Enoch Choi, MD  
Male, 46
Palo Alto, CA

Specialties: Family Medicine

Interests: sinusitis, Migraine, Low back pain
Palo Alto Medical Foundation
Urgent Care
Palo Alto, CA
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Stories from San Diego Fire Medical Relief Clinic in Ramona, CA

Nov 05, 2007 - 0 comments

san diego




medical relief


relief clinic






disaster relief



5 days ago, Christ in Action arrived in Ramona, CA and called MPPC (Menlo Park Presbyterian Church) for a medical relief team to join them in assisting the survivors of the fires around San Diego. After a flurry of calls, 9 committed to go: MDs, RNs and support counselors flew down 3 days ago to spend the last 2 days providing medical care in a local church, Mountain View Church. Even though we've returned, we've come back to tell folks that these survivors still need our help. Christ in Action will be there another 2 weeks, feeding folks and helping survivors rebuild. For me, the opportunity to go down was sponsored by my partners at PAMF Palo Alto Medical Clinic and PAMP Palo Alto Menlo Park Parents Club which I sit on the board of.

I was surprised to get the call last week, since I'd checked with the Red Cross and MVDR (county volunteer corp) and they said there was no need. When we arrived, I found that the Red Cross doctor that had been there for the week since they reopened Ramona to let survivors return, was just leaving. The Red Cross told me that the medical needs due to the fire had been met, and the doctor wasn't needed since the rest of the needs were pre-existing to the fire.

Boy were they wrong, we went to the Local Assistance Center (LAC) to offer our services, and in the 1 hour it took the county officer in charge of the whole site to decide to kick us off ("we can't take the liability of you providing care here), we cared for half a dozen survivors. We were unceremoniously escorted off by 5 county officials, and returned to the church which was 2 miles away. What's the big deal with that? Well, many of these folks barely had the resources to get to the LAC, much less get to our church. One survivor gave the story of how they collected bottles for recycling over the last week to save up for the gas to get to the LAC, and couldn't afford to make it up to our church-- sure enough, we didn't see them.

The folks around Ramona weren't like those in nearby affluent San Bernardo which although more severely affected, had many more resources to draw from. More than 350,000 sq acres were burned, with 200 homes consumed in Ramona and nearby. Folks in Ramona told us stories like the following:

The most touching moment the first day for me was praying with someone who shares my wife's name, with a toddler daughter coloring with crayons hiding under the chair her mother sat on. Her house burned down a second time, after having lost her house to the 2004 fires. This woman is amazingly thinking of entering Christian ministry since she realizes that her story is powerful in showing God's provision even through contracting MS, losing sight in 1 eye and 1 ear. She'd left her husband with the kids due to something told to her that was a lie and she was informed it wasn't a lie so she returned to her family.

One mom came in with kids just my own children's ages and genders, and the younger had asthma just like my son. It was all too close for comfort. The mother was disabled, on SSI, complained of the must & mold in the motels they were evacuated to first (which exacerbated her son's asthma). She was overwhelmed with the generosity of the indian reservation who set her up with a mobile home and made it handicap accessible with a ramp, all donated to her. My dad was really marvelous with the boy, gently encouraging him not to sleep with the cat since that'd hurt his asthma. It saddened me to hear how the father refused to stop smoking, making the son's asthma worse. The daughter's vomiting turned out to be a simple case of overindulgence -- eating waaay too much halloween candy. ;)

Many couldn't refill their chronic medications even though their doctors were back in their clinics, they were overwhelmed and not able to get thru the many voicemail messages. Antihypertensives, diabetes medicines, congestive heart meds, blood thinners (coumadin) were some of the critically needed medicines we wrote prescriptions for due to being lost in the fire 12 d ago. Some folks even had excellent PPO insurance but couldn't reach their doctors, but in the frequent instances of those underinsured (out of insurance due to job loss, or Dr in Mexico) we could point them to the Red Cross who would pay for the medicines if they had a doctor to write the prescription. But the Red Cross doc had left. Reminded me of post-Katrina where we could write "shelter eligible" on the prescription and the pharmacy would bill FEMA. The local Ramona pharmacy was providing discounts for survivors.

While at the LAC, just before we arrived there was someone who needed an inhaler and I couldn't find them (they were supposed to have gone over to the taiwanese buddhist relief table). That frustration of not being able to find the survivor, reminded me of a time I accidentally gave one person's advair to another person in Katrina mistakenly, with the unwitting donor saying "well I hope that fellow needed it more than me".

Open wifi in LAC was a blessing... Although Globalcom set up satellite dish for wifi here at the mountain view church, it always happened to be down when i needed it. I think it was God telling me to focus on my teammates and the work, rather than liveblogging it. I managed to liveblog some of it from my phone, but it got too busy to after a while.

