Gabriella Pridjian, MD

Gabriella Pridjian, MD
   Professor and Chairman
   The Ernest A & Elizabeth Miller-Robin Chair in Obstetrics & Gynecology
   Assistant Dean for Lakeside Hospital and Clinics
   Adjunct Professor of Pediatrics
 Clinical Geneticist, Human Genetics Program

 Hello, this is  Roberta Speyer.  I am reporting for OBGYN.net.  I am here in New  Orleans and we came to attend the ASRM meeting which is one of the first  medical meetings that has been held in New Orleans since hurricane  Katrina.  I am here today with Dr Gabriella Pridjian, who is the Chair  of the Tulane Medical Center University OB/GYN department.  Today is  October 22, 2006.  But there was a date not too long ago last year, the  29th of August that you were here in this office?

That’s correct. That was the day we had that hurricane.

 The reason we are doing this  interview is because it occurred to us that so many of our viewers  around the world who share in their hearts the love of obstetrics and  gynecology do not understand what a terrible ordeal they went through  here. You must also worry about what might happen if such a disaster  happened somewhere where you lived, in your hospital. So we are going to  let Dr Pridjian tell us a little bit about what happened here and what  advice she can give to her colleagues if you ever find yourself in some  type of situation that is a natural disaster, that is perhaps very  unanticipated and sudden. What happened?

Well, I can start a couple days  before the actual hurricane hit and it hit on Monday morning, August 29,  2005. We were approaching the weekend before, it was Thursday or  Friday, and we got wind that, indeed, there was a hurricane en route and  in a very short period of time, it appeared to have taken a change in  its projected path and we were right in the middle of the projected  path. So we have hurricane preparedness plans in place, so we did the  usual things. We have faculty in various hospitals that we cover,  obstetrics and gynecology, and we put our residents there. Our hurricane  plans were definitely in place.

 Did you move people? Move staff around to other locations?

To some degree we did, but most of the staff and residents evacuated and just the core was here to man the hospital.

The patients? Those who could be  evacuated, discharged or moved safely to other areas, that was  performed. But we still had patients in all of the hospitals. We did not  evacuate all of the patients. We just couldn’t. We did not have the  time.

 No time. And you, yourself personally, did you leave?

No, I did not, I stayed here. As a  matter of fact, I lived in this office for about four days after the  storm until I could evacuate through Tulane Hospital and Clinic via  helicopter.

 I am not sure people realize in this  part of downtown New Orleans just how high the water came and just how  isolated you were. What was that like? What facilities did you have and  what did you lose over those four days you were here?

Initially after the storm, we felt  pretty good because we just had some damage, the electricity was out,  but things were all able to be repaired within a week, but when the  flooding came, that is when the disaster really occurred pretty  dramatically. Eventually, we got five or six feet of water here. This  downtown area is in the bottom of the bowl, so to speak, so all the  teaching hospitals, Charity, Tulane and various other companies, were  all under water. The first floor of the medical school was completely  flooded. The generators were in the basement, they eventually stopped  working. The hospital generators eventually stopped working. Within 24  to 36 hours, we had no land lines with respect to telephones, we had no  cellphone service, the internet was not working, we could not  communicate through the Tulane website. We were pretty much in  isolation. There were very few areas of communication and that was our  major problem, initially just trying to communicate. There was a command  centre established in the hospital to help the faculty and the  residents and staff and to evacuate patients. We were fortunate that we  had a little portable radio with some batteries and we listened to the  one and only radio station that continued on the air through the whole  hurricane and the aftermath.

 In this situation, you said at first  you did not think it was so bad and then I guess it was the breach of  the levees, when the water started to escape and started to rise and  fill up the first floor of the building. When you started to realize  just how bad it was and you were listening to the radio, the only  communication you had with the outside world, were you expecting a  response? What were you expecting to happen from the outside world and  what was your reaction or your department? How did you have to take  things into your own hands? Tell us a little bit about that process.

Well, I think the first thing we  thought about were patient-related. I think we are all in this business  because we care for patients and they always come first and that was our  first goal – to make sure all of our patients were safe. That was done  with the help of Hospital Corporation of America, or HCA Corporate, who  was very on the ball and sent helicopters, helped us in all the ways  they could and we evacuated our patients directly from this downtown  area to other hospitals in the HCA system. We feel very fortunate that  we did this very efficiently, given other circumstances in the city.  Some of the hospitals, the Charity system, those hospitals were a little  slower in getting their patients out.

 Charity is right behind us here where we are sitting.

 There is a wall and behind this wall  is a road and you pointed it out through the window to us that that was  where you were watching the water rise.

 They are still not open and they will not.

No, the old Charity Hospital that we know so well, the very tall building, will probably never re-open again as a hospital.

  Your hospital came in and was able  to evacuate people, they had a system in place to bring them out. Did  they bring them outside the state, to other hospitals within the state?

 Most of them are in this state but also outside the state, as well.

 About how long did it take to get everybody evacuated?

 I think all the patients were  evacuated about two or three days after and all the faculty and staff  about four or five days after.

 So in the scope of the disaster as we know it, you were actually very good at your first response.

 I think this downtown hospital was fantastic at our first response.

