DukeEngage | Duke Center for Civic Engagement

This post is a few days late as I am now home, still reflecting on my last two months in the Big Easy. I would like to date what is written beyond this sentence as Friday, August 1, 2008…

The day was ending and my bittersweet last moments on the 12th floor of 1515 Poydras had come to an end. I wished off my coworkers, gladly welcomed their last-minute advice on life, and walked into the scorching 97 degree, humidity-saturated day. I did not just leave the comforts of air-conditioning but I left where I felt most comfortable as my stay in New Orleans was near its end. During the last few weeks I began to spend more time with my coworkers than my fellow DukeEngagers. This is no slight against DukeEngagers. It is just the way things turned out. No longer was working out or playing sports after work an option because of my injuries. Around the time of my second injury (the dislocated finger for those keeping tab) I had moved desk locations to a room more prone to conversation and engagement. I actually enjoyed staying at work until five o’clock, a change from the groans and dozing head that usually signaled a day’s end.

So, understandably, it was a poignant goodbye as I left work for the last time today. But, the goodbye was necessary as we will see next. “You will appreciate it after it’s gone.” I think we have all heard this phrase uttered to us in some form. Over the past few weeks I was liberated from taking the streetcar home. Now, I enjoy the streetcar but the novelty wore off after the first month, especially after getting a ride with a coworker once. It was then I realized a trip that should take eight minutes was taking 45 minutes on the streetcar. Today, however, I snubbed a ride home knowing this would be my last opportunity to take the streetcar ride home until my next visit to New Orleans. It was one of my best decisions of the summer; it was after these 45 minutes did I realize that I Am Engaged.

After the ten minute walk down Poydras to St. Chaarles for the streetcar stop I waited the usual five to ten minutes for the streetcar to arrive. During this time the crowd waiting at the stop obviously grew; however, as the crowd grew, smiles escalated. I am in the middle of downtown New Orleans surrounded by skyscrapers and folks in business suits. The stereotype of northern cities is that everyone minds his or her own, walks their walk, and talks their talk. Constant hustle and bustle. I never noticed this walking downtown everyday for work. Interesting…

Applause all around me!

Ah, the streetcar has arrived. Such a great site: the streetcar driver looking down on us from his perch as we are all literally at his mercy. So many times, especially at the downtown stops, does the driver yell out of his open window (without even grazing the brakes, may I add) “Notha’ car comin’ right behind me!” with such a candid smile that all you can do is laugh as it rolls by and you are forced to wait another few minutes. Thankfully, today was not that day. The driver came to a graceful halt and was all smiles as he welcomed all of us aboard. It was at that point when I realized it was August 1. My month long streetcar pass for July had expired. I pulled out a dollar but had no quarter (yes, New Orleans transportation seems to think $1.25 is a convenient fare for the streetcars and buses). What real man carries change anyway? Pshh…Anyhow, I have been here for two months. Why panic? It is called the “Big Easy” for a reason. I told the driver the honest truth and he smiled, told me to put my dollar in the machine, and that “We ain’t gonna murder you o’r nuthin’ son.” Call me too analytical or whatever, I took kindly to the “We” in his statement. Nawlins is one great family.

And like any family would, as I got on the streetcar and saw no empty seats a young lady to my right was kind enough to slide over on that full bench so I could sit down. I am pretty sure half of her rear-end was struggling to stay on the bench but she did not mind. The eye-to-eye contact just said it all. You would have thought we were kin if you saw it play out. At the next stop, well, we did not stop. The exact scenario I described above about the driver passing happened. And as if God was confirming my beliefs about this city, the people waiting at the stop all laughed when the driver yelled that a car was behind him. No groans, no flipping the bird, and no anger.

