Battlefield Medicine Lifts Up a Weary South Florida : Storm: A loose group of doctors, nurses is trying to cope with sweeping health problems after hurricane.

Carefully, and with steady hands, the soldier sutures the wound. Forceps in his left hand, a surgical steel needle driver in his right, he weaves a black thread through thick skin, closing a bloody four-inch gash left by a chain saw that churned up his patient’s left thigh.

Needle in, needle out. Each stitch is tied neatly with three square knots. The patient, a 32-year-old resident of Leisure City, Fla., had been clearing avocado and mangrove trees felled by Hurricane Andrew when he lost control of the saw. Propped up on his elbows, he watches with stoic indifference as the medic, Navy corpsman Richard Fail, sews up his leg.

The procedure takes place in a military medical tent on a hot September night. Fail has taped plastic sheathing over the patient’s leg to create a sterile “surgical field” surrounding the wound. But there is a problem: The bare bulb spotlight he uses to guide his work is attracting mosquitoes, threatening the cleanliness of the operation.

“You gotta work fast,” hollers Dr. Ronald Baird, a camouflage-clad physician who is pacing about the tent with a clipboard, supervising. “You got bugs being drawn by your lights. You don’t want ‘em to get in your field.”

Such is the state of modern medicine in post-hurricane southern Florida, where Andrew visited the citizenry with a host of medical and public health problems while also ripping apart the network that is supposed to handle them.

Hundreds of private doctors and dentists were put out of business--if not permanently, then at least temporarily--by the Aug. 24 storm. Eight hospitals were damaged and three were evacuated, although the largest, 120-bed Homestead Hospital, is back in operation. Physicians whose homes were left in tatters by Andrew’s 160-m.p.h. winds are now living in trailers in the hospital parking lot, searching for apartments in between treating patients.

A loose confederation of military doctors, volunteer physicians and Florida public health nurses is struggling to fill in the gaps, working under conditions that are austere at best. The obstacles they encounter and the lessons they learn during the aftermath of the costliest natural disaster in U.S. history will likely be studied by disaster-response experts for years to come.

Tens of thousands of people are being treated in makeshift medical tents that have sprung up throughout the devastated area, staffed by the military and two private health maintenance organizations. At the Humana Medical Plan’s tent in Florida City, a big sign is posted reminding patients not to eat or smoke in the open-air facility. “This is a hospital!” it proclaims.

Public health nurses, clad in hot pink T-shirts that read “Nurses Care for America” roam the storm-stricken neighborhoods, knocking on doors and spreading tips on simple hygiene in what has been a successful effort to prevent an outbreak of disease.

Military medical trucks, identifiable by the red cross on their windshields, rumble down the streets, gathering up people who need help and who, because the phone system is down, can no longer pick up the telephone and dial 911.

“Tailgate medicine,” is what one top official of the U.S. Department of Health and Human Services called it.

“You’re going by the seat of your pants out here,” said nurse Betty Schoenherr, who traveled south from Daytona Beach, Fla., to join in the relief effort. “When you’re in a public health unit, you’ve got everything at your disposal. You get out here and it kind of reminds me of what you would see on ‘China Beach’ or ‘MASH’ or something.”

While a feared outbreak of typhoid or cholera never materialized, other maladies have. Doctors report numerous cases of gastroenteritis--diarrhea and vomiting--resulting from the tainted water supply. Dehydration is also a problem.

As was the case after South Carolina’s Hurricane Hugo in 1989, authorities say more people are being injured in the rebuilding and cleanup effort than during the hurricane itself.

Chain saw gashes and cuts from clearing out broken glass and rubble are a common sight at the medical tents, and the Dade County medical examiner’s office reports that at least two people have died during the cleanup campaign. One fell while repairing his home, and the other was struck by a large branch as he was cutting down fallen tree limbs.

Generators are proving to be a health risk, as people who use them improperly become overwhelmed by fumes. Kerosene lamps are a danger as well; one elderly man stumbled into the Humana Medical Plan tent last week after a lamp exploded, burning down half his house. A diabetic, he had lost his insulin in the fire.

At Homestead Hospital, doctors report that the emergency room is three times as busy as usual. “Normally we see 60 people a day,” said Dr. Mohammad Masri, looking weary and unshaven. “Now we are seeing 200.”

Strange skin rashes have been afflicting people who live near commercial areas. Nurses suspect that when the storm ravaged commercial buildings, it also unleashed asbestos particles into the air. The particles, they surmise, collect on garments hanging on outdoor drying lines.

On top of these physical ailments, the mental health of the populace is suffering. Vietnam War veterans are spooked by the military helicopters constantly flying overhead. Children cry during the frequent afternoon downpours. Insurance adjusters report that it takes longer than usual to process claims because each storm survivor has a story to tell. There is, it seems, a collective need to vent.

“These are things that aren’t going to go away,” said Dr. Gwen Wurm, an administrator for the Florida Department of Health and Rehabilitative Services whose district encompasses storm-stricken Dade County. “We are going to be living with a whole lot of health problems for some time to come, as long as we have people living in congregate living situations, tent cities and shelters. . . .

“It’s a level of disaster and displacement and destruction that is very hard to conceive of,” she continued. “To me, the biggest sign is that in 1992, we still have 100,000 people over two weeks after a disaster without power and without water that they can drink out of their faucets. That is wild.”