 Others, as you well know, in living  still in this community, did not fare so well. Many people were not able  to evacuate and many people in many other hospitals and tertiary care  facilities, were not able to mobilize as quickly. What advice would you  give to chairs or directors or other physicians around the world? We see  there are many disasters, some of them weather-related, but just  natural disasters. Things happen. It is a big world. What advice would  you give to colleagues around the world about how to prepare. What do  you think you did right that helped you come out as well as you did and  what, maybe, could be done better?

I think the most important part  would be to take any threats seriously. I think part of the problem in  New Orleans is we have a lot of hurricane threats. We have not had a bad  hurricane for a long period of time. We have to take each threat very  seriously and plan accordingly. Secondly, I think our major problem in  the immediate post-storm time, was communication. Simple things we  learned are generators do not go in the basement, especially in an area  that is prone to flooding. Later, after the storm, there were problems  communicating still when all of the faculty and residents had evacuated  to various parts of the country. We had no contact numbers, we could not  reach them through the Tulane email system. So now we have contact  numbers for all of our faculty, residents and staff who don’t have a 504  area code because all of the phones, either cellphones or land lines,  did not work in the 504 area code. I now have all this information  electronically on a USB key in my purse when I walk around so in case  something should happen, it is readily available. I would suggest that  practitioners do this, as well. We also have our electronic information  now backed up in a distant server, not in this area. So if we had to get  to information on the Tulane website, we could do that easily and not  through all the hoops we had to jump through to get our website back up  and functional so we could contact each other. The other area I think is  important is patient information. That was also a very difficult  situation. Patients in the hospital or even individuals who left this  area who needed medical care had no records. When patients were  evacuated, although records tried to accompany the patients, it did not  always happen. In OB/GYN, for example, a high-risk woman would have no  information and she would end up in somebody’s obstetrical emergency  room and we noticed there were a lot of caesarian sections and we tried  to figure out, in retrospect, why. I think it was the lack of  understanding of what the problem was so let’s just do a c-section. That  is an anecdotal type of evaluation.

  They just did not have access to the records and so they had to do the best they could with minimal information. .

 Yet these are patients who were  already seeing someone like you who is a maternal-fetal medicine  specialist. Patients who thought they had already done everything they  should do. They had good records. But those records were not readily  available to follow them.

 Just curious – do you see in the  future more of a need for the ability for patients to be able to carry  some of their records with them on memory sticks or things like you are  suggesting you do now for your department.

Right. What we did with our  obstetrical patients this year for the hurricane season is we gave them a  duplicate ACOG obstetrical flowsheet and when they came for their  visits, we filled in theirs, we filled in ours and they just walked  around with theirs. If they had to evacuate, they had their medical  record. In the ideal world, we would all be on electronic medical  records and they would be backed up in some faraway place in addition to  the central location. We are not quite functional in the ideal world  yet. But that would be the best thing we could do.

 On the other hand, it’s OBGYN.net  and we love the internet, but there is something to be said for  duplication of effort, so having things for people, would you give them  that advice to have electronic copies, but also to have paper copies?

 Have as many duplications of  information at various points is what I am hearing you say. Remote and  not all at the point where the disaster may occur.

 To round things out, if you could  just tell us a little bit about what it has been like getting back on  track in the last year for your department. Has it been difficult  because when you dealing with high-risk pregnancy and you are dealing  with obstetrics and gynecology, perhaps it is a little different than  emergency medicine or perhaps it is the same? Tell us a little bit about  how you fit in to the equation of bringing your services fully back  online?

It has been quite a challenge,  probably the greatest one I have ever had to undertake. With respect to  patient care, we came back, some of my faculty members were here the  last week of September when we were just allowed to come back in to the  city, and started to see patients and give obstetrical care. We trickled  in as time allowed and access to individuals’ homes was allowed. For  example, I could not access my home until the second week of October and  there were some homes which could not be accessed for much longer after  that. Most of our faculty members were scattered throughout the  country. Many were in Houston. We did have some meetings with respect to  planning the department in Houston.

 Are you pretty much back up and running with a full team now?

We only lost a couple faculty. The  resident training has been a continuing challenge, although that is  getting better and better. We have lost a lot of clinical volume in the  city for resident training. In the initial year after the hurricane,  residents trained temporarily in Houston and other areas of the country  and they have all since returned, most of them. As the volume increases,  we feel more comfortable that the residency training program is still  doing quite a good job in training obstetrician/gynecologists for the  future.

 Some cities really stepped up to the plate to help you. Was Houston one of them?

Houston was wonderful, especially  Baylor who took the lead and helped train many of our residents, not  just in our specialty, and many of our medical students, as well.

 Well, we certainly appreciate your  taking the time today. You know, she has to come in on Sunday to talk to  us because on Tuesday she has to wait for the repairman to come out to  the house and fix the stove, right?

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OBGYN.net Conference CoverageFrom the American Society of Reproductive Medicine, New Orleans, LA 2006

Gabriella Pridjian, MD speaks with Roberta Speyer about her experiences during hurricane Katrina

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Gabriella Pridjian, MD

Articles

Gabriella Pridjian, MD speaks with Roberta Speyer about her experiences during hurricane Katrina

Gabriella Pridjian speaks with Roberta Speyer about her experiences during hurricane Katrina Video