UNHEALTHY SITUATION

Section: Health

Kate Moran

Nurse practitioner Dorothy Davison used to believe the level of health care available almost anywhere in the United States far outstrips what patients can find in the Third World countries where she has done relief work.

Then she came to post-Katrina New Orleans.

At the free clinic Davison and her husband, a physician, run in eastern New Orleans, they have encountered diseases run amok: astronomical blood sugar levels among diabetics, an advanced case of cancer that had eaten away at a woman's breast. The situation is blamed on the scarcity of health care in one of the most devastated parts of the city.

The clinic has been a lifeline to residents in the east, but Davison has had to tell their "distraught" patients that it will close in less than a month.

Operation Blessing, the charity that launched the clinic after Katrina and raised thousands of dollars to support its operations, has exhausted the stash of private donations that came pouring in after the storm.

Operation Blessing began its Katrina relief efforts by shipping medications to Louis Armstrong International Airport, which was converted into a medical triage center just days after the storm.

The free clinic in the east opened in April 2006, and since that time it has helped almost 35,000 patients and dispensed more than 83,000 free medications.

"Since we have been there, we have found it has been like an oasis of healing in a sea of suffering," said Bill Horan, president of Operation Blessing International. "It has been a great honor to serve the people of New Orleans. We wish we could do it forever, but we simply can't."

The closing threatened to strand thousands of uninsured patients in eastern New Orleans without health care in their neighborhood, but the city Health Department -- aware for some time that the clinic would close -- has made provisions to turn an obstetrics clinic on Read Boulevard into a full-service primary care office by January.

Horan said Operation Blessing is also talking with a partner that could take over the clinic's assets and continue to serve patients in the east after the medical office and pharmacy close Dec. 21. He declined to name the partner for fear of jeopardizing negotiations.

Davison and her husband, Dr. Dale Betterton, have run the clinic with the help of doctors from the Mayo Clinic in Minnesota, who come to New Orleans one week a month to volunteer their services.

Davison and Betterton accept no money for their work, and they lived out of a trailer in Slidell for much of the time they have worked here. They now live in a house in Slidell paid for by Operation Blessing.

The couple met on a volunteer mission to the Dominican Republic after a hurricane, and they both took early retirement to dedicate themselves to international relief missions.

Shocking conditions

Davison said she never expected to work within the United States, but she has encountered runaway chronic disease and other conditions here that testify to widespread difficulty finding health care since the storm.

Just last month, two patients came to the clinic with lesions covering their bodies. Davison diagnosed them as having full-blown cases of AIDS. Patients often find out they are HIV-positive before the virus progresses into AIDS, but these patients had never been tested.

"You usually don't see that in this country," she said.

Davison said the patients she treats are often "newly made poor" -- former members of the middle class who had a house, a steady job and health insurance before Katrina. They "did everything right" but suddenly found themselves on the underside of fate, she said.

When she has referred them to the state's Charity hospitals for specialty care, she said, some of her patients have experienced the indignities of being shuffled through an overcrowded system for the first time. An uninsured patient with prostate cancer she saw in October 2006 could not get an appointment with a urologist in the Charity Hospital System until the following April.

Davison has found herself on the phone many times advocating for patients who have no insurance and no place to turn for specialized care that the clinic cannot provide.

When the patient with the corroded breast went to an emergency room but was not admitted to the hospital because she had no insurance, Davison said she called Tulane Medical Center and had the chief executive on the phone "in five minutes."

"Besides being medical workers, we've been case workers," she said.

A far ride

The Operation Blessing clinic provides all types of primary care services, plus dental care, foot care for diabetics, Pap smears and other gynecological care, HIV testing and a pharmacy.

Demand is so great that new patients must show up at 6 a.m. to check in with a security guard and sign up for an appointment later in the day.

"At first, there was hardly anybody here. Once people started hearing about it, it's been packed," said Gilda Faciane, an eastern New Orleans resident who first went to the clinic for an infection and found out she had diabetes. She now goes for regular check-ups.

When the clinic closes in three weeks, patients such as Faciane say they will have to travel considerable distances to find free or low-cost health care. A few primary care practices have returned to the east, but Operation Blessing was the main clinic that catered to the uninsured.

Faciane already drives her father-in-law to Jefferson Parish three times a week for kidney care, which is not available in their neighborhood. She does not know where she will turn for her own health needs once the Operation Blessing clinic closes, but she expects it will involve another bothersome car trip.

"They provide a service for people who have no place else to go," Faciane said. "Whether they know it or not, we all appreciate it."

The clinic that the Health Department plans to open will be just down the block from the beehive of trailers where Operation Blessing's medical offices are based. Dr. Kevin Stephens, the department's director, said the city clinic will not be free but will charge a fee based on a patient's income.

"The city has stepped up to the plate to get services to the people in New Orleans East, because we know they need it," Stephens said. "We're doing everything we can with limited resources."