A holiday in fiji

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!