The actual disaster response operations are a tiny sliver of my work. Our most recent operations were for Katrina and the Pakistan earthquake. You know, they could have been just awful, depressing experiences for the people who went, but it fundamentally changed their lives for the better. How many people get a chance to be part of something like that? The personal impact when you help someone in need is tremendous.
I always pictured myself as a doctor but avoided it because my parents wanted it. I was fairly-research oriented before I went to med school but I always thought I'd become a doctor to be able to fund my interests, woodworking, travel, whitewater canoeing, all the things you like to do when you're a kid and you dream about being able to do forever.
I truly fell in love with my job ten days after I arrived at Hopkins. Even if I was independently wealthy, I wouldn't change anything about my job. I still pinch myself in the morning. I am literally doing a dream job. That's not to say that my professional life isn't filled with endless headaches and issues, but I really believe it may be one of the most fulfilling positions in the world.
I feel a passion about my work that is bigger than Hopkins. I feel evangelical about my field. It is always growing and developing, and I ask myself, Who gets to do this kind of stuff? Just about nobody.
My job has changed immensely since September 11. There was truly a tangible impact in my work because of Hopkins' close cooperation with the Department of Homeland Security. Without 9/11, we wouldn't have had the stimulus to develop CEPAR.
When I first came to Hopkins, the Emergency Department was a mess. Local patients were ill-treated and unsupervised, the department was overworked. I'm very proud of improving our emergency care. While we still have our issues in providing care for such a huge number of people, I'm amazed at the exponential, almost inconceivable upgrade in dedicated care that the staff give under the most difficult circumstances.
I want everyone to remember that I did not single-handedly do something for the better; I did not make the change myself. You can only help guide an issue and find people who share your passion, vision, and views and then work together.
We were well-organized for about four years before Katrina hit. Right when the storm happened, the federal government put out a very early bulletin calling for a huge need for medical assistance. They were setting up 40 250-bed field hospitals in the region. We knew they would certainly want Johns Hopkins on the ground, but we wanted to make sure the team we sent didn't get broken up and sent to different places. It was very important that we didn't have itinerant doctors and nurses wandering around, not knowing each other or their capabilities.
We put together a plan to develop, build and manage a field hospital in the aftermath of Katrina. It required an enormous staff, only one-third being doctors and nurses. We needed all aspects of staff who normally run a hospital, from administrators to social workers to dieticians. We requested potential Hopkins volunteers before we made the phone calls over Labor Day weekend and raised 500 volunteers.
The National Institutes for Health were setting up a hospital in an air hangar in Mississippi. They contacted us on a Sunday and asked if we could mobilize to assist them with 100 Hopkins volunteers in 18 hours. By noon on Monday, we had a 109 person team ready to go. We took volunteers from all our divisions, from Bayview, from Howard County, from the School of Nursing, even from the main University campus. The team ended up never deploying.
I think the government plan for Katrina was well-intentioned but ill-concieved. I was skeptical of the overwhelming call for medical staff to staff field hospitals. That had never been necessary for any disaster in the developed world.
We had two teams deployed in Jefferson Parish to relieve the Western Jefferson Hospital, but the doctors and nurses (at West Jefferson reportedly) resented the attempt. They didn't want strangers taking over their jobs. They were dedicated to finishing their work.
What was needed more than anything was very basic medical care. People had no access to their medications. They needed things as simple as blood pressure pills.
People think that Katrina created the public health issues in Louisiana and Mississippi. What they don't realize is that that public health disaster was always there. Katrina just unearthed it. There are huge masses of the population without adequate healthcare, and I don't think, even with the attention from Katrina, that that's going to change. There simply isn't the political will in this country to provide basic healthcare for all its citizens. Medicine has become too much of a business commodity. It's become something you trade on the New York Stock Exchange.
When the second team returned home early from helping Katrina victims, there was a sense that they had been kicked out. The volunteers said that they were providing medical care to this underserved population that had never had any before, and they had a feeling that this was very embarrassing for local officials who had failed them, so they were asked to leave. I don't really know if this is true or if local doctors simply took over, but we were definitely asked to leave before the mission was over.
The information coming out of Pakistan is very sketchy and sporadic right now. It is such a big place that it's hard to know what's going on. At first glance we have received reports that there aren't enough supplies, but it's hard to know if that's the big issue or just the toenail of the elephant.
CEPAR is prepared to respond to all the classic terrorist threats, biological, chemical. We attempt to integrate our response with those of the entire region. We are essentially concerned with broad-based medical and public health issues that may arise from any high-consequence event. We try to be proactive and bring Hopkins assets to assist the state. For example, we developed the plan for statewide smallpox vaccination. Currently we are tackling the difficult issues of preparing for pandemic and avian flu.
Gabe Kelen is the Chair of the Department of Emergency Medicine at the Johns Hopkins University and Director of the Johns Hopkins Office of Critical Event Preparedness and Response (CEPAR.)
CEPAR is responsible for coordinating the Johns Hopkins University and medical system response to terrorism, natural disasters and public health emergencies. The organization works closely with state and local authorities and the Department of Homeland Security, and has provided public policyand legislative advice to the federal government.
--- Interview by Matt Hansen
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