1. A holiday in Fiji
S. Manders MD FACEM
11 April 2012

3. Fiji
• South Pacific nation
• 332 islands (110 permanently inhabited)
• Population 849,000 (2009)
• Culturally varied
• Indigenous Fijian
• Fijian Indian
• Other Pacific Islander

4. 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

18. Meanwhile...

19. 2 April 2012:
Tropical Depression 19F
strengthens to become
Cyclone Daphne
category 2
95 km/h
985 hPa

21. Source: The Fiji Times

22. 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

23. Source: The Fiji Times

24. Intermezzo
Phuket, 2 January 2005

27. Nadi, 3 April 2012

28. Nadi, 3 April 2012

29. Nadi, 3 April 2012

30. Nadi, 3 April 2012

31. Lautoka, 4 April 2012

32. Lautoka, 4 April 2012

33. Lautoka, 4 April 2012

34. Nadi Hospital, 4 April 2012

35. Teams
• Doctor
• Nurses including paediatric
• Dietician
• Public health inspector
• Driver

36. Tasks
• Head count
• Adults
• Children
• Infants
• Assessment of sanitation, water supply
• Nutritional assessment & supplementation
• Medical surveillance & management
• Prevention & vector control

37. Nadi area, 4 April 2012

38. Nadi area, 4 April 2012

39. Nadi area, 4 April 2012

40. Medical supplies

41. Medical supplies
• Equipment
• Stethoscope (1)
• Mercury sphygmomanometer (1)
• Glucometer (1)
• Scissors* (1)
• Non-sterile gloves*
• Sharps container*

42. Medical supplies
• Antibiotics
• Amoxicillin 500 / 250 / elixir
• Flucloxacillin 500 / 250 / elixir*
• Erythromycin 250 / elixir
• Metronidazole 500
• Chloramphenicol 250

43. 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

44. Medical supplies
• Children
• Multivitamins
• De-worming tablets*
• Milk powder
• Rice & lentil mix
• Paed dosing syringes / cups

45. Medical supplies
• Other
• Paracetamol / ibuprofen
• ORS
• Ranitidine

46. 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

47. Narewa, 5 April 2012

48. Narewa, 5 April 2012

49. Nadi District School, 5 April 2012

50. Nawaka, 5 April 2012

51. Nawaka, 5 April 2012

52. Nadi Muslim College, 5 April 2012

53. Nadi Muslim College, 5 April 2012

54. 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

55. ‘Surprise finds’
• Severe exacerbation COPD
• Severe PVB + anaemia
• Rheumatoid arthritis?

56. 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

57. 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

58. 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

61. Nadi, 6 April 2012

62. Nadi District Hospital, 6 April 2012

63. Nadi Rural Local Authority Office, 6 April 2012

64. Nadi Sangam Primary School, 6 April 2012

65. Nadi Sangam College, 6 April 2012

66. Nadi area, 6 April 2012

67. Nadi area, 6 April 2012

68. Nadi area, 6 April 2012

69. Nadi area, 6 April 2012

70. Nadi area, 6 April 2012

71. Nadi area, 6 April 2012

72. 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

73. 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

74. What was I happy I brought?
• Head torch
• Hand sanitiser gel
What will I bring next time?
• Old stethoscope
• Scissors / multitool

75. Any questions
?

76. Vinaka vakalevu!