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Despite some successes, health care system in New Orleans continues to face challenges


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Washington — What began nearly two years ago as a temporary health care site operating off of a card table on a New Orleans sidewalk has developed into a permanent primary care clinic serving more than 12,000 patients since Hurricane Katrina struck.

The Tulane Community Health Center at Covenant House operates with a unique set of resources that includes faith-based groups, medical and nursing students, corporate sponsors, academic institutions, government agencies and the people of the Middle Eastern nation of Qatar, which has given millions of dollars in hurricane recovery assistance.

The center is just one example of the successes achieved in reviving a health care system decimated by Hurricane Katrina and the flooding that followed.

Another is the Daughters of Charity Health Center-St. Cecilia, a communitybased clinic serving New Orleans’ Ninth Ward and the Bywater neighborhood that has received $3 million from the United Health Foundation to become a model “center of excellence” for primary care in a community setting.

“In some ways we are definitely ahead of where we were two years ago,” said Dr. Cathi Fontenot, medical director at the Medical Center of Louisiana at New Orleans (formerly Charity Hospital), in a recent interview. “But the state of health care in New Orleans is still critical.”

Among the problems are a shortage of medical professionals, especially specialists and surgeons; sharply decreased availability of mental health services, coupled with the increased need for those services following the trauma of Hurricane Katrina; and the continued closure of four of New Orleans’ seven general hospitals, some of which may never reopen.

“As you might imagine, finding physicians and other clinical personnel willing to move to New Orleans is a challenge,” Dr. Karen B. DeSalvo, executive director of the Tulane Community Health Center at Covenant House, told a House subcommittee earlier this year.

“There are concerns about long-term job security and frustrations about trying to maintain a high standard of practice in a broken environment,” she added. “One of my physicians has been so frustrated with the difficulties of providing basic care for his patients that he considered returning to Liberia to practice.”

The House Energy and Commerce Committee’s Subcommittee on Oversight and Investigations has held two hearings on “Post-Katrina Health Care in the New Orleans Region: Progress and Continuing Concerns.”

Kim M. Boyle, who chairs the health care committee of the Louisiana Recovery Authority, told the subcommittee in August that Hurricane Katrina, and Hurricane Rita three weeks later, led to the closing of 30 hospitals in Louisiana, seven of which remain closed.

“The health care system’s speedy, comp rehensive, sustainable recovery is critical to the future of the city and all of south Louisiana,” said Boyle, who also addressed the Catholic Health Association this spring about the challenges still facing health care practitioners in the New Orleans area.

“Uncertainty about health care access has slowed the recovery, undermining public confidence about returning home,” she said. “Business owners will not bring investments and employees to a city without available health care services.”

At the same August hearing, Diane Rowland, executive vice president of the Henry J. Kaiser Family Foundation, said a foundation survey found that nearly half of adults in post-Katrina New Orleans reported problems with health care coverage and access, and one in 10 adults rated their overall health as fair or poor.

She praised the Louisiana Children’s Health Insurance Program, known as LaCHIP, for expanding its coverage to children whose families make up to three times the federal poverty level.

“Louisiana has been most successful in reaching out and providing coverage to low-income children, substantially reducing both the share of children without coverage and disparities in coverage,” she said.

“Only 9 percent of households with children reported having an uninsured child, a comparable rate for both African-American and white households despite the substantially higher rate of uninsurance for African-American adults compared to whites,” she said.

The region’s move from a primarily hospital- based health system—in which many of the area’s uninsured relied on hospital emergency rooms for their care —to a community-based system also could yield benefits for the people of New Orleans in the years ahead, said New Orleans Mayor Ray Nagin in August testimony before the subcommittee.

“In spite of unprecedented challenges presented in the aftermath of the largest natural and man-made disaster in our country’s history, we have made great strides in re-establishing the health care systems that the people of the Gulf Coast deserve,” Nagin said. “With your continued support we will not only return to pre-Katrina capacity; we will become a 21st-century model of health care for the nation.”