"Are you evacuating?" a patient asked Harold Ginzburg, M.D.,
J.D., M.P.H., over the phone on the Sunday morning before Katrina hit on
August 29. Like many others in the Crescent City, Ginzburg thought he had seen
it all when it came to hurricanes.
"I never evacuate," replied Ginzburg, who spent 20 years in the
Navy and the Public Health Service, much of it dealing with disaster medical
That was about to change in the face of Katrina's winds and high water. In
New Orleans, along the Gulf Coast, and at sites where residents fled, medical
services were first disrupted and doctors dispersed. Once the storm passed,
medical care was organized by disaster relief organizations or by physicians,
nurses, and others on the spot, wherever that happened to be. What follows are
snapshots of that effort to care for those most acutely affected by the
"I think you should evacuate," said his caller firmly, so
Ginzburg copied his patient and business records onto a CD, tossed underwear
and socks into the same red rucksack he had lugged around the world for years,
and headed out of town. He ended up at Jacob's Camp, a summer camp outside
Utica, Miss., with 250 fellow evacuees and became what he had always
preached—"a doctor without electricity."
Psychiatry under field conditions called for pragmatic adaptability.
"You need to allow people to grieve without labeling them mentally
ill," said Ginzburg. "Giving them reassurance and some productive
work around the camp can help them become resilient. If I can't get a patient
to smile, I know I have a problem."
Ginzburg was the only doctor, but there were nurses, social workers, and
counselors among the evacuees. Utica has no physician, but the town's
pharmacist offered his stock of drugs.
"I could use phenobarbitol and Dilantin or Dilantin and
phenobarbitol," he said. The only psychoactive drugs were out of another
era as well: Stelazine, Thorazine, and Haldol. The drugstore did not carry
oxygen, so when two patients ran out, Ginzburg trekked down to the local
welding supply shop and negotiated for a bottle of industrial
Psychiatrist Lawrence Hipshman, M.D., M.P.H., spent 10 days after
Hurricane Katrina sleeping on baggage carousel 8 at Louis Armstrong
International Airport in New Orleans.
"Room service at this hotel is really terrible," he said
The airport served as a way station for evacuating the victims of Hurricane
Katrina by air or bus. Hipshman helped triage and stabilize the newly
displaced persons before they moved out of the airport and across the
"We've seen the whole gamut," said Hipshman, a clinical
assistant professor of preventive medicine at Oregon Health Sciences
University in Portland and a member of the Oregon Disaster Medical Team."
There are patients with preexisting mental illness who are coming off
their medications, so their underlying illness is
up and is worsened by the events they've experienced."
Many others were understandably pushed to the edge first by the hurricane
and flood and then by appalling conditions where they had sought shelter
before being taken to the airport, he said. "Some had anxiety, acute
stress reactions, or some sort of adjustment disorders," he said."
Some were nearly suicidal, they were so distraught. Substance abusers
were either intoxicated or in withdrawal. People were overwhelmed by
conditions inside the Superdome and were in a prolonged state of agitation and
panic. They felt abandoned and devastated."
His job involved more than prescribing, he said. "Part of what I did
was wander around just talking to people waiting to be moved, just offering
some humanitarian contact, letting them know they're safe and cared
Hipshman's second task was helping the helpers—personnel from the
police, National Guard, Air Force, emergency medical teams, and others. The
scale of the disaster led many into emotional difficulties perceived by
themselves or others.
"This was not like seeing a car crash scene," he said."
They saw people with nothing—no food, no clothes, no home. They
saw death and trauma, and they found it hard to manage their sense of being
overwhelmed. They got teary-eyed and had to take a break. It was hard for them
to accept that they were not in complete control."
The medical team was well supplied with general medications but had a
limited supply of psychoactive drugs. While that amount was adequate for the
acute phase of the emergency, it was not enough for the next stage—when
existing prescriptions ran out. Donations from pharmaceutical companies
expanded their selection.
Resident Patricia Diaz, M.D., spent August 27, the Saturday night
before Katrina hit, in the crisis-intervention unit at Charity Hospital
watching television reports of the storm's progress and decided to stay with
the 100 patients left in the hospital. When the storm hit on Monday, the power
went off, as the generators in the basement were flooded. The Tulane
University Medical School Internet server went down and phone service died,
but tech-savvy residents figured out how to use their still-functional beepers
to send text messages to the outside world. With no air conditioning and
running water to flush away waste, the hospital was soon hot and foul smelling
(see box at left).
"Many psychotic patients were so out of it that they didn't know what
was going on until we showed them the flood out the windows," said Diaz,
who is in her second year of a combined psychiatry, pediatrics, and child
psychiatry residency at Tulane.
Staff and patients lived on cold canned food from the hospital commissary,
although some patients kept demanding hot meals. "They got a little
desperate because they were out of touch with families and had no television
to watch," she said. "We played cards with them or did group
therapy to keep them entertained."