A man with only a few coins soon came on the streetcar, explaining to the driver that he was only going a few blocks. He placed what he had into the coin machine and took a seat across from me. Call me cold-shouldered but growing up in the north you rarely will find a group of randomly selected people who do not mind talking to a homeless person…especially if much of the group were in business outfits. This guy came on the streetcar and started throwing out jokes left and right. It had rained a bit that day. He said he got poured on twice that day. He asked us if we were surprised and some guy from the back of the streetcar exclaims “Hell no, it’s New Orleans!” He said that he had been waiting 15 minutes for the streetcar. He asks us with a stern face “Why was the streetcar late?” He then shrugs, smiles, raises his hands palms upward, and says “Who knows?” The streetcar bursts into laughter because here in New Orleans, who does know? Live life easy and do not complain about what you cannot control.

The last interesting note I took on this final journey down St. Chaarles was when this woman had rung the bell to stop, walked to the front and realized that she was at wrong street when the streetcar made the stop. Nothing wrong with this. She then, however, proceeded to make the same mistakes for three more consecutive streets! I looked around each time and all I saw were smiles. The streetcar driver showed no chagrin and even explained what landmarks to look for next time. Four unnecessary stops! All of this resulting in a streetcar full of smiles.

Now, I have mentioned many miniscule details that I noticed during this last streetcar ride. During the walk back to my dorm, however, I realized that this is why I spent two months in New Orleans. The other day (Friday, July 25) we had went to a reception with Lt. Governor Mitch Landrieu. Without making a whole new blog post, Landrieu told us that currently the city is on its knees. There are problems in every American city, whether being health care, education, housing, insurance, city sewer systems etc. all cities have problems. However, he added that New Orleans was different: New Orleans has all of these problems. In his eyes we are “rebuilding a civilization.” He told us touching stories about his mother and random New Orleanians who could not live anywhere else. Down in the south, especially in New Orleans, people do live with their pasts.

To further cap off the remarkable self-reflection and realizations during the past hour, I was able to fully understand words from the CEO (Joe) of my company earlier that day. In one of the more remarkable experiences of my two months I had the opportunity to sit in a sort of “executive meeting” at LPHI. I was there to present the policy brief I had been working on for the past month. Besides those two minutes, the rest of the hour was spent soaking in knowledge as three of the smartest people at LPHI talked about what steps to take next to better New Orleans health. Seeing as I was just an undergrad, they took the time to give me a crash course on public health. At the end of the meeting Joe took on a serious tone. He began brainstorming about possible connections to help make LPHI more community based. He seemed very concerned about this and said something to the sort of being up here in our building, educated with mostly master degrees or greater, it is sometimes difficult to connect with the people on the ground.

I then realized what I had learned as I observed the actions of New Orleanians for two months. To really work in a position of power in a service-based organization (like a public health institute) you must understand the people. Sounds cliché. Sounds easy. To put it in the context that made me understand it though was imagining if someone was trying to change me. To really get through to me someone would have to spend time to get to know me, understand what is important to me. Once you understand that New Orleanians do not bow to anybody, live life and enjoy every minute you start to understand the context of the mental health issues which abound. You understand why eating large food portions are part of New Orleans history. You understand why rebuilding the city is necessary. No more asking why Katrina had to hit. Because, “who knows?” Let’s just make the best out of it.

Thank you to Duke, Melinda Gates, and the Duke Endowment for giving me this great opportunity.
 

First, I have to apologize to my avid readers for the delayed blog post. It has been quite a busy week and a half. I have managed to continue my visits to the Oschner Emergency Department. Last Monday I dislocated my finger playing some basketball. I could therefore blame my lack of blogging on an inability to type but I have mastered the art of typing without my right pinky. Not too hard, but I do now appreciate the little things in life because I did not think my pinky was very important until this week.

On Thursday we visited Langston Hughes Academy, a charter school with really great staff who seem very committed to improving the poor New Orleans school system. And poor might be an understatement. Granted, I work in a Public Health office everyday so I have not been able to witness the lacking educational system firsthand. However, from this talk with a few teachers and speaking with fellow DukeEngagers I am in shock at my ignorance and the Oakland County and Duke bubbles that I have grown up in. I have done service in many different types of socioeconomic areas so I do not consider myself usually part of “bubbles” per say. I have worked with inner-city kids from Detroit & Durham school systems but neither compares to the inadequacies of the New Orleans school system pre-Katrina. We were given the 2008 report of The State of Public Education in New Orleans. Much of the following information will come from the speakers and the report.

