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In Katrina's wake, hearing care providers struggle to pick up the pieces

Hogan, Michelle

doi: 10.1097/01.HJ.0000287051.63651.8c

Like hundreds of thousands of their neighbors and clients whose lives were turned upside down by Hurricane Katrina, audiologists and hearing instrument specialists are finding that the road to recovery is a slow one. An update on how some of them are coping.

Michelle Hogan is an editorial assistant with The Hearing Journal

Seven months after Hurricane Katrina ravaged the Gulf Coast, hearing instrument specialists Doriana and Al Vicedomini were not sure whether they would stay in Louisiana or relocate. Their hearing aid business in Metairie, LA, just north of New Orleans, had sustained heavy water damage after the ceiling collapsed, and their home in Kenner, LA, where they had another office, was flooded and their patient files soaked. Al Vicedomini hung more than 1000 pages from these files on a dozen pieces of string in the backyard to dry in the sun, somewhat restoring them.

Vicedomini said that about 20% of their clients had left the area since the storm struck last August 29, and his family was still separated. The Vicedominis' two children are living with Doriana in Suffield, CT, while Al tends to the business in Metairie. “There's not a whole lot of reasons to go back,” Doriana said in a phone interview. “There's a lot more reasons not to.”



Like so many of the people whose lives Katrina disrupted, the Vicedominis are in an extended state of limbo, trying to figure out their next step. “That secure feeling you're used to having is gone, and you live your life day to day and just hope you get through that day,” Doriana said. She added, “I think things are a lot worse than people realize.”

Scores of audiologists and hearing instrument specialists in Louisiana and Mississippi have seen their homes, offices, and clinics damaged or destroyed, and many have lost a significant percentage of their clients to relocation. Katrina has also led many practitioners to relocate, some temporarily and others permanently, some away from cities to outlying suburbs, others out of the area altogether.

Melinda M. Peat, MCD (master of communication disorders), the speech pathology/audiology program manager for the Louisiana Department of Health and Hospitals' Office of Public Health, estimated that 75% to 80% of audiologists formerly working in New Orleans left after the storm. Loss of hearing healthcare providers and public health employees, as well as the crashing of the Vital Records Registry when Katrina left the Department of Health and Hospital's database underwater, has severely disrupted the system of providing care for the deaf and hard of hearing. “It takes tremendous coordination among service providers to draw on what is left of the system, to see that the patients or clients receive the care that they need,” Peat said.

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The Office of Public Health used to receive newborn hearing screening data on the electronic birth certificate, but the vital records database was down for 6 months following the hurricane. “I think hospitals have done a good job continuing with the newborn hearing screening, but as far as getting useful data, we just hit a brick wall,” Peat said. “But we're now starting to pick up the pieces.”

Christy Fontenot, MS, who works in Louisiana's Early Hearing Detection and Intervention program and is president of the Louisiana Speech-Language-Hearing Association, said patients have been notified of hearing screening results, but follow-up has been difficult. Women's and Children's Hospital in Lafayette, where she works, received many of the babies who were evacuated during the hurricane. However, the hospital was often unable to follow up with the families of those who failed the screening because they did not have permanent addresses.

Loss of patient records also heavily impacted private practices. Michael Seidemann, PhD, estimated that he lost 25% of his records when his Kenner, LA-based forensic and industrial audiology practice, Audiological Associates, Inc., flooded. His home also flooded, but he has been able to remain there. He noted that many of the local people who would normally have filed hearing loss claims against their employers have not because they have left the area. On the other hand, Seidemann says, a general increase in large-scale hearing loss cases is keeping him busier than ever overall.

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Kresge remained high and dry

Among the facilities that escaped physical damage during the hurricane and subsequent flooding was the Kresge Hearing Research Laboratory. Thanks to the laboratory's location on upper floors of the Louisiana State University (LSU) Health Sciences Center in New Orleans, most of its equipment and research escaped unscathed. However, the flooding citywide forced the program to relocate temporarily to LSU's main campus in Baton Rouge.

Meanwhile, Kresge has lost much of its talent because of Katrina. As of March, two faculty members had left, and another was likely to leave, said Bronya Keats, PhD, professor and chair of the Department of Genetics at LSU. “It leaves us with a lot of building to do to try to make Kresge vibrant again,” she said. “I will do what I can to try to build, but obviously trying to recruit people to New Orleans is going to be an uphill battle for a while.” She does not expect Kresge to add any faculty members for at least a year.

Keats's home in New Orleans flooded, and since October 21 she's been living in a house she purchased in Mandeville, LA. As far as her research is concerned, though, Keats considers herself lucky. She and her lab associates had been working on creating a mouse model for Usher syndrome and, they believe, the first group of mice for the project was born the night of the hurricane on the first floor of a building that got about 6 feet of water. The animal care workers moved the mice to safety on the second floor, and Keats and her lab had their colony of Usher mice.

