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Ten years ago, Hurricane Katrina hit low-income neighborhoods in New Orleans hard. Hospitals and clinics were destroyed, and access to health care, which was already difficult, became even more problematic for low-income residents. Today, as NPR's Patti Neighmond reports, Katrina's devastation has produced something of a silver lining for basic routine medical care.
PATTI NEIGHMOND, BYLINE: The St. Thomas Community Health Center is one of the newly renovated low-income primary care health clinics in New Orleans.
MARY ABELL: Hey, how are you?
ERMENCE PARENT: How are you?
ABELL: Glad to see you.
NEIGHMOND: Internist Mary Abell greets her patient of five years, 62-year-old Ermence Parent. Parent only sees Abell for routine checkups these days, but five years ago, she was in crisis. Her leg hurt so much she had problems walking and was using a cane. She'd seen other doctors and a chiropractor, but got no diagnosis. Then she came here, where she met Dr. Abell.
PARENT: She had me get up and walk to, like, the end of the hallway and walk back. I told her about the X-rays. She pulled up the X-rays. She looked at everything. She said, baby, your hips are gone. She said, in about six months, you're going to be in a wheelchair.
NEIGHMOND: About a month later, Parent received her first hip replacement - nine months later, her second.
PARENT: You know, changing those two hips just rejuvenated me. It gave me years back on my life - I mean, years. You can see it in my face - years.
NEIGHMOND: She slept better, started exercising again and lost weight.
ABELL: I'm delighted that you're focused on wellness. That's what we want you to do.
NEIGHMOND: When Katrina hit, many health facilities were destroyed and had to shut down - urgent care centers, nursing homes, pharmacies and hospitals, including the beloved public hospital, Charity Hospital, which served generations and generations of the city's poor. For many, it was a precious connection to health, from childhood through old age. But Abell says the attachment people felt may have been based more on sentiment than fact, especially when it came to primary medical care.
ABELL: Patients had to use the emergency room if they didn't have health insurance and they had an ongoing chronic problem. And for the very few opportunities to get into a medical clinic at Charity Hospital, the wait would be significant.
NEIGHMOND: Patients could wait all day, she says, and many ended up just leaving, which could exacerbate chronic problems that brought them there in the first place. But after Katrina's devastation, federal, state and private foundation money poured into the city to help rebuild and renovate dozens of low-income clinics.
ABELL: Today, a patient can call and get same-day primary care. This is not urgent care. It's not emergency room care. It's real primary care that not only is looking at an acute problem, but putting it appropriately in the context of the patient's chronic issues, whether they be social issues, emotional issues, financial issues or medical issues.
NEIGHMOND: In a recent NPR-Kaiser Family Foundation poll, 72 percent of adults agreed that progress has been made in making medical facilities and services more available, but the majority also said more needs to be done to provide care for uninsured and low-income people. And among African-Americans, nearly half said they were very worried health care services may not be available when they need them. Only 13 percent of white adults said they were very worried. One of the biggest weaknesses in the current system, says Abell, is specialty care, like orthopedics, neurology and cardiology.
ABELL: When you can't get your patient in to be seen for an issue that's evolving, and you know that some specialty advice would be helpful, that was a real problem.
NEIGHMOND: But a new state-of-the-art hospital opened this month. Abell expects it will make specialty care more available. That includes mental health care, which, right now, is a huge, unmet need, according to Rashain Carriere-Williams, who directs programs at Boys Town, a community group that helps troubled families and children. Part of the problem - a dramatic lack of psychiatrists. After Katrina, psychiatrists evacuated like everyone else, but most, says Carriere-Williams, never returned, putting the people she works with at a disadvantage.
RASHAIN CARRIERE-WILLIAMS: A lot of times, it's easier to get them in to see a psychologist 'cause there are more of those than psychiatrists. But when it comes to the medication management and medication issues, it's difficult.
NEIGHMOND: Psychologists can't prescribe medication, which is often what's needed. Today, Carriere-Williams says there's only two or three psychiatrists in the entire city who will take Medicaid and are willing to see her patients and their families. And there's not nearly enough inpatient hospital beds, she says, which has resulted in heartbreaking situations.
CARRIERE-WILLIAMS: We had a youth in one of our short-term residential programs. And he came in, and he stated that he wanted to harm himself.
NEIGHMOND: Doctors at the hospital emergency room said the boy needed inpatient mental health care.
CARRIERE-WILLIAMS: What was devastating to me about it was because the only inpatient bed that we had in the state of Louisiana was in Shreveport, La., which was six hours away - away from his family, away from us.
NEIGHMOND: The family drove their child there for a 72-hour hold. The child temporarily got needed care, but the experience was grueling, at a time when the family was extremely fragile. Carriere-Williams says she's hopeful the new clinics and hospitals will begin to fill the big gaps in mental health services. But based on the Louisiana's and New Orleans's history, she says, she's skeptical. Patti Neighmond, NPR News.
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