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NEAL CONAN, host:

Sixteen months after Hurricane Katrina pounded the Gulf Coast and left New Orleans a mass of gutted neighborhoods, parts of the healthcare system in that city remained pretty much the way they've been since August 2005 - broken.

Both state and local governments have been unable to agree on how to replace Charity Hospital, which was severely damaged during the storm and serviced most of New Orleans poor and uninsured. That has put severe strain on other hospitals in the city already struggling to provide care with limited resources.

Karen DeSalvo is chief of general internal medicine and geriatrics at Tulane University and special assistant to the president for public medical services. We have spoken to her many times since Hurricane Katrina, most recently when we went to New Orleans in May of this year.

She joins us now from there at the studios of member station WWNO. And Dr. DeSalvo, it's nice to talk to you again. Season's greetings.

Dr. KAREN DESALVO (General Internal Medicine and Geriatrics, Tulane University): Season's greetings. Thanks for having me.

CONAN: When last we spoke, you said primary care infrastructure still wasn't very good. Has it improved?

Dr. DESALVO: You know, it has improved. It's incremental and we still have a ways to go, but the absence of the charity system where most of the city's poor received care sort of led to the emergence of neighborhood clinics that were very, you know, grassroots, organic. Entities that came up from card tables, sort of, that popped up on the street corners, and from new partnerships that developed. And so - that we've lost the cornerstone of what we had pre-storm. We have been able to recreate that in a way that I think is better for the city in the future.

CONAN: And do you think that this is going to evolve, maintain, sustain, develop into something new?

Dr. DESALVO: You know, that was the big question, Neal, and maybe past - this past May, we had about 15 of these sites. We have about 23 now, so they are definitely growing. Some of them are still mobile clinics, you know, on - sort of in vans, if you will. But most of them are in permanent structures.

They are partnerships that are public-private partnerships that have financial sustainability as least for the next couple of years, and they - I mean we are all busy. Tulane has a clinic that we started at Covenant House. It's a free clinic, and we have just been busier. The longer we expand our hours, the more days we are open, the busier we get. So all of us are experiencing that same thing.

And what we are trying to do is keep this innovation alive and go to the people for healthcare instead of making them come to us.

CONAN: What about mental health? Charity Hospital used to take a sizable number of psychiatric patients, and of course people's psyches under considerable stress in the past 18 months or so. What are the options for the mentally ill today?

Dr. DESALVO: Just a little bit stress. You know, that was one of the things we did best at Charity Hospital was take care of particularly the severely mentally ill, people who don't have many other options and who often require hospitalization. We have not gotten that back up and running.

A part of Charity Hospital system is up, some of the outpatient clinics and a small version of the hospital. But that's not taking in patients, psychiatric care, so it continues to be a major concern for the healthcare community. For those people who are severely mentally ill, there's really very few hospital beds that they can go to in the area in its entirety. And they end up sort of waiting in the emergency room for days on end for an appropriate bed for their care.

CONAN: After care is another issue for people who are discharged from hospitals.

Dr. DESALVO: It still is an issue. Just like there are not enough places for people to live in general, there aren't enough facilities like nursing homes, for example, for folks to go to, or rehabilitation facilities, group homes, those sorts of places. So the backlog continues where people have difficulty getting discharged from hospitals. But I'll tell you, that really has improved in the past few months.

CONAN: One of the things that most impressed me when we met in New Orleans late last spring was that, despite all the problems, your belief and hope and resilience of not only the health care system but the people of New Orleans to develop and find new solutions.

Dr. DESALVO: Oh, I think that's one of the best qualities of the people in New Orleans. We are nothing if not resourceful and innovative. And it has been a pleasure working with so many groups on the ground trying to get this thing going. I mean even if the governments can't completely agree on the best thing to do with buildings and what-not, we have not stopped.

And we've recognized that there are public health needs. There's medical needs. And we have found very creative ways to make it happen in partnership with the patients as well.

CONAN: But dealing with those big bureaucracies must be frustrating some of the time.

Dr. DESALVO: Well, sometimes. I mean it can be immensely helpful. We have received some financial support from, you know, the federal, state and city governments. But it has not really been as generous as probably some of the private support that we have received, which I think was surprising to me going into this storm. But, all things considered, it's been a sort of a benefit because that private money, the foundation money, has given us the flexibility to be creative in developing these new medical homes, if you will, these neighborhood clinics.

Instead of being stuck in the paradigm of the old traditional healthcare that was, you know, all paved for specific things in a specific way with a large set of rules, which is unfortunately how health care is. We've been able to be more creative, do home visits, for example. Use mobile units to deliver care, do group visits, really try to experiment in ways, in a positive way, to make health care much more patient centered.

CONAN: Dr. DeSalvo, thanks very much speaking with us again.

Dr. DESALVO: Sure. Thank you.

