Thomas offers a variety of programs. It partners with the Isaac Stauffer Memorial Eye Clinic to offer free eye exams and glasses for the uninsured. It also owns a mammography machine and provides comprehensive exams for women. The only area clinic to offer cardiology testing, St. Thomas conducts testing on-site and refers patients who need advanced treatment to a hospital. Dr. Erwin, like most of the people we met in Louisiana, believes that the catastrophe of Katrina revitalized altruism in a lot of people. Before the hurricane, the healthcare system throughout Louisiana was in dire straits and Katrina wiped the slate clean so the system could be rebuilt.

September 19
Hurricane Gustav took its toll on St. Charles Community Health Center, just outside New Orleans, which we visited on our last day. The main clinic was spared, but the Behavioral Health/Podiatry/Administration building across the street sustained severe structural damage. The roof was picked up, causing leaks and water damage and the fire escape was torn from the building and destroyed. The building is uninhabitable, so the departments housed in that building had to move into the main facility. Behavioral Health now occupies the kitchen and psychiatry appointments take place in IT offices or empty treatment rooms. Repairs will take four to six weeks. Julia Bodden, Community Outreach Coordinator, told us that St. Charles closed for a week after Gustav because of a power outage. When they reopened, the clinic saw about 45 additional patients a day from surrounding parishes. Its mobile unit was sent to the food-stamp line to treat people waiting in line in extreme heat and humidity. 

We also met Maria Rivas and her young daughter. Ms. Rivas was one of the first patients to go through St. Charles’ Pregnancy Program, started nearly two years ago with Direct Relief grant funds. She has served as an advocate for St. Charles among the area’s growing Hispanic community.

March 2007
by Kathleen Hertel

In honor of the National Children’s Dental Health Month, Direct Relief International sponsored its 14th annual round of free dental clinics in Santa Barbara County, California. Four clinics were held in high-need communities between February and April, helping connect 18 county dentists with 105 children who lack the resources to receive needed dental services.

Created in 1993 to address the needs of uninsured county children, the Healthy Smiles Dental Program, directed since its origin by Direct Relief program officer Martha Angeles, collaborates with more than 30 other community groups to screen, identify, treat, and educate these children to ensure that their current dental problems do not develop into more complex health conditions.

Though all dental disease is preventable, two of the main obstacles to children’s dental health are parents’ lack of access to oral health information and their inability to pay for preventative dental health services for their children. Healthy Smiles provides preventative services such as bilingual oral health education, cleanings and restorative care for children with severe need, and dental hygiene kits for families. The kits include toothbrushes, toothpaste, and floss.

The process begins as children from selected elementary schools in the County are screened to determine the state of their oral health and whether or not they have access to dental insurance through a parent’s employer or through Denti-Cal. If a child is not covered by any type of insurance, he or she may be eligible for complimentary treatment through the program.

The clinics have been an invaluable resource to families without dental insurance in Isla Vista, a small, largely immigrant-inhabited community bordering the University of California – Santa Barbara (UCSB) in Goleta. This year’s Isla Vista clinic, hosted at UCSB, brought together 16 children and six local dentists, as well as many dental hygienists and other community volunteers in an effort to tackle the issue of children’s dental health problems.

Angelita Echeveste, the Family Resource Center Coordinator at Isla Vista Youth Projects, serves as a link between Direct Relief and the children from Isla Vista Elementary School who are selected for treatment. She stressed that although parents are generally very concerned with their children’s health, they find it difficult to take time off of work either because they do not want to ask for a day off for fear of losing their jobs or because they feel they cannot afford to lose the income of a full workday.

After the first contact is made, however, Echeveste does whatever she can to make it possible for the parents to bring their children to the clinic. She tells them that “If they can’t come into my office, then I’ll go to their house and we’ll fill out the application.” Her flexibility and persistence resulted in the successful recruitment of 20 kids for the Isla Vista dental clinic.

As she was excitedly waiting for treatment, Mirna, a kindergartener at Isla Vista Elementary School, shared what she had learned from the “tooth fairy” at school. She explained that, “your teeth can get germs in them,” and that she and her classmates have toothbrushes in their classroom in case they did not brush their teeth at home. Through the new healthy diet education portion of the program, Mirna learned the importance of calcium for her teeth and bones and proudly claimed, “I always drink milk. I’m a cow.”

