When catastrophe strikes: Hurricane Katrina
    Within hours after Katrina smashed into the coast of Louisiana and Mississippi, Emory Healthcare and other components of the Woodruff Health Sciences Center had mobilized to help those left injured, sickened, and displaced from their homes and schools by the largest natural disaster ever seen in the United States. They met planes of evacuees, helped reconnect people with their families, organized volunteers, adopted shelters, opened their homes, made room for extra students, and worked in droves on double shifts. For many clinicians who may have thought there was little they hadn't seen after a career in medicine, Katrina was a life-changing experience. One doctor who befriended a toddler who had watched her mother being swept away in the floodwaters said, "My tears were for sadness, but they were also signs of respect for the tremendous resilience and courage that I encountered while interacting with those impacted by Katrina."
    Beyond the call of duty
With early newscasts of the devastation still blaring from their TVs, many Emory Healthcare workers were ready to rush to areas affected by the hurricane. A quickly formed Emory medical oversight team determined that the infrastructure in those areas was simply too damaged and recommended that most clinicians stay in Atlanta, where thousands of evacuees would soon arrive.
     The VA Medical Center served as the field coordination center, and dozens of Emory medical, nursing, and public health faculty, staff, and students joined triage teams that met each plane, screening arrivals to determine who needed what medical care and to offer reassuring words: "You are not forgotten. We are here." Before the first weekend was over, they had triaged approximately 2,500 medically fragile patients.
     Even more evacuees arrived in Atlanta on their own, presenting themselves at Emory emergency departments for counsel and care—patients with skyrocketing hypertension, patients overdue for dialysis, patients halfway through chemotherapy, patients who had been scheduled for heart surgery, patients whose bodies threatened to reject transplanted organs. Many had lost their medications in the floodwaters, along with their glasses, clothes, and family photographs. They had no idea where their physicians were. At least two babies were delivered. One doctor later said the experience was as if an entire hospital had suddenly dismissed its doctors and nurses and emptied out all its patients, leaving them bereft not only of care but also without any prescriptions or medical records. For the Emory doctors, every case meant starting from scratch.
     Emory Healthcare took these patients in, as they needed it, without regard to their insurance coverage. Of the almost 400 patients hospitalized in Atlanta area hospitals during the first days after the disaster, nearly 40%—more than 150 patients—were sent to hospitals owned by or affiliated with Emory. Administrators scrambled to free up beds, imaging equipment, and operating rooms in facilities already at capacity. Emory Healthcare doctors, nurses, physician assistants, pastoral care staff, social workers, and others, many already working overtime, volunteered in droves for double shifts, both in the hospitals and in Emory outpatient facilities, where another 800 Katrina evacuees received treatment.
     Nor did Emory simply wait for patients to come to them. Emory emergency medicine physicians quickly took the lead to develop a plan to provide medical coverage at shelters—both the large shelter in the Georgia Tech coliseum and many smaller ones operated throughout the city by the American Red Cross, Salvation Army, and other organizations. Emory physicians and trainees, with vital support from Grady Health System pharmacists and other staff, provided essential medical services that prevented deterioration of medical conditions such as asthma, diabetes, and epilepsy. This work not only helped the people in question but also helped keep them out of the city's already overloaded emergency departments.
     Faculty and students in the Nell Hodgson Woodruff School of Nursing also took the lead in coordinating recruitment of 900 volunteers to staff the American Red Cross's three mega shelters and scheduled nurses and nursing students to provide 24/7 triage for anyone who came into the Salvation Army relief shelter on North Druid Hills. Nursing faculty and students provided more than 360 volunteer hours themselves at this shelter, which they arranged to have "adopted" by the University.
     Psychiatry faculty and residents went wherever the evacuees were to care for both pre-existing psychiatric disorders and post-traumatic stress syndrome, depression, and other tragedy-related problems. In the hospitals, clinics, and shelters in the Emory area, Emory Healthcare chaplains worked around the clock to counsel and comfort every single patient.
     The Rollins School of Public Health assembled teams of students to visit the six metro area shelters daily, compiling reports on medical conditions and needs under the direction of the lead epidemiologist in the state health department.
Big Mama    
  I must not be in New Orleans anymore  
  All that Louisa remembered about Katrina was the water, first spreading across the newly mopped floor of her hospital room, then rising to her knees. She didn't remember the helicopter in which she had been evacuated to Atlanta or the transfer from Emory Crawford Long Hospital to Wesley Woods Hospital for further evaluation and care.
