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HIV, ADAP in Texas; HIV Doc's Story of Being Stranded in New Orleans in Ritz Carlton
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Sept. 9, 2005, 8:31PM
STATE OF ALERTNESS
Texas health officials have made a series of quick practical decisions that benefit Louisiana evacuees and Texans both. The state can do even more
Copyright 2005 Houston Chronicle
AIDS Foundation Houston
http://www.aidshelp.org/
In a disaster marked by gross ineptness on the part of many leaders, a set of rapid-fire decisions by Texas public health officials exemplifies clear thinking in Katrina's wake. Among the measures meriting praise - and emulation by other states:
Texas' HIV Medication Program and the AIDS Drug Assistance Program are offering free antiretroviral therapy to evacuees in Texas who fill out a single-page form. An approved patient can receive a free 30-day supply of medication at a participating pharmacy.
The state pharmacy board authorized Texas pharmacists to offer evacuees up to 30 days of medication, including HIV-AIDS drugs. Texas law ordinarily forbids pharmacists to supply more than 72 hours' worth of medicine without authorization from the prescribing doctor. These relaxed rules conform to existing Texas law, which lets pharmacists use professional judgment in giving emergency refills in cases such as natural disasters.
The Texas Department of Transportation is giving evacuees medical transportation service, including rides to doctor's appointments and dialysis treatments. The state health services Web site provides information about finding dialysis providers.
The Department of State Health Services has waived eligibility rules - which call for residency and income tests - for Katrina victims receiving maternal and child health care, family planning services and breast and cervical cancer care. Among many other benefits, this relaxed policy allows Planned Parenthood centers that receive federal funds to independently offer free one-month supplies of birth control to evacuees.
What is striking about all these measures is their acknowledgment that a healthy population is a public good. It goes without saying that this approach should prevail for permanent residents. Untreated diabetes, unmedicated AIDS and unwanted pregnancies among the evacuees could create serious new crises.
There are two more essential health care measures that Gov. Rick Perry and the Legislative Budget Board have the power to take at once. They should direct the Health and Human Services Commission to find a way to:
--Set an immediate start date for state mental health services for adults, including evacuees. These services were slashed in 2003, then restored in the last Legislature. They are now scheduled to restart on Dec. 1. Leaving tens of thousands of traumatized people untreated will guarantee future misery for Houston.
--Set immediate start dates for podiatry, glasses and hearing aids to be available for adults, including evacuees. Again, these services were cut in 2003, then reinstated this year. These restored services begin Oct. 1. But the faster Louisiana evacuees get needed glasses, hearing aids and foot care - the faster they can become self-sufficient again.
Clinic at hotel in Big Easy kept local doctor going
Work distracted him from danger family faced
By LEIGH HOPPER
Sept 9, 2005 Houston Chronicle
An impromptu clinic set up in a French Quarter hotel bar was an oasis of civility and order as bedlam engulfed New Orleans last week.
Houston physician Roberto Andrade, in New Orleans with his family for a meeting, was one of 17 doctors and pharmacists trapped by Hurricane Katrina in the Ritz Carlton on Canal Street. They raided a Walgreens drugstore under police escort and treated hotel guests - and passing police officers - with diabetes, hypertension and other health issues while they awaited rescue.
"We started feeling like we were doing something good," Andrade said. "The patient care helped us you don't know how much."
Andrade, a Baylor College of Medicine assistant professor who works with HIV patients at the Harris County Hospital District's Thomas Street Clinic, said work kept his mind off looming danger. The only time his resolve faltered came when he carried his youngest son on his back through floodwaters and the 7-year-old asked, "Daddy? Are we going to die?"
Andrade was in New Orleans on Aug. 28, hours before Hurricane Katrina made landfall. At the airport, with plenty of time left to reach safety, he learned his wife's departing flight had been canceled, and they returned to the Ritz.
Back at the hotel, Andrade and other physicians couldn't find rental cars or buses to get them out before the storm. Monday morning, they marveled at the relatively light damage.
They took photos in front of downed trees and a car crushed by falling bricks. That night, they realized the second phase of the disaster was coming as water surging over the levees began filling the streets.
Spreading the word
The doctors held a meeting and told Ritz-Carlton hotel administrators to spread word among 1,300 guests they would be operating a clinic. Accompanied by a fireman and two police officers, doctors waded into the Walgreens across the street.
They grabbed medicines for common ailments, antibiotics, diapers and baby formula. They loaded up food and even toys for the children - 10 boxes in all. They carefully noted everything with plans to return the leftovers.
Almost immediately, an insulin-dependent hotel guest complained of feeling woozy. He hadn't been eating properly. A glucose monitor filched from the drugstore showed his blood sugar was dangerously low, so doctors treated him.
They had anti-anxiety medicine and sleeping pills on hand but decided not to give those out, fearing groggy guests might miss a chance at evacuation. Police, who were getting skin infections from foul floodwater, started dropping by for doses of Cipro, a powerful antibiotic. When they paused to rest in the clinic, Andrade noticed their hands shaking violently, probably from exhaustion.
Plagued by memories
As days passed, Andrade and his colleagues grew more anxious. A building across the street caught fire. The food ran out. The bathrooms were overflowing with human waste. Andrade kept his wife and children in a nearby room, in case help came or they had to flee danger together.
"We were desperate and getting more angry, (asking ourselves) 'Where is the help? What's going to happen in the next two days? The smell is getting worse,' " he said.
Near midnight, four days after Katrina hit, authorities evacuated the hotel because of a spreading fire. Federal Emergency Management Agency buses took everyone to Baton Rouge about 1 a.m. last Friday, and from there Andrade and his family flew home.
Since his return to Houston, Andrade said he's been plagued by nightmares of filthy water rising toward his family. On Wednesday he was back at work, hugged by friends who heard his story. The tension of a week began to unwind. Talking to co-workers , he paused to collect himself.
"I feel a little fragile," he said later.
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