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Parallel Universes

Somewhere within the storm-ravaged ruins of a former neighborhood in the Lower 9th Ward of New Orleans, a man lives in a little white trailer he's converted into the kind of shrine you sometimes find at fatal crash sites. Plastic flowers, twinkling lights and laminated news clippings are arranged like costume jewelry around a whiteboard listing a dozen or so names in heavy black ink. They are, beyond doubt, the names of people consumed by Hurricane Katrina or the toxic floods that followed. A U.S. Flag flies above the trailer. The man sweeps gravel away from the curb in front of it. When approached, he acts as if no one is there, as if he is the only one left alive. Vacant-eyed, he pushes the broom back and forth, cleaning a street only he lives on, distantly tending to the business of recovery.

More than 40 months have passed since the hurricane blasted ashore, ripped apart the levees and swamped the city. Since that time, progress toward reconstruction has been measured in fits and starts, between unrealized expectations of cranes on the skyline and the incremental arrival of shiny, new manufactured homes and freshly seeded lawns. Gaps are steadily filling in between the memory of what was, the wreckage of what remains from the disaster, and the prospects of what will become of a city that's still about 100,000 people short of its pre-hurricane population.

By the fall of 2008 - from Gentilly to the Superdome to Jackson Barracks - the recovery effort had gained noticeable momentum. Areas of finished reconstruction appeared to outnumber the weed-tangled lots and hollowed-out structures. After a successful stand against a new hurricane season last August that threatened to unleash another round of hell upon the city, there was even a sense of triumph. The evacuation was smooth. The new barricades held. Ike and Gustav blew on by, passing up New Orleans to take out their vengeance on the south Texas coastline instead. Southeastern Louisiana residents returned to their homes and resumed the many challenges of their revival.

That takes us up to what might be. "We can be a lot more attractive than we were, even before the storm," says Kurt Weigle, president and CEO of the city's Downtown Development District. "There's this way of thinking about how to design cities. It's kind of ‘back to the future.' The way cities used to be built, before World War II, was that you could walk to a lot more things. You didn't have to get into your car. As our population ages, I think it is going to be important to build cities that way, so you can get there by foot or via public transit. For instance, if you are getting treatment at the VA medical center, you could basically walk outside, down the street, to a little café or to a sundries shop, maybe even do a little clothes shopping, what have you, everything in close proximity. Basically, it's building a little neighborhood within the larger city."

The Department of Veterans Affairs, which lost all but two floors of its downtown medical center to the storm and floods of 2005, and the aged Louisiana State University-run Charity Hospital, which was gutted by the catastrophe, are at the nexus of this vision. For the past three years, VA and LSU have been working together to design a 70-acre, 624-bed, $2 billion joint complex that would be a 2,000-job flagship of a new bio-medical corridor - a "little neighborhood within the larger city" - linking the VA medical center, a new LSU teaching hospital and various other health-care services, businesses and research facilities in a trunkline of economic opportunity along Canal Street.

The initiative aims to attract private-sector research projects and stir into existence a number of retail, food and lodging businesses. A $650 million federal appropriation to rebuild the New Orleans VA Medical Center is already in hand, to be used once plans are finalized. Gov. Bobby Jindal gave his support to the project last summer after a month-long review. Planners negotiated with historic preservation interests over the preferred site just northwest of the French Quarter and in October were told of a $79 million state commitment to buy out the desired property and relocate residents who live in the complex's eventual footprint. VA announced the downtown site as selected on Nov. 25 in a press conference given by Mayor Ray Nagin that included LSU, VA, state and federal speakers. Planners believe there's about $500 million in FEMA money available to help offset the cost of building a new LSU teaching hospital, and operating expenses would be controlled both for VA and LSU, once the project is finished, by a consolidation of such services as laundry, food, maintenance and labs. The LSU facility, which mainly provided care for low-income and uninsured patients at the Charity hospital, and VA each would have its own distinct bed tower. The project is closely watched around the country as other cities try to iron out med-school and state partnerships to build new VA medical centers where they are overdue.

