When the Saints Came Marching In
A team of 13 joined Maryland emergency workers to aid a Katrina-ravaged community

At the airport, Sept. 5, before taking off for New Orleans. From left, standing, Sue Bailey (JHBMC), Lou Ann Rau (JHHCG), Lauren Baker (JHH/Wilmer), Amy Herbert (HCGH), Jennifer Roos (HCGH), Michelle Whitfield (JHH), Paula Murphy (JHH), Donna Hawley (BMC), Mitch Brittain (BMC). Sitting, Mike Millin (JHH), Maggie Neely (JHHCG), Sherry Holland (HCGH). Not pictured: Steve Sisson (JHH).

Suddenly the tempo picked up. Patients and volunteers at the site couldn’t restrain themselves. They tapped, they clapped, they burst into song as the musician belted out “Hallelujah, I Love Her So.”

Among the emergency workers at the clinic were 13 Hopkins physicians and nurses. Carefully hand picked by the Office of Critical Event Preparedness (CEPAR), they represented an ideal mix of specialists culled from four JHM entities: Hopkins Hospital, Bayview, Howard County General, JH Home Care Group. They had been deployed in response to a request for assistance from the Maryland Department of Health and Human Services.

The first medical team from Johns Hopkins dispatched to the Gulf Coast, a small group of disaster experts led by Tom Kirsch, ED physician and CEPAR assistant director, had been sent by the Red Cross to evaluate access to medical centers. The team of 13 was the second group to go. This is their story.

**********************

Nurse team leaders Paula Murphy, left, and Michelle Whitfield prepare to post their handmade sign.

It was a diverse group—an internist, ED doctor, triage nurse, wound care specialist, pharmacist and mental health expert, to name a few—that lifted off from Martin State Airport on Labor Day on an Air National Guard C-130 cargo plane. They, along with other Maryland emergency workers, were bound for West Jefferson Medical Center, a community hospital in Jefferson Parish, just across the Mississippi River from New Orleans. In the days after the storm, “West Jeff” was one of three fully functioning medical centers out of 20 left in New Orleans.

All 10 women and three men sacrificed Labor Day barbecues, routines and the comforts of home. “When we got to the base for takeoff, I tried to absorb everything various people were telling us, but I got overwhelmed,” recalled Sherry Holland, a critical care nurse at Howard County General Hospital, who had just bid farewell to her husband and three children. “I asked myself, ‘What was I thinking?’”

But when the group arrived in Louisiana, Holland realized this was where she was needed most. “We saw miles of debris—huge twisted signs strewn about everywhere. Not one house escaped damage. Roads were flooded. The driver had to keep changing routes.” The people seemed almost exotic. “I felt like I was in another country,” said Hopkins ED nurse Paula Murphy, a team leader. “The language sounded different; the dialects were colorful.”

Bayview nurse Mitch Brittain with a young patient.

In the beginning, they ate army-rationed meals, drank bottled water and had only cold showers. Every night at 7:30 they met to review the day’s events and find ways to improve efficiency. Team Echo was beginning to feel like a family. And like a family, all were assigned chores, like kitchen duty and bathrooms. “Even though most of us didn’t know each other, we all worked together seamlessly,” Sisson said.

They traveled between Meadowcrest and their clinic in emergency vehicles, with police escorts, taking in the devastation along the way. With no way to promote their clinic, Team Echo at first had to create their own signs, using magic markers on sheets and pillowcases, which they posted in front of the clinic. They recruited reporters and volunteers on the street to spread the word.

Home Care's Lou Ann Rau attends to a lineman's foot ulcer.

Within two days, said Sisson, business was booming. Within a week, Team Echo was treating 150 patients a day, on average, out of the clinic they established in the cafeteria of Westwego Elementary School. Complaints ranged from hypertension and diabetes to cuts and scrapes—more primary care than they expected.

Some patients were distraught and needed psychiatric treatment. An elderly woman who had run out of her insulin showed up weak and gasping for breath. A man came in with chest pain, grief-stricken. A little boy named Destiny brought his grandfather in for treatment, then returned every day for help with his multiplication tables. A woman in her 70s came in for postoperative care. Her father had lost all his siblings in a hurricane a generation before. Now she was searching for her older sister, who was in a nursing home.

“It was like a regular emergency department. In eight days, we created an entire health system out of nothing,” said ED physician Mike Millin, referring to the six-clinic network.

During their final days at the clinic, Dinty Moore was no more; Southern hospitality was in full swing. The principal of the school, mayor and councilwoman would greet the group daily, delivering boxed lunches. Displaced chefs from favorite haunts, like Emeril’s and Ruth’s Chris, hired by the mayor, arrived at Meadowcrest to prepare dinner. “We were living high on the hog,” said Holland. “We had seafood chowder to die for, fried catfish and barbecued ribs.”

A weary Team Echo awaits departure in a Louisiana military hangar.

Just like the jazzman’s music that day in the clinic, the town’s tempo had picked up.

In the famed “second line” at a New Orleans funeral parade, people march and sing upbeat music to follow the first line’s mournful sounds as they carry the deceased through town. As Team Echo prepared for its bittersweet sendoff on Sept. 18, children, patients, city officials seemed like a second line, brimming with optimism.

—Judy Minkove

The Group That Never Went When NIH director Elias Zerhouni asked Gabor Kelen to help staff a field hospital on the Gulf Coast, he set into motion a round-the-clock Labor Day weekend marathon in which Kelen, CEPAR director, assistant administrator Dianne Whyne and countless others scrambled to get the word out to Hopkins Medicine employees. More than 600 answered the call. Some, who would be left behind, offered to pitch in for their absent colleagues. By Sunday, Kelen, Whyne and others had pulled together a team of 109 physicians, nurses, pharmacists, technicians and administrators from throughout JHM. They were going to help staff a 250-bed field hospital in an aircraft hangar at Key Air Field, a National Guard post in Meridian, Miss., about 50 miles north of New Orleans. They were all set to rendezvous at Phipps on Tuesday, Sept. 6, at 6 a.m. for immunizations and briefings before boarding a government-chartered flight to Mississippi. But late Monday evening, the trip was postponed for 24 hours. The trip was finally canceled because patients never materialized at the Meridian field hospital. All this came as no surprise to Kelen, who believes the role of field hospitals has been greatly exaggerated. Such hospitals, he argues, are useful only in the first 24 hours. “That is when people who are truly having heart attacks can be helped. Without this, such people will die and many did. After 24 to 48 hours, the minimum time to set up a field hospital and appropriately locate patients, the need is for primary care—lack of meds, out-of-control diabetes and hypertension, minor injuries, etc.” Clinics set up by small groups of volunteers, such as those deployed by Johns Hopkins, can be a help, Kelen says. “They keep volumes away from hospitals.” The current “seat-of-the-pants approach” to disaster preparedness, Kelen says, is to be expected. “There is no science behind disaster planning and response at this point. Although disaster plans can be meticulous, for the most part everything is empiric.” —Anne Bennett Swingle