New Orleans Medic Scott Weinstein

New Orleans, September 9, 2005 —This is a scribble of some impressions and an evaluation of the situation from my isolated perspective. It is also an expanded medical version of what I sent out earlier to others.

Been in N.O. for two days, ironically, got a lift here on an ambulance with a detail to help provide vaccinations & medical care to some of the security forces in the city. (Tetanus, and for some who want it — Hep A & B). The CDC says not to worry about strange diseases that are not common in Louisiana like cholera — it wont suddenly grow because of a hurricane. We are worried about vibrio choliform from open wounds in cuts exposed to the contaminated water. Many of the security and civilian search and rescuers are sometimes waste-deep in the water so they are at greater risk. Besides that, we are seeing with those used to air-conditioning, a lot of heat rashes; plus a significant amount of hypertension and diabetes — especially with the N.O. residents and police who are stressed out and don't have their meds.

Psychologically, the N.O. people and the staff who have been here from early on are most at risk. They are not only fried, but don't know what has happened to their house or sometimes their family. Many are working themselves hard to cope. Fortunately, in the last few days, they are either catching up on some sleep, or taking off to give themselves a break.

Street people are kings

From a medical perspective, there is little to do here besides roam the neighborhoods looking for people and seeing if they want medical help or a ride to the evacuation centre. There are plenty of ambulances, and some nurses and doctors from my clinic doing that, so I will leave. The people I came across most at risk are the very poor and the mentally ill. For some of them, they refuse help and given the lack of local social and medical services, combined with the right to refuse treatment, etc., there is not much we can do but offer our aid.

Ironically, now the street people are kings, as they are the only residents outside for all the media and police to interact with. A cop told me today that a General directing boat searches interviewed one homeless person asking for information on who might still be living in a certain area.

But I also can't get this one women off my mind who clearly was determined to stay on the street despite her decrepit situation and it seems everyone offering her money and a comfortable shelter to leave. I fear she could die, but if we simply grab her, she will have to be forcefully evacuated to a psychiatric/medical facility somewhere…

City under siege

Meanwhile, there is a medical clinic in the Sheraton Hotel dedicated primarily for the Immigration police, but also for some of the other security services. We are not supposed to treat civilians, (but of course we do on our own). In a day or two, the clinic will move to a tent and may be Armed Force medical staff only. There is a large hospital — Oschner — for civilians — with electricity and water, but for some unknown reason, the sheriffs office in that parish wont allow civilians to enter.

The city is under a soft form of a state of siege - or let's just say that that you can't swing a dead cat without hitting a soldier or cop.

Military Woodstock

It is so fucked up. Bush has promised "boots on the ground" in a public relations effort to show he is doing something, but soldiers are not necessary — this is a humanitarian & environmental disaster, not a war — or it shouldn't be a war.

I think it is quite safe to walk around the city, despite the paranoia of the news media and the armed forces. Or let's say that it's a typical American city that has been emptied of most of it's residents.

While all the police types are armed to the teeth and wearing bullet proof vests, we civilians are chilled in our regular clothes and mostly unarmed. I will say that having hung around more EMTs and Paramedics than I could ever imagine, I am more turned off by the growing wanna-be militarization look and attitude they have. Their uniforms look like they belong on a SWAT Team, and many of them are packing guns.

Sometimes I think I am watching a scene from Iraq — all the streets are being swept repeatedly by heavily armed cop cars from all states, the N.O.P.D., the FBI, and the Armed Forces. But the streets are not being sweeped by brooms, and that is a priority because the uncollected fetid trash is a bacterial breeding ground. So if disease is a rationale for evacuating the dry areas, well, clean up the garbage! No brainer there. Not one garbage truck has entered the city, but ambulances, police cars, humvees and vans with tinted windows and emergency lights from all over the country are patrolling.

I call it a military Woodstock, and when I ask them what they are doing here, they mention that "everybody wants to get in on this" or protecting (each other) or providing security.

Regardless, most of the individual guys who are heavily armed are decent and they are actually friendly to the residents - offering them food and bottled water. Those doing search and rescue are very dedicated to saving people. Last night, some soldiers told me how happy they were to rescue a family of 6 from their flooded home. Some understand that it would be better that they did not have a forced evacuation, but that if people must leave, that civilians should interact with the residents.

