Samuel LeBaron, MD, PhD on post-hurricane relief

Professor of family medicine Samuel LeBaron, MD, PhD, returned on Oct. 21 from doing a week of health-care relief in Mississippi with six Stanford medical students. He spoke with Medical Center Report managing editor Jonathan Rabinovitz about the tent clinic where he worked in Waveland (pop. 6,674), about 50 miles east of New Orleans.

1. It's been more than a month since Hurricane Katrina hit. Were things beginning to return to normal?

LeBaron: When I arrived there on Oct. 13, I was the only general doctor for Waveland and a nearby town, Pearlington. Another doctor from Northern California had just left. There were the Stanford students, plus five students from other medical schools, and a local retired ophthalmologist. We were the only option for several thousand people in the area. A few other doctors arrived later in the week to spend several days, but it was amazing how little coverage there was. It appears that we as a nation don't have the ability to mobilize health-care workers in a dire emergency.

Driving up and down the beach road in Waveland was like ground zero after a bomb blast. There were broken trees everywhere, cars and tractors turned upside down and not a single intact house for miles along the beachfront. The whole town had been under 25 feet of water.

The clinic was part of a tent complex that included all sorts of volunteer groups. It was in an enormous parking lot in a strip mall where all the buildings had been decimated. There were lots of truck trailers bringing in supplies, many cars, some RVs and trailers and a lot of smaller camping tents, used by local residents who had nowhere else to go and wanted to be close to people and to food.

You could see how tough things were by the plight of one elderly couple in their 60s. Both had cancer. The woman has uncontrolled diabetes as well as severe chronic pain from osteoarthritis. They were living in this parking lot under a blazing sun, trying to survive by pitching their tiny tent under the shadow of a line of portable toilets. When one of our students heard about them -- and that they had no medication -- she began regularly visiting them, and I did too. We brought them medications, offered them some comfort and helped them move to the top of FEMA's list for trailers, but when I left they were still in the tent.

2. How busy were you?

LeBaron: My daily routine was to walk into the main tent that we used for the clinic at about 7:30 a.m., and I'd work pretty much continuously until 8 p.m., sometimes until 10 p.m. I typically saw 60 to 70 patients a day together with the students.

The few occasions when there were no patients, I would use to clean the area, to organize or to do some teaching. I was occasionally able to take five minutes to sit for lunch, but usually I brought my food back because there were too many patients. I would apologize to patients for wolfing down food while conducting a visit, and they were always telling me, "Doc, sit down, have your meal!"

3. How would you describe the sort of problems that patients were having?

LeBaron: We saw a lot of people with skin problems -- rashes, infections and trauma from clean-up work -- and respiratory issues having to do with exposure to dust and mold. The most common theme thoughout virtually all the visits was stress related to severe loss, grief and an uncertain future.

But we also saw a lot of people for primary care needs. These patients knew they had diabetes, hypertension and seizure disorders, but they had no place to go to get their ongoing care. All of the local doctors offices had been wiped out. Although there were a few physicians who were trying to reestablish themselves, they were often some miles away. Many of the people I was seeing had no transportation, and about half had no medical insurance. They had no jobs and no money, so even if they could get transportation, they had no way of paying the bills.

It was not unusual to see, for example, a patient like this one: a 55-year old woman who had come in with skin problems and a cut on her toe, but also had a fever, diabetes and hypertension -- and hadn't been able to take medication for a month because she had run out of her supplies. Many of these people were living in tents or under an awning or in a garage. Because they had run out of medication, we often found uncontrolled hypertension and very high blood sugars.

We were fortunate in that we had supply of drug samples we could give them, but that was just buying time. There had been a local clinic for low-income people in town, and it's supposed to reopen, but no one knows when.

4. How were people's spirits?

LeBaron: My estimate is that 80 percent of the patients showed evidence of a high level of anxiety or depression. Post-traumatic stress disorder, I would say, is endemic. People were being heroic, but at times it was too much.

5. How did you wind up spending a week in a tent?

LeBaron: The man who organized this clinic is a 26-year-old EMT from Chicago. He went down there with a small personal tent and and began offering first-aid on his own. He was joined by some volunteer doctors, and the government eventually gave him some tents.

But there was a point that he needed additional help, because the doctors were coming and going so quickly. He sent a message through the American Medical Students Association list-serv, and some of our own students wanted to join him. They asked associate dean Julie Parsonnet if the school would allow them to leave. She immediately offered to pay their way, with one condition -- they had to have their work supervised by a faculty member.

I was the one she asked to go, and I dropped everything. I had to go to my colleagues in clinic and teaching associates and check whether they could pick up the slack. All of them said, "Go. We'll cover for you."

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