Weigle says the LSU-VA project stands to accomplish two important goals for the city: restoring veteran and low-income care beyond its pre-Katrina capability, and fast-tracking the economic recovery. "It makes us a magnet for folks to come for medical care," he says. "We shouldn't, in Louisiana, have to send so many of our citizens to Houston or Atlanta or Birmingham to get leading-edge care. So, just the fact that we are retaining more of the health-care dollar here and even starting to attract folks from other surrounding states, starts to create economic opportunity - things as basic as more room nights in hotels and sales at restaurants. You also create more jobs."

VA's Julie Catellier, director of the Southeast Louisiana Veterans Health Care System, says the project indeed has great potential to revive the rattled local economy. But, she adds, "There are two parallel universes. In terms of an economic engine, yes, VA will play a very big part. The part that we talk about the most, though, is recovery of health-care services for veterans. This is about veterans. This is about getting care to America's heroes. That's the focus."

Since Hurricane Katrina, Catellier has focused on little else. She came to the New Orleans VA as a disaster-recovery coordinator after the hurricane and floods. In that capacity, she worked through the development of a triage center at a former Lord & Taylor department store, later expanding outpatient services and clinical capacity at various locations around the city, ramping up tele-medical services, contracting with non-VA providers and finding room for veteran patients with acute-care needs in VA medical centers in other major cities across the South. Soon after

the storm, the New Orleans VA system was treating nearly all its pre-Katrina patient load with less than half the staff.

"Our demand is high, which we think is a good-news story," Catellier says "One of the questions we talked about after the storm was, ‘Are the veterans going to return?' This year, we will hit approximately 90 percent of our pre-Katrina workload. About 20 percent of the patients we are seeing are new to VA. But we are at about 1,000 employees, which is about half of where we were, pre-Katrina."

The system urgently found new ways to deliver care, as plans to build a new medical center were proposed and debated. Opposition came from those who doubted the wisdom of rebuilding in an area that was badly flooded in 2005 and amid questions of what to do with the Depression-built Charity structure and the old VA medical center. Some doubted that state, FEMA and VA could cover the massive cost. As supporters of the joint project - including the Louisiana American Legion - worked through the pros and cons of the hospital complex of the future, veterans needed help now. "Necessity is the motherhood of invention," Catellier says. "We still need acute care, but we can buy it, and we can use other VAs, too. It's good care, but it's not convenient care. That's the problem. Patients have to travel outside their local communities." She said the system stood to spend approximately $40 million on contracted care for veterans in 2008.

The long-term answer is, of course, a brand-new hospital. New Orleans ranked far down a long list of major-construction priorities for VA prior to Katrina. Although not nearly as bad or old as many other VA medical centers around the country, the New Orleans VA Medical Center had what federal officials call "legacy infrastructure" - based on a time gone by, back before massive MRI and CT scan equipment were influencing not only the quality of health care but the architecture and engineering of hospitals. Katrina, for all the devastation it caused, gave New Orleans a chance to catch up fast and build the first new VA medical center in nearly 20 years.

"You have a big opportunity you never get unless you have a major disaster, and that's to build it right the second time... and build the infrastructure to meet the function," Catellier says. "We really do have a once-in-a-lifetime opportunity."

"There are so many things that are going to happen because of the storm," says Ron Gardner, a Vietnam War veteran and vice chancellor for LSU Health Sciences Center. "It's like there's a whole lot of planes stacked up over New Orleans trying to decide when to land."

Cathi Fontenot, medical director for LSU's Medical Center of Louisiana, adds that the need to replace the 1939-built Charity Hospital existed long before Katrina struck. "We've been through a lot of planning over the past 10 years or so on the LSU side of the street," she says. "Optimism is now at an all-time high. Just knowing this is coming is going to go a long ways toward getting us back."