Convincing residents to leave

Most of the few remaining residents I've met can be placed into three groups. In the French Quarter which is above water, there are 'middle class' whites who emerged after a week, citing security fears for them remaining inside. Then there are poor whites and black who simple don't want to leave because this is THEIR city, and why should they leave. Some are homeless, extremely destitute and desperately poor, and some are alcoholics and mentally ill. Yet most that I met were resistant to the idea of being forced out.

Being New Orleans, there are a lot of characters - I like this place! One homeless guy pushing his grocery cart of cans down the street considered my offer to evacuate if the military would let him keep his cans. "No sir" I replied, "I don't think they'll let you bring the cans on their helicopters, but maybe you can redeem the cans with the military." He wisely saw through my bs.

In the areas that are flooded, (at least the edges where I could walk or ride in an ambulance) everyone remaining is black and equally poor. There is such a stark in-your-face jolt of poverty and race here in a major American city, that even the soldiers here are shaking their heads.

I spent half the day yesterday helping or persuading people to leave - using an ambulance as a taxi. Most of the folks we took were old and infirm. Rumor from various military forces was that today, the law would change and forced evacuations would begin. We told people that coming with us was a better deal with us than with the guys with guns, and that they should bring ID, addresses of family & friends, and a change of clothes. Half had no ID or addresses… Fortunately, the military was letting people bring their pets, so that was a relief for some. But still, the evacuation procedures at this point are being controlled by the guys with guns.

Today, I think we may have made a mistake. The atmosphere seems more relaxed, and there isn't the rumours of a forced evacuation. In fact, there are plenty of store owners back in town to fiddle with their stores.


In deciding what to do, there is a dilemma that must be resolved — how involved with the armed men do you want to be? They control the evacuation procedure for people without private rides. They are both patrolling for "bad guys" to kill, and also to search and rescue people. They have for the most part, assisted EMTs, nurses and doctors by providing transportation and some logistics. The ambulance I was hanging with was asked by a nice National Guard sergeant to help him search an public housing complex one last time to make sure there were no incapacitated survivors. You can go out without security forces into the neighborhoods and they don't bother you. But you cant really help a survivor effectively without at certain critical points, engaging with and getting the cooperation from the armed forces who have laid siege to the area and the evacuation facilities. It is not just New Orleans that is occupied by cops, but all surrounding parishes that never had any violence, and all public medical facilities that have sprung up. Certainly, independent medics can set up independent autonomous clinics and operate that way, but this is huge — and our numbers are small.

Maybe residents can stay, or maybe it could turn ugly. New Orleans business owners are allowed back in & out to check out or secure their place. The worst thing would be for New Orleans to be under Marshal Law, with no independent media and observers to prevent a secret & bloody military operation.

Militarized evacuation

People are being evacuated two ways - they can get a private ride out, or they can got to the Convention Center (again!).

While the convention center is closed & all the stinking trash is still outside, people (remember these are the poor) are first lined up in the hot sun across the street. (I asked the medical staff to get more tents for shade for the folks - tents that are being stored at the near-by Louis Armstrong Airport that people are being evacuated to.)

Then evacuees get frisked, bags (if they have any) searched by military, go through a medical triage if they need assistance, then board a Blackhawk helicopter for a deafening 15 minute ride to the airport. While the 'copter crew and I would stare out the open windows for a view of the devastation, the evacuees are huddled on the metal floor staring like a deer in the headlights. At the airport, they sit on the baggage carriers and get towed into a terminal, walk past more security and up to the second triage medical area with impressive MASH tent setups. (Uhh, I got evacuated by mistake because I was hanging with a line of people about to get on a helicopter, and the nurse told me to get on, so I thought they wanted me to be a flight medic. After an hour in the airport, I was able to catch a ride back. The nurse told me she thought I wanted to be evacuated. The mistake made a my co-workers really jealous.)

By the time the evacuees are in the airport, they seem stunned - some are just flattened by the fact that one hour ago they were in their homes, and now after a crazy ride they are being asked to choose where in the state or country they want to go according to the limited options of departing buses and planes. Within an hour, they are gone…

There is an attempt by one Louisiana social service worker to record them, but most just get into a bus or plane and off they go to whatever un-coordinated place they end up next. On the positive side, New Orleanians are a proud group, and if anyone will home back to their city, it would be them.