After her daughter was called in by the dentist, Mirna’s mother Patty commented that she “sees the program as a good opportunity.” When asked whether it was difficult for her to make time to come to the clinic, Patty replied that it was not an issue for her because she has a flexible schedule. She stays home to take care of her children in addition to being on-call for small domestic jobs in the area while her husband works in the fields.

Upon receiving fillings for her cavities, Mirna walked back into the waiting room, but a big frown had replaced her anticipatory smile. Silvia Erickson, the Dental Hygienist who worked on Mirna, shook her head and laughing slightly said that her patient was very sad when she found out that not even her cuteness could get her out of the uncomfortable treatment. She emphasized that “with a good diet and good hygiene we can avoid all these problems and it [prevention] is a cheaper, much less painful way.”

Barbara Sherman, another dental hygienist, stressed the importance of prevention as she presented the new bilingual health education portion of Healthy Smiles at the Isla Vista dental clinic with Martha Angeles and distributed a Spanish-language information sheet covering healthy snacks. She believes that “health education should start when women are pregnant” because of the importance of baby teeth. Sherman lists the development of smiling, speech, and holding space for permanent teeth as some of the reasons mothers should pay attention to baby teeth.

Since most of the cases at the clinics are serious and treatments are needed on both sides of the mouth, one day is not enough to put the kids back on track. While Angeles is very satisfied with the continued success of Healthy Smiles and the enthusiastic volunteers who make the event possible, Angeles hopes that next year she can encourage more families to attend and that she will be able to provide additional health education covering a healthy diet.

August 2006
By Lindsey Pollaczek and Damon Taugher

Damon Taugher, Domestic Program Officer, and Lindsey Pollaczek, Disaster Assistant, are traveling along the Gulf Coast this month meeting with current hurricane relief partners to assess current needs and explore new possibilities to provide medical assistance. A key component of the assessment trip is to discuss with partners any preparatory needs for the current the hurricane season.

Nearly one year since Hurricanes Katrina and Rita made landfall, we hoped to get an inside look into the status of Louisiana’s healthcare system to understand how the rebuilding effort has progressed. During these last several days we have meet with partner nonprofit hospitals, community health clinics, and healthcare associations in New Orleans, Lafayette, and Baton Rouge to get a sense of what remains to be done. Although each individual clinic has a unique and often incredible story, there are several key issues that tie each together; issues that require focused attention and support in order to strengthen the provision of Louisiana’s healthcare.

Throughout the state, particularly in New Orleans, staffing shortages have significantly hindered the ability of healthcare providers to meet the needs of the populations they serve. From our conversations, it is clear that there is a specific shortage of registered nurses, many of whom evacuated New Orleans and have yet to return. With fewer nurses and healthcare professionals to service increased populations, patients often wait weeks to see a doctor and receive needed medications. Direct Relief International partner, East Jefferson General Hospital, a facility which is renowned for its Nurse Magnet status, is suffering from a shortage of 100 nurses, a need so great they are reviewing recruitment options of nurses from other countries.

Access to medications, particularly at community health clinics, remains a critical issue. In our meetings with Algiers Community Health Center in New Orleans, Lafayette Community Health Care Clinic, and Capitol City Family Health Center in East Baton Rouge Parish, nurses and doctors work with a limited stock of medicines to provide care to medically underserved and uninsured residents. We were amazed at the extent of health services these clinics were continuing to offer with such limited resources. We were also acutely aware of how valuable shipments of medicines and supplies from Direct Relief are and how continued support is needed to strengthen the capacity of these organizations to meet the needs of their community.

An additional concern of the healthcare professionals we met is access to transportation. The thousands of people that fled New Orleans since the storm have relocated to other cities, where they reside in FEMA trailer parks that often lack sufficient public transportation. Many providers have been forced to invest already tight resources into mobile medical units and patient vans to meet the needs of patients living out of reach of public transportation. Without such measures, many patients would go without healthcare.
The population continues to ebb and flow throughout Louisiana; many people are returning to New Orleans, while other evacuees have become permanent residents in new homes and cities. Many of the facilities we spoke with are still treating an increased number of patients compared to pre-Katrina levels, which makes the need for medical professionals, medication, and transportation services even more critical.

The situation remains complicated for health care providers. One year later, there is a still an enormous amount of work left to be done. The partners we have met with are all incredibly dedicated, passionate, and hardworking; with limited means they will continue to provide health care to their communities in every shape and form possible, but they recognize the challenges that lie ahead. Direct Relief remains committed in its support throughout Louisiana both through increased material support and cash grant program.

