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A holiday in fiji

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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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