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New Orleans had 7000 HIV-infected citizens before Katrina, and no one knew whether they had reached care providers after the storm. Despite devastation of the infrastructure, HOP providers, of whom I am one, opened a temporary clinic using volunteer couriers to transport laboratory samples and medications to and from neighboring cities. Today, the clinic is housed in an aged building while our clinic home undergoes remediation for mold. Laboratory tests for CD4 cell counts and viral loads are performed in Houma, Louisiana, since Charity's equipment was decimated. Microbiologic testing remains unavailable. Services have been pared down to basic primary care, social services, and mental health care for patients infected with HIV. Yet we have welcomed back some 750 of our 3000 patients, with many more expected to return later this year.
Like the HOP clinic, Common Ground is challenged by the dearth of facilities and laboratory services in New Orleans. On September 9, three street medics broke through the barricades that surrounded the city to set up a first-aid station. They soon connected with community activist Malik Rahim and together envisioned a grassroots clinic to address the city's health care void. Their vision was embraced locally, and thanks to the Internet, volunteer providers streamed in from around the country.
Initially housed in a mosque, Common Ground seeks to offer sustainable primary care based on the model of other free clinics. Its hunt for support includes requests to local hospitals for laboratory services and appeals to foundations such as Direct Relief International, the National Association of Free Clinics, the International Medical Corps, and Veterans for Peace, as well as private donors.
As of early March, Common Ground volunteers had provided 10,000 free patient visits. Clients include former Charity patients, migrant workers, and nurses and teachers who lost their jobs and health insurance. "These people are overwhelmingly grateful for the clinic and enthused about the care they receive, even though we often have minimal resources," remarked Caroline Christopher, an internist with Tulane University Medical Center. "We spend so much more time with patients now, hearing about their lives." Services include immunizations, primary care consultation, prescription assistance, acupuncture, mental health care, herbal medicine, and massage therapy. The clinic recently moved from the mosque into a remodeled corner grocery store it has leased.
As national attention to New Orleans wanes, fewer volunteers are coming. Common Ground is recruiting local volunteer professionals who will commit to regular hours and is seeking funding for 12 paid positions. The task is challenging, since as the population returns, local professionals are busy with their paying jobs. Not surprisingly, some of the most enthusiastic volunteers are medical residents from Louisiana State University and Tulane.
Difficult as it is to accept that resources are now profoundly limited in New Orleans, Common Ground doctors say there are positive effects on their medical practices. "We make do with drastically fewer lab tests, and we try to manage more complicated things on our own," says the clinic's medical director Ravi Vadlamudi. "The best adaptation seems to be that everybody is a little more human."
Source Information
Dr. Berggren is a teaching physician and primary care provider at the Charity HIV Outpatient Clinic in New Orleans.
An interview with Dr. Berggren and Dr. Tyler J. Curiel can be heard at www.nejm.org.
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