Tuesday, November 15, 2011

An interview with DR. KAREN DESALVO, a national leader in health care reform

Dr. Karen Bollinger DeSalvo has spearheaded the recovery of the health care system in New Orleans following Hurricane Katrina, making it a model for community-based medical service. She is at present on leave from Tulane, where she is professor of internal medicine and vice-dean for community affairs and health policy with responsibility for implementing the school’s mission to build healthier communities, including oversight of community health center programs. Under her leadership, Tulane University School of Medicine won the top award for community service from the American Association of Medical Colleges in 2011. She has become a national leader in the drive for sensible and sustainable reform in health-care delivery systems.

Q: The city has seen a transformation of health care delivery since Katrina and you’ve been at the center of it. As Vice Dean for Community Affairs and Health Policy at Tulane you oversaw the development of neighborhood health clinics throughout the city that delivered better primary and preventive care at less cost. You’ve said that changes in medical care since Katrina have “put New Orleans ahead of the curve” nationally. It’s a complicated story but can you give us an overview? It’s often said that New Orleans is “incubating the future of education in America.” Can the same be said of medical care? Where’s medical care in New Orleans going next?
A: The widespread devastation of the healthcare infrastructure gave New Orleans an unprecedented opportunity to redesign a major American health sector from the ground up. We began our work on a new policy and system framework in the days following the flooding even as we were working to restore basic services like 911 and providing first aid on the streets. What we imagined was a high quality, cost-effective health system founded upon a distributed network of community health sites that used health information technology to improve the safety and efficacy of care. It would be supported by a sustainable, flexible financing model that would support community based primary care and give even the most vulnerable better access and choice.
In the ensuing 6 years, New Orleans has seen the successful development of that envisioned health sector. We now boast an innovative, modernized community health network providing neighborhood-based access to quality care for everyone, including the most vulnerable populations in the region. The transformed system has been recognized by the US Health and Human Services Secretary Kathleen Sebelius and the National Committee for Quality Assurance as a best practice and innovation others should follow.
The next chapter of our transformed, model health system is still being written but it will involve weaving together the component parts of the health “sector” we created in the last six years – neighborhood based primary care, health information technology and our quality efforts — into a health “system” that is more accessible and more seamless for patients and able to direct people not only to the best quality health care, but also to services that will improve their overall health.
Q: There’s still a lot of anger in New Orleans about the closing of the Ruth’s Chris Steak House at Broad and Orleans. But the corporation that now owns the restaurants gave the building to Tulane to move the Covenant House Health Clinic there. I think there’s great karma in this: my mother left a cardiologist’s lab at Tulane Med School to buy Chris Steak House — turning from a cardiologist’s lab to becoming something of a cardiologist’s nightmare. [Forgive me, Mom, I know not what I say]. And I love the fact that, Karen, you love to fish almost as much as Mom did. I’ve heard you say regarding the anger about the Broad St. building that "People are grieving for a wonderful past. Our job is to create a wonderful future." What are the plans for Broad and Orleans? When might it open?
A: We are thrilled that we will be able to put the Ruth’s site back into operation for the community as a health center. The building became available at just the right time for us. We had outgrown our current location and were looking for a permanent home. We will relocate from our current site a few blocks away and be a source of quality health care for everyone, especially those most in need including the uninsured. The health care services will be a more efficient and effective version of what we offer at our current site. These include primary care for all ages, mental health services, and women’s health. Because we are a part of Tulane School of Medicine, we also train doctors and others who will be part of the future health care workforce. We will be ready to serve patients there in April 2012.
Q: So much can be saved when preventive medicine is practiced – money and lives. I know that y'all have been doing creative things to draw the community into your care. Tell our readers about the drum circle that brings culture bearers like Mardi Gras Indians to the clinic, and about other creative programs.  [for some of my pix of Mardi Gras Indians go here]
A: Preventing diabetes or treating it early saves lives and money. The same is true across a host of other acute and chronic illnesses. With that focus in mind, our clinic team aims to identify people at increased risk and empower them to be partners in managing their own health. For a town with a culture as rich as New Orleans, this simply cannot be done without taking in to account important cultural legacies such as the Mardi Gras Indians. If we open our minds and healing options to include innovative solutions such as drum circles, we are not only more effective but also more integrated in to the community we serve.
Q: Tell us the story of how the Covenant House clinic began. I know it started just a few days after the hurricane…
In the days after Katrina, a group of volunteer Tulane faculty and doctors in training came to New Orleans to provide basic health care for first responders and New Orleanians who had not evacuated. They set up makeshift first aid stations around the City including on Rampart Street at the Covenant House complex. Word spread quickly and within days up to 150 people were coming by for tetanus shots, diabetes care, and other basic services like treatment of rashes and cuts. We moved in to a building on the campus to establish a permanent site of primary care for the neighborhood and have been there ever since. I always say we "jumped off the cliff and built our wings on the way down" since from that first day we were on the street, we weren't certain what the future would bring for patient need, service delivery or funding. And somehow, we have been able to do more for our patients, the neighborhood, and build a model of care and health care training now recognized as one of the best in the nation by the American Association of Medical Colleges.
Q: There are a lot of untold heroic Katrina stories. Your husband Jay DeSalvo, an emergency-room physician, stayed after Katrina to work the ER, to empty the refrigerators of fifteen friends and neighbors, and to climb roofs to help repair them. And there is heroism is dealing with the aftermath of Katrina now 6 years after. Can you tell us some things about the everyday heroism you’ve been witness to?
 I see the heroism in the everyday actions of everyone who has stayed in this city, or come to help her stand up again. We were knocked to our knees in a devastating blow. It takes a mix of everyday heroism and resiliency to stay and be part of the rebuilding after such devastation. I am proud to have been part of a larger community, including my husband, who chose to stay and bring back one of the great American cities.
Q: You’re a native of Austin TX who came to New Orleans for medical and graduate school — two cities where “there is a there there.” What do you miss about Austin? What do you love about New Orleans that Austin doesn’t have?
Austin is a wonderful town that was the ideal place to grow up. I was raised by my very poor single mother and Austin gave us access to advantages like education, arts, and recreation a no or low cost. It was also very safe. This allowed my sisters and me to grow and develop our intellectual curiosity in a way that most children in poverty do not get to experience.
What I love about New Orleans is that it has a rich history, a rich culture and soul that runs brightly through the lives and institutions here. As a city it has its own life and we are merely interacting with it. It gives me energy and inspires creativity. And the water all around us makes for a magical feeling of connection with not only nature, but with the rest of the nation and the Caribbean. 


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