Sandy Nissley woke up for cooking every day at 3am, and that 1st night got us into our rooms at 11pm.

The few lacerations we treated, reminded me of sewing up a hand laceration post-Katrina since it was our first patient in both situations, and in Katrina the dust was billowing about, whereas this time we had a very nice sunday school room to operate from.

Children in strollers, and toddlers, heartbreaking, seeing father hug his child toddling into church sooo tightly as if they hadn't seen each other in ages whereas I'd guess that they'd been apart for no more than a few hours since they'd lost their house and had to be travelling together. It made me think, if I lost everything, how much I'd cherish my loved ones more. Some of these folks were told that they'd have 2 hours to evacuate and 30 seconds after getting that call, the flames were starting to consume their homes. Reminded me of the folks who told us that they had no warning other than the Katrina floodwaters bursting thru their front door, and as they ran towards it, getting swept up such that they'd be swimming out of the home thru that very door.

It was such a privilege to be there here to help, and hear their stories. Did I mention that you can go down and help? Christ in Action is taking all volunteers that come.

My Dad told the story of a Chinese provincial governor invited his medical missionary team to come help last month provide "sight to the blind" through the volunteer surgeries of US overseas chinese ophthalmologists. He encouraged us to get political support for our missions in the future.

One local pharmacist was giving refills even with "no refills" since the survivor was out (meds burned with the house) and couldn't reach Dr. since their office wasn't open since there was no clean potable water. How can you let folks back here into Ramona for the last 9 days without clean water until 3 days ago so clinics can't run. Wal-mart donated truckloads of water but that's not sufficient to re-open a clinic.

A dozen navy volunteers came to the Christ in Action site to lend a hand.

A HVAC pensylvania guy drove 43 hours straight (tag teaming with a buddy) to come to volunteer. He showed me how much he really cared for the Nissleys by bringing them Starbucks coffee -- the kinds they liked.

A SF firefighter paramedic and UC davis med school matriculant, who is taking year off to figure out what to do, had just finished a week's duty on the fire line, and saw that CiA was here, so after getting home and clearing it with her family, came right back to volunteer. Ironically, she was feeding us in St. Bernard parish 2 years ago -- we were in that Wal-mart parking lot at the same time. She'd been there with firefighters, and met CiA for the first time there. Who knew we'd meet again 2 years later.

Sandy's husband lost 230 lbs through gastric bypass and needs plastic surgery to remove excess skin, willing to be a demonstration case. I'm advising thailand but if any of you have ideas of american plastic surgeons, Denny's willing to be an educational case if they can have a discount since it's all out of pocket.

A panama canal crane guy I diagnosed with pneumonia, 30 years in panama, fixed CiA's electrical system, now runs forklift here from 3am- 9pm, it's amazing how hard these volunteers work.

My cousin was one of the other physicians, and it was my first time working alongside her... Incredibly energetic, compassionate, and was very helpful with her great spanish. God let her conference on Saturday get cancelled, so she could join us the 2nd day as well.

A local orange county hospitalist was so energetic he reminded me of the energizer bunny.

My strongest memories of my dad here are of doing devotionals in preparation for the sermons he'd be giving on his return. Dad was fabulous with the asthmatic kids, since he was a pediatric allergist. His style of interacting with the kids was so hands-on, hugging, playing with them, it showed me how warm pediatricians are trained to be.

Mauishowers.com gave me the longest showers I've had in recent memory: 10 minute, soooo long! very relaxing.

1st day's meals:
bkfst: biscuits & gravy
lunch: shredded chicken burritos
dinner: spaghetti & meat sauce, wheat baguette

2nd day's meals:
bkfst: chorizo & eggs
lunch: hamburgers

These meals were prepared to feed 1000 or more at a time, it's incredible how huge the scale is. Many firefighters, FEMA, contractors, other volunteer agencies (cityteam, billy graham and samaritans purse) all ate the food we did, as it was probably more palatable than the MREs they'd have otherwise.

The daily devotionals ended with a song, and with so many choir singers in the team, my wanting to continue was cut short by waiting patients...

Our team leader was very self-sacrificial, Melinda delayed her lunch for us and manned the fort.

I realized that giving the same level of care to Medi-Cal (CA state medicaid) patients isn't enough. In Ramona, i did TARs, called in rx, did everything we could for them. In Palo Alto, I give the same level of care to everyone (including medi-cal) but what i do for wealthy PA'ans isn't sufficient to hook indigent patients with the resources they need. They have more needs and not understanding of how to access them since unaware that they're available. It made me want to do more for my own indigent patients when get home.

Doing more overseas is easier without liability concerns, just go and do, no politics. Makes me want to do more international medical missions rather than local US. ones where we'd get thrown out of relief sites.