     It was as if, Wizard of Oz style, she had suddenly been dropped from the sky into a new land. She was not quite sure where Atlanta was or why her family never came to see her. In the confusion of hurricane evacuation, Louisa's last name had been listed wrong on her New Orleans hospital armband, and she couldn't remember it. She knew the first names of her children but not their last. Eventually, Jennifer Schuck, assistant director of social services at Wesley Woods Center, coaxed a street address in New Orleans from the swirl of Louisa's memories. As later would be recounted on CNN, Schuck was able to confirm the address and obtain a last name of the residents. She then spent her every free moment on the Internet, searching locator websites set up by the American Red Cross and other organizations. Finally, on a website of a small radio station in New Orleans, she found pleading messages from Louisa's children, who had been evacuated to Chicago. Where was the woman they called "Big Mama"? Was she lost in the waters or had she been taken somewhere else?
     When Jen made the phone call to Chicago, there were sobs of relief. Then she stepped into Louisa's room. "I have some news for you," she said. When she added, "Big Mama," Louisa's eyes brightened in recognition, and she too began to weep. She must be home.
     A week earlier, Louisa had arrived in Atlanta with no medical records. Her costs at the two hospitals had been almost $10,000, the bulk of it at Wesley Woods. Did the mysterious Big Mama have any Medicare or Medicaid benefits left to reimburse these costs? No one at either hospital had asked during her treatment and did not know the answer until long after they had stabilized her condition to the point where she could join her family in Chicago.
    Tracking down the displaced  
    Emory psychiatry professor Nadine Kaslow watched in dismay as Hurricane Katrina destroyed the sites of at least five training programs, disrupting not only the lives of patients being served but also those of the young psychology graduate students and postdoctoral fellows working there. Many of the students lost irreplaceable research data, and all lost time toward their careers. Kaslow made it her personal mission to find every one of these students in the country who had been displaced, tracking down dozens of them and then reaching out to help. At a ceremony in which the American Psychological Association presented her a presidential citation for this work, she reacted with surprise. What she had done seemed natural to her. "In this sea of sadness and despair, I only wanted to do a good deed for a great group of people," she said.  
    Opening school doors  
    Katrina struck just as students were beginning the new academic year. Tens of thousands of students at all levels were suddenly left school-less. Their clothes, computers, and books were gone, and their schools themselves were beyond quick repair. The situation was particularly critical for students in professional schools, where the class sequence was less flexible, and for international students with visas but without families in the country.
     Although almost all of the academic divisions at Emory were already full, that did not stop schools from offering space to displaced students—but only as transients, since Emory wanted to assure that Tulane and other hurricane-area schools would not permanently lose the students they would need to rebuild. A sizeable number of the 100 undergraduates offered places at Emory were in the nursing school, which also opened its doors to transient graduate students. Emory's medical school also offered to accept medical students and residents displaced by the hurricane, but national medical education organizations decided to temporarily consolidate all displaced medical students in schools in Houston and Baton Rouge.
    Setting another place at the table  
    On what was supposed to be the first day of class, Tulane University told its faculty, staff, and students to leave New Orleans immediately. Tulane also lined up 10 buses to evacuate those without transportation. Among the 500 people climbing aboard with only a small bag was Ana Chevez, a pediatrician who serves as coordinator of her native El Salvador's national immunization program. Chevez and other high-level public officials from numerous developing countries had arrived in New Orleans only days before to spend a year as Humphrey Fellows at Tulane's School of Public Health and Tropical Medicine. Instead, they spent the first three days of the semester sleeping on a gym floor in Jackson, Mississippi. On Tuesday, after the levees broke in New Orleans, there was no going back. On Wednesday, Hurricane Katrina hit the Mississippi coast, hard enough to knock out electricity and running water in distant Jackson. After five nights in the gym, two without power, the students were bussed yet again, this time to another gym at Georgia Tech. In the meantime, Emory's public health dean, Jim Curran, was on the phone with public health deans across the country, sorting out which schools could take in more of the displaced students. The Rollins School of Public Health was full, but in an emergency the school could always find another place at the table. Chevez was one of more than two dozen international students for whom the school made room.