***(I will note below when the background on New Orleans education is over for those not particularly interested…)***

Prior to Katrina 65,000 kids were enrolled in the Orleans Parish School Board (OPSB); cut that in half and you have the current enrollment post-Katrina. Before I talk about the problems and improvements of the schools I think it is interesting to understand the history of the school system. Today charter schools abound as New Orleans has more than any other urban school district and many debate the adequacy of this third tier of schools (in addition to school-district run public and private schools). It turns out that there have been divisions in the school ranks since the 1800’s. French Creoles wanted a separate system where only French would be spoken. As Catholic and Jewish immigrants arrived they also advocated for separate schools because of the Protestant prayers used in public schools. At the end of the civil war when New Orleans had surrendered to Union troops public schools reopened and a separate school system for freed slaves was created.

Many believe that the school desegregation movement started in the mid 1900’s. In fact, Union troops tried to desegregate schools in 1868, creating a constitution where there could be no race-based segregation. Of course, the Union troops were met with great opposition and, arguably, this could be the root of all of New Orleans education problems. Resistance to integration led to the birth of many white supremacist groups. Not only did less African-American children attend these integrated schools due to violence, but more white children began attending private schools. As the early 1900’s came along, white student enrollment doubled while African-American enrollment remained stagnant. This all changed as African-American citizens realized the consequences of a poor school system. Organized and determined, the first African-American school in New Orleans was established and this spurred more African-Americans to attend schools. However, since so many resources had been invested in the spurt of white student enrollment African American schools were severely lacking.

In 1954 is when the story starts getting familiar for everyone: Brown v. Board of Education. School segregation is no longer legal. It took six years, however, for the first African-Americans to attend a formerly white school and even then, it was only a whopping amount of four African-American girls. Almost identically to when the Union troops tried to desegregate the schools. A federal judge ordered the process to be expedited and by 2005 “New Orleans was 65% African American, yet the public school population was 94% African-American.” 40% of children lived below the poverty line but 73% of public school students qualified for the free lunch program. The public school system was horrendous and there was a great achievement gap within socioeconomic levels. As some other New Orleans blemishes are blamed against leadership, the educational leaders did not do much to help the situation. Turnover was high as eight superintendents served in the seven years prior to Katrina. I do not know much more about the school board’s instability. It could have been that major change was needed; so much that the whole system would have to be turned over and that was just improbable with 60,000 kids to educate (not that the schools were doing much educating- more on this in a bit!) Anyhow, major change did happen. People looked at the bright side of things and saw Katrina as a chance to start from scratch and fix the whole school system.

Schools here are graded on a scale of 200 by whatever measure the state uses. One of the teachers at Langston Hughes told us about how many schools were horrendous. The average for all the schools was a score of around 70, I believe. Therefore, 70 became the benchmark for whether a school was allowed to survive which is setting a very low standard. So, now during post-Katrina a new superintendent, Paul Vallas, was brought in. He is known for recovering the poor school districts of Chicago and Philadelphia so hopefully he continues to show dedication. The school system according to the teachers had gotten better. The surveys in this report show higher satisfaction among the public. However, improving the schools from prior levels is not difficult. For example, one example that was given was a school which went from a score of 9 to 40 during this past year. Remember, this scale is out of 200.
 

***End of Education Background***
 

To tie things in with my work and prior posts, it seems that much of the improvements have again been a result of the non-profits at work in New Orleans. Charter schools are being opened as often as Kwame Kilpatrick sends inappropriate text messages (and for the non-Michigan residents, that is fairly often). While non-profits cannot directly take credit for any improvements in the public school system I would like to think that the success of these schools forces public schools to perform better. Charter schools like Langston Hughes are going the extra mile to bus kids (spending 25% of their budget on transportation) from cities as far as an hour away so they can get a fine education. Again, please remember that all of my opinions are pure speculation as I have done a lot of individual reading to learn about the educational system here.