Authorities arrived on Thursday and evacuated the most critically ill
patients. Boats came the next day to rescue the remaining staff and patients
and take them to buses bound for the Louisiana State Hospital in
"We learned a lot about working toward the common goal of
survival," she said. "Everyone was trying to help each other
The week before Katrina arrived, Brian Stafford, M.D., the child
psychiatry training director at Tulane, was not in New Orleans—he was
working as scheduled in Lafayette, La. On Thursday of that week, he drove to
Dallas with his wife, and after the hurricane hit, they went to Baton Rouge to
work in the main shelter in the Pete Maravich Activity Center and the nearby
Stafford helped set up a small shelter for children separated from their
parents by the chaos of the rescue process. To provide some stability, the
designated children's area accepted only volunteers who committed to 12-hour
shifts and were willing to return. Media access was limited to minimize
disruption. The staff found teachers and day care workers among the evacuees
who provided structure for the children by arranging meals, playtimes, and
naps. They also worked with parents who needed help. By September 12, children
were attending school in Baton Rouge, and family reunification appeared to be
progressing well, said Stafford. All school-aged children are being followed
through school-based clinics and linked to mental health care services in the
Baton Rouge area, he said.
"New Orleans is more than just a city down the road," said
Mississippi native Grayson Norquist, M.D., M.S.P.H., who was visiting
the city as the storm approached. "New Orleans serves as a cultural
center for the entire region, so its loss is a blow for all of us."
Along the Mississippi coast, hospitals and community mental health
facilities were gone or damaged, patients evacuated, and staffs dispersed,
said Norquist. The New Orleans Veterans Affairs hospital was closed and its
director sent to work at the VA in Jackson, Miss. Private patients reported
that they could not find their doctors, and physicians did not know where
their patients were.
Before the storm hit, Norquist and his wife returned to Jackson, where he
had begun work eight months earlier as chair of psychiatry at the University
of Mississippi Medical School after 14 years at the National Institute of
Mental Health. For the first time ever, all area mental health and substance
abuse agencies met together and agreed to coordinate their services for the
2,000 evacuees in the Jackson Coliseum.
"Our attitude was that these are our people, and we're going to take
care of them," recalled Norquist. "We'll worry about who's going
to pay for it later."
As in Lafayette, La., local practitioners organized the response to the
influx. There appeared to be no central agency coordinating the medical relief
effort. "It's not clear how the U.S. Department of Health and Human
Services funneled medical volunteers," he said.
Robert Dahmes, M.D., found himself a refugee in his own country,
legally cut off from his livelihood when he crossed a state line. Dahmes was
born and raised in New Orleans and maintained a private practice and worked on
clinical drug trials there. The storm dispersed his patients, and his research
records were lost. He spent three weeks in Sparta, Ga., at his sister-in-law's
house, trying to get medical authorities in Georgia, Mississippi, and Alabama
to respond to his licensing requests.
Out-of-state volunteer physicians working in disaster zones were given
temporary licensure to work there. But nonreciprocal state-by-state licensing
requirements created an unexpected burden for doctors evacuated after Katrina.
No one had foreseen the displacement of an entire city for months or years,
leading to its citizens' having to seek jobs in other jurisdictions.
In the end, Dahmes decided to return home to clean up his house and try to
restart his practice. The state's office of emergency preparedness said it
would hire him to provide counseling for storm victims once his office is in
working shape again.
Britta Ostermeyer, M.D., expected evacuees from New Orleans to come
to Houston, but had no idea there would be so many. Doctors, counselors, and
other personnel from area hospitals and the Red Cross set up medical
facilities in four hours in the arena next to the Houston Astrodome. They
partitioned off 10 examining rooms and used a table inside the dome as a
screening station. Hospitals donated drugs to create an instant pharmacy.
As they met with patients, psychiatrists and counselors listened to stories
of survival laced with fear of dying, of watching others die, and of not
knowing whether their neighbors had been rescued, said Ostermeyer, an
assistant professor of psychiatry at Baylor University School of Medicine and
director of the Ben Taub Hospital psychiatry outpatient program. Many had
symptoms of depression, anxiety, and acute stress reactions. Fewer than a
dozen, most with previously identified mental illness, needed to be
"Most patients showed enormous gratitude for getting to Houston and
finding shelter and necessities like clothing and shoes," she said. The
clinic in the arenaFIG4 closed on
September 18, as patients were absorbed into mental health units of the Harris
County Hospital District.
Britta Ostermeyer, M.D., stands before a makeshift examining room at the
Houston Astrodome. "Most patients showed enormous gratitude for getting
to Houston and finding shelter and necessities like clothing and
Photo courtesy of Britta Ostermeyer, M.D.
"We always said this would happen someday, that the city would be
under water," recalled New Orleans native Joni Orazio, M.D. After the
storm, up to 13 relatives camped out at her house in Lafayette, along with her
immediate family. After tending to her patients each day, Orazio volunteered
to work at the Cajun Dome, the sports arena for the University of Louisiana at
Two nephrologists from the Lafayette Parish Medical Society organized a
makeshift clinic at the dome. Orazio started on the medical side, then
switched to a separate part of the clinic for mental health services. She
worked side by side with local psychiatrists, psychologists, social workers,
and health administrators who staffed the clinic from 6 a.m. to 10 p.m.
Doctors emptied their stores of drug samples. A pharmaceutical rep dropped off
Doctors thumbed through the Physicians' Desk Reference, trying to
figure out just which "little white pill" an elderly evacuee was
taking for her high blood pressure. They wrote 30-day prescriptions for
patients to get them through the first phase of the emergency but tried to
avoid any Schedule II drugs.
Orazio could issue emergency certificates for commitment to open beds in
local hospitals, if needed.
"It's not easy to talk to a scared delusional person with the cops
standing there, but we were lucky to have the hospital nearby," she
After a week of this, she said, "I found out I wasn't