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M. P. Ravindra Nathan
By M. P. Ravindra Nathan, MD, FACC, FACP

“0200 – The Arrival - New Orleans Louis Armstrong International Airport

“We filed off the bus, rubbing our eyes. Immediately, a police car pulled up.

‘Where do you want us to put her?’ the officer asked.

‘Put who?’ we asked.

‘A woman in labor, two previous C-sections, contractions two minutes apart.”

Dr. Kelly Klein, a family practitioner and mass casualty specialist, and I looked at each other. Get ready to deliver a VBAC (vaginal birth after C-section), I thought.

The team scrambled. Where was the best lit place on the cement? Grab some sheets. Towels? Delivery kits?

Dr. Klein and I walked over to the writhing woman, her face contorted in the agony of labor. ‘Ma’am,’ we asked, ‘why did you have two Cesarean sections?’

Grimacing, she grunted, ‘I don’t dilate.’

Dr. Mona Khanna, CBS 11’s Medical Correspondent and a member of the TX-4 Disaster Medical Assistance Team, lends a patient a helping hand in New Orleans after Hurricane Katrina struck.
Stunned, I looked at Dr. Klein. She stared back at me wide-eyed. We had to get this woman to a hospital with surgical capabilities fast or her baby would die.”

* (The above is an excerpt from Dr. Mona Khanna’s (CBS 11’s Medical Correspondent and a member of the TX-4 Disaster Medical Assistance Team) account of the harrowing first 24-hours on duty in New Orleans (NO) after Hurricane Katrina struck.)

Most of the headlines during the monster storm Katrina failed to capture the dire health problems facing the hurricane victims in NO, especially in the early stages. Health care delivery came to a dead stop in one of the largest cities in America! Lacking such basic necessities like running water, working toilets, food and electricity and floods everywhere, many medical institutions had to be closed and patients transported to other cities, most of them out of state.

Florida also received its share of displaced people. “I saw three new consults in the hospital today, all from NO to a shelter here. Very ill, dehydrated, and no medical records; didn’t even know what drugs they were on,” Dr. C. Venugopal, a cardiologist from West Palm Beach, said.

Just when you thought it was safer to venture out, comes roaring Rita with 120 miles/ hour wind and massive evacuation from Houston and other areas. In spite of getting an early start from his home, one of my Houston friends, Dr.V. Menon, e-mailed me, “It took nearly 20 hours to cover a distance of 165 miles from Houston to Austin, Texas. A true gridlock, quite a rough journey with no toilet facilities en route.” He was fleeing from Rita, of course.

It would be deceptively easy to think that after the storm subsides and flood waters recede, everything will return to normal. It certainly wasn’t so with Katrina and indeed, many major storms can have a big impact on your health. We Floridians know what can happen when hurricanes blitz our coasts. During Hurricane Frances -- one of the major hurricanes in 2004 -- many of my patients were admitted to the local hospitals, either because of injuries, exhaustion or worsening of their existing conditions. One was hit with a flying orange and sustained a facial injury! “Doc, it was like a deadly missile, I didn’t think I would live,” he said.

Then comes the power outage and flooding and all other related conundrums. Many actually drown in some flooded areas.

When flood waters stay stagnant for several days, a whole set of new problems arise. Dr. Prem Menon from Baton Rouge, who witnessed the aftermath of Katrina, wrote: “Due to lack of electricity, running water, sewage overflow, looting, rape, violence and spontaneous fires, the city of New Orleans became a dangerous place to be. The stagnant water was like a toxic gumbo. The health department is concerned about outbreaks of Hepatitis A, E. coli diarrhea, tetanus, salmonella and other infections.”

After the crisis started, many Centers for Disease Control and Prevention (CDC) employees were dispatched to NO by U.S. Surgeon General Richard Carmona to give hepatitis vaccine to those still trapped in NO. The main advice was, “Don’t drink any stagnant water or get contaminated in other ways.” Even washing your face with such water can be quite dangerous.

Many Indian physicians pitched in during this crisis. A team of Indian doctors under Dr. Kalpalatha Guntupalli (past president of American Association of Physicians of Indian Origin) was on hand at the Houston Astrodome working tirelessly round the clock. Guntupalli said in an e-mail communiqué, “Most people had smiles larger than you would expect when they saw us. They are grateful to be alive. Their stories are heart wrenching.”

Dr. Hemant Vankawala, an emergency doctor and a member of TX-4 Disaster Medical Assistance Team (DMAT), pulled continuous duty for over a week at the NO Airport during Katrina and his account is equally frightening. “We practiced medical triage at its most basic – ‘black-tagging,’ the sickest people and culling them from the masses so that they could die in a separate area.” During Rita’s onslaught also, many Indian physicians helped out, some working 48 hours non-stop, to attend to the victims.

Make a medical check list

“At least we get a good three-day notice here before the hurricanes arrive, not 30-second warning before earthquakes hit the California valley where I come from,” said Jack Siegel, one of my patients who recently moved to Brooksville from California. This is absolutely true. I tell all my patients, “When mandatory evacuation orders come, you better leave your house or mobile homes.” Fortunately FEMA, volunteer EMTs and the local police work together and set up shelters in the local schools and other convenient places and are given bottled water, food and medicines as needed. Even tetanus injections.

The final death toll from Katrina has climbed to 1,250 now. Many lost their lives because they took this storm lightly. They got trapped in their own homes, which became their graveyards. And survivors are facing a difficult future. Having lost everything and their lives disrupted in ways too difficult to even imagine, they have to start lives all over again, in all probability in a different place. “The ultimate impact will be on mental health,” says CDC’s Julie Louise Gerberding. This is often called ‘disaster psychiatry.’ When your personal life is shattered, your neighborhood has been destroyed and you don’t know how to start rebuilding your lives, you become depressed. You will need psychiatrists and counselors to help you out.

Hurricanes are purveyors of perils. Being prepared is just about the only thing you can do to remain healthy.

In Florida as well as in the Gulf States, we can expect to get hit by a few every year. Don’t think you can ride out a Category 2 or above with a beer party in your house. The more precautions you take, the less you suffer. Keep a hurricane kit handy and make a medical check list, which should contain basic details of your illnesses, enough medications for a week, recent lab work up if any, essential documents and other items. Doctors, nurses and paramedics will help you in the hour of need but you need to be able to give enough information.

Before the zero hour approaches, just flee from the monster. Man is no match for nature.

* “Katrina – The Storm after Hurricane” by Mona Khanna, MD, MPH, to be published in a forthcoming issue of AAPI Journal.

Cardiologist Dr. M. P. Ravindra Nathan lives in Brooksville.

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