The aftermath of a disaster - recovery following the volcanic eruptions in Montserrat - Poster abstract

OBJECTIVE: To analyse the adverse health effects following the major volcanic eruptions in Monsterrat and describe how the recovery process has dealt with these problems. DESIGN AND METHODS: The records of the health clinics were analysed for information on diseases resulting from volcanic activity. The official records of the Health Department were reviewed for evidence of the recovery process and its effects on health services. RESULTS: Direct effects included trauma - 19 fatalities and 10 severe burns following one pryroclastic surge; respiratory - an immediate exacerbation of symptoms in known asthmatics and a small increase in attendances at clinics during the early stages of the eruption. Subsequent analysis found no increase in respiratory disease following ash falls and no differences in clinic attendances comparing a clinic in a high risk area with one in lower ash areas. A survey of police staff exposed to high levels of ash found no impairment of respiratory function. Indirect effects included mental illness. There was no increase in the incidence of new illness but problems occurred because of disruption of support structures. Post traumatic stress syndrome was widely reported anecdotally but there are no survey data to support this impression. Health infrastructure was gradually restored by converting a school into a temporary hospital, refurbishing health clinics and recruiting and training staff. The Disaster Preparedness Team was strengthened. These improvements, and the setting up of an embryonic Health Information System permitted better analysis of records. A system of clinical audit had resulted in better treatment of patients. CONCLUSIONS: The major eruptions of the volcano in Monsterrat between 1995 to 1999 caused a number of health problems. These were made more difficult to contain by mass relocation of the population, closure of clinics and transfer of rudimentary clinics in north of the island. The Health Department is now in an advanced state of recovery following the crisis and many of the health problems are being resolved.(AU)

Montserrat. Managing health care in a volcanic crisis

The volcano on Montserrat, after being dormant for over 400 years, has been active for the past two years, last erupting on 27 June, 1997. With the capital, Plymouth, in the unsafe zone, major dislocation of people, facilities and services has occurred. The Health Department is splintered over five sites across an eight mile span and the temporary 30 bed hospital, sited at a primary school, is separated from its Casualty and Out-patient Department and Operating Theatre by 0.25 mile. In order to maintain continuity of care for communities, efforts have been made to keep evacuated clients and their community health workers as close together as possible. The mass emigration has depleted the health services, creating severe stress for those remaining. Elderly relatives have frequently been left behind, necessitating the establishment of special geriatric care facilities to cater to their needs. Increased and continuous health surveillance and mass media education have been integral to the prevention of major disease outbreak - particularly with added challenges to food safety, and management of liquid and solid waste disposal. Cooperation from neighbouring states, particularly Antigua, Barbados and Guadeloupe, as well as from the United Kingdom, has been critical in the management of the continuing crisis.(Au)