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Nursing the Ninth Ward

Daniel Rothschild

August 11, 2007

Wall Street Journal

"You do not want to be sick in New Orleans." These are the stern words of Alice Craft-Kerney, a 21-year-veteran trauma nurse at the health clinic she runs in the Lower Ninth Ward -- a New Orleans neighborhood hit hard by Hurricane Katrina.

Nearly two years after Katrina hit, Ms. Craft-Kerney is a realist. New Orleans has a critical shortage of health-care facilities and a city government staffed with officials who can be an impediment to opening new clinics. She knows this because the city tried to stop her from opening her clinic in one of New Orleans's poorer neighborhoods.

When Katrina flooded New Orleans in August, 2005, Ms. Craft-Kerney worked at Charity Hospital, a hard case of a health-care facility that was run down and serving many poor, uninsured patients. Six months after Katrina, she returned to the city and felt called to open a small, nonprofit clinic.

She knew that the images broadcast on national TV, showing the Lower Nine as a hopeless ghetto of poverty, were misleading. She grew up there and still has family there. What she remembers was a place where neighbors looked out for each other and PTA meetings were standing room only. It also had homeownership rates approaching 60%.

But immediately after the storm, every hospital and medical facility in Orleans Parish was closed. Many have been slow to reopen. Charity Hospital, which served poor residents from throughout the city, suffered significant damage and remains shuttered. It may never reopen.

The current situation is bleak, as Mayor Ray Nagin testified to Congress earlier this month. Only 12 of the city's 23 hospitals and five of 13 public clinics have reopened, most at decreased capacity. Over all, New Orleans has two-thirds fewer hospital beds than it did pre-Katrina. As residents move back, some patients are forced to wait days for a bed. Mortality rates are up.

So when Ms. Craft-Kerney returned to New Orleans in February 2006, she and a team of volunteers decided to open a health-care clinic.

Her immediate problem was that she had no idea how to build one from the ground up. But, she told me, "the dots just started to connect." She convinced an old friend and fellow nurse, Patricia Berryhill, now remarried and living out of the city, to donate a Creole-style one-story house, set back from the road behind a wrought iron fence, to use as a clinic.

Dozens of volunteers, friends, foundations and donors brought their skills and resources to the table. Volunteers pitched in to renovate the house. Several contractors worked for free. A Florida State University student, Joe O'Shea, took a semester off to raise money. A group called Leaders Creating Change Through Contribution raised $30,000 and put in a week of rebuilding. Physicians and hospitals from as far away as Idaho donated equipment and advice.

Acts of serendipity helped the process along. One volunteer went to Home Depot to buy a plumbing part only to return with the part and a plumber he had met at the store who wanted to help. Office equipment arrived from anonymous donors. A medical software company donated patient management programs and training.

After months of work the clinic was set to open its doors on Aug. 30, 2006 -- 366 days after the storm. Ms. Craft-Kerney planned a grand opening, only to learn from zoning officials that the city was shutting her down before she saw a single patient.

It turns out, the city considered her clinic to be a commercial enterprise and Ms. Craft-Kerney made the mistake of opening it within a "residential" neighborhood. Her clinic also ran afoul of a few arcane codes, such as not having a second guardrail along its handicapped ramp. It seems, despite long waits to get building inspectors to visit homes, several inspectors managed to attend her clinic's grand opening where they noticed the code violations.

If asked about it, Ms. Craft-Kerney won't spend her time criticizing city officials. Instead, with the help of an architect and an attorney who volunteered their time and the assistance of a kind soul in the state fire marshal's office, she got her clinic up to code.

In March, 2007, she finally began seeing patients and right away witnessed the neighborhood's desperate need for health care. The clinic's staff, which includes a nurse practitioner, are capable of performing outpatient services such as diagnosing basic ailments, writing prescriptions and offering advice on how to receive more advanced care. But one of the first patients to walk in the door was so sick she needed emergency treatment. Ms. Craft-Kerney called an ambulance.

Since then she has seen hundreds of patients, most of whom need more routine services. Typically, the clinic sees about 14 to 16 patients a day. They come not just from the Lower Nine but from all over the area, including nearby St. Bernard Parish. The nearest hospital is about 30 minutes away, assuming the drawbridge over the Industrial Canal is open. Otherwise, it's a longer drive.

The Lower 9th Ward Health Clinic is a sign of hope in a community that has had few since Katrina. Its exam rooms, supply cabinets and antiseptic smell are similar to any small doctor's office in America. The sheer normalcy of the facility is jarring in a neighborhood that is still full of buildings in disrepair. And it's a working example of how a determined group can do more than government officials working in a distant office.

Ms. Craft-Kerney's clinic has been seeing patients, while Louisiana's $7.6 billion "Road Home Program," which is supposed to restore the city by handing out grants to residents, has been beset by problems. The state is only now working its way through applications fast enough so that its backlog cases are being cleared faster than new applications are being filed.

Ms. Craft-Kerney isn't bitter about her experiences. "I'm not a Katrina survivor. I'm a Katrina overcomer," she tells me. It's just too bad she not only had to overcome the fury of nature, but also the bungling of bureaucracy.