Post on 19-Jan-2015
description
transcript
A holiday in Fiji
S. Manders MD FACEM
11 April 2012
Fiji
• South Pacific nation• 332 islands (110 permanently inhabited)
• Population 849,000 (2009)
• Culturally varied• Indigenous Fijian• Fijian Indian• Other Pacific Islander
Fiji
• Independence from UK 1970• Ongoing constitutional crisis
• Coups (1987 x2, 2000, 2006)
• Constitution suspended (2009)
• Military government• Economy
• Subsistence agriculture• Export crops (sugar, coconuts, ginger, copra)• Tourism
Meanwhile...
2 April 2012:
Tropical Depression 19F strengthens to become
Cyclone Daphnecategory 2
95 km/h985 hPa
Source: The Fiji Times
Severe flooding
• Heavy rainfall western side of Viti Levu• Sudden severe flooding Friday 30/3• More flooding Sunday 1/4• Thousands of displaced residents• Seven dead
Source: The Fiji Times
Source: The Fiji Times
Intermezzo
Phuket, 2 January 2005
Nadi, 3 April 2012
Nadi, 3 April 2012
Nadi, 3 April 2012
Nadi, 3 April 2012
Lautoka, 4 April 2012
Lautoka, 4 April 2012
Lautoka, 4 April 2012
Nadi Hospital, 4 April 2012
Teams
• Doctor• Nurses including paediatric• Dietician• Public health inspector• Driver
Tasks
• Head count• Adults• Children• Infants
• Assessment of sanitation, water supply• Nutritional assessment & supplementation• Medical surveillance & management• Prevention & vector control
Nadi area, 4 April 2012
Nadi area, 4 April 2012
Nadi area, 4 April 2012
Medical supplies
Medical supplies
• Equipment• Stethoscope (1)• Mercury sphygmomanometer (1)• Glucometer (1)• Scissors* (1)• Non-sterile gloves*• Sharps container*
Medical supplies
• Antibiotics• Amoxicillin 500 / 250 / elixir• Flucloxacillin 500 / 250 / elixir*• Erythromycin 250 / elixir• Metronidazole 500• Chloramphenicol 250
Medical supplies
• Skin & eye care• Dressing packs (given to local nurse)
• Chlorhexidine + cetrimide cream• Benzoic acid + ASA lotion (fungal infections)
• Zinc oxide ointment• Permethrin cream*• Tetracyclin ophthalmic ointment• Chloramphenicol eye drops
Medical supplies
• Children• Multivitamins• De-worming tablets*• Milk powder• Rice & lentil mix• Paed dosing syringes / cups
Medical supplies
• Other• Paracetamol / ibuprofen• ORS• Ranitidine
Medical supplies
• Did not have (or *insufficient):• Scissors*• Dressings* / plaster (‘Band-aid’)
• Permethrin*• Antifungal cream*• Water for irrigation• Food & drink for team• PPE* / hand sanitiser
Narewa, 5 April 2012
Narewa, 5 April 2012
Nadi District School, 5 April 2012
Nawaka, 5 April 2012
Nawaka, 5 April 2012
Nadi Muslim College, 5 April 2012
Nadi Muslim College, 5 April 2012
What did we see the most?
• D & V• Cuts & scrapes• Skin infections
• Fungal (tinea)• Boils & other Staph• Scabies ± infection
• Chest infections• Surveillance for:
• Leptospirosis• Typhoid fever• Dengue
‘Surprise finds’
• Severe exacerbation COPD• Severe PVB + anaemia• Rheumatoid arthritis?
Leptospirosis
• Leptospira bacteria (spirochaete)• Animal urine, contaminated soil• Symptoms:
• Fever, headache, vomiting, conjunctivitis, sores• Complications:
• Renal failure, liver failure, meningitis, death• Treatment:
• Penicillin OR doxycycline
Typhoid fever
• Salmonella typhi, food- & water-borne• Symptoms:
• High fever (>2 days)• Headache, diarrhoea / constipation, malaise
• Complications:• Delirium, sepsis, bowel perforation, myocarditis, death
• Treatment:• Chloramphenicol, ciprofloxacin, ceftriaxone, ...• Antibiotic resistance a major issue
Dengue
• Arbovirus, transmitted by Aedes mosquito• Symptoms:
• High fever• Severe pain
• Headache, retro-orbital & diffuse body pain, sore throat• Vomiting• Centrifugal maculopapular rash (resembling measles)
• Complications:• Dengue haemorrhagic fever
• Treatment:• Supportive - analgesia, rehydration
Nadi, 6 April 2012
Nadi District Hospital, 6 April 2012
Nadi Rural Local Authority Office, 6 April 2012
Nadi Sangam Primary School, 6 April 2012
Nadi Sangam College, 6 April 2012
Nadi area, 6 April 2012
Nadi area, 6 April 2012
Nadi area, 6 April 2012
Nadi area, 6 April 2012
Nadi area, 6 April 2012
Nadi area, 6 April 2012
What went well?
• Evacuation Centres• Everywhere• Extremely well known to public• Local health officer for each EC
• Good public health response• Infectious disease surveillance• Focus on child health• Vector control
What could have gone better?
• Medical supplies• Slightly haphazard & incomplete
• Transport• Shortage of cars
• Water & food supply• Both to population & teams
• Communication• Lack of clarity top-down• Micro-management from top levels
What was I happy I brought?
• Head torch• Hand sanitiser gel
What will I bring next time?• Old stethoscope• Scissors / multitool
Any questions
?
Vinaka vakalevu!