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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 ...
Fiji• Independence from UK 1970• Ongoing constitutional crisis  • Coups (1987 x2, 2000, 2006)  • Constitution suspended (2...
Meanwhile...
2 April 2012:  Tropical Depression 19F   strengthens to becomeCyclone Daphne               category 2                 95 k...
Source: The Fiji Times
Severe flooding                                       Source: The Fiji Times• Heavy rainfall western side of Viti Levu  • ...
Source: The Fiji Times
IntermezzoPhuket, 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 assessme...
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) ...
Medical supplies• Antibiotics  •   Amoxicillin 500 / 250 / elixir  •   Flucloxacillin 500 / 250 / elixir*  •   Erythromyci...
Medical supplies• Skin & eye care  •   Dressing packs (given to local nurse)  •   Chlorhexidine + cetrimide cream  •   Ben...
Medical supplies• Children  •   Multivitamins  •   De-worming tablets*  •   Milk powder  •   Rice & lentil mix  •   Paed d...
Medical supplies• Other  • Paracetamol / ibuprofen  • ORS  • Ranitidine
Medical supplies• Did not have (or *insufficient):  •   Scissors*  •   Dressings* / plaster (‘Band-aid’)  •   Permethrin* ...
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 ± i...
‘Surprise finds’• Severe exacerbation COPD• Severe PVB + anaemia• Rheumatoid arthritis?
Leptospirosis• Leptospira bacteria (spirochaete)• Animal urine, contaminated soil• Symptoms:  • Fever, headache, vomiting,...
Typhoid fever• Salmonella typhi, food- & water-borne• Symptoms:  • High fever (>2 days)  • Headache, diarrhoea / constipat...
Dengue• Arbovirus, transmitted by Aedes mosquito• Symptoms:  • High fever  • Severe pain     • Headache, retro-orbital & d...
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• G...
What could have gone better?• Medical supplies  • Slightly haphazard & incomplete• Transport  • Shortage of cars• Water & ...
What was I happy I brought?• Head torch• Hand sanitiser gel  What will I bring next time?• Old stethoscope• Scissors / mul...
Any questions     ?
Vinaka vakalevu!
A holiday in fiji
A holiday in fiji
A holiday in fiji
A holiday in fiji
A holiday in fiji
A holiday in fiji
A holiday in fiji
A holiday in fiji
A holiday in fiji
A holiday in fiji
A holiday in fiji
A holiday in fiji
A holiday in fiji
A holiday in fiji
A holiday in fiji
A holiday in fiji
A holiday in fiji
A holiday in fiji
A holiday in fiji
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A holiday in fiji

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Transcript of "A holiday in fiji"

  1. 1. A holiday in Fiji S. Manders MD FACEM 11 April 2012
  2. 2. Fiji• South Pacific nation• 332 islands (110 permanently inhabited)• Population 849,000 (2009)• Culturally varied • Indigenous Fijian • Fijian Indian • Other Pacific Islander
  3. 3. 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
  4. 4. Meanwhile...
  5. 5. 2 April 2012: Tropical Depression 19F strengthens to becomeCyclone Daphne category 2 95 km/h 985 hPa
  6. 6. Source: The Fiji Times
  7. 7. Severe flooding Source: The Fiji Times• Heavy rainfall western side of Viti Levu • Sudden severe flooding Friday 30/3 • More flooding Sunday 1/4 • Thousands of displaced residents • Seven dead
  8. 8. Source: The Fiji Times
  9. 9. IntermezzoPhuket, 2 January 2005
  10. 10. Nadi, 3 April 2012
  11. 11. Nadi, 3 April 2012
  12. 12. Nadi, 3 April 2012
  13. 13. Nadi, 3 April 2012
  14. 14. Lautoka, 4 April 2012
  15. 15. Lautoka, 4 April 2012
  16. 16. Lautoka, 4 April 2012
  17. 17. Nadi Hospital, 4 April 2012
  18. 18. Teams• Doctor• Nurses including paediatric• Dietician• Public health inspector• Driver
  19. 19. Tasks• Head count • Adults • Children • Infants• Assessment of sanitation, water supply• Nutritional assessment & supplementation• Medical surveillance & management• Prevention & vector control
  20. 20. Nadi area, 4 April 2012
  21. 21. Nadi area, 4 April 2012
  22. 22. Nadi area, 4 April 2012
  23. 23. Medical supplies
  24. 24. Medical supplies• Equipment • Stethoscope (1) • Mercury sphygmomanometer (1) • Glucometer (1) • Scissors* (1) • Non-sterile gloves* • Sharps container*
  25. 25. Medical supplies• Antibiotics • Amoxicillin 500 / 250 / elixir • Flucloxacillin 500 / 250 / elixir* • Erythromycin 250 / elixir • Metronidazole 500 • Chloramphenicol 250
  26. 26. 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
  27. 27. Medical supplies• Children • Multivitamins • De-worming tablets* • Milk powder • Rice & lentil mix • Paed dosing syringes / cups
  28. 28. Medical supplies• Other • Paracetamol / ibuprofen • ORS • Ranitidine
  29. 29. 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
  30. 30. Narewa, 5 April 2012
  31. 31. Narewa, 5 April 2012
  32. 32. Nadi District School, 5 April 2012
  33. 33. Nawaka, 5 April 2012
  34. 34. Nawaka, 5 April 2012
  35. 35. Nadi Muslim College, 5 April 2012
  36. 36. Nadi Muslim College, 5 April 2012
  37. 37. 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
  38. 38. ‘Surprise finds’• Severe exacerbation COPD• Severe PVB + anaemia• Rheumatoid arthritis?
  39. 39. 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
  40. 40. 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
  41. 41. 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
  42. 42. Nadi, 6 April 2012
  43. 43. Nadi District Hospital, 6 April 2012
  44. 44. Nadi Rural Local Authority Office, 6 April 2012
  45. 45. Nadi Sangam Primary School, 6 April 2012
  46. 46. Nadi Sangam College, 6 April 2012
  47. 47. Nadi area, 6 April 2012
  48. 48. Nadi area, 6 April 2012
  49. 49. Nadi area, 6 April 2012
  50. 50. Nadi area, 6 April 2012
  51. 51. Nadi area, 6 April 2012
  52. 52. Nadi area, 6 April 2012
  53. 53. 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
  54. 54. 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
  55. 55. What was I happy I brought?• Head torch• Hand sanitiser gel What will I bring next time?• Old stethoscope• Scissors / multitool
  56. 56. Any questions ?
  57. 57. Vinaka vakalevu!
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