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Taking their toll: Hurricanes test resolve of pediatricians :

October 12, 2017

Living through Hurricane Katrina as an intern at Tulane University in New Orleans drove Brent D. Kaziny, M.D., M.A., FAAP, to strive to make a difference when Hurricane Harvey wreaked havoc on Houston. The emergency physician — who coordinates medical aspects of disaster response at Texas Children’s Hospital (TCH) — helped the hospital sustain “normal” operations, something he said was impossible during Katrina.

Record-breaking floods, lack of power, spoiled vaccines and other challenges plagued providers in hospitals, offices and clinics across the U.S. Gulf Coast and Caribbean. Despite improved disaster preparedness in some locations, infrastructure problems — like impassable roads and lack of power — stymied efforts as Hurricanes Harvey, Irma and Maria raged.

When Hurricane Harvey hit Houston, special doors on the main campus building at Texas Children's Hospital protected against flooding. Photo courtesy of Deborah Hsu, M.D, FAAPMeeting patients’ needs

During Harvey, Dr. Kaziny kept his eye on all available resources, checking that staffing was appropriate in the hospital and that there were no patient safety issues. He also made sure patients didn’t miss hemodialysis.

“I was able to access the Coast Guard and other resources to get them (the dialysis patients) in touch with the head of our renal group and get them into our facility,” he said. “There were stories of families taking big trucks and boats and other means to get to the hospital, and also patients flown by Black Hawk helicopter to the medical center … to get access to the care they needed to stay alive.”

Some patients endured transfers between hospitals.

A child 130 miles from Houston with a single ventricle defect and in progressive cyanosis got to TCH via the Coast Guard for emergency surgery.

“With a skeleton crew, we were prepared to render needed medical care, conducting emergency open heart surgery and a cardiac cath while our city was still under water,” said pediatric cardiologist M. Regina Lantin-Hermoso, M.D., FAAP.

Corrie E. Chumpitazi, M.D., FAAP, part of a “ride-out” team in the TCH emergency department (ED), said more routine cases included children with infected wounds, asthma exacerbations, seasonal viruses, diarrheal symptoms, and constipation from lack of fresh fruits and vegetables.

Patient families throughout the hospitals were urged to stay while conditions outside remained dire or they didn’t have a safe discharge plan.

Team spirit

At UTHealth/Children’s Memorial Hermann Hospital in Houston, surgeon Charles S. Cox Jr., M.D., FAAP, performed emergency surgeries throughout the disaster, brushing aside his contributions to laud others.

“It’s the people that don’t get a lot of the credit that are the ones who actually make it work,” he said. “The people who keep the building running, who clean the rooms, who feed the entire hospital three meals a day for six days in a row, who do all the laundry or clean the instruments. None of it works if they are not all doing their thing.”

That sense of camaraderie seemed to help many get through the worst of the storms.

“There were nurses working and taking care of children while their own children were being evacuated,” recalled Amir M. Khan, M.D., FAAP, chief of neonatal-perinatal medicine at McGovern Medical School at UTHealth-Houston and medical director of Hermann’s neonatal intensive care unit.

Keely Smith, M.D., FAAP, medical director of general pediatrics at Hermann, said “Everyone stepped up, even the families. …The big issue was fatigue and not knowing what was coming next.” She also serves as division chief of pediatric hospital medicine at McGovern.

The Florida flooding didn’t deter Lisa A. Gwynn, D.O., M.B.A., CPE, FAAP, for long. Based at Miami Miller School of Medicine, she oversees a pediatric mobile health clinic affiliated with the Children’s Health Fund, as well as nine school-based health clinics. Before the clinic went back on the road to see patients, Dr. Gwynn had the team decompress.

“We let everybody vent and get their own experiences out so we could be there for each other, because it’s difficult to respond to disaster when you’re going through it also,” she said.

Office challenges

Although she lived through Hurricane Andrew 25 years ago, Dr. Gwynn said there were additional elements to deal with this time. “Our reliability on power, with our cellphones, our computers, our (lack of) ability to communicate … not having power is really harder on us.”

Pediatricians with spoiled vaccines in their offices or school clinics struggled to find options for reimbursement. They also had to deal with the conditions of their staff members and gaps in their patients’ care. Shannon J. Fox-Levine, M.D., FAAP, with three offices in Palm Beach County, Fla., said those with true emergencies sought out EDs for care.

Ongoing issues

Continuing concerns are the mental health needs of children and long-term public health effects of the disasters, such as contaminants in the water from flooded toxic waste sites in Houston.

Toni A. Richards-Rowley, M.D., FAAP, who sandbagged her office near Tampa, said many people in Florida also remain anxious about conditions of family members in the U.S. Virgin Islands or Puerto Rico.

A destroyed power grid (only 15% with electricity at press time) and lack of clean water contribute to the misery in Puerto Rico, and some pediatricians have taken to walking around the island to see patients. There's also been a very slow response for help, said Fernando Ysern, M.D., FAAP, who re-opened his office — without electricity.

In any location, those who are isolated, sick or poor carry heavier burdens.

“The problem with any disaster is it’s always the people who are the most needy or on the edge of living that are affected the most,” said Joyce E. Mauk, M.D., FAAP, president of the Texas Pediatric Society.

Recovery will be long and difficult, Dr. Lantin-Hermoso acknowledged.

“Although the amount of flooding was unprecedented,” she said, “we have to remain strong, and we will be, for the sake of the children we serve.”

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