September 14-17 2005
by Chris G. Brady

TRIP PURPOSE

The objective of the trip was to meet with current and prospective Direct Relief International partners in the Mississippi Gulf area. Overall I was extremely impressed by the commitment of the people I met there, and the quality of their work post Katrina. As expected the most marginalized groups have been hit the hardest. Geographically, from what I saw in Mississippi, Gulfport, Biloxi and Waveland were the most affected towns. The bulk of the recovery work has fallen on individuals and smaller groups. The churches have been particularly effective getting aid to people who really need it.

The devastation along the Gulfport coast reminded me of what I saw on the southern coast of Sri Lanka following the tsunami. Up to two miles inland was practically flattened. All that remained in some sections were the foundations of homes and businesses. Also like Sri Lanka, it will be some time before they sort out land ownership issues. These upcoming land disputes are bound to hold up significant reconstruction efforts.

Reuben T. Morris Gulfport Wellness Foundation (Dr. Al McNair):

Dr. McNair is a fantastic leader in his community. His wife is another tireless worker determined to do whatever it takes to fill the gaps. He is the President of the local African American Physicians Association. As with many of the people I spoke with the question of whether medical professionals will move away is a serious concern. Dr. McNair said that 35 of his medical professional friends have already decided to leave the area. Approximately one third of Dr. McNair’s staff are homeless (he runs a newly constructed Surgery center and a Digestive Care facility).
 
While they feel that the “crisis mode” has subsided, the future is anything but clear. They talk of a general diaspora of talent from the area. Dr. McNair would like to do whatever it takes to get nurses and doctors from relocating. In this vein he sent a letter to the Biloxi Regional Medical Center asking for special consideration to help physicians on the Gulf get on their feet. The Medical Center is planning to use this appeal to bolster their case in the US Congress.

Gulfport Memorial Hospital (GMH):

Despite the fact that Gulfport Memorial hospital is located right next to one of the hardest hit coastlines it was able stay operational throughout the crisis (it is probably 80% + operational at the moment). The main entrance is closed, but most of the services are functioning. The hospital was extremely fortunate to have water and some electricity following the hurricane. It should be noted however that m ost of the employees have suffered some degree of personal trauma. As such it is very common to see skeleton staffing and truancies (people attending to their personal business).

The special needs shelter GMH set up was a great success. The hospital administrators immediately designated the cafeteria as a shelter and brought in 800 to 1000 individuals & families. It was called “the Village” and was also charged with dispensing drugs. In fact they provided over 1,500 individuals with free prescription drugs between the hurricane (Aug. 30 th) and the 15 th of September (the village closed just before I arrived).

I was fortunate to have had the opportunity to spend an hour with the CEO and two administrators to discuss the situation.

• As mentioned above, homelessness is one of the biggest issues for the hospital. Out of 2,220 staff almost 500 of them lost their houses.
• Our shipment was critical and supplemented their existing stock (which mainly consisted of a wide range of pharmaceutical samples). Once the shelter closed the surplus stock was passed on to other clinics in the area.
• It was clear that the hospital was very responsive to the needs of the community. They opened their one water spigot (from a well) to the public and even established a gas station immediately following the hurricane.
• The CEO reported that their medical supplies have stabilized. The regular supply channels are back up and running and capable of satisfying their current needs.
• The hospital spent approximately $100,000 to run the temporary shelter, and the $50,000 provided by Direct Relief International will go towards that debt.
• The hospital has created a fund for homeless employees. They are considering giving each of these victims with $1,000. The fund is at @ $250,000 now. We talked about how Direct Relief International could contribute to this fund, or support other hurricane related activities (such as establishing a phone bank).

International Relief and Development (IRD):

I met with Arthur Keys (CEO) and the IRD health staff (Bridget and Dr. Lisa). Their seven person team had spent the last week assessing the situation. IRD seems intent on committing a significant amount of resources to the redevelopment of communities in the Biloxi and Gulfport areas. Arthur was clear that supporting healthcare initiatives would be a priority. They have already tied in with the Backbay Mission and several Vietnamese groups living in Gulfport. In terms of material aid Heart to Heart has already sent IRD several shipments of personal care products to pass out as they see fit.

