[Rhodes22-list] A letter from a physician on the front lines at New Orleans airport

[Bill Effros]

A letter from a physician on the front lines at New Orleans airport:
Hemant H. Vankawala, M.D.

greetings from the new orleans airport

for those of you who dont know i am a member of the texas-4 disaster
medical assistence team (DMAT).  we are a part of FEMA. i joined a
couple of months ago and my team was activated 11 days ago.  for the
past 8 days i have been living and working at the new orleans airport
delivering medical care to the katrina hurricane survirors.

let me start by saying that i am safe and after a very rough first week
am now better rested and fed

out team was the first to arrive at the airport and set up our field
hospital.  we watched our population grow from 30 dmat personal taking
care of 6 patients and 2 security guards well to around 10,000 people in
the first 15 hours.  these people had had no food or water or security
for several days and were tired, furstrated, sick, wet, and heart
broken.  people were brought in by trucks, busses, ambulances, school
busses, cars, and helicopters

we recieved patients from hospitals, schools, homes, the entire
remaining population of new orleans funneled through our doors.  our
little civilian team along with a couple of other dmat teams set up and
ran THE biggest evacuation this country has ever seen

the numbers are absolutely staggering

in hind site its seems silly that a bunch of civilian yahoo's came in
and took over the airport and had it up and running exceeding its normal
operating load of passengers with an untrained skeleton crew and
generator partial power.  but we did what we had to do and i think we
did it well

our team has been working the flight line off loading helo's. overnight
we turned new orleans airport into the busiest helicopter base in the
entire world.  at any given time there were at least 8-10 helo's off
loading on the tarmac, filled with 10-40 survivors at a time, with 10
circling to land, it was a non-stop never ending process 24 hour a day
operation.  the cnn footage does not even begin to do it justice.  the
roar of rotar blades, the smell of jet A and the thousands of eyes
looking at us for answers, for hope. our busiest day we off loaded just
under 15,000 patients by air and ground. at that time we had about 30
medical providers and 100 ancillary staff.  ALL we could do was provide
the barest ammount of comfort care.  we watched many, many people die. 
we practiced medical traige at its most basic, black tagging the sickest
people and culling them from the masses so that they could die in a
separate area.  i can not even begin to describe to transformation in my
own sensibilities from my normal practice of medicine to the reality of
the operation here.  we were SO short on wheel chairs and litters we had
to stack patients in airport chairs and lay them on the floor. they
reamined there for hours too tired to be frigthened, too weak to be care
about their urine and stool soaked clothing, to desperate to even ask
what was going to happend next.  imaging trading your single patient use
latex gloves for a pair of thick leather work gloves that never came off
your hands and you can begin to imagin what it was like.

we did not practice medicine

there was nothing sexy or glamerous or routine about what we did we
moved hundreds of patients an hour, thousands of patients a day off the
flight line and into the terminal and baggage area patients were loaded
onto baggage carts and trucked to the baggage area, like, well,
baggage.  and there was no time to talk, no time to cry, no time to
think, because they kept on comming.  our only salvation was when the
beurocratic washington machine was able to ramp up and stream line the
exodus of patients out of here

our team work a couple of shifts in the medcal tent as well.  imagine
people so despeate, so sick, so like the 5-10 "true" emergencies you may
get on a shift comming through the door non stop that is all that you
take care of.  no imagine having not beds, no O2, no nothing except some
nitro, aspirin and all the good intentions in the world. we did
everything from delivering babies to simply providing morphine and a
blanket to septic and critical patients and allowing them to die.

during the days that it took for that exodue to occur, we filled the
airport to its bursting point.  there was a time when there were 16,000
angry, tired, frustrated people here,  there were stabbings, rapes, and
people on the verge of mobbing.  the flight line, lined with 2 parallel
rows of dauphins, sea kings, hueys, chinooks and every other kind of
helocopter imanigable, was  a dangerous place. but we were much more
frightened when ever we entered the sea of displaced humanity that had
filled every nook and cranny of the airport.  only now that the
thousands of survivors had been evacuated, and the floors soaked in
bleach, the putrid air allowed to exchange for fresh, the number or
soldiers allowed to outnumber the patients, that we feel safe

i have meet so many people while down here.  people who were at ground
zero at 9-11, people who have done tusanmi relief, tours in iraq and
every one of them has said this is the worst thing they have ever seen. 
its unaminous and these are some battle worn veterans of every kind of
disaster you can imagine.

watching the new reports trickle back to us has been frustrating and
heart braking.  there is NOTHING anyone could have done to prepare for
this.  it was TOO huge, even now its so big its almost impossible to
comprehend.  the leaders needed to see first hand the damage but did not
because their safety could be guarenteed.  its a war zone in new
orleans.  it is covered in raw sewage with no infrastructure. every
engineer i have spoken with believes that most of the city will have to
be plowed into fields and that rebuilding what is left will take
decades.  it will NEVER be the same.  never.  ever.

for those of you who want to help the next step is to help those who
arrive in your local area.  the only real medcial care these survivors
will recieve is once they land in safe, clean area far from here.  for
the 50,000 people we ran through this airport over the last couple of
days, if they were able to survive and make it somewhere else, their
care will begin only when providers in dallas and houston and chicago
and baton rouge (etc) volunteer at the shelters and provide care.  and
yes there are many, many more on their way

many of the sickest simply died while here at the airport, many have
been stressed beyond measure and will die shortly even though they were
evacuated.  if you are not medcial then go the shelters, hold hands,
give hugs and prayers.  if nothing else it will remind you how much you
have and how grateful we all should be.  these people have nothing.

not only have they lost their material posessions and homes, many have
lost their children, spouses, parents, arms, legs, vision, everything
that is important.

talk to these survivors, hear their stories and what they have been
through, look into their eyes

you will never think of america the same way
you will never look at your family the same way
you will never look at your home the same way
and i promise it will forever change the way you practice medicine

many, many stories to tell when i get back
looking forward to seeing you all again

we are VERY safe down here (now thank god)
and we shall be home soon

hemant vankawala

Hemant H. Vankawala, M.D.

"Despise not anyone,
and do not deem anything unworthy of consideration,
for there is no man that does not have his hour
and no thing that does not have its place."
            --Pirkei Avot, chapter 4, section 3

            ---from, The Mishna