Kim Knoblock was a licensed practical nurse at a Bay St. Louis nursing home. But on Aug. 29, when Hurricane Katrina took her home, her mother's home, and then her mother, staying on the Mississippi Gulf Coast became too much to bear.
Knoblock relocated to Bush, La., and plans to look for work somewhere away from the water. She says no to the danger, the responsibility, the professional hazards and the deep emotional wounds that come with working in a hurricane-prone area.
"I will not put myself in that situation again. They don't pay you enough. No amount of money is worth what I lost and what I went through that day."
Knoblock, 44, is part of a trend that is alarming the medical community in the Katrina-ravaged areas: Doctors and nurses have been clearing out and don't plan to come back.
The medical community says doctors on the Coast — many of whom had their practices wiped out along with their equipment and medical records — have been neglected. And a failure to stabilize coastal health care, they say, could seriously hamper the state's recovery.
"If we don't get something moving fairly fast, we're going to lose quite a few of the physicians," said Joe Dawsey, the executive director of Coastal Family Health Center, which is treating patients out of mobile units since losing its Bay St. Louis and Biloxi clinics in the storm.
Dawsey already has fielded requests for references from out-of-state offices where his doctors have applied and he expects to lose about half his 32 nurses. He recently received notice from his nursing director who lost everything in the storm. She called to say, "I just can't take it anymore," he said.
Those who've suffered significant loss or those who don't have strong ties to the community are the most likely to leave, they say. There are 771 doctors licensed to practice in Jackson, Harrison and Hancock counties, according to the State Board of Medical Licensure.
If primary care doctors leave, specialists could follow. And if private employers increase their pay to lure doctors back, it will make it doubly difficult for the center, which serves mostly uninsured patients, to compete for physicians.
While many patients have left the area themselves, others, including relief workers and repairmen, have flooded in. Doctors report a rise in depression among those who've stayed, some of whom still are waiting for travel trailers as the temperature begins to drop.
Others have set up trailers on their property next to their destroyed home and, like Donna Sims of Pass Christian, are forced to look at their loss day after day. Sims, who was treated for an infected cut on her foot at the center's Biloxi mobile unit, spoke of a more persistent health problem.
Dr. Bert Welch, a Jackson anesthesiologist, is coordinating some relief for struggling coastal physicians. The two questions he's heard most from doctors, he said, are: "How can I get my clinic back," and "how can I pay for it?"
The anesthesiologist is using his medical equipment sales and distribution company, Med One LLC, to help streamline services for the doctors, including bulky loan applications to the Small Business Administration. The idea is to help them pull together a profile of need, including construction and equipment costs, they can take to the SBA, a process he hopes will speed up their financing.
He also wants to direct them to services, perhaps with the help of other companies, and has arranged for a contractor to go to the Coast to start surveying gutted offices. Doctors ideally will have assistance with acquiring everything from office furniture and medical equipment to cottonballs and gloves.
Physicians also need to know how to start again without their medical records. Some have expressed interest in electronic recordkeeping, he said. Companies that provide services such as bill collection also may have left the state. And Welch is considering creating a pool of office staffers, where physicians can share employees on a prorated basis.
He also has discussed with the governor's office and some congressmen the possibility of using money from Katrina disaster funds to help the doctors. It's important to give them a reason to stay, he said, "because when they're gone, more than likely, they're gone."
Moran came back for a visit days before the storm and now expects to stay until February to tend to damage at his Gulfport property. The problem is he is uninsured, HIV-positive and must rely on the local health-care system for medication.
He was referred to three different cities for blood work and paperwork, like a "chicken with my head cut off running everywhere," he said, before ending up at the Biloxi clinic. He will return home eventually, but says patients here have a reason to worry. "I would be concerned about the flip-flop you have to go through," he said.
Dr. Scott Russell, medical director of the Coastal Family Health Center, now reports to the Biloxi mobile unit to treat patients. The internal medicine doctor whose home sustained little damage, said he is committed to staying on the Coast.
"The funny thing about that is, I actually have thought several times to myself, if there was ever a time I wanted to leave, now is the perfect time," he said. "The problem is I like my job, I like where I am."
"It's horribly frustrating because I can't find most of my patients, they can't find me. I don't know if they've got their medications or if they're even alive. I deal with a whole bunch of HIV patients and I can't find them."
He said some doctors are leaving, saying they can't tolerate such primitive circumstances. He believes, however, that although conditions are difficult now, they will turn around in three to six months.
Knoblock wants to find new employment as a nurse, but plans to look for a job in a doctor's office as opposed to a nursing home, where demands are higher in the event of a storm.
The owner of the nursing home where she worked was caring, she said, and ensured patients were safely relocated. But she warns patients others may not be so careful, and could cut corners to save money during an evacuation, affecting supplies such as the back-up oxygen. "They really need to take a very good, long, hard look at where they are," she said.
Employers expect nurses to put patients first, she said. But in the event of a monster hurricane, hospitals are vulnerable to looters. And if power goes out, nurses must ventilate patients manually with air bags, with no one to take over — all while grappling with the wrenching moral dilemma of who should be the priority.
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