Prior to staging this assessment IRD’s board of directors signed off on a plan to establish a satellite office in Biloxi. They intend to share an office building with Oxfam and the Gulf Coast Community Center. The commitment is to operate in the Biloxi/Gulfport area for at least one year.

• Tidbits:
  Apparently Gulfport is planning to set up a tent city for 10,000 homeless in the area. Estimates are that 70% of the housing was damaged in these two areas.
• Several people mentioned that the numbers of homeless is impossible to gauge. This is because of the “invisible homelessness” - people living/staying with others.

Unified Command Center (WIC center outside of Gulfport):

I spent several hours at the centralized command center for the State and Federal emergency assistance in the Gulfport area. FEMA, US and State Public Health Services, Homeland Security, the National Guard and a variety of other military branches were represented (plus the press). I spoke with the US Health Services pharmacist about their short-term plans. He described their intention of setting up a centralized distribution system. These plans have been put on hold due to their inability to find warehouse space. In addition, there were few local medical professionals willing or able to staff the center and pharmacy on a permanent basis. Almost all of the people I met were from out-of-state, on one to two week assignments. They did provide me with an extensive needs list collected from various facilities in the area.

Demographics of the towns visited:

Gulf City Visited | Population | Avg. Household Income (’99)
Gulfport                 71,127         $27,054
Ocean Springs        46,060         $26,000
Biloxi                     50,644         $19,606

Slidell Memorial Hospital, Louisiana:

Driving through Slidell’s business district was like going through a ghost town. Most of the businesses were either shut up or in pieces. I had scheduled an 8AM meeting with the chief pharmacist of the hospital, Bruce Clements. He called at the last minute saying he could not make the appointment. Clement’s explained that he could not make due to personal issues. I found this to be a common refrain during my trip. His assistant, Liz Edwards, showed me around the pharmacy and answered questions. The pharmacy was quite disorganized. The person in charge was unable to provide me with information on their current stock situation. Clearly they did not have an idea of the true inventory status due to the overwhelming influx of donations. The medical supply situation was in a similar state of disarray.

Slidell hospital is operating a successful immunization station outside the main entrance. There was a long line going up the street and they claim to be immunizing 1,000 people each day with Tetanus and Hepatitis A.

Like GMA, almost half of Slidel Memorial staff lost their homes. The hospital has established a fund to help these families. Arriving at a monetary figure to distribute to affected staff has been an extremely challenging exercise for the administrators. Most of the hospitals have committed to keeping all staff on payroll for at least three months.

Liz described their plans to purchase a van to shuttle patients to and from their homes. A large number of people had lost their vehicles and are in need of this type of assistance. They plan to submit a grant request to Direct Relief International next week.

Enterprise Corporation of the Delta (ECD), Jackson Mississippi:

Bill Bynum is the CEO of ECD and has played a key role in connecting Direct Relief with several of our key Mississippi partners (Doctors McNair and Rigsby)

ECD is a private, nonprofit community development financial institution that provides commercial financing, mortgage loans and technical assistance to support businesses, entrepreneurs, home buyers, community development projects, and health care infrastructure including community health centers. ECD also sponsors Hope Community Credit Union, which provides a range of financial products and services that meet the needs of low- and moderate-income residents in its three-state service area.

In response to Hurricane Katrina, ECD established a fund to target financial assistance to churches and other community groups that are providing extensive support to displaced persons during this emergency phase.  Bynum and two of his staff discussed how we can support ECD’s immediate and longer-term efforts. In particular they are interested helping community clinics get back on their feet financially. They are set up to provide bridge loans to non-profits and help these institutions shortcut the traditional lending process.

Mississippi Emergency Management Agency (MEMA):

I visited MEMA’s donation coordination center in Jackson and the 320,000 square foot warehouse on the outskirts of the city. An Emergency Management Volunteer accompanied me to the warehouse and shared her experiences.

I was able to locate the 24 pallets of CeraLyte we had sent that week. The warehouse coordinator was more than willing to allocate 4 pallets to Dr. McNair. In fact Dr. McNair can ask for an entire truckload of materials (approx. 24 pallets) if he gives them a needs list. Obviously this is the type of information that should be shared among the healthcare community on the Gulf.

Mississippi’s Lieutenant Governor, Amy Tuck, was touring the MEMA warehouse at the same time. We briefly discussed the overall recovery effort and she thanked us profusely for our support.