Scutmonkey Chronicles

Commentary on healthcare in general, life as a medical student, and issues of concern thereof. Readers warmly encouraged to contribute their "best" and "worst" experiences with the healthcare system (who knows, some budding young doctor might learn something from your pain...?) Submit via comments section, or email me at if you'd like to become a regular contributor. Welcome, and don't forget to double-glove!

Saturday, November 19, 2005

My Experience with Katrina Relief: Faith, Hope, and Bureaucratis Interruptus

During the last two weeks of September, I had the privilege of being part of a team that opened and ran a crisis medical clinic for hurricane evacuees. The clinic was located in Concordia Parish, Louisiana, which had become temporary home to about twelve thousand displaced folks from Southern Louisiana and Mississippi.

It was one of those experiences that really jars a person's consciousness and forces a re-prioritizing of what is important in life. I could (and will, a little bit later on) go into detail about negative aspects of the experience, such as dealing with red tape from FEMA and the public health structure. Before discussing that, though, I want to emphasize that more than anything else, I was impressed with and inspired by the endurance and spirit of the people we took care of. I cannot really imagine myself keeping that of an good attitude under those circumstances. Can you?

Had dinner last Sunday night with an extended crew of docs and nurses who took over the clinic after my team left. What an incredible group of people! Over corn bread, pulled pork, and red beans and rice we shared our experiences and made tentative plans to provide more support if we can. For me personally, that meeting might end up with me following some of these folks into their residency program.

Besides eating, a major purpose of the gathering was getting together a nomination for the Florence Nightingale Award for our local host in Concordia, an exceptionally committed and brave nurse named Grace Woods. In addition to securing space for the clinic and getting people to donate the various furnishings it required, Grace put together the teams of medical volunteers from around the country, got us housed, fed, and trucked around town, and put out fires on a daily basis that would have stopped less dedicated people cold in their tracks.

It would be impossible to tell you in one blog entry all the reasons why Grace deserves this award, but I will sum it up by telling you that when she heard that she'd been nominated, her reaction was to ask why. We ended up with upwards of twenty pages of testimonials to accompany her nomination. I know there are probably a lot of deserving candidates out there, but I sure hope Grace wins.

Besides being impressed by Grace and inspired by the people we had the privilege of taking care of, experiences differed somewhat among the three teams who worked the clinic. However, two issues really came to light as commonalities. The first was the need to be creative under what could only be described as frontier conditions. When slide fixative was not available, hair spray got the job done. When lighting in the clinic was not adequate, backpacker-style headlamps were pressed into service.

(Now, for comic relief, imagine a scrub-clad med student, can of Aqua Net in each hand, getting ready to declare a medical emergency to jump a long supermarket line, stopping herself just in time to realize how that might seem to the other customers...)

The second and less comical commonality was unanimous frustration with red-tape loving bureaucrats. I am NOT talking about the boots-on-the-ground government Joes rowing around flooded streets, searching houses. This criticism is targeted at the mid and higher level wonks who not only did not do their own jobs, but seemed to relish stopping other people from doing theirs.

We came to call this phenomenon "Bureacratis Interruptus." Although it eventually was applied to all situations involving red tape, the name was originally given to one very deserving mid-level FEMA official sent from Washington to "help" in our region. Although I did not witness it personally, "B.I." became famous for telling a roomful of meeting participants he was calling his boss for an answer to a question they had posed (and posed for the third or fourth time...), then dialing his own voicemail and carrying on a pretend conversation. Unfortunately, what this gentleman did not realize was that the volume on his phone was set to such a volume that everybody within thirty feet figured out what he was doing. BUSTED!

The most heinous of the FEMA gaffs that I can attest to personally is the continued failure to honor an agreement made with local pharmacies to reimburse them for the gratis filling of prescriptions written at our clinic. In effect, this put the pharmacies in large amounts of interest-bearing debt. For WalMart and CVS, this may not have been such a huge deal. For the Mom and Pop pharmacy outfit in town that gave away $32,000 in free medicine during the seven weeks our clinic operated, the burden was huge. (As a side note, WalMart and CVS stopped honoring the deal weeks before the Mom and Pop guys did.) At any rate, this failure to pay back pharmacies was a major factor in the decision by the last team to man the clinic to cease operation and transfer care of our population to another site.

Although FEMA was the most obvious and obnoxious offender, another serious "B.I." contender was a federal and state public health structure that threw up unending obstacles re: honoring out of state licenses and issuance of badly needed vaccines. Way to encourage altruism, guys! Lower on the offender list would be the well-intentioned but out of touch leadership of the Red Cross.

(to be continued...)


At 22 November, 2005 11:20, Blogger banzai said...

[(snip)everybody within thirty feet figured out what he was doing. BUSTED!]

A new version of the old "those who can, do; those who can't ...". Those who can, do; those who can't, work for the government.


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