In Katrina’s Wake
By Joseph L. Andrews ’59, M.D.
Dr. Joseph “Joel” L. Andrews ’59 spent two weeks in the New Orleans area in December 2005 as a physician volunteer for the American Red Cross Hurricane Katrina Disaster Relief Programs. Over the course of his time there, he witnessed firsthand the storm’s devastating effects on residents in the city’s various communities.
My first New Orleans house call is one I will certainly never forget. I was working in the Red Cross office in Metairie when I received an urgent request to help evaluate a very agitated man in Mid City New Orleans. I left the office immediately and drove south on Interstate 10 to North Carrollton Street. There I found Arlo, a retired psychologist from California and Red Cross volunteer mental health worker, waiting in the parking lot of an abandoned Burger King. Arlo had visited a client, Floyd S., the previous day at the request of a Red Cross emergency crew. Floyd had told the crew that he would die if he did not receive his medications soon. When Arlo visited Floyd, he had found him extremely agitated, with probable diagnoses of schizophrenia, manic-depressive disorder and hypertension, along with other medical conditions.
I followed Arlo down a side street. The wooden houses on this block had received major hits, both from Hurricane Katrina’s high winds and from the storm’s flood waters. Most buildings sported bright blue FEMA tarps, designed to stop water from leaking through roofs whose shingles had been torn off by Katrina’s strong winds. Tall debris piles littered sidewalks on both sides of the street, blocking some access points. Cars were coated with dried flood muck.
Arlo and I entered the shotgun-style house where Floyd was staying. Although the building was elevated about four feet off the ground, the flood surge had done its dirty business. The house smelled dank from muck and mold. Filthy clothes and furniture were strewn haphazardly in the front room. Brown lines on the walls about four feet above the floor were evidence of earlier flooding. Clearly, no one had done any cleanup here in the three months since Katrina struck.
We found Floyd lying on a bed in the back room of the house. We asked him to come out to the front room, and he did, reluctantly. I asked him to sit down, and I settled down across from him on a filthy rocking chair. Then I tried to take a medical history. Floyd told me that he was 53, but his lined face, jumbled speech, unkempt grey dreadlocks and unruly white beard gave him the appearance of a man 20 years older.
Floyd said he had not taken his psychiatric or blood pressure medicines in more than three weeks, since he was unable to get his prescriptions filled. The more we talked, the more agitated and incoherent Floyd became. Then he stood up abruptly and ran out the door.
Arlo and I went outside and saw Floyd talking to three men on the front porch of a house a few doors down. We went over to talk to the men, who told us that Floyd became increasingly agitated when he could not take his meds. Neither his wife nor his sister could tolerate him this way, they said, so he often came to them. The men said that they sometimes brought over food for him, and Earl, a tall man in yellow Lakers sweatpants, said that he had sometimes paid for Floyd’s medications in the past. Agreeing that Floyd needed immediate hospitalization to get him back on his medications, Arlo and I took him back to his own home.
Standing in the street, I used my cell phone to call East Jefferson Hospital (in suburban Metairie) to talk to the ER doctor who had written Floyd’s prescriptions three weeks earlier. He was not there, so I called the hospital’s Record Room in an effort to learn more about Floyd’s diagnoses and treatments. The clerk there told me she could not release any information unless I faxed her a release signed by the client. I told her that I didn’t have access to a fax machine and that there was no way I could get this man to sign a release in his current condition. The Record Room clerk hung up.
I then called the New Orleans police to request transportation to the hospital. Five minutes later a squad car pulled up, then another, and another, until finally a squadron of six police cars blocked the street. A posse of 12 New Orleans police offers emerged from their cars and walked toward us. They chatted amiably to each other, like attendees at a reunion. They asked us if Floyd was armed. We said we didn’t think so. A stocky cop frisked him, then snapped handcuffs around Floyd’s wrists. Understandably, Floyd became much more agitated as he sat forlornly on the front steps.
I asked a police officer, “Why all the cops and the cuffs?” She replied, “For a show of force. The cuffs are because recently an officer got shot in a similar situation.” Six squad cars then departed. One hauled away a handcuffed, and now severely agitated, Floyd.
