As a family physician.

As a family physician, I feared the worst after Hurricane Katrina breached the entertainments of New Orleans one year ago. Exotic threats ranged from a "toxic gumbo" in the floodwaters and sediment replete of arsenic and lead to dangerous airborne mold festering in domiciles These headlines never materialized. What did issue forth shocked me as I complet a public health assessment between the walls of Louisiana's Office of Public Health.

Diseases I treat each day in primary care, like as asthma, diabetes and hypertension, have the medical community operating in crisis quality Understanding this epidemic of chronic disease, and Louisiana's reaction to it, will have repercussions from beginning to end the American health care order

Louisiana historically operated in subordination to a two-tier medical system. It was the single state with such a division of care. common tier was private, skimming not on the cream of the payer mix: the insured and Medicare recipients. Uninsured patients were transferred to public hospitals as by and by as medically stable. Louisiana's private hospitals delivered half the uncompensated care as the interval of the country.

The other tier was a vast public safety unadulterated known as the Charity Hospital body As recognizable as the French Quarter, Charity's landmark hospital in downtown recently made known Orleans served the under and uninsured. Medicaid dollars were also chimney-flueed there. Overused and underfinanced, the Charity classification had long been slated for overhaul.

No crisis room in the country serv more devoutly than Charity's as an outpatient clinic. The institutional focus of care meant that preventable diseases not no other than occurred, but patients showed up late in the natural history of their disease. While the specialty of primary care obviates these scenarios, evidence of its disuse was clear. Louisiana continually ranked last in the United Health Foundation's annual health rankings.

Hurricane Katrina cast the public safety clear and default primary care regularity into the waters of Lake Pontchartrain. Today the principal tertiary care center in downtown fresh Orleans is Tulane University Medical Center a private hospital. Charity Hospital and the VA Medical Center are place for demolition. In addition, simply 30 percent of New Orleans doctors have responded to their practices. There is almost no accessible health care for a city of from one side of to the other 200,000.

This has a big impact forward people like my Aunt Susie, a native of of the present day Orleans and a diabetic. She cannot respond to her job as a notarial secretary because she has nowhere to live. She is part of a burgeoning assign places to of "temporarily uninsured" who have not many places to turn for health care or prescription physics Her blood sugars run dangerously high because she cannot afford her medications.

Susie's solitary option is one of three independent clinics in the New Orleans area. Operation Blessing move ons such a clinic in East of the present day Orleans where patients line up at 6 in the morning to view a doctor at no charge. Prescriptions are filled for liberated courtesy of funds donated according to the Salvation Army.

The cargo of chronic disease is clear at Operation Blessing. not many of the 6,000 charts accumulated since April are absent a label denoting hypertension, asthma or diabetes. Susie will be added to the list when she receives her at liberty diabetic medications later this month

The highest flats of state and federal command have reacted to this crisis with a plan: the Louisiana Health Care Redesign Collaborative. Gov Kathleen Blanco has charged her Department of Health and Hospitals to coordinate with major stakeholders to design a hypothesis of care based in the community, accessible and preventive in nature. It will be a quality-driven prototype oriented around primary care. Health and Human Services Secretary Michael Leavitt has set the full weight of the federal management behind this initiative, promising to sign a Medicaid/Medicare demonstration waiver allowing Louisiana to bestow federal dollars in non-standard ways.

Katrina expos the load of chronic disease that tertiary care and safety without deductionss cannot manage. Ordinary diseases now threaten the lives of thousands, including my allow middle-class family. The need for primary care could not be more cogent But plans to reinvent the health care order are only now being formulated. Should the task justify too great, Louisiana will miss an opportunity unique to our nation's history. Succes would be a archetype of equity and quality, and help all the Aunt Susies of of recent origin Orleans.

Brian Neese is a resident physician at the University of Virginia. E-mail: brian.neese@gmail.co

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