Reimagining and Recreating Health Care Systems along the Gulf Coast

ABSTRACT I use the metaphor of water to argue for reimaging and recreating health care systems along the Gulf Coast that were destroyed or severely damaged during Hurricane Katrina. Rather than merely treating the symptoms of an ineffective system, I argue for the active participation of the residents of New Orleans to address core problems and better ensure that the needs of those without resources are met. Based upon the experiences of the Community Voices learning laboratories, I maintain that mental health, men's health, and oral health should be explicit priorities in order to provide much needed community-based primary care. ********** Surely there shall yet dawn some mighty morning to lift the Veil and set the prisoned free. Not for me,--I shall die in my bonds,--but for fresh young souls who have not known the night and waken to the morning; a morning when men ask of the workman, not Is he white? but Can he work? When men ask artists, not Are they black? but Do they know? Some morning this may be, long, long years to come. now there wails, on that dark shore within the Veil, the same deep voice, Thou shalt forego! (W.E.B. DuBois, 1903). STANDING ON THE SHORES OF LAKE KATRINA On 29 August 2005, Hurricane Katrina made landfall as a category four hurricane, causing widespread damage along the Gulf Coast of the southern United States and virtually destroying the city of New Orleans when the levees failed to hold back the waters from Lake Pontchartrain. Standing on the shores of Lake Katrina, I watched in horror as most local, state, and federal agencies waited before responding--if at all--to the unfolding disaster. In the faces of the victims I saw dignity and nobility despite unimaginable loss and tragedy, and I identified with the residents of New Orleans as a member of the larger African American community. My colleagues at the National Center of Primary Care (NCPC) at the Morehouse School of Medicine in Atlanta, Georgia, and I witnessed our own people dying and suffering, and we vowed to be a part of the recovery of New Orleans by ensuring that the wisdom we had gained through decades of experience in the health care arena is brought to bear on the current crisis. Indeed, the mission of the NCPC is to promote excellence in community-oriented primary health care and optimal health outcomes for all Americans, with a special focus on underserved populations and on the elimination of health disparities. Among the casualties of Hurricane Katrina is the storied complex, including the main Big Charity hospital, its sister University Hospital, research laboratories, and physician offices. Some argue it should be razed. Others demand it be rebuilt. Since it is a public hospital system, its damages are being acutely felt among the poor and working class residents of New Orleans, the overwhelming majority of which are African American. According to Ceci Connolly (2005) of the Washington Post, But the debate over Charity, once the linchpin in this city's health care system, has come to symbolize much more than a battle over a cherished relic. Providing medical care is one of the most daunting challenges for New Orleans as it rebuilds, and the choices made now will determine whether one of the nation's poorest cities can adequately care for its legions of uninsured. WADING THROUGH THE FLOOD If we take a longer historical perspective on the current humanitarian crisis, the results are all too predictable. The unequal distribution of safety along social and racial lines is a constant theme, regardless of the human or natural disaster in question (Canadian Medical Association Journal 2005). Hurricane and flood preparedness in New Orleans has been of central concern since the city's early settlement. New Orleans was built on a delta marsh. Many sections of the city lie beneath the level of neighboring water bodies. …

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