Now, taking all of the insight I have gained into the New Orleans education system has not been entirely extracurricular. It has motivated me to work harder here at LPHI. We had a conference call with a few leaders from Louisiana Medicaid last week. They did not seem to optimistic about the project I am currently working on of getting behavioral health care reimbursed in schools. Speaking to the Langston Hughes teachers, getting mental health care services to students is of the utmost importance. Many kids now have PTSD (post traumatic stress disorder) and it has become extremely difficult for teachers to get through to the students. How can you blame them? I have never undergone a traumatic event like Hurricane Katrina but I can understand how the anxiety caused by such an event could lead a child to not worry about multiplication tables. One of the teachers said that she takes time to drive two of her kids to the psychiatrist every month to get them the necessary treatment. At least those two kids are getting their care though, right? Wrong! The two kids are placed in a group of seven other needy people and asked to spill their guts out to this psychiatrist who I bet is getting reimbursed for providing nine different therapy sessions.
 

Realizing such blunders is making me very eager to finish this policy brief which I have been working on for the past month. I hope that in months or years time from now (since legislators take their sweet old time with everything except getting their pay raises) I will look back on my experience here in New Orleans knowing that I helped in the fight to get Medicaid to reimburse social workers and the like in providing mental health services to students.
 

Today, for example, I walked into work ready to fight against the evil that is Medicaid. Instead, I found one of the lovely people from the admin office seated in my desk. To put things into perspective, I was placed at a vacant desk out front at the start of the summer because there was no place in the intern room. This desk is outside of a nice glass-walled conference room overlooking the Superdome and downtown New Orleans. Well, it turns out that Newt Gingrich and the Secretary of the Louisiana Department of Health and Hospitals Alan Levine were coming to LPHI today! And guess what? I could not be seen apparently! I am guessing that I am so valuable that LPHI did not want me stolen from them to work for Mr. Speaker Newt Gingrich. While I know that is not true I would love to think that I am too cool for that man because apparently he is quite the stickler. (Side story: Coming up the perfectly fine marble-covered, mirror-walled elevator of our nice building with a fellow intern, Mr. Speaker found it necessary to exclaim “This is disgusting!” so everybody around him could feel jolly about themselves) Oh well. At least he did not attribute his displeasure with the elevators to “drunkeness” and being “hungover” and needing to “sober up” like the Republican we have leading our country would have said. What a joke…
 

Another joke is the lack of America’s support for Iraq. Seven athletes train their bottoms off for the Olympics, they qualify, and less than a month before competition they are told that they cannot compete. First, FIFA tells Iraq they cannot qualify for the World Cup the week that qualification starts and then this. Injustice, if my blogs have not shown, are my number one pet peeve in life. Iraqis should be able to compete in the Olympics and I should be able to sit 10 feet from Newt Gingrich…
 

This week was very laid back. On Tuesday night we ate at Tujagues, the second oldest restaurant in New Orleans. It used to be a Spanish armory and the only menu option is a 6-course meal, the same meal served to soldiers back when the original owners ran the place. We had the privilege of listening to Allison Plyer while eating dinner. She is the head of the Greater New Orleans Community Data Center (GNOCDC). This non-profit is extremely important as they provide up-to-date information on all kinds of New Orleans data. The work is very important in order for to allow decision-making during recovery efforts reach the greatest number of people.

For example, the Census had released a figure for the current populations of New Orleans that the GNODC did not find accurate. They submitted some sort of challenge which would have brought millions more to the city as federal funding is provided per population. The most interesting fact I found from Allison’s speech was that unemployment is DECREASING here in New Orleans while figures are skyrocketing in other parts of the country. Foreclosure rates are also lower. All this has to do with the great amount of opportunity that exists here in New Orleans.

