Sunday, July 30, 2006

Around the Gulf, Workers Care for Sick and Deal With the Dead

(HealthDayNews) -- In the flood-ravaged Gulf Coast, health workers continued to use what meager resources they have to care for thousands of hurricane refugees huddled in shelters Sunday, as officials begin at last to deal with the dead.

And the nation's top health official admitted what most people have feared: The dead will number in the thousands.

Health and Human Services Secretary Michael Leavitt said he couldn't provide a precise number on the impact of the devastation, but he told CNN, "I think it's evident it's in the thousands."

Leavitt also announced Sunday that he and other top health officials were headed out to tour evacuee centers throughout the Gulf Coast region to assess and coordinate relief efforts.
"We want to make sure the full reach of the federal government's health and human services are being extended to every area where evacuees are being located," he said in a prepared statement.

In Houston's Astrodome -- now home to more than 11,000 refugees -- doctors triaged the worst cases, focusing on those at highest risk.

"You try and focus on the task at hand, you know," Dr. Evan Melrose, of Texas Medical Center, told the Associated Press as he weaved his way from one exhausted, disoriented patient to the next. "But when you see what's in their eyes, well, I've found myself pushing back tears."

Another Red Cross volunteer, Dr. Mary Cavnar Johnson, told the AP she treated 50 people within 4 hours Saturday at the Astrodome -- her normal patient load as a private practitioner is just 30 patients per 8-hour day.

In Biloxi, Miss., the kind of water-borne disease health officials have feared has begun to finally surface six days after Katrina hit, with officials closing a shelter there after more than 20 residents developed vomiting and diarrhea linked to what doctors believe may be dysentery.

Although residents had been warned to avoid drinking the water at the local school, some may still have done so, officials say. On the other hand, "Who knows what they swallowed before they got here, half of them were swimming in stuff that we don't even know what it was," Biloxi police Cpl. Kayla Robert told the AP. All of the sick are being treated with antibiotics, officials said.

Back in New Orleans, the city began the grim job of dealing with those who did not survive Katrina's wrath, with paramedics beginning to remove corpses from around the convention center.

Although the exact number of dead remains unknown, Louisiana Gov. Kathleen Blanco said Saturday that she expected the death toll to climb into the thousands. Craig Vanderwagen, rear admiral of the U.S. Public Health Service, told the AP that a morgue set up at St. Gabriel prison was expecting to receive 1,000 to 2,000 bodies.

Three babies have died of heat exhaustion at New Orlean's crowded, sweltering convention center, Mark Kyle, a medical relief provider, told the AP. The situation there may have improved: FEMA spokesman Marty Bahamonde told the news agency the center is now "almost empty" after 4,200 people were removed on Saturday. At one point over 25,000 had huddled at the center.

Rescuers were also able to evacuate everyone from both Charity and University hospitals late Friday, the AP reported.

"The last information I have is that all of the buildings are empty," Don Smithburg, head of the Louisiana State University hospital system, told the wire service.

Roughly 2,200 people were evacuated, including 363 patients; three terminally ill patients died during the rescue effort. Smithburg told the AP he did not know how many died while waiting for help. With food and water running out, some hospital employees had given each other intravenous fluids to stay alive.

"Some of them are on the brink of being unable to cope any longer. We just can't get our people out fast enough," Smithburg said.

Doctors and nurses are still caring for refugees at a makeshift triage unit at New Orleans International Airport. Officials say thousands had already been treated, but that less than 200 remain.

"In the beginning it was like trying to lasso an octopus. When we got here it was overwhelming," Dr. Jake Jacoby told the wire service Saturday.

Elsewhere in the city, the Ochsner Clinic Foundation seemed almost an oasis of calm, despite having been without power for much of the past five days, and still without plumbing.
The facility was built on high ground, above sea level, Dr. Steven Deitelzweig, the chairman of hospital medicine, said.

Deitelzweig has not left the building since Sunday, he added in a late-night phone interview Friday.

His staff (about 40 percent of whom are on duty) are seeing the gamut of problems, he said. People with chronic ailments such as diabetes, heart failure and pulmonary disease who have run out of medicine have arrived in comas, or with their problems otherwise exacerbated.

The team is also treating a good many cuts, some from people who were in a hurry to rebuild their homes. The lack of drinking water in the city has resulted in dehydration and resulting renal insufficiency, as well as infectious diarrhea.

A lack of water also affects the pathology and dialysis machines, among others, which need water to function, Deitelzweig added.

But because the power came back on, there is air conditioning, so conditions are "comfortable," he said. However, doctors and other staff have been advised that the number of patients will likely rise dramatically in the next 10 days, he noted.

And Deitelzweig said he doesn't know when he will see the outside world again: National guardsman will not allow anyone out the front doors.

Despite the fact that hospitals throughout the city had at least been stabilized, and even with the arrival of military convoys carrying food and water to thousands of desperate people in the New Orleans Convention Center following President Bush's visit to the area Friday, lingering health problems remain.

One expert thinks that a variety of health dangers are a significant problem for refugees along the 90 miles of Gulf Coast that took the brunt of Monday's storm.

The first problem is access to clean, potable water, said Dr. Eric A. Weiss, an emergency medicine expert at Stanford University School of Medicine. He also noted that "people, particularly elderly people, have been displaced from their normal medical care. They need access to their medications and to physicians."

Weiss downplayed concerns about diseases from the vast number of corpses floating in the water. "The danger is highly overrated," he said. "There is not a significant danger of disease from floating bodies."

Another expert sees the raw sewage mixing in the floodwater as a potential threat to public health. This is particularly true for people who are exposed to the water, and who have open wounds or who can't wash their hands.

"While there are a lot of chemicals in the water, they probably don't rise to the level of an acute toxin," said John Pardue, director of the Louisiana Water Resources Research Institute at Louisiana State University. "Probably the biggest danger right now is the sewage."

Pardue plans to start sampling the water in New Orleans to determine its chemical and biological elements that could cause public health problems.

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