05-SEP-A-8
A NEW DAY ON THE LOUISIANA GULF COAST
ACROSS THE MISSISSIPPI RIVER FROM FLOODED
NEW ORLEANS IN JEFFERSON PARISH,
AS WE BEGIN WORK IN WEST JEFFERSON HOSPITAL
September 6, 2005
I am up and out at 5:00 AM although the rest of my gym-ful of cot-mates are still quietly snoring in the dark. I am functioning off the battery power in the laptop, whereas the hospital will be using a generator. They are expecting that a full complement of staff will come to work today under the curfew restrictions—they have to arrive with a full tank of gas (however achieved) and with proof of residency and workplace, then they can enter the Parish of Jefferson, where I am in the rather cushy West Jefferson Hospital; I hear that East Jefferson Hospital is worse, so we may make a sortie in that direction. As always happens with an overwhelming infusion of relief supplies and personnel, there is a question of how and whether we will be used to best effect. I heard the chief of staff and CEO of West Jefferson Hospital welcome us warmly to his 400+ bed hospital which does full service including neurosurgery and cardiac, with only the latter suspended, but there are 260 patients here now, in what he considers a lull before the influx of all the returnees or the rumors that we are open for business with an infusion of expertise from the East Coast.
As he explained, and we all are ready to learn, this whole thing requires flexibility in the extreme, and we are all on a full time learning experience without much precedent, but perhaps establishing a few. We are getting up and pacing about, some less patiently than others, with some sense of guilt as many are expecting breakfast that our presence here has so far imposed extra consumption more than a positive return in productive output. We will see how this “discovery day” develops.
THE “LEARNING ORGNAIZATION”:
WE ARE BREIFED, DEBRIEFED, RAPIDLY MOBILIZED,
SCRAMBLED TO ONE SITE AND PULLED BACK AS AN
OVERABUNDANCE OF RETURNIGN STAFF AND A PAUCITY OF PATIENTS, MAKES A TOTAL RETOOLING OF THE MISSION COMMAND NOW CALLS FOR “OPERATION LIFELINE”—
WITH THE PLEADING OF THE JEFFERSON PARISH PRESIDENT
WE DECAMP FROM WEST JEFFERSON HOSPITAL,
AND ARE CONVOYED FORWARD TO AN ABANDONED
TENET HOSPITAL “MEADOWCREST” AHEAD OF THE SECURITY AND “FEMA COMMAND CENTER” THAT WILL FOLLOW, AND SET UP IN THE ABANDONED FACILITY
FOR DEPLOYEMNT IN SIX ABANDONED SCHOOLS IN TEAMS EQUIPPED BY SCAVENGING SUPPLIES FROM THE ABANDONED AND PLUNDERED MEADOWCREST HOSPITAL
I had just studied the “organizational learning” of flexibility in massive focused campaigns which might have failed if they had stuck rigidly to their early design based on smaller pilot programs, and succeeded only after the innovation in administration that came form listening to the input of the participants and moving to different strategies. The example was the smallpox eradication campaign—which succeeded for seven reasons to vary form the pre-planned design along the course of the otherwise impossible and unaffordable system. I discussed this uniquely timed ELDP project with MD Homeland Security Chief Clay Stamp—and it fits this situation precisely. We may have come here to do one thing and we have quickly found that we are needed to do another. There are a number of type A personalities here who are so upset that they are not busy doing what they had imagined they would be doing (having never done or even anticipated doing anything at all like this, let alone at this great a scale, and have been unable to learn along with the group. A number have asked “Just tell us the plan for Day One, then Day Two and through to Day Fourteen” not realizing that things have been changing by the minute here. As I type this the vast array of convoys are passing my Room 321 Meadowcrest Hospital Room between me and the eerie darkened outline of downtown New Orleans across the River. We are learning, even as a group. The most voluble Type A complaints came form people who had planned to charge in on a white horse, displacing the locals who may have known better about what to do and how to do it. A few of those just came back today, after a long week on duty, and having visited their homes by boat, entering the second—and in one case—the third floor. They are obviously different people than they were when they came to work last week.
But, today a first newspaper was published about “coming back.” And the Gates of the locked down parish of Jefferson were opened for the next two days when the residents will be able to return to look at and if possible salvage something from what was home—if they pass a police checkpoint inspection, prove their residence, and have a full tank of gas. That means that the patients (200+ in West Jefferson Hospital) would be taken care of by a nearly full complement of physicians and staff, and they do not need us. We were mobilized by a report of 60+ elders trapped in a building and a number wanted to just run over there to enter as entrepreneurial rescuers. Not on this scale! No one goes anywhere without our advance security detail—shotgun wielding sheriffs’ deputies and humvees filled with national guard troops and a complete “recon.” WE did clear the building but only after the restraints were put on the “Do Something!” folk, and they were told that no one undertakes any private recons, rescues, or treatments except as part of the group in an organized undertaking. To reinforce this, they are reminded that they are now sworn in officers, and will obey orders and also they have the unusual officer’s prerogative of resigning and leaving if by noon today when the next C-130 return flight takes off.