Lack of coordination

When I last wrote 2 days ago, I mentioned the lack of coordination between various agencies and facilities. This is still a major problem. Most medical facilities don't know what other medical facilities are running, nor their phone numbers. No one has any realistic idea what will happen to a survivor who evacuates to a government or charity facility down the line of steps. None of these evacuees are given any money - just bottled water, food and sometimes donated clothes. Information is unreliable.

I liken the execution of this disaster response to fire fighting. Most of the time, fire fighters sit around, cook, eat, shoot the shit, and train. But they are paid to be prepared, trained, supplied and have a plan for the rare times they have to fight a fire. Once in a blue moon, they have to coordinate with other fire houses and fight a major fire. They don't wait for the house to start burning before stocking their fire engines or figuring out what they should do.

"You'll have to clear that with FEMA"

The levees of New Orleans was the third highest risk of a disaster in the US according to the FEMA (Federal Emergency Management Agency). Yet they and Dept. of Homeland Security (DHS) which they are now under, ONLY sat around a shot the shit, while eating up billions of dollars for security.

One Homeland Security manager coordinating the response told me yesterday that they were ordered to take FEMA off their badges and vehicles because the country is so angry at FEMA. When I asked him what he thought of that, he said "FEMA is a bunch of fucking shit." A doctor I work with coined a new joke. What's the Cajun expression for "Go Fuck Yourself"? - "You'll have to clear that with FEMA".

Regardless, FEMA, like most of the rescue people and managers I have met, are composed of well meaning people, but the top management is incompetent, and the organizational command scheme is either non-existant or idiotic.

ABC's of organizing a rapid response

The disaster response is federally, state and locally managed. From my perspective, they have the resources, but not the common sense. They ignore the basic ABC's of organizing a rapid response that any of us who have organized for a major demonstration are aware of: Coordination, Mobilization, Supplies, and Goals. For Katrina, there was (and still is) no adequate coordination between the various agencies. The supplies came late, and in the case of the missing garbage trucks vs. flood of guns and rifles, are not always appropriate. The mobilization is inappropriate — this post 9-11 disaster is defined as a security operation or a war, and the mobilization is of soldiers, cops and mercenaries along with church charity organizations. But the civilian/non-armed government volunteers and skilled workers are not being allowed into New Orleans without military approval. Supplies were tardy, and still there is erratic distribution. And goals? Who knows what they were.

Also, the hierarchical and authoritarian structure of the government means that there is a lot of orders that are being followed because people HAVE to follow them — against their better judgement.

Everyone wants to help

Simply put, the wrong agencies are being asked to do the job, because this country is so incredibly militarized at the expense of civil infrastructure. Most problems respond poorly to a war response.

Some things are working well: By and large, everyone wants to help. The civilian volunteers like myself are able to get around well and get involved if they take initiative and are ready to hustle or bullshit their way through the bureaucratic roadblocks. The New Orleans police, firefighters, ambulance crews and hospital workers really did work for 5 days straight on hardly any sleep. Pets are being rescued and sheltered. There is free medical care and free food. Among the people here, there is a sense of community and solidarity - even across the politically antagonistic mix of soldiers, federal police and humanitarian volunteers. Some immigration officers who fly immigrants out of the US to where-ever (including Comair renditions to be tortured and maybe killed) where happy to wear a different hat helping people. No one pretends that the organized response isn't fucked up.


So, now the challenges are multiple - first the larger issue of dealing with poverty and racism that makes this evacuation into a humanitarian disaster - why were the evacuees housed in the stadium and convention center when huge hotels in the dry French Quarter were available? The government is paying for hotels to house the security forces - but not the evacuees. How come the evacuees are STILL being crowded en mass into facilities when there are millions of homes in America that can board one or two or a whole family - segregation under the veneer of rescue?

From a technical view, the challenge is to demilitarize disaster rescue, and ensure competent management of the civil response.

People fear the government will opportunistically use Katrina like 9-11 to further militarize and privatize. We can't let it happen.

p.s after I wrote the first draft, I caught a ride tonight back to Baton Rouge with a cop, carrying my co-worker and three dogs they rescued from a flooded house. We ended up at a makeshift no-kill shelter at the LSU Agriculture school.

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