Medical response to Katrina

The October 13th NEJM has a number of articles about the medical response to Katrina, all from people involved. They are all free full text

One point made by two articles is that public heatlth measures come first. All the docs like me who imagine making a difference by taking care of patients one-by-one are not really needed, at least early in the process:

In the immediate aftermath of a disaster involving large, displaced populations, doctors, as difficult as it might be to accept, are one of the least useful commodities. The first priorities, standards in the developing world, are security and safety for the population, then water, sanitation, food, and shelter. Once the humanitarian-aid staff is safe from danger, the most effective way to save lives is to ensure the availability of clean water, secure a place for bodily wastes away from the water supply, and then vaccinate every child younger than 15 against measles. Only after these needs have been addressed can curative care become operational.

Unfortunately, the skill set for such a response was not on the curriculum vitae of any of the health care workers who had shown up to volunteer. All the eager, superbly trained doctors and nurses who told me "I'm here to help" almost always meant that they were ready to deliver care in the same way they did at home. But the burden of the initial emergency response is on logistics, not on the provision of direct care. Indeed, attempts to provide direct care in a setting with no coordination or infrastructure can distract from the urgent mission of establishing basic human security and meeting immediate needs.

Apparently some of the doctors who stayed in hospitals in New Orleans didn't get the memo about how there wasn't any looting or violence:

My husband was exposed to sniper fire twice while helping to evacuate the emergency-room dock. People with guns shut down an entire hospital evacuation for many hours. The real Katrina disaster was not created by the elements but by a society whose fabric had been torn asunder by inequality, lack of education, and the inexplicable conviction that we should all have access to weapons that kill.

Of course doctors can be as vulnerable to hype as anyone else. Another doc, who went to help at the convention center, found himself welcome if impotent:

We found that a physician in scrubs with a stethoscope and a kind but forceful police officer were immediately welcomed into the crowd. . . .

One elderly, obese, diabetic, wheelchair-bound woman said she thought she had something wrong with her legs. I lifted her housecoat to reveal multiple bilateral deep epidermal ulcerations on her tibia and feet, as well as a few gangrenous toes. I told her that I couldn't do anything for her right now but that I'd get help as quickly as I could. She said, "That's OK, honey, I'm old, they don't hurt that bad, and there are some sick babies here — you go worry about them."