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updated 9/2/2005 5:00:21 PM ET 2005-09-02T21:00:21

Joe Guarisco has lived most of his 51 years in New Orleans. "It's home," he says. Now, amid what he says is the most devastating hurricane of his lifetime, Guarisco has been doing his job as the head emergency-room physician at the Ochsner Clinic, one of only three hospitals left functioning in the storm-damaged city.

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"This is the nightmare scenario they've been talking about for 30 years," Guarisco says.

The wreckage created by Hurricane Katrina has left a public health disaster in its wake. Already, the American Red Cross is moving out its biggest deployment ever. The city's mayor has said the death toll may reach into the thousands.

During the storm, Guarisco kept a nurse and a doctor, as well as security guards and National Guardsmen at the door. Each day, he says, they turned away a hundred patients who were more in need of shelter than medical care, and admitted 75 who had real medical needs. With only a minimum of electricity generated by diesel generators to run monitors, ventilators and other medically necessary equipment, a skeleton crew has kept watch over the hospital.

The Ochsner clinic is a precious 7 or 8 feet above sea level, a distance that has kept it from being flooded out of commission like other hospitals on land in New Orleans, much of which is below sea level.

But two of Ochsner's three diesel generators failed, leaving only a minimum of electrical power. Until Wednesday night, the hospital's air-conditioning wasn't working. Some doctors and nurses, who have been at the hospital nonstop since the storm began, have suffered from dehydration. Keeping the staff calm has itself been a problem.

"We have storm shutters on," Guarisco says. "It's hard to tell days from nights. It's a bizarre situation."

Other hospitals were far less lucky, as the floodwaters shut them down.

"The health care system is at least crippled, if not completely out of commission," says Irwin Redlener, of the Columbia University Mailman School of Public Health.

Tenet, the big hospital chain, has shut down several of its hospitals in the hurricane zone. "We believe it will take months to get our hospitals fully operational again," says Tenet spokesman Steve Campiani, "and some may be closed for a considerable period of time."

Through the storm, however, Ochsner has kept going. Many patients were evacuated, but doctors were able to keep a makeshift neonatal intensive-care unit running for 26 babies — all of whom have been evacuated. One sick infant, on a machine that recirculates the blood, will have to stay put. At the hospital's heart transplant center, five patients have been cared for and will probably stay put.

"I'm so proud of these people, it's incredible," heart transplant doctor Hector Ventura says of his colleagues.

Holding steady
Thanks to Wi-Fi technology from SpectraLink, phones inside the hospital have been working. Outside lines, through a satellite phone, have at least been functional — although most computer systems are down. Many doctors, nurses and staff don't know whether their homes are still there. Even if they do, they can't go home.

Guarisco's wife, the head of the hospital's information technology department, is also considered essential personnel. The couple and their two children, ages 3 and 12 years, have been living in his office.

Outside the hospital, there is chaos among the few who did not evacuate. Says Ochsner spokeswoman Katherine Voss, "It's the most incredible looting you've seen in your life."

So far, most of the injuries Guarisco and his team have seen have been of the type one would expect following a flood. There have been electrical injuries, slips and falls, and lacerations, as well as patients who need chronic care, such as kidney dialysis, or are dehydrated, starved or lacking necessary medicine.

Michael Vanrooyen, a public health expert from the Harvard Health Initiative who is coordinating disaster relief for the American Red Cross, warns of more problems ahead.

Diarrheal illnesses from contaminated drinking water could be a major problem, as could respiratory problems among evacuated people kept in close conditions, such as in refugee camps. If the waters remain in the city for any considerable length of time, however, other illnesses from bacteria, viruses and parasites are expected to emerge. Mosquitoes also may begin breeding extensively, leading to outbreaks of West Nile virus.

Mental illnesses, such as depression and post-traumatic stress disorder, will also probably emerge. As venomous snakes flee the flood, there could be a spike in snakebites.

To those concerns, Guarisco adds another: chain saws. Following Hurricane Hugo, there was a bump in chainsaw injuries as people returned to their homes to rebuild. Guarisco expects to see many such injuries. Still, he says, his city will survive. There are 120-year-old houses in the area where he lives that have survived other bad storms.

"I think the city is intact," he says, "but it's pretty bad. It's going to take years."

© 2012 Forbes.com

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