Of particular concern is the fate of southern Florida’s more than 380,000 elderly people--18% of whom are living at or below the poverty line. Tent cities and shelters are no place for the infirm, and authorities have been scrambling to find new living quarters for those who lost their houses at the same time as the hurricane shut down eight nursing homes and caused severe damage to 38 of 93 small group homes for adults.

Hazel Alexander, 71, was among those displaced. The wheelchair-bound woman, who suffers from a pancreatic disorder, spent three uncomfortable nights in the tent city at Homestead, sleeping upright in her chair because she is unable to lay flat.

“This is rough,” she said bravely during one of those nights, “but everyone tries to make it as nice as they can. I wouldn’t want to stay here for too long, though.”

As it turned out, she did not have to. When the tent city began filling up, a corps of public health nurses set up an outpost in an attempt to weed out people too fragile to live in a tent. They sent Alexander to a group home with air conditioning and a proper bed.

The biggest obstacle for those working in the trenches is communication, or rather the lack of it. Ordinarily simple tasks--phoning in a prescription to a pharmacy, ordering a laboratory test--are now complex, if not impossible.

Without television to spread news, other means must be found. At night, the Goodyear blimp--diverted from a Washington Redskins-Dallas Cowboys football game when the hurricane hit--flew overhead, its bright orange digital readout telling residents where to go for medical help and reminding them to boil water and wash their hands.

For a time, the medical tents flew bright red parachute balloons overhead so that people could find them, but that ended when the balloons were stolen by gangs.

And consider the dilemma of Dr. Richard M. Sword, a Hawaii psychologist who was sent to southern Florida under the auspices of the National Medical Disaster System, a federal network of volunteer medical relief teams coordinated by the U.S. Public Health Service.

“I got a call today from a Red Cross center,” Sword said in an interview last week. “A patient showed up and was disoriented, didn’t know what day it was or where he lived and yet he wanted to be taken home. Now that’s a little bit of a problem.”

The doctor happened to know that the Army’s 82nd Airborne Division had a psychiatrist working in Florida City, near the Red Cross center. The only problem was finding him. Sword tracked down the school where the Army was camped out and spoke to a teacher, who passed the word onto a soldier, who found a medic, who located the psychiatrist, who went to the Red Cross facility to help counsel the patient.

“You learn how to get in touch with each other in creative ways,” Sword said, “how to make things work when everything doesn’t work.”

Volunteers like Sword provided the first line of medical defense after the storm. As soon as Andrew hit, the Public Health Service deployed six DMATs--disaster medical assistance teams--to the afflicted area to help local doctors. Another five teams have since joined the effort.

In all, more than 450 volunteer doctors, nurses and other medical professionals were sent to southern Florida by the government. So far, they have treated 14,000 people and delivered six babies. The military, which provided reinforcements to the DMAT effort, has treated more than 25,000 people.

The DMAT doctors and nurses are trained to cope with calamities both natural and man-made--earthquakes, fires, industrial accidents. Many worked in South Carolina after Hugo, the first time the National Medical Disaster System was activated.

But nothing prepared them for the scope of Andrew.

“We never expected a disaster of this magnitude, where mile upon mile of houses are gone and the infrastructure is gone,” said Frank Young, deputy assistant secretary of the Department of Health and Human Services, which oversees the Public Health Service. “That’s something we never planned for.”

Likewise, the storm caught the state’s public health nursing corps off guard. Schoenherr, the Daytona Beach nurse, said she intends to rewrite her disaster manual after her experience in southern Florida.

Experts in medical disaster relief say there is much to be learned from Hurricane Andrew. Tom Reutershan, who runs the National Disaster Medical System, says every aspect of the medical community’s work--from how drug prescriptions were filled to patterns of disease and injury--will be scrutinized in preparation for the next disaster.

State and local officials in Florida, meanwhile, are now faced with twin challenges in the health care arena. Over the short term, they must phase out the DMATs and the military presence. The more difficult task comes over the long term--rebuilding southern Florida’s crippled health care network.

Some see this as a golden opportunity to improve health care in an area that, with its large population of migrant workers and impoverished immigrants, has been chronically underserved in the past. State officials and private doctors agree that the hurricane exposed a health care system that was inadequate long before the storm demolished it.

“What this hurricane did was take the facade away from the poverty that has been hidden for so long,” said Dr. Jose Greer, an activist physician who works with Miami’s homeless. “It blew away more than buildings.”

In the aftermath of the storm, Greer and his Camillus Health Concern have set up clinics for the 30,000 migrant workers whose camps were destroyed. In addition to treating the injured, he and his colleagues discovered a surprising absence of basic medical care. Children had never been immunized. Adults were sick but had not seen doctors for fear of losing a day’s pay.

Now, with some estimating that as many as 20% of all private physicians will leave the storm-stricken area, authorities say it will be more important than ever to have a good public health system.

They also expect the needs of the region to change as a result of the devastation; more mental health centers and substance-abuse treatment programs will likely be necessary, as well as clinics to provide routine medical care. The challenge will be to cater the new system to the new face of southern Florida.

“We are allowed to start over,” Greer said. “We should take that chance and do what’s right.”

Stolberg reported this story while on assignment in Florida.