The Parish President was told that a couple of the overheated types were eager to go back home if they were not doing what they had come to do. Again with tears, he exclaimed “Oh, God No! Please send them on a forward mission into the parish where they would be even more needed, and that would be into the parish toward a rough neighborhood on the border of which is Meadow crest Hospital a fully operational hospital abandoned by Tenet and its administrators and staff on the first day of the storm. “A NEW MISSION was set up and named “Operation Lifeline.” We will go out into the community where the people could not or would not leave when the evacuation order came to them, and we will deploy to abandoned schools and our twelve mixed teams of MD’s nurses, pharmacists and therapists would function as a FEMA emergency triage station at each point treating some, stabilizing others and shipping back the sick to West Jefferson since it is now fully functional –AND NOT TO MEADOWCREST WHICH IS SUUT DOWN AS A HOSPITAL AND IS NOW OUR OFFICIAL HOTEL WITH EMERGENCY COMMAND STATUS. The Search and Rescue crews sent down form Maryland will arrive later, the FEMA disaster teams will send their pallets of supplies, later, and the more important electric utility crews will be later camping out on the first floor of the hospital. We, the advanced team, will have the special opportunity to set up this base (in a building owned by the Jefferson Parish before they contracted it to be managed by Tenet Hospital Group before they fled with the storm) for the next many months of rescue work still coming, and we are ahead of everything except our own national guard security team, without which they will not let us go in at all. But, we are NOT TO TREAT patients at the now-abandoned hospital which is only our hotel function, but we will officially plunder it of supplies, clean it up, and make it habitable for us and all those who follow. Do you now understand the new mission “Operation Lifeline, Sir?”
I was interviewed by the Baltimore Sun reporter Douglas Elrich on how this mission compared and contrasted with similar disaster relief missions in Africa. I helped put together our own team for Team #3 for the following day, and could not believe the magnificent facilities totally abandoned and polluted by the looters and almost abruptly abandoned by the administrators and nursing staffs—hauling out what patients remained leaving a few cadavers in the OR before they were later removed. I am in Room 321, saying as I arrived to help clean it up—“If I wanted to live in the odor of decaying meat, I could have stayed home where I seem to have had a similar power failure of even longer duration!” We have “liberated” a full stock of the munificent supplies that other looters had not yet accessioned, and equipped our teams for full deployment in the communities tomorrow, even ahead of the huge FEMA team arrival. Security is supplied by the sheriffs just now, as the Red Cross comes to deliver us two meals per day under armed guard. We will have in about ten minutes the whole EMS system driving heavy equipment down from Maryland and Anne Arundel County after 37 hours drive and a few breakdowns. We have a psychiatrist on team who will give a short session tomorrow on stress management for the hyper team members –the most hyper clearly never having been in the situations in which I have been in which things NEVER go according to plan and one must go with the flow to get as much good done, often in ways never anticipated.
The Parish president thanks us for our flexibility and making the new focus the remote communities of Jefferson Parish which have not yet been approached as opposed to those already swarming with personnel, and a flood of volunteers will be following us in the system we are inventing as we go on the fly. As I look out at the enormity of the response now apparent out there—I see more Humvees guarding huge military trucks filled with supplies and disaster relief teams are following them in the same kinds of convoy in which we have been moved in each of four decampments, I see the wisdom of a flexible and variable response as things change in this still fluid disaster and its response. I am glad I am here early, for the very reasons that are driving some hyper members of the team absolutely batty—they came to do one thing and are now hurry/waiting for another as yet unknown. They are clearly not as good as I am from longer experience in dealing with sustained ambiguity. There is enough disaster to go around without making much more of it—a thought that I pondered while trying to get out from under a toppled over Viking appliance just before leaving.
Suddenly, our advance outpost is swarming—all the EMS and security and FEMA people are arriving with all the lights and sirens flashing and the electric utility crews are expected soon. Along the way I see the signs I had first seen on TV—“You loot, we shoot” even getting a few photos of them along with the devastation of the deserted communities around me. There are only two kinds of folk still out there—disadvantaged hurting folk who could or would not leave and desperadoes preying on what advantage they can take of the situation. We do not go anywhere, even the die hard sinners who want to step outside to smoke, without the company of the armed guards—and not beyond the yellow police tape that cordons us in. It is a harsh world out there where we will be taking care of people between lines of MPs to be sure they are not out to get the drugs they seek rather than the ones we are intending to dispense.
“Organizational Learning”----I have the Real Time Laboratory of flexible leadership crisis response unfolding here and we are inventing each new page of the book being assembled—the only pages of which currently extant are those you hold here and now!