Community-Based Health Care for 'The City that Care Forgot'

References to New Orleans as “the city that care forgot” first appear as far back as the 19th century. Although this reference has pointed, generally, to the high levels of poverty, we submit that forgotten “care” may refer to inadequate preventative and ambulatory health care for its residents. As the most recent US census and health statistics data indicate, this epithet remained apt through the city’s mandatory evacuation in anticipation of Hurricane Katrina making landfall last month. Twenty-eight percent of residents in New Orleans lived below the poverty line (43% of children under the age of 5 years). Health statistics reported by the Centers for Disease Control and Prevention estimated that 60% of adults in Louisiana were overweight, 25% had diagnosed hypertension, 31% had diagnosed high cholesterol, 8% had diagnosed diabetes, and 85% of residents did not participate in physical activity on a regular basis. Louisiana placed 50th in overall health (i.e., the absolute least healthy state), a precarious ranking it has held for 14 of the previous 15 years. The devastation that Hurricane Katrina and its aftermath wrought on the city of New Orleans has been described in vivid detail throughout the world’s press. We relate the salient facts here in brief. On August 29, 2005, Hurricane Katrina slammed the Gulf coast of the United States with sustained winds of 165 miles per hour. On August 30th, 2005, the levees protecting New Orleans from Lake Ponchartrain failed, resulting in widespread flooding in 80% of the city. During the days that followed, the plight of New Orleans’ poor was played out repeatedly on the international news. Evacuation plans for the poor and infirm were not well planned, executed, or communicated. In the nightmarish situation that followed the actual storms, tens of thousands were stranded on highways and at “refuge” stations waiting to be taken away from the heat and squalor. Many of these people were elderly and ill and had not been able to evacuate. Before Hurricane Katrina, the Medical Center of Louisiana at New Orleans (also known as Charity Hospital) served as the health care safety net for many of these people. Opened in 1736, it was the oldest continually operating hospital in the United States and had remained a crucial source of healthcare in the “city that care