OBGYN.net Conference CoverageFrom the American Society of Reproductive Medicine, New Orleans, LA 2006
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
Roberta Speyer: 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?
Doctor Pridjian: That’s correct.
Roberta Speyer: Under pretty different circumstances.
Doctor Pridjian: That’s correct. That was the day we had that hurricane.
Roberta Speyer: 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?
Doctor Pridjian: 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.
Roberta Speyer: Did you move people? Move staff around to other locations?
Doctor Pridjian: To some degree we did, but most of the staff and residents evacuated and just the core was here to man the hospital.
Roberta Speyer: What about the patients?
Doctor Pridjian: 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.
Roberta Speyer: No time. And you, yourself personally, did you leave?
Doctor Pridjian: 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.
Roberta Speyer: 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?
Doctor Pridjian: 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.
Roberta Speyer: 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.
Doctor Pridjian: 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.
Roberta Speyer: Charity is right behind us here where we are sitting.
Doctor Pridjian: That’s correct.
Roberta Speyer: 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.
Doctor Pridjian: That’s right.
Roberta Speyer: They are still not open and they will not.
Doctor Pridjian: No, the old Charity Hospital that we know so well, the very tall building, will probably never re-open again as a hospital.
Roberta Speyer: 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?
Doctor Pridjian: Most of them are in this state but also outside the state, as well.
Roberta Speyer: About how long did it take to get everybody evacuated?
Doctor Pridjian: 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.
Roberta Speyer: So in the scope of the disaster as we know it, you were actually very good at your first response.
Doctor Pridjian: I think this downtown hospital was fantastic at our first response.
Roberta Speyer: 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?
Doctor Pridjian: 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.
Roberta Speyer: They just did not have access to the records and so they had to do the best they could with minimal information. .
Doctor Pridjian: Right.
Roberta Speyer: 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.
Doctor Pridjian: Right.
Roberta Speyer: 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.
Doctor Pridjian: 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.
Roberta Speyer: 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?
Doctor Pridjian: Absolutely.
Roberta Speyer: 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.
Doctor Pridjian: Definitely.
Roberta Speyer: 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?
Doctor Pridjian: 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.
Roberta Speyer: Are you pretty much back up and running with a full team now?
Doctor Pridjian: 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.
Roberta Speyer: Some cities really stepped up to the plate to help you. Was Houston one of them?
Doctor Pridjian: 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.
Roberta Speyer: 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?
Doctor Pridjian: That’s right.
Roberta Speyer: Because when you live in New Orleans and the repairman decides he’s coming, that is a pretty important day.
Doctor Pridjian: Absolutely.
Roberta Speyer: Clear the calendar.
Doctor Pridjian: It’s hard to get a repairman to do a small item. Most of them are working on such large projects.
Roberta Speyer: Well, I am very glad you took the time to talk to us about this and I am sure the last thing everyone would like to take away from this is, is there anything anyone can do? People who would like to help, maybe do something to help Tulane or any of the medical centers in New Orleans? What would you suggest? What could someone do? Donations, things like that.
Doctor Pridjian: I think the individuals who were hit the most with respect to the medical centers are the young doctors in training. They were displaced, they had to live in different areas. Many of them had homes that were ruined, their textbooks were ruined. So I think if you are thinking along the lines of donations, I think it would be toward their needs.
Roberta Speyer: So everyone should try to see if they can help. How would they identify somebody? Is there a way, if we put your email up next to this interview and your department assistant, if somebody would like to help or get in touch with you if they have books or possibly opportunities, they could help with residents, they could contact you?
Doctor Pridjian: Yes.
Roberta Speyer: Thank you so much. Thank you for taking the time.
Doctor Pridjian: Thank you. Absolutely.
Roberta Speyer: Good luck with the stove and thank you so much. As I said before, this is Roberta Speyer. I am here for OBGYN.net and we are here in New Orleans talking with Dr. Gabriella Pridjian about what it was like for the OB/GYN department at Tulane after Katrina hit. Thank you.
Doctor Pridjian: Thank you.