To picture the adaptations small-businesses had to make post-Katrina think about the situation of the police in East Orleans Parish, a task force that should be one of the first businesses to get back on its feet. After Katrina the East Orleans PD worked out of FEMA trailers. Only recently did someone donate some warehouse space to give the police a proper place to protect the city. I found that pretty shocking…soon after I read an article in the Times Picayune that made me even more astonished at the lack of appreciation some top cops show to the police officers. The officer was 10 minutes away from retiring, cleaning his office out, when he was suspended for wearing a light blue uniform. You would think with all the problems here cops would worry about something else? I do not really know what to say to that article.

Not too much happened this week though as both my bosses were out for most of it. It was relaxing and all I can say is that I am looking forward to making the most of my last 3 weeks here.
 

I saw a very humorous and somewhat worrisome headline today: Google trying to take privacy seriously. How nice? Anyone who knows me understands my obsession with Google applications (g-mail, calendar, reader, news, docs, Picasa etc.). While Google never ceases to amaze its users it has recently undertaken some large endeavors: Google Health and a partnership with the web-based genetic testing company, 23andMe. It is clear why privacy for users is of the utmost importance. Since this has nothing to do with New Orleans my venting will stop there and you can read the article for more about Google’s recent privacy blunders.

This past Thursday we were invited to dinner at Dr. Bronfin’s house, a Duke alum and pediatric specialist (craniofacial, I believe?). Two other doctors were there: Dr. Finger (pediatrician as well and also a Duke alum) and Dr. Guarisco. Dr. Guarisco is famous for leading the only ER that was open during Katrina’s totality! All three of these doctors work at the renowned Oschners Hospital and I would give up my job in exchange of talking to each of them for a few hours each day. As past readers would know, I am deeply interested in health care and this night was designed to garner information about the health care situation in New Orleans since Katrina.

It turns out that in the days following Katrina Dr. Guarisco obviously expected an overload of patients in the ER. When he woke up and reported to work, however, there were basically no patients. Everyone had left New Orleans. Incredible considering the damage that had to be done to many New Orleanians due to the Hurricane. In the 30 days after Katrina they got a lot of social service cases like homeless patients. Soon after, as few people returned to New Orleans, they received the trauma patients like workers falling off from roofs, lacerations etc. Then after months/a year, the hospital received the general medical problems in bulk as New Orleanians who were moved out of state were without health care and medicine.

Dr. Guarisco was visibly irritated with the current American health care system and I loved it. I really would have loved to go on a giant tirade but that would have been rude. Anyway, he started talking about long waiting times. He found the idea of patients waiting ridiculous. No matter whether you are interested in health care or not this has to be interesting: he said we could map out the times of what medical services will be needed in the ER. Certain medical problems occur at special times of the night and are always prevalent in the ER. He mentioned that if you looked at ER rooms across America you would find similar curves. With this information how can we still have long waiting times?

I mentioned my interest in Prospective Health Care and preventive medicine. While I already knew this, they mentioned that we cannot do preventative care yet with the current reimbursement system. Doctors presently get paid to do more procedures and test the patient more, not to go and talk to patients. I mention this because it was great to hear that these three doctors were in such agreement. All three noted the importance of changing the current reimbursement system which was kind of comforting to hear for me.

Currently New Orleans has dedicated a proposed one billion dollars to the building of a new Charity hospital in New Orleans for the uninsured (500 extra hospital beds). All 3 doctors could not imagine the need for 500 more beds. They said that they were doing more than fine and the money could be used elsewhere. Dr. Guarisco mentioned that the billion could be used to insure every uninsured New Orleanian! It is incredible some of the money that goes to waste in the health care industry. However, Dr. Finger thinks that Louisiana Governor Bobby Jindal is too smart with respect to health care to allow the proposal to pass. I will keep you posted on any developments as summer goes on.

Related to the reimbursement topic from a moment ago, another interesting fact anyone really should care about: ENTs (ear, nose, and throat doctors) put tubes in someone’s ears (a 5 minute job) and get reimbursed 600 dollars. Albeit the job’s importance, 600 dollars seems just a bit too much. Mental health issues are huge as I have mentioned before but psychiatrists get reimbursed maybe 70 dollars per each hour they sit down with a schizophrenic. The health care system is so wasteful and irritating.

