Family medicine specialist brings
classroom to Katrina
It’s been two months since family medicine faculty member Samuel LeBaron, professor of medicine (family and community medicine), returned from providing 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). It’s about 50 miles east of New Orleans and directly in the eye of deadly Hurricane Katrina — which produced winds recorded up to 160 miles an hour.
Q: When you arrived, were things beginning to return to normal?
LEBARON: When I arrived there on Oct. 13, I was the only primary care doctor for Waveland and a nearby town, Pearlington. Another doctor from Northern California had just left. The Stanford students, plus five students from other medical schools, and a local retired ophthalmologist 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.
Q: Is there anything we can do about that?
LEBARON: On a strictly micro level, Stanford colleagues and medical students have been making trips to Mississippi. For example, in November, a new physician in our clinic, Rika Bajra, went to a community near Waveland. This was her second disaster effort this year. She had helped out with tsunami relief in Asia a year ago. More broadly, we should be looking at the possibility of a health care “national guard” that could be mobilized quickly to backstop local doctors until they can get back on their feet after a disaster.
Q: What did things look like when you arrived?
LEBARON: 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.
Q: Where did you see patients?
LEBARON: 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.
Q: I’m sure you saw your share of tough stories?
LEBARON: 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.
Q: 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 the time 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!”
Q: 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 complaints related to dust and mold exposure. The most common theme throughout virtually all the visits was stress, related to severe loss, grief and an uncertain future. My estimate is that 80 percent of the patients were suffering from some degree of anxiety or depression. Post-traumatic stress disorder, I would say, is endemic. 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, about half had no medical insurance, and many had no jobs. We were fortunate in that we had a 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, but it had not yet reopened. Also, the local hospital was working on a plan to pay the local doctors while they got their practices going again.
Q: How did you integrate medical education into the relief effort?
LEBARON: The students were the first contact with patients, and there were some incredible lessons. The students were expected to find out what the acute problems were and to find out if there were any chronic problems. Many of the 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. The students took appropriate histories and then presented the patient to me in the patient’s presence. Then we would work out a short term, medium, and if possible, a long-term solution based on what was realistic for the patient. I also wanted the students to ask each patient, “Where were you when the storm came?” This often triggered a flood of heart wrenching stories. For example, one patient was holding on to a neighbor who was torn away from her grasp and swept to her death by the storm waters. Other patients were trapped inside their attics for four or five days before being rescued.
Q: Clearly all the stories weren’t dramatic?
LEBARON: No, but the lack of obvious drama masked some genuine suffering. For example, some people escaped without injury but returned later to find their homes completely destroyed. The “lucky” patients who weren’t injured were then faced with the dilemma of saying to their neighbors who had lost a loved one, “Well we only lost our homes.” But this was a big deal. Some of these people were in their 60s or older and had just lost everything they had saved for all their lives. They faced the reality of never being able to replace their losses.
Q: How did you and the students wind up in Mississippi?
LEBARON: An EMT from Chicago was leading efforts but he needed help. He sent a message through the American Medical Students Association list-serve, and some of our own students wanted to join him. They asked the senior associate dean of medical education, 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. The students approached me, and because there were no physicians available locally to supervise them, I dropped everything and went with them. 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.” Now it’s time for me to catch up. I’m hoping soon not to have to work every weekend.