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A 'doctor without orders' joins homegrown relief effort

Bypassing bureaucracy, an internist teams up with health professionals making their own way to the Gulf Coast

From the November ACP Observer, copyright 2005 by the American College of Physicians.

By Janet Colwell

Like most people watching the destruction wrought by Hurricane Katrina, William E. Fox, FACP, felt his heart go out to injured victims who'd lost their homes and jobs. As a physician, he knew he could do more than just send money, so he signed up almost immediately as a medical volunteer.

But despite the tremendous need for aid, his offer went unheeded. After filling out the volunteer form on the Department of Health and Human Services' Web site, he waited in vain for a call. Frustrated by the continuing horrors shown on television, he and several colleagues decided to bypass the system.

"There was no way that I found to help through official channels," said Dr. Fox, 38, a general internist who shares a practice in Charlottesville, Va., with Richard K. Brantley, ACP Member. "Finally, I said, 'There's too much bureaucracy—I'm just going down.' "

Underground network

Through a colleague, he heard about Long Beach, Miss., population 17,320, a coastal community 60 miles from New Orleans. Long Beach had been nearly leveled by the storm, with about 40% of the town's homes destroyed and thousands more significantly damaged.

Amid the destruction, local nurse Jennifer Knight, RN, was trying to staff a makeshift clinic in Coast Episcopal School, a private elementary school: After the privately-owned urgent care center where she worked was flooded, Ms. Knight salvaged a few supplies and contacted several physicians, including a family physician in Charlottesville, who passed the word on to Dr. Fox.


William E. Fox, FACP (center), is flanked by hospitalist Lee D. Litvinas, ACP Member (left), and general internist Carolyn J. Dalldorf, ACP Member, out side a makeshift clinic in Mississippi. The three internists came from Charlottesville, Va., to provide volunteer care.




Seventeen days after the storm, Dr. Fox asked his partner to cover for him for a week and joined the third wave of physician volunteers from Charlottesville. (When the disaster struck, Mississippi arranged for volunteer out-of-state doctors to get emergency medical licensure.)

When they arrived, they found virtually non-existent lab facilities, energy-sapping heat and humidity, and no patient privacy. The physicians—who referred to themselves as "doctors without orders"—immediately set up a minor-trauma service, free pharmacy and triage area. "It was," Dr. Fox said, "real basic medicine."

The Virginia physicians rotated in weekly shifts and recruited other colleagues—-family practitioners, general internists and emergency physicians—from their hometown as needed. An entire network of ad hoc free clinics sprang up along the coast, he said, all independent of any official oversight.

"We are in Army mode," said Dr. Fox in mid-September, when he was interviewed on-site. "I go on reconnaissance missions and see the other clinics, and we barter. Yesterday, we traded albuterol inhalers and antifungal cream for Augmentin."

'A war zone'

Arriving on a plane operated by Angel Flight America, a national nonprofit that flies mercy missions, Dr. Fox said the area resembled a war zone.

"There was incredible destruction everywhere and a military presence throughout," Dr. Fox recalled. That presence proved to be a big help, as Army personnel set up large tents to house the clinic, allowing physicians, nurses and non-medical volunteers to use the school as a dormitory.

"At times, there were up to 200 volunteers who had come here to serve," said Dr. Fox. "Some were living in tents and trailers on the grounds because the school couldn't accommodate everyone."

Others were as generous with supplies, Dr. Fox said, as the physicians were with their time. The school halls were stacked with boxes of donated medical supplies, many of them from a local hospital that was up and running soon after the storm. "Pharmaceutical reps donated medications and people sent in money," he said. "Volunteer physicians brought medications with them from their communities."

As for Dr. Fox's new patients, most had lost their homes in neighborhoods rendered unlivable. "The lucky ones were living with relatives or friends but many people were in shelters or living out of their vehicles, he said. "One day I visited a group of 12 people who'd been living in a small grocery store with no air conditioning."

About half the clinic's patients came in for prescription refills because their medications were washed away and their doctors' offices and pharmacies were shut down. Dr. Fox treated allergies and upper respiratory infections due to humidity, dust and black mold. He also saw plenty of skin infections; minor trauma, such as cuts and puncture wounds; and asthma exacerbations.

Returning to his comfortable private practice a week later provided a stark contrast. Whereas at home he's thinking about how to lower a patient's cholesterol or blood pressure, his mission in Mississippi was about basic survival.

"I was treating a patient when he got a cellphone call from a FEMA rep saying that they got a trailer for him," Dr. Fox said. "He had been living out of his truck." The trip to Mississippi, he added, was his first experience volunteering after a disaster—and "one of the most rewarding experiences I've had as a doctor."

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