Charles I. Berlin, PhD, the long-time director of Kresge and now emeritus professor, insisted that the faculty who left Kresge will not stop collaborating. He said, “We'll continue to work together and finish our work. The Kresge concept won't stop, and LSU, if and when it's ready, will reactivate it.” Berlin's home in New Orleans was also flooded, and he said he will not rebuild in that location—80 yards from the London Avenue canal levee that broke. He is living in Tampa for now, where he has an appointment at the University of South Florida.

LSU's Department of Communication Disorders, which moved with the rest of the Health Sciences Center to Baton Rouge, was on schedule to move back to New Orleans for the summer session starting in May, said Barbara Wendt-Harris, PhD, director of the audiology program and clinical assistant professor. Two students in the department left LSU because of the hurricane, but the faculty all returned to work even though about a quarter of them had lost their homes and another 50% had suffered damage to their homes. Among those whose homes were destroyed was Wendt-Harris, who has been staying with a friend in Metairie.

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Because the hurricane changed New Orleans so dramatically, she expects it to have lasting effects on the department. “We're looking at putting some satellite clinics out where the population now is. I think the mix of the city is going to change. We need to be ready to deal with where the new population is going to be and who it's going to consist of.”

Robert Turner, PhD, a professor in the department, gave credit to the Health Sciences Center's administration, faculty, and students for staying open while so many other universities closed. He also spoke positively of the temporary move to Baton Rouge. “Everyone's been wonderful over there and made us feel right at home. I'm going to miss them when we go back,” he said.

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At press time, the population of New Orleans was less than half what it had been before Katrina, and the population of St. Tammany Parish, to the west and north of New Orleans, had swollen by an estimated 70,000 or 80,000 people by early April. Lynn Creel, MCD, had been affiliated with two otolaryngologists before the hurricane, but after the storm she went into private practice, opening one office in Metairie, where she had practiced before, and planning to open a new location in Mandeville, on the north shore of Lake Pontchartrain, because of the growing population there.

Creel said she lost at least 20% of her patient base because of relocation, but gained another 20% to 30% because of new patients. “Many, many of my geriatric patients still cannot find their primary-care doctors, so there's a real need or a real void for healthcare right now, which benefits us,” she said. “There are only a few hearing aid dispensing practices available, and so I have been doing as well, if not slightly better, than before the storm.”

The new population distribution is also a consideration for Tulane University Hospital and Clinic, said John Risey, MCD, a Tulane audiologist. It is not yet known when Tulane University Hospital and Clinic's ENT clinic, which relocated to Metairie after Katrina, will return to New Orleans, Holly C. Adams, vice-president and executive director of TUHC Clinic Operations, wrote in an e-mail in April. Risey added that it is the population decline in New Orleans, not physical damage, that may delay the clinic's return. Because the ENT clinic is located on the third floor of TUHC, it escaped unscathed when parts of the hospital flooded.



Risey, who works with another audiologist, said they are seeing no more than a quarter of the number of patients they saw before the storm. Two Tulane ENTs left after the hurricane, and the three remaining are working in Metairie. The relocation has limited the scope of services offered, Risey said. “We still do hearing testing, and we're able to fit hearing aids, but we really can't do the other things we were doing at our main location.” The New Orleans clinic had a large balance lab, but Metairie doesn't have the space for that.

At Children's Hospital New Orleans, on the other hand, Amanda Giles, MCD, is seeing about 50% to 60% more patients than before the storm—10 to 12 patients a day, compared with 6 to 8 pre-Katrina. Children's Hospital stayed open during the storm and then closed from September 1 to October 9. While Giles's workload has increased, the number of patients seen by the department overall has decreased, since Children's Hospital lost an audiologist to relocation. Giles said the number of patients she sees is limited only by how many she can fit into her schedule. “It's difficult because a lot of places that were offering pediatric services no longer exist so there's a high demand for audiology,” she said.

For Amy Rigamer, MCD, too, business is as good now as before Katrina, if not better, because of the increase in new patients. While the New Orleans otolaryngology office where she primarily works did not sustain physical damage, her home, located just four blocks from where the London Avenue levee broke in Gentile, New Orleans, was immersed in 7 feet of water. Rigamer had been living in Jefferson in half of the double-house that contained her husband's business, and she planned to move to a new home in Gentile in April.

Catherine F. Kirkwood, MCD, whose Metairie home was flooded 18 inches deep, has been living on the second floor with her four children while the first floor is being repaired. Her business, which she runs with her father, James Faust, BC-HIS, had roof damage, and while they have picked up some new patients, the new business has not made up for the one-third of patients lost. She said, “We have a very elderly clientele, and many of those patients were evacuated by family members to other states and other locations, and they are not bringing them back.”

Despite the hardships, she is hopeful. “We're a third-generation hearing aid dispensing practice. We've been around for 70 years, so we are probably one of the oldest practices in all of Louisiana. We intend to stay here and continue to operate at full capacity for as long as we can.”