Local physicians were obviously overwhelmed, usual telephone refills backed up and unable to get approved to get processed, new prescriptions for those lost in fire undone. The situation begs the question for the need for PHR-personal health record access to request to automate this workflow more to decrease work of listening to phone messages and approving these prescriptions which so obviously need to be approved.

If your medication list not in your wallet (or better, a PHR), and if your house, clinic, & pharmacy all burn down, how are you going to know what your medicines are? We helped who we could with approximate prescriptions, but it would have been so much better with the system the government set up after Katrina with KatrinaHealth.org which aggregated the million patient's pharmacy records into one website that I used there to look up their meds and write their prescriptions. No guessing what the blue pill or red pill was, like I was doing here in Ramona.

A paraplegic was driven to LAC for me to examine her in the car (I couldn't write a prescription without examining her in person) so I could order seat riser and shower chair for her, hasn't showered in 12 days since can't transfer without it. Medi-Cal TAR called in, done electronically by pharmacist, and the pharmacist thanked me for coming to help.

CVS pharmacy open 'till 9pm

Walmart $4 prescriptions helped many indigent, but patients still want to be on their old meds. In comparison, meds are much more expensive here than in mexico where many of the residents go to get their meds and bring them back over the border.

We brought our clinic to Calvary Chapel 2 nights ago, where they were hosting a meeting for many survivors (i estimate 100 in the sanctuary) and the pastor asked for a show of hands to see if anyone needed medical care, and noone raised a hand. I can't believe there wasn't one person there who had a medical need. What I heard is that folks in Ramona are very proud and self-suffictient, so they'll probably get the immediate needs in order, and medical ones are ones that can wait.

In reflecting on things we could have improved, since transportation from LAC was such a problem for some, we're looking into whether or not MPPC will allow us to run shuttles via the rental van to bring folks from LAC to the church based clinic. Or else just set up and care for folks out of the minivan on the street just outside the LAC. They could chase us off county property, but I suspect they couldn't shoo us away from parking on public roads.

A senior Red Cross volunteer's attitude was very concerning to me: "these folks were in bad shape before we came, and will be in just as bad shape after we leave" with the implication that the work they were doing was for naught, and not lasting. I'm hoping that attitude was from fatigue from a week of volunteering, since I hope that the pre-existing indigent state of the victims wouldn't prejudice the care provided to them. For me, I realized just how much worse the fire make these already suffering folks suffer more -- if you're already stretched thin, there's nothing like a disaster to push you over the edge.

The need is still there. Folks still need medical care and other relief. If you're available, call & head down and there's plenty to do. Contact
Dr. Denny Nissley
executive director,
Christ in action
Phone 703-368-6286
fax 703-368-6470

It was a great couple days, and I hope to be able to return. I'm meeting with someone from my neighborhood who's driving down a loaned stationwagon full of donations, and my Palo Alto Menlo Park Parents Club is doing a bake sale this coming saturday at the Menlo Park Trader Joe's. Last time they raised over $26,000 for Katrina/Rita survivors, let's see us blow through that record!

chased off county property: they don't want the liability

Nov 02, 2007 - 0 comments

I'm turning in after seeing 20 returnees to san diego fires... got escorted out of LAC (ramona FEMA local assistance center): county doesn't want liability of us providing care there even though Red Cross MD left yesterday and no MDs to help these poor people.  Local county officials will hopefully direct folks to the church we're at 2 miles away but we could do so much more from LAC since some folks have no money to even get there.  some collected bottles and sold them for the gas $ to drive there, much less drive up the hill to us.  AAAARRRRGGGGGHHHHH!!!!!

the resilience of these people is amazing.  God is providing miraculously for them through many volunteers...

Busy first day of fire relief clinic

Nov 02, 2007 - 0 comments

I'm disappointed that Ramona FEMA Assistance Center can't allow us to set up relief clinic due to liability concerns, going to senior center next to see if they'll host us since it's closer to here where everyone is coming for aid.  Their Red Cross volunteer doc in their clinic left yesterday, since numbers of returnees seeking aid have decreased.  In the 15 minutes we've been here we've treated 3 folks and there were half a dozen who needed care but no physician here, so they sent them back to their own physicians who don't have time to see them right away.

This morning we treated a dozen folks, will write more later...

Pneumonia in 1st San Diego fire clinic patient

Nov 02, 2007 - 0 comments

I'm diagnosing pneumonia in 1st san diego fire medical relief clinic patient, and getting the patient out of our common sleeping area, the high school sunday school room of the mountain view church...  and hopefully giving the rest of the folks a chance to sleep past 5.30!  I'll bet the coughing didn't start until now due to the body's dip in endogenous steroid levels around now.  Folks work hard here, starting at 3 or 4am and going to 8 or 9.  Breakfast starts at 6 so I think i'll go get some grub.