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Bascom Palmer’s Vision Van offered services to battered Louisiana
Shortly after Hurricane Katrina struck, faculty from Bascom Palmer Eye Institute were in the heart of the hardest hit areas, offering medical services and aid.
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When Hurricane Katrina struck the Gulf Coast, it did not take long for senior officials at Bascom Palmer Eye Institute to respond using their newly commissioned Vision Van, a 40-foot-long, fully operational ophthalmic services vehicle. Over the course of one week, several ophthalmologists and ophthalmic technicians from Bascom Palmer rotated in and out of Louisiana, bringing much-needed medications, optical equipment and general medical knowledge to the storm-ravaged area.
“Basically, we were meeting an unmet medical need,” said Carmen A. Puliafito, MD, MBA, professor and chairman of the Bascom Palmer Eye Institute. “Evacuees and a vast majority of the patients we saw were individuals from New Orleans, from those areas that had been completely swamped. They had been rescued from attics; they had lost everything.”
 Ophthalmic technicians Gregory Freelove and Ramon Diaz, Dr. Andrew Moshfeghi and members of the 82nd Airborne Division in front of Bascom Palmer’s Vision Van. Images: Bascom Palmer Eye Institute |
Getting started
Two members of the Vision Van team, Stephen Couvillion, MD, and Andrew A. Moshfeghi, MD, headed to Louisiana before the rest of the team to secure physician accreditation and to scout the best sites for relief effort, said Mike Kelley, a senior administrator with Bascom Palmer and the driving force behind the Vision Van’s mission to the Gulf region. Other Bascom Palmer physicians involved in the effort included Ben Mason, MD, and Dr. Puliafito.
The Vision Van has been operational only for 5 months, Dr. Puliafito said. At a cost of about $400,000, the van is a fully self-contained unit, complete with a 14 kW generator, three air conditioning units, a fundus camera, an autorefractor, more than 1,000 bottles of ophthalmic medications, and hundreds of pairs of spectacles and contact lenses.
The van was funded by a grant from the Josephine S. Leiser Foundation of Fort Lauderdale, Fla., Dr. Puliafito said.
Stocking up for the relief effort involved more than $100,000 worth of ophthalmic products, Dr. Moshfeghi said in a Web log about the experience. Bascom Palmer provided “all the necessary components of a functioning exam lane and minor operating room with enough materials to last several weeks,” Dr. Moshfeghi said.
(The blog, covering the period from September 15-25 and including comments from physicians and administrator Mr. Kelley, can be read on the Bascom Palmer Web site, www.bpei.med.miami.edu. Click on Katrina Relief Efforts and then on the dated entries in the right-hand column.)
First impressions
The Vision Van first went directly to Baton Rouge to treat evacuees, but the state health department reassigned the group to New Orleans, Dr. Puliafito said in an interview with Ocular Surgery News. Once there, they treated not only displaced residents but also many emergency personnel as well.
“We had a lot of the first responders – police, etc. They were living on a cruise ship. When we saw members of the Louisiana National Guard, many of them had all kinds of eye irritations,” Dr. Puliafito said.
Before leaving Miami, the Vision Van had been stocked with contact lens solution and sunglasses, he said.
In New Orleans, the scene was “frenetic, yet controlled,” Mr. Kelley said on the blog. The helicopter aircraft carrier Iwo Jima was located about 200 yards south of the Vision Van, which took up temporary residence near the Ernest N. Morial Convention Center, he said.
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“We saw a huge line of troops from the 82nd Airborne, Homeland Security personnel and sailors attached to the Iwo Jima” as they came off duty, Mr. Kelley said. “Some had been in their contact lenses too long; others were complaining of fecal-contaminated dust swirling around, now that the mud was drying out.”
Many of the patients seen in the Vision Van had known ophthalmic conditions, such as glaucoma or refractive errors. By Dr. Puliafito’s calculations, during the week the Vision Van was in Louisiana, the group dispensed between 350 and 500 pairs of eyeglasses. Dr. Moshfeghi saw upwards of 50 patients a day, Mr. Kelley said.
On the third full operational day in the region, the group of four ophthalmologists and four technicians saw “more than 100 patients,” with many more still waiting for care, Dr. Puliafito said on the blog.
“During the time we were in Baton Rouge and New Orleans, we were continuously being resupplied from Miami,” Dr. Puliafito told Ocular Surgery News. He noted that some of the people affected by the flooding stayed in New Orleans, while others were transported to Baton Rouge.
“We got the Vision Van loaded up pretty well,” and industry played a large role in making the van functional, Dr. Puliafito said. Among the organizations he credited for their contributions to the Vision Van were Alcon, Allergan, Topcon, Marco and the Congressional Glaucoma Caucus Foundation.
At the time the van was operational in New Orleans, the number of local residents still in the city was “very, very small,” Dr. Puliafito said, but New Orleans was home to more than 10,000 military personnel.
“Everyone was thrilled we were there, to be honest,” he said. “What we were doing there reinforced how important our profession is. There was an unlimited stream of people the whole time we were there.”
The physicians treated mostly refractive errors, topical inflammation and glaucoma — often for patients who had evacuated without their medications, Dr. Puliafito said. The van was equipped to handle cases of endophthalmitis, but that was not necessary, he said.
“The intensity level was not necessarily as high” as the physicians had thought it might be, he said. No one needed emergency surgery, and the Vision Van was able to accommodate everyone. The physicians referred many patients to Louisiana State University in Baton Rouge for follow-up care. Everyone who underwent an ophthalmic exam in the Vision Van “got a complete record of the visit” so follow-up care could have more continuity, he said.
Local facilities lacking
When the Vision Van was in New Orleans, no other medical facilities other than those onboard the Iwo Jima were operational in the city, Dr. Puliafito said.
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“Right now, there are no ophthalmologists in New Orleans,” he said.
“The damage to the medical infrastructure in New Orleans is without parallel in U.S. history,” Dr. Puliafito said in the Bascom Palmer blog. “The Ochsner Clinic and two other hospitals in Jefferson Parish are open and are bearing the burden for the entire community.”
Mr. Kelley said a prevailing belief is that Charity Hospital is so badly damaged from Hurricane Katrina that it will have to be demolished.
The van’s self-sufficient generator and ability to run air conditioning was of paramount importance, Dr. Puliafito said. Failure of hospital power generation systems was “the key factor” in patient deaths immediately following the hurricane, he said. In some facilities, the temperature rose to 106°.
While the Vision Van was in New Orleans, Lt. Gen. Russel Honoré, Commander of Joint Task Force Katrina, presented Carl-Edouard Denis, Ramon Diaz, Gregory Freelove (all ophthalmic technicians), Dr. Moshfeghi and Mr. Kelley with a medallion “For Excellence Presented by Commanding General First United States Army—First in Deed.”
The Vision Van left New Orleans when the threat from Hurricane Rita began to escalate. The van was left in Baton Rouge, and a new team of Bascom Palmer staff was scheduled to depart for storm-ravaged southwestern Louisiana at the end of September.
“We are tired and hungry, but there is always one more patient who needs to be seen, one more addition to the line who can’t wait until tomorrow,” Mr. Kelley said on the blog from Day 6 of the Vision Van’s mission.
For your information:
- Carmen Puliafito, MD, professor and chairman of the Bascom Palmer Eye Institute, can be reached at 900 NW 17th St., Miami, FL 33136; 305-326-6303; fax: 305-326-6308; e-mail: CPuliafito@miami.edu; Web site: www.bpei.med.miami.edu.
- Michelle Dalton is the managing editor of the OSN SuperSite. She writes daily updates on all aspects of ophthalmology.