CONAN: Karen DeSalvo, chief of general internal medicine and geriatrics at Tulane University, joining us today from the studios of member station WWNO in New Orleans. We're catching up each day this week at this time with people we met during the year, people who made news during the year. You are listening to TALK OF THE NATION from NPR News.

In the aftermath of Hurricane Katrina, New Orleans' musicians like the Jordan family have continuously worked to preserve the rich musical heritage of that city. We heard a performance from the Jordan's in our broadcast from New Orleans last May. They shared their personal stories of survival in the wake of Katrina.

Three of those family members are back with us today - Rachel, Stephanie and Marlon Jordan are also in the studios of member station WWNO in New Orleans. Nice to have you back at the program. Good to talk with you again.

Ms. STEPHANIE JORDAN: Thank you.

Mr. MARLON JORDAN: Happy to be here.

Ms. RACHEL JORDAN: Thank you.

CONAN: The rebuilding stage, in some respects, it seems to be beginning. Rachel, you had your roof replaced?

Ms. R. JORDAN: I had it - yeah. That happened two days ago, so…

CONAN: Two days ago?

Ms. R. JORDAN: …the rebuilding process is very slow.

CONAN: Very slow, but it's finally getting done.

Ms. R. JORDAN: Ah. Well, that's just the first part of it. There's a lot more to be done. I just had to save what I have, you know, with the roof being so severely damaged. If I didn't, you know, try to get a roof on, the whole house probably would have had to been knocked down. So it was more of a preventative thing so that I wouldn't - my whole house wouldn't be destroyed by all the rain and elements.

CONAN: And Stephanie, as I understand it, you're still waiting for your house to be gutted?

Ms. S. JORDAN: Yeah. I'm going to have it gutted in a couple of days. So I'm excited about that, I guess.

CONAN: I guess. It's got to be a mixed feeling in a bit of a way.

Ms. S. JORDAN: Oh, yeah. I cried a lot when I realized that, you know, my little dream home would be changing. But, you know, everybody's dream home was changed and gutted. It's, you know, it's a strange thing. You know, but it's progress.

CONAN: Marlon, is the family still scattered?

Mr. M. JORDAN: Yeah. Yeah. Yeah. I was thinking about it at Christmas, how all my cousins and everybody, we came together on one of my other cousin's house on the west bank and how everybody is just all over the place, you know, and in different places in Louisiana. You know, my dad and mom are in Baton Rouge, and my sister's in Baton Rouge. And, you know, my other brothers, you know, a lot weren't here. Yeah, I was, you know, just thinking about that. And, you know, the family is still scattered.

CONAN: Where - did you guys manage to get most of yourselves together for a Christmas holiday?

Mr. M. JORDAN: Oh, yeah. Yeah, we did. We did. Hear we go. We did do that so I was glad about that. And a lot of my cousins, you know, I saw at Christmastime and it was a really good time.

CONAN: That's nice to hear. When we broadcast with you folks from New Orleans in May there was a sense of hope we heard from you guys. Do you feel that that mood is still there, or has it changed? Stephanie?

Ms. S. JORDAN: Well, I still live in Maryland, you know. Paperwork, paperwork, paperwork, you know. I submitted my Louisiana recovery papers and that sort of thing, still sort of working things out with the insurance companies. Visited my house last week. It's difficult because it's so quiet, you know, it's a whole community that's gone.

And that quiet is so deafening. It's so daunting. I'm hopeful, but you look at a whole community and, you know, you have - it's a resurrection of an entire community that's pretty much dead. You know, we lived in New Orleans East, which is part of the Ninth Ward, not the lower Ninth Ward that was really devastated.

Most of our homes are brick homes so we survived, you know. The houses came out, you know, of the storm. But the flooding and the devastation, you know, just removed people, removed everything, so an entire community has to be rebirthed.

And then, you know, when you read the local papers - of course I'm away and I come in, the first thing I want to do is actually read the papers. And you sit there and you read about this fighting between local, state and federal representatives, and you go, OK, so when politicians fight, the people suffer.

CONAN: Yeah. Marlon, we just have a few seconds left. But that silence that Stephanie was talking about, does that extend to the nightclubs and the arena halls there in New Orleans? Is there work?

Mr. M. JORDAN: Yes, there's work. But there's, you know, still it's hard to make a living down here. You know, I still don't play down here but maybe once a month, you know what I mean. It's just, you know, the people are not here to support it. And, you know, it still - it's a rough time. You know, we still need the help so, you know, like my sister said, you know, the politicians need to get together and work this thing out.

CONAN: Well, thanks to you all and we wish you good luck with construction and good luck with finding work in the new year. Thanks for being with us.

Mr. M. JORDAN: Thank you.

Ms. S. JORDAN: Thank you.

CONAN: Marlon, Stephanie and Rachel Jordan of the Jordan family. They joined us today from the studios of member station WWNO in New Orleans.

This is TALK OF THE NATION from NPR News. I am Neal Conan in Washington.

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