It is so interesting to see issues I learn about at Duke come into fruition here in New Orleans. At work one of my research projects is to find reasons for Medicaid to reimburse behavioral health care in schools. The wife of Dr. Finger, also a doctor, mentioned how LPHI currently provides funding through grants for one of the schools she helps out at. Once again it made me realize the importance of non-profits here in New Orleans. This summer has shown me the power of what a few founding individuals with a purpose can do to spark change. There is no need to wait for stagnant governments and unnecessary one billion dollar hospitals.
 

For dinner Tuesday night we ate with Jim Kelly, CEO of Providence Community Housing and Catholic Charities. As part of the perks of DukeEngage we get a group dinner once a week at a fancy restaurant with a speaker. However, I would not need to be coerced with a pricey menu to listen to Jim Kelly again. He has knowledge about all facets of New Orleans life. His connections run so deep it turns out he works with some LPHI people which I found interesting. Jim spent a great deal talking about mental health issues and how economic/social/political issues all have an effect on the health of people. When I heard that we were listening to a speaker from Providence I did not expect to be hearing about health issues. However, I guess that was one of the main points of the talk: every aspect of our lives is related to our health.

With four DukeEngage kids working with Providence, I realized how all of our internships really relate to one another. You cannot pick one problematic issue with New Orleans and talk about that singularly. Sounds simple, but it is very difficult and disconcerting to think about. The rebuilding process is very difficult. The U.S. economy is evidently lacking so in New Orleans the situation is worsened because of the necessary rebuilding. I believe it is now the poorest American city. Mental health issues abound and when people sought refuge after the hurricane, they had to worry about possibly paying mortgage payments etc. on their new homes in their new city/state and on their New Orleans home. They had to focus on rebuilding on top of these payments. And on top of this, families had to worry about a horrible school system. How can residents return with a bad school system? What did a family with four kids all placed in different schools have to go through when Katrina hit?

Talking to Mr. Kelly made me realize how important public health work is, PARTICULARLY with respect to disaster relief. Doctors must leave not just for personal reasons but if there business goes down 40-60% can you blame them? Now that upper-class workers such as doctors and lawyers have left many investors into the economy have left. Concurrently, quality health care diminishes with less medical personnel available. Jim said something interesting: “we have sickness-care not health care.” We have no methods of prevention available.

He echoed my statements from my last blog about non-profits really driving the rebuilding process. However, he places less blame on inactive leaders/businesses because they focus on profit and therefore must take fewer risks. They wait for non-profits to spearhead a project then become involved. Also, he described how funny politics is here. Mayor Ray Nagin won his first term with an 80% white vote and 20% black vote…the numbers were the exact opposite when he was re-elected. How weird? Once, a corrupt governor here ran and people advertised for him with the slogan “Elect a crook, its important” because the crook running for government was running against David Duke who, as we know, is a very influential bigot.**See Below**

To cap this blog off we will end with a great, personal story from Mr. Kelly: After Katrina had hit there had been so many old, ill, and fragile people at Louis Armstrong Airport. Literally ALL of baggage claim was packed. He walked in and said the only thing he could do is act as a son. He touched people, comforted them, etc. Then he went into an adjacent room from the baggage claim area and it was also full of ill people. However, these sick people were in critical condition. They were sending Hospice people to come help them. He ministered to each person individually. When he got to one woman he spoke to her, told her she looked beautiful and that she will be ok as God would take care of her. After he finished talking to her he realized she was in comatose and had just been staring straight ahead with a blank expression. At that point Jim blessed her with the sign of the cross on her head. Suddenly, he felt her hands push up from her chest. He pushed them back down and told her that she would be alright. She then pushed up again and he pushed down. Then she pushed harder for a third time and she reached up frailly and returned his blessing with the sign of the cross. What a powerful moment! United in prayer and Christ.

** I do not like to sucker-punch people as I did in this sentence about David Duke so to make things clear, David Duke claims, and I quote, he is not a “white supremacist” but only a “white nationalist” who supports “racial segregation and white separatism.”…You have got to love Louisiana politics.