Two days later I returned to Floyd’s neighborhood with Tim, another mental health worker. Floyd’s neighbors told us that the police had taken him to Ochsner Foundation Hospital in Jefferson. They brought him back at 3 a.m. with more paper prescriptions, but without any actual drugs. He still had not received any meds. Earl promised that the next day he would go purchase drugs for Floyd—but when I called two days later Floyd still had no medications.
We found Floyd on the steps of a ramshackle religious shelter several blocks away. As I climbed up the steps, Floyd apparently recognized me. He smiled, greeted me by name, then started singing “Somewhere Over the Rainbow.” Why that? I thought. Then I remembered. The first time I met Floyd I had introduced myself as “Dr. Andrews. You know…like Julie Andrews.” Now I patted him on the shoulder and told him that it was really Judy Garland who sang the rainbow song in The Wizard of Oz; that Julie Andrews had starred in The Sound of Music. Floyd just kept singing “Over the Rainbow” anyway. He looked pleased with himself. I too was pleased that he was in a better mood and “with it” enough to smile and reach out to make some social connections.
During my two weeks making home visits in New Orleans, I saw firsthand Katrina’s effect on people. I also saw the storm’s effect on infrastructure, especially in the most heavily damaged section of New Orleans, the Lower Ninth Ward, where powerful waves from the breached levees had pulverized wooden houses and left only splintered timbers. Very few wooden houses are left standing. A few more brick houses still stand. Cars were smashed and piled one upon another, coated with dried-up muck. New Orleans looked like London must have looked after the Blitz. According to the Times-Picayune, the Army Corps of Engineers tagged an estimated 5,534 houses red, meaning “houses are unsafe to enter or in imminent danger of collapse.” Occupancy was still prohibited. A nightly curfew was still imposed.
A colossal debate rages on. On one side are the federal, state and city officials who believe that all the houses in this flood-prone, low-lying area should be bulldozed, leaving the land as marsh. On the other side are the residents, who feel strongly that the final decisions about whether to rebuild should be left to each individual home owner.
I visited sections of New Orleans with moderate house damage, such as Mid City and Lakeview and the suburbs of Metairie, Kenner and Westwego. After Katrina, 86,934 houses in New Orleans were tagged yellow, indicating “partial structural damage or other hazards.” These houses are still standing, often with blue tarps, gutted innards and debris piles outside. Many of these neighborhoods still had no electric or water services.When I visited these houses with Molly, a Red Cross case worker, I discovered that most of the owners did not have flood insurance. Their savings have been depleted by months of living as evacuees; after returning to New Orleans, these homeowners dipped further into savings to rehabilitate their gutted homes, often at the mercy of scarce and expensive contractors.
Molly and I made a case visit to C.G., a 43-year-old cancer survivor who lives in a small, raised two-bedroom ranch house in Westwego with her boyfriend and teenage son. C.G. had been evacuated to Lafayette, La., after Katrina and had only recently returned to her home. During the flood, water had risen to four feet inside her house. Her roof still leaked. Her house smelled of mold, even though she had scrubbed the walls with Clorox and later applied fresh paint. Like so many returnees, C.G. spoke rapidly, relishing a rare chance to ventilate, to share her harrowing experiences with sympathetic listeners. When Molly told C.G. that she qualified for modest Red Cross aid ($665 for a family of two), in addition to the previous FEMA aid she had received, C.G. cried and hugged Molly and me. She would now have enough money to buy more food and a few Christmas presents.
Parts of New Orleans experienced little damage from the flood surges after Katrina. These sections—the French Quarter, Garden District and downtown Business District—have been dubbed “the island” and “the sliver by the river.” They were built on higher ground and are generally wealthier (and whiter) than the rest of the city. Here 35,475 houses were tagged green: “House is safe to enter and occupancy is permitted. May have some minor damage that requires repair.”
I drove to the Garden District to visit my 92-year-old cousin, Louise, who was recuperating from a stroke in the Touro Infirmary Hospital, one of only two hospitals in New Orleans then open. I saw only minor damage in the Garden District: some uprooted trees, scattered blue tarps.
I met with other cousins at Clancy’s, an upscale Garden District restaurant. Here most of the customers were neighbors who knew each other. I listened to tales of flooded basements and shorted electrical circuits. But unlike evacuees from most other New Orleans neighborhoods, many Garden District residents are back. Unlike residents of the poorer New Orleans neighborhoods, most Garden District families had left days before Katrina struck. They were among the first to get out and among the first to return.
