In addition, this was the fist time I recall hospitalists playing a prominent role in the medical response (see “Tours of Duty,” p. 1 and “The Red Badge of Katrina,” p. 13). To be sure, hospitals and healthcare personnel responded actively to tragedies like this one before hospitalists. But to the many advantages we bring as hospitalists, we can now add being in place—in the hospital—when disaster strikes. I do not pretend that this reason will convince many hospitals to start hospitalist programs—there are better and more pressing reasons to do so. But the ability to respond to disaster is clearly a benefit of a hospitalist program.
Included among the many e-mails circulating on the SHM listserv and among hospitalists was the question of whether hospitalists were included in official disaster response plans including those by FEMA and other agencies. After Hurricane Katrina, we will be.
Dire Inequities
Among the many tragedies revealed by Hurricane Katrina perhaps none was so striking as the inequities in our society. Even if we are willing to accept that in a free-market society some have more than others, the desperate situation faced by so many in New Orleans who were left behind is an indictment of a system that pays too little attention to those who have no resources.
We are aware of inequities in healthcare evidenced in part by the fact that millions of Americans have no health insurance. This tragedy showed that, in addition to not having health insurance, being poor exposes you to the brunt of a natural disaster that those with money can escape. The buses that arrived days after Hurricane Katrina to take people to Houston and elsewhere should have been there days before the hurricane.
What role do we play in changing this system? I can’t say that I have easy answers. Many of us contributed our skills after the tragedy to help those in need. Some of us farther away contributed money or goods to assist those affected by the hurricane. Some of us will begin or continue to advocate for a more just system.
While some of these issues are beyond the scope of SHM, during our planned legislative day preceding the 2006 Annual Meeting in Washington, D.C., we will have the opportunity to meet with our elected representatives to tell them about hospitalists and hospital medicine. We should share with them our experience from the frontline of American healthcare: Every day we care for many people who present to the hospital with illnesses that could have been prevented or significantly ameliorated by earlier intervention if they had only had access to healthcare. We are direct witnesses to what befalls those who lack health insurance and have poor access to healthcare. I hope that one of the messages we bring to Congress is that all Americans should have access to healthcare with health insurance.
The scenes of the hurricane-ravaged Gulf Coast also led me to reflect on the fragility of life and its precarious balance. Here in San Francisco we are safe from hurricanes, but at the mercy of earthquakes. It is still true that anyone who experienced the 1989 earthquake here in San Francisco can tell you exactly where they were and what they were doing at the time.
Final Thoughts
In the wake of Hurricane Katrina my wife and I have been talking a lot about earthquakes and how to ensure that we are prepared—if such a thing is even possible. The news reports tell us to have 72 hours’ worth of food and water, a battery operated radio, gas in the car, flashlights, and other necessities. We promise ourselves to get all the supplies we need and believe we will do so. But I also realize that denial is part of life and that in living near an earthquake fault denial might be necessary; just as living on the Gulf Coast may require a certain denial about the destructive power of hurricanes. But as one e-mail correspondent from New Orleans wrote, “Despite it all, this is a soul-edifying experience.”