Big Chief Theodore Emile “Bo” Dollis, a musician and one of New Orleans’ legendary Mardi Gras Indians, spent the last years of his life struggling with the effects of a stroke and failing kidneys that forced him onto dialysis for nearly a decade. But unlike most people without health insurance, he got top-notch care at the New Orleans Musicians’ Clinic until his death this past January at age 71.
“I don’t know if my husband would have survived as long as he did without the Musicians’ Clinic,” says his widow, Laurita “Big Queen Rita” Dollis. “That’s because he got everything he needed – X-rays, blood work, referrals to specialists – without any stress and didn’t have to wait hours in the emergency room just to see a doctor.”
The clinic on a leafy street in the city’s Garden District is part of one of the great success stories to emerge from the rubble of post-Katrina New Orleans, experts say. Now the clinic is one of a network of more than 70 community-based medical clinics in the Big Easy, up from just a handful before the storm.
Following the catastrophic hurricane, health care administrators and providers strategized to make their public health system more resilient in a disaster, and focused on improving patient delivery to the city’s indigent population—a change that studies since have shown is remarkably better for patients.
“In the aftermath of Katrina, few could have predicted that the next 10 years would bring a profound transformation to the health system here in New Orleans,” says Charlotte Parent, director of the New Orleans Health Department.
New Orleans’ ranking in county health assessments by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute has improved for three consecutive years. The uninsured rate tumbled from 25% before the storm to about 16.9% in 2013, due to the Greater New Orleans Community Health Connection (GNOCHC), a joint federal and state program that provides insurance to the poor.
Things certainly didn’t look promising right after storm, which flattened the city and triggered the collapse of the public health system. The breach of the city’s levees and flooding that overtook 80% of the city shuttered 13 of 16 acute care hospitals, including Charity and University Hospitals, two fabled public facilities that had long served the poor. The storm also displaced thousands of health care providers, from nurses and doctors to specialists. Those medical professionals who stayed faced serious shortages of laboratory facilities, hospital beds and pharmacies.
“We lost everything—our offices, our staff, even our bank accounts were frozen,” Bethany Bultman, the musicians’ clinic’s executive director, said.
Public health officials saw an opportunity to replace an antiquated system that had forced the city’s poor and uninsured residents to rely on public hospitals located in the city’s central core, such as “Big Charity,” or go to hospital emergency rooms when their untreated conditions escalated out of control. Before the storm, it often took months to get an appointment at the hospital and even then, many patients waited hours to see a doctor. Often, treatable ailments festered into into life-threatening ills.
“Bring a book because you’d spend the whole day there even if your appointment was at 8:30 in the morning,” Dollis recalls. “And you didn’t know which doctor you might see – which meant that you’d have to tell the same story all over again. That’s why so many people ended up in the emergency room, because they didn’t want to go through all that.”
Health officials, faced with near total destruction, sought to rebuild the health system from the ground up by making health care and preventive services more accessible for the city’s poor and uninsured residents. To meet initial demand in the months right after Katrina, health officials set up 18 impromptu street clinics in New Orleans’ poorer neighborhoods. The “clinics” were the barest of bare bones, operating in tents in front of police stations and the casino, in abandoned department stores and supermarkets, in church basements and rectories, and in school dormitories. Doctors and nurses practiced medicine at card tables, and stored medication and vaccines in ice chests.
“Prior to Katrina, there was no network of community primary care centers and you’d hear story after tragic story of generations of people, even pregnant women, who relied on the ER as their only source of care,” says Dr. Diane Rittenhouse, a family doctor and health policy analyst at UC San Francisco who evaluated efforts to improve health care in New Orleans after Katrina.
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