Dining in the Garden District or French Quarter now, one can almost believe Mayor Ray Nagin’s mantra that “New Orleans is coming back.” But the fashionable Garden District, the touristy French Quarter and the downtown Business District always were and still are worlds away from New Orleans’ battered, lower, blacker and poorer neighborhoods, including the now empty Lower Ninth Ward.
The evening after Floyd sang to me on the porch, I attended a panel discussion by the Health/Social Services Committee, part of Mayor Nagin’s Bring Back New Orleans Commission. Three months after the storm, the news was not good: 13 of 17 public health clinics were destroyed by Katrina; only two of New Orleans’ 11 hospitals were open; most doctor’s offices were still closed. Most patient records were destroyed or lost. Most evacuees had moved elsewhere without their medications, prescriptions or records. And about 50 percent of evacuees were uninsured. New Orleans’ medical care system, always shaky, now lay shattered in Katrina’s wake. There were no medicines for Floyd—and thousands of other residents of New Orleans—because these residents had no money, no insurance, no phone, no transportation.
At the Health Committee’s meeting former U.S. Surgeon General David Satcher lauded the residents of New Orleans for their “resiliency and commitment.” He noted, however, that the trauma and violence that many children endured during Katrina made it likely that these children, as well as many adults, would experience Post-Traumatic Stress Disorder, increasing their tendency toward violence as they grew older.
Next, the chairs of six subcommittees (Primary Care, Specialty Care, Hospitals, Public Health, Environmental Health and Social Services) presented their proposals for improving health in New Orleans. They noted sadly that Louisiana had placed 49th out of 50 states in measures of the quality of health care before Katrina. Their wish lists that night included measures that did not exist pre-Katrina, such as improved cooperation and coordination between hospitals, universal access to all health facilities and better evacuation plans to prevent another catastrophe.
I noted two important shortcomings with the hundred or so proposals on these planners’ wish lists. No mention was made about how all these desirable proposals would be paid for, and no one gave a timetable for when they would actually take place.
Clara D. and Girlie
Several days later I made my way down unlighted corridors leading to a warren of small rooms in a building on Burgundy Street, not far from the French Quarter. I was making a house call on Clara D., an 87-year-old lady who lives alone with her black dog, Girlie. A former shrimp factory worker, Clara had been evacuated to nearby Kenner after Katrina; she had returned to her cluttered two rooms only a short time before we met.
In addition to multiple health problems, Clara was most worried about her finances. She receives $579 a month from Social Security and $75 in food stamps, which she says will soon decrease. Her rent is $400 a month. Little is left to pay for medical care and drugs. And, like most elderly shut-ins in the Big Easy, Clara has no phone, no transportation, no doctor or clinic, and no accessible pharmacy.
I spent more than 30 minutes on my cell phone trying to obtain health care services for Clara. I tried to arrange for transportation, insurance, medications and a clinic appointment. But all to no avail. Each published resource number that I called accessed a recorded message, which merely listed many more numbers to call. No actual services were provided. I felt like shouting, “We need real services, not more numbers! And we need them now!”
Despite the optimistic dreams of its health care planners, New Orleans has a long way to go to create an effective medical care infrastructure to provide equitable delivery of high-quality health care for all, especially since it never really existed before Katrina.
Perhaps city officials and health care planners should figure out how to more effectively harness the underappreciated strengths of concern and support demonstrated by the neighbors of New Orleans’ poor, forgotten, elderly and ill. This compassion is demonstrated so admirably by Floyd’s neighbors every day; it would go a long way to addressing the significant challenges faced by the city now.
Dr. Joseph L. “Joel” Andrews ’59 is a physician volunteer for the American Red Cross. A practicing internist and a lecturer in medicine at Tufts University School of Medicine in Boston, he also is a freelance writer and author.
Photos (from top): Flooded rooftops: Smiley N. Pool/Dallas Morning News/Corbis; The author: Dr. Joseph L. Andrews '59; House: Ted Soqui/Corbis; Silas Walker: Barbara Davidson/Dallas Morning News/Corbis; Clara D.: Dr. Joseph L. Andrews '59