Five years ago, New Orleans attorney Ermence Parent was struggling to find out what was wrong with her leg. She was 58 years old, and her right leg hurt so much that she needed a cane. That was not only painful, but frustrating for a woman who routinely exercised and enjoyed it. Parent sought advice from several doctors and a chiropractor, but got no diagnosis.
Then she made an appointment at the newly renovated St. Thomas Community Health Center, a primary care clinic dedicated to providing quality care for people regardless of insurance status. Most patients, including Parent, are on Medicaid or Medicare. Some pay on a sliding scale. Parent saw internist Dr. Mary Abell, who is now medical director of the clinic.
Abell took a careful medical history, looked at Parent's X-rays and watched as she walked up and down the hallway
"'Baby, your hips are going,' " the doctor told Parent. The attorney had "bone-on-bone" arthritis. Without surgery, the doctor said, "'in about six months you're going to be in a wheelchair.' "
Instead, about a month later, Parent received her first hip replacement, and nine months later, her second.
Today, she's back to exercising, has lost weight and sleeps more soundly. "You know, changing those two hips just rejuvenated me; it gave me years back on my life," Parent says.
When Katrina hit in 2005, many health facilities were destroyed or otherwise shut down, including urgent care centers, nursing homes, pharmacies and hospitals. The renowned and beloved Charity Hospital, a public facility that had served the city's poor for centuries, was forced to close.
Many said the loss of the hospital was devastating. Charity represented a precious connection to health from childhood through old age.
But the attachment people felt to the old institution may have been based more in sentiment than fact, says Abell, especially when it came to primary care. She says patients had to rely on a trip to the emergency room if they didn't have health insurance and had ongoing chronic problems.
"Before Katrina, there was no primary care or preventive medicine — really, truthfully — for patients," Abell says. "None. Zero."
Back then, a patient with a medical problem that wasn't acute often had to wait months to schedule an appointment, she says. And once they showed up for the appointment, they might have to wait all day — or even end up with the wrong clinic or with the wrong physician. Abell says the situation was "very disrespectful" to patients.
Today is a "different day," Abell says. In recent years, a network of renovated and newly built primary care health clinics has opened, which she and New Orleans residents hope will bring a new degree of stability to the health care that the city's low-income residents get.
Katrina was devastating, Abell says, but after its ruin, New Orleans received a dramatic infusion of cash from the state and federal governments, and from private foundations. The funds resulted in new hospitals, new clinics and an enormous state-of-the-art facility that replaced the old Charity Hospital.
University Medical Center New Orleans, which opened this month, is just a few blocks from the shuttered hospital. The new facility's gleaming buildings, hundreds of patient beds and high-tech specialty care, stand in startling contrast to the old institution.
Abell has high hopes the new medical center will provide timely, excellent care for both acute and chronic needs. And her biggest praise is for the new network of primary care clinics.
"Today, a patient can call and get same-day primary care," Abell says, an improvement that Ermence Parent attests to, as well. A few months ago, when Parent's leg became swollen, she called the clinic and was seen right away.
In a recent poll of New Orleans residents by NPR and the Kaiser Family Foundation, 72 percent of adults agreed that progress has been made in the availability of medical facilities and services in the city. But the majority of residents — 64 percent — also said more needs to be done to provide care for people who are uninsured and have low incomes.
And among African-Americans, nearly half said they're very worried that health care services may not be available when they need them. Only 13 percent of white adults said they are very worried in that way.
According to Abell, one of the biggest remaining weaknesses in the current system in New Orleans is timely access to specialty care like orthopedics, neurology and cardiology.
It's a problem, she says, "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." She says she's had to rely on personal connections -- and 30-plus years of experience working in the city — to help her poorer patients gain timely access to specialty care. She's anticipating that the new University Medical Center will help remedy that.
That hope extends to mental health care, as well. Rashain Carriere-Williams, who directs program operations at Boys Town Louisiana, a community organization that helps troubled families and children, says the need for mental health treatment in the city is huge.
After Katrina, psychiatrists fled New Orleans, along with many other people. Unfortunately, Carriere-Williams says, most psychiatrists never came back. In the entire city, there are now only two or three psychiatrists who accept Medicaid and are willing to see her patients and their families, Carriere-Williams says.
"A lot of times it's easier to get them in to see a psychologist, because there are more of those," she says. But psychologists can't prescribe the medication some patients need.
Although the new hospital has some beds dedicated to patients in need of mental health treatment, the number of beds isn't nearly high enough, she says.
She's been faced with heartbreaking situations — including one New Orleans boy who recently threatened suicide and had to be placed on suicide watch. The only facility with an inpatient bed was a six-hour drive from the city. The family drove their child there for a 72-hour hold, and the child temporarily got the needed care, says Carriere-Williams. 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 the community's mental health needs. But, based on Louisiana's and New Orleans' history in that regard, she says, she's skeptical.
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ARI SHAPIRO, HOST:
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. Transcript provided by NPR, Copyright NPR.