     Ruben Jamalyan, a health care reform administrator from Armenia, was another, but his journey to Emory was even more circuitous. Because his wife and 2-year- old child planned to join him in New Orleans, he had just gotten a small apartment north of the city. During the evacuation, Tulane administrators tried desperately to get through on Ruben's cell phone, but the networks were jammed. After holding a bus for two hours, they had to leave without him. Unsure what was happening, Ruben made his way to the Superdome. The nightmare of confusion, deprivation, filth, and danger was far beyond what people saw on television, he said. After five awful days, with only minutes notice, he was loaded onto a bus for Dallas and from there to Atlanta and the Rollins School.
     At Rollins, the new students were virtually adopted, given clothes, places to live, pots and pans, gift cards, and study opportunities as close as possible to what had been planned for them at Tulane. Rollins took no money from the Humphrey Foundation for their tuition; that continued to go to Tulane, so faculty there could continue to be paid. Catastrophe was no stranger to most of the arriving international students—many had lived through earthquakes, hurricanes, even revolutions and civil wars in their own countries—but Hurricane Katrina gave them unexpected insight into this country's readiness to open its hearts and homes. That, as much as the public health classes and work experience they received at Emory, is what they will carry home.
  Reaching out to help  
  People from throughout the University opened their hearts, wallets, and homes. Halls across the campus were stacked with boxes of diapers, food, blankets, and clothes. In the hospitals, social services and pastoral care received mountains of clothes and personal items donated by local churches, synagogues, and mosques and sorted and distributed them to patients, many of whom had arrived in Atlanta with only the clothes on their back and shoes moldy from walking in filthy waters. A quickly established Emory website collected more than $10,000, in addition to fund-raising efforts across the Woodruff Health Sciences Center (WHSC), often led by students and staff. A message sent out by the WHSC CEO to faculty and staff said not to worry about Emory getting the "credit" for gifts—just give them. Money. Blood. Time. In addition to a service that matched more than 200 health care workers with health-related needs, Emory Healthcare's HealthConnection switchboard staffed a special line where employees could register to volunteer. A university-wide email calling for 200 volunteers to sort supplies at the American Red Cross went out at 9:44 pm one evening, followed the next morning by a second message saying that more than enough people had already signed up. The response was similar when a request went out for people to house evacuees.  
    Katrina pet rescue  
    Taking care of animal friends  
  When liver transplant recipient Lorne Bennett and his wife Valerie were evacuated from New Orleans, there was no room in the boat for their pets. All the Bennetts were allowed to bring with them was a bag filled with Lorne's medications. An anesthesiologist at the hospital where Valerie worked and where Lorne had been a patient promised to watch over their two dogs, cat, and guinea pig, and some 30 other pets left behind by other evacuated patients and staff. The pets lived on the roof of the hospital until they too were evacuated to Houston.
     Meanwhile, at Emory Hospital, nurses and physicians involved with Mr. Bennett's care realized that the couple was grieving over their pets left behind. Pet lovers themselves, the clinicians called social services, where other pet lovers quickly became involved. The story was put on the Internet, and a couple from Houston volunteered to drive the animals 16 hours to reunite them with their "parents." Social services worker Michelle DePaola took the Bennett's dogs into her home, and nurse Terri Walter volunteered to care for the cat and guinea pig until Mr. Bennett was released from the hospital.
     Others were watching out for animal friends as well. Reseachers in the areas hit by Katrina were dazed by the loss of research data and equipment, but their first concern after the safety of staff and students was for the research animals in their facilities. Staff at Yerkes National Primate Research Center worked with colleagues at the National Institutes of Health to help ensure that Yerkes' sister primate center at Tulane University was well equipped with food and supplies.
    Offering shelter  
    Many Emory staff opened their homes to evacuees, included displaced family members of their own. Tomika George Davis (right, in red), a medical secretary at Emory University Hospital who is from New Orleans, housed relatives for many weeks following the disaster. "Nearly every year, New Orleans has been evacuated because of a hurricane, and nothing terrible ever happened," she says. "That's why a lot of people didn't evacuate. The Saturday night before it hit, we got a call from my cousin asking if he could come up and stay. During the first weekend, we ended up with 13 people staying. The second week we had 15 people. We had people sleeping on air mattresses all over the place. Some of my family members lost homes—lost everything.
It was a very trying time."

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