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Audiologists and hearing instrument specialists along the Gulf Coast and beyond have been touched by the personal accounts they have heard from their patients. Margaret Carlin, PhD, professor in the Department of Speech and Hearing Sciences at the University of Southern Mississippi, plans to compile stories she's heard. For the first 2 weeks after she reopened Better Hearing Center, her practice in Ocean Springs, MS, Ross Sowell Deavours, AuD, said she just put a pot of coffee on and her patients would sit in the lobby and share their experiences.

Deavours, who lost a lot of patients to the storm, said, “We're not back where we were before the storm, but I'm still paying my bills, which is good. I've had a lot of older adults in my practice leave the area because it's too physically demanding to stay here. And I've had more patients die since the hurricane than I've ever had in this period of time.” While her business was not physically damaged, her home in Vancleave, MS, flooded, but she has been able to live there while waiting to repair the damage.

Karen Slater-Miller, AuD, likened the first few months of seeing patients to a counseling session. She heard about people climbing through windows into the flood waters and, as they swam away from their homes, seeing their possessions float away. One patient was trapped for 3 hours with her foot lodged in debris and the water rising around her before it finally receded. But, four of the five audiology practices Slater-Miller was running along the coast of Mississippi before the storm survived. Only the office in Bay Saint Louis was destroyed, and the ENT physician who had worked there decided to move out of state. Her two practices in Gulfport and one each in Biloxi and Orange Grove had structural damage, but are now open. And, although many patients left the area, she said the clinics are seeing 10% or 15% more patients.

Slater-Miller and her immediate family members—two sisters, brother, and mother—all lost their homes. Her close-knit family was suddenly scattered after the storm, with her sisters having moved to Alabama and her mother an hour inland. But she said there was a silver lining to her personal tragedy: Being far from her family brought her closer to her boy-friend, and the couple married in January.

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In Biloxi, MS, Katrina destroyed the building that housed the dispensing business of George “Jordy” Pitalo, BC-HIS, and his father, George Sr., as well as the family's pharmacy. Since mid-September, he has been seeing his regular customers for maintenance visits in a fenced-off area inside a wholesalers' warehouse. He has retained most of his clients, and plans to reopen in a new location in Biloxi in November. Pitalo has received assistance from Phonak, Siemens, Starkey Laboratories, and GN ReSound in replacing the equipment he lost. “They were all willing to bend over backwards to help us out, so it's been really nice to work with people who can see the problems that we're having down in this area,” Pitalo said.

Other hearing professionals also attested to the help they received from large companies. For the first 2 months her office was open following Katrina, all the services Deavours provided were offered free of charge—she used funds from the Starkey Hearing Foundation to fit people with hearing aids and get their aids repaired for free, as did Carlin.

Starkey Labs also replaced hearing aids for many of Slater-Miller's patients free of charge, and GN ReSound donated a computer to her practice. Rigamer said that Siemens was very accommodating in providing replacements to patients who lost their hearing aids in the hurricane. Kirkwood said she had a few patients who received FEMA (Federal Emergency Management Agency) money to replace their aids.

In addition to the large companies that provided replacement hearing aids, equipment, and other sources of relief, individuals in hearing healthcare also offered assistance. Hearing Professionals Inc. in Maryland donated a dozen or so behind-the-ear instruments to the Biloxi and Pascagoula, MI practices of Gordon Stanfield, PhD, both of which had water damage. For the first few months after the hurricane, Stanfield slept in 13 different beds in four states. He even spent a few nights sleeping in the recliner in his clinic and going to the gym across the street to shower and shave. His home in Biloxi had 2 feet of water, and he has been living in a new house in town since early December as he repairs his old home.

He said everything is relative in terms of damage from the storm, though. “When somebody says, ‘How'd you do?’ I'd say, ‘Well let's see. I had two feet in my house, two feet in my office in Pascagoula, lost two cars, but actually I didn't have too much of a problem.’ It's relative to what everybody else had, because we had a lot of friends who were cutting holes in their attic to get out with the water up to their neck.”

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Stanfield said many local businesses are in need of employees, and “help wanted” and “now hiring” signs are familiar fixtures. Deavours said waiting an hour or two for a table at a restaurant or 30 minutes in line at McDonald's is not unusual. Creel reported that many chain restaurants in the area have not even reopened.

As the halting return of businesses to the area shows, the Gulf Coast is still very much in a state of uncertainty, with residents, including hearing professionals and their patients, pondering every day whether to leave the area or to stay. Many of those interviewed for this article expressed frustration with the slow pace of the rebuilding effort. In March, more than 6 months after Katrina hit, parts of New Orleans were still without electricity, and residents were waiting to find out if they should rebuild homes overtaken by flooding. Yet, even as most of these professionals agreed that the Gulf Coast might never be the same, most were optimistic it would be back—maybe even stronger.

“The people who are doing the work here are really incredibly committed and really stalwarts,” Berlin said of his fellow audiologists in the New Orleans area. “They've been moving ahead against enormous obstacles, but they're making progress. They're hopeful and positive, and I see no reason to say they'll fail. These are not people who are used to failure.”

© 2006 Lippincott Williams & Wilkins, Inc.