Bringing health care to those in need
Just before sunset, Manuel Morales, a 29-year-old construction worker wearing the sweat and dust of a long day's labor, trudges into a medical clinic on the edge of the French Quarter complaining of dizziness and weight gain. There he's met in a brightly painted exam room by a dark-haired woman in a crisp white coat. When she asks him to remove his shirt to be examined, Morales turns shy. "Soy gordo!" he says, and an interpreter translates, "I'm fat!"
Dr. Karen DeSalvo doesn't miss a beat. "This is New Orleans," she says with a grin. "We're all fat here."
Within minutes, DeSalvo is able to reassure Morales that he isn't suffering from anything that staying out of the sun and drinking water instead of soda won't cure. Before the doctor leaves the room, Morales takes her hand. "Thank you for caring about people like me," he says in earnest Spanish. "You are an angel."
Or something very close to it. The next day, during morning rounds across town at Tulane's University Hospital—Dr. DeSalvo, 41, is the medical school's Chief of Internal Medicine and Geriatrics—patients light up when they see her. She sits on the edge of beds and holds hands, calming patients while also checking for fever, dehydration or a rapid pulse. One is a man in his 50s who served in Vietnam but is now frail and homeless; he cowers in his bed, afraid he'll be put back out on the street. DeSalvo responds with a gentle directive. "Look at me," she says. "Wouldn't you feel better if you had a bath?" When the man replies that he's too weak to stand, De Salvo pats his arm. "I know," she says. "We'll send someone in to help you."
Help is in short supply these days for New Orleans' poor and displaced. Two years after Katrina, the vicious storm's impact on the city's health care system is still painfully evident (see box). All the major hospitals were flooded, including one where water moccasins and an alligator took up residence in the lobby. Two-thirds of the 3,200 physicians left town and didn't return. In short, for those who need medical care, says Dr. Irwin Redlener, director of Columbia University's National Center for Disaster Preparedness, Katrina was "a mega-disaster."
In the storm's immediate aftermath, DeSalvo was among a small corps of local doctors who leaped into action, setting up emergency card-table clinics to care for the injured, frightened and lost. "I saw this family at the Convention Center [where residents took refuge from the floods], and they looked shell-shocked," she says, retrieving from her computer a photo of a man and woman huddled together with their terrified children. "That's when it hit me: There will be tens of thousands of people like this who've lost everything. They survived. And I want to make sure they never feel abandoned again."
Even in the middle of the tragedy, DeSalvo began to realize that the storm's devastation might also be an opportunity. "I figured I'd never again get another chance," she says, "to rebuild a whole healthcare system from the ground up." With Charity Hospital, the 1930s-era facility treating the majority of New Orleans' poor, now destroyed, DeSalvo instead envisioned a system of smaller neighborhood clinics that could provide health care where it was needed most.
On Sept. 9 the first clinic opened on the porch of Harrah's Casino. Within just a few weeks, DeSalvo and her colleagues had established a network of 18 PATH clinics (for Partnership for Access To Healthcare) that today see 18,000 patients a month, treating them for everything from broken bones to indigestion. This past spring she traveled to Washington, D.C., to lobby for federal help, and on May 24 the U.S. Dept. of Health & Human Services awarded DeSalvo and her colleagues $100 million to keep the grassroots clinics flourishing. Says Louisiana Lt. Governor Mitch Landrieu: "Dr. DeSalvo didn't say, 'I can't.' She said, 'I'm going to find a way.'"
The seeds of the doctor's firm but gentle hand lie in her youth in Austin, Texas. The daughter of a mechanic who abandoned three young girls and a wife who had survived thyroid cancer, DeSalvo says her father's departure only strengthened her. "We'd go to his apartment and climb all over him, yelling, 'Daddy,'" she says, "and he wouldn't even look at us." In contrast, on the rare nights she could wangle a babysitter, her mother, Elaine, a medical office manager, would sometimes volunteer at a women's shelter. "She sewed our clothes and grew our food. We were really poor, but Mom said there was always someone worse off than we were who needed our help," says DeSalvo. "I grew up believing that's what you do—work hard and try to make the world a little better."
All these years later, says DeSalvo's husband, Jay, 42, an emergency room physician in St. Tammany Parish, she "has a passion to explore issues way beyond most people—especially in patient care. I find that really attractive." The two met in 1992 when both were residents at Charity. At first, DeSalvo, then dating someone else, turned him down, only to change her mind. By then, she says, "I had to make a bet with him over a Saints game just to see him again." The gambit worked: The couple, married in 1995, now live in an 1,100-sq.-ft. bungalow across the city line in Jefferson Parish.
Their home, decorated with paintings by DeSalvo's older sister, an artist, serves as a retreat after 80-hour work weeks spent juggling administrative duties with what DeSalvo loves most—hands-on patient care. But despite the tough schedule and the hopelessness that sometimes threatens to engulf her city, she voices only one regret. "I wish I had been here for the storm," she says quietly, recalling how she and Jay were on a rafting trip in Alaska when they learned of the destruction Katrina had caused and rushed home. In the long months since, however, "I feel I've been able to contribute," says DeSalvo. "I know that every day, people are getting care who would not otherwise get it. Even on the worst days, something good is happening here."
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- Patricia B. Smith/New Orleans.