At the earliest, the VA-LSU complex would be finished in 2013, eight years after the sky began to spin and darken the southern horizon. In the meantime, New Orleans faces a more immediate issue within its patient population - a spike in mental-health needs, exacerbated by the events of 2005, particularly for veterans already suffering from post-traumatic stress disorder.

Stephen Lassere, a 65-year-old Vietnam War combat veteran who battles PTSD, cannot forget the effect the storm had on him. "We battened down," he remembers. "We couldn't get in or out. No electricity. No water. Nothing. There were trees all over, buildings down, and the roof was leaking from the storm. For four days, we had no services at all, and we were taking care of these elderly people the best we could. It was like someone bombed the place. To me, it was very traumatic."

The internationally broadcast horrors that followed Hurricane Katrina - bodies plucked from attics, family members separated from one another, looting, violence and mass exodus - were widely expected to cause a PTSD spike among ordinary residents and enflame conditions for combat veterans already diagnosed.

"There are quite a few (veterans with PTSD) who stayed in town through the storm and did amazingly heroic things," says Dr. Madeline Uddo, team leader for the VA system's PTSD program. "They went out in their boats and rescued people. They saved people's lives. They pulled people from roofs. They pulled people from windows to get them out. They went into survival mode, and they were able to deal with the crisis much better than most people. Some of those veterans now are experiencing a worsening of their symptoms because of what they saw. They had PTSD before and now have the added memories and reminders of the storm."

The VA system, fulfilling its civil-defense obligation to care for anyone in the event of natural disaster or attack, often was called upon to provide expertise in PTSD treatment to the community at large. Demand swiftly overwhelmed capacity.

"The mental-health crisis in New Orleans is atrocious," Catellier says. "Citizens in this area, the metropolitan area, because there are so few acute beds and so few community resources, are mostly taken to jail. At one point, during the height of the problem last year, there were 200 people a day being brought to jail rather than some kind of treatment. Very bad. So, we've focused on mental health."

"We are seeing more Vietnam veterans come in for treatment who have never been in for treatment before," Uddo explains. "There are several factors. One is the hurricane, the extra stress that has created. One is that they are aging and may be having physical problems; maybe their wife is sick or someone close has died. Or they are retiring."

In the months immediately following the storm, non-veterans also turned to VA for help. "After the storm, we were seeing anyone," Uddo says. "Rules did not apply. We saw quite a few civilians who were coming in with hurricane trauma. We would see them and treat them the same as we treated veterans at the time."

Even now, with non-veteran patients getting care in other facilities, the Southeast Louisiana VA system faces growing mental-health demand and has added 26,000 square feet of clinical space and more than 20 provider positions to cope with it.

Elsewhere, the problem persists, due in part to the loss of Charity's inpatient beds. "The crisis is in the community in general because we lost so many of the psych beds and providers," Uddo explains. "With our system, we are providing services we didn't provide before the storm. The veterans are not feeling the crisis the same way the people in the community are."

Ted Dorsa Jr., a Korean War Navy veteran who endured the triggering effect of the hurricane on his combat PTSD, says he's not sure what happened to many of his fellow veterans who were receiving mental-health care prior to the storm. "People scattered," he says. "Some came back. Some didn't. I was shook up, but I guess over time, it settled in, like it did for a lot of citizens."

Veterans poured into the expanded outpatient clinics, and those who needed inpatient care were sent to facilities in neighboring states.

Lassere and Dorsa say a new VA medical center cannot come soon enough. "We have two floors," Dorsa says. "That's it. That's the VA medical center. Why are we sitting on our hands so long?"

"They don't have enough doctors - enough psychiatrists - to go around," Lassere says. "They are not coming here because they don't have a hospital. A doctor wants a hospital, not a clinic. You can't attract quality people if you don't have a hospital. We need that hospital. And, to me, it's taking a little too long."

Jeff Stoffer is editor of The American Legion Magazine.

 

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