Disaster Reports Number 5: Hurricane Gilbert in Jamaica, September,
1988
Table of Contents
Disaster Reports Number 5: Hurricane Gilbert in Jamaica, September, 1988.............................................1
Introduction.............................................................................................................................................1
Prologue.................................................................................................................................................1
Background.............................................................................................................................................2
The hurricane and its effects..................................................................................................................3
The surveillance system.........................................................................................................................5
Relief shelters.......................................................................................................................................15
Preparedness and response.................................................................................................................18
Lessons learned...................................................................................................................................19
Appendix 1............................................................................................................................................20
Appendix 2............................................................................................................................................21
References...........................................................................................................................................21
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ii
Disaster Reports Number 5: Hurricane Gilbert in Jamaica, September,
1988
Introduction
Pan American Health Organization − Emergency Preparedness and Disaster Relief Coordination Program
Disaster Reports is a publication of the Emergency Preparedness and Disaster Relief Coordination Program
of the Pan American Health Organization. The reported events, activities and programs do not imply
endorsement by PAHO/WHO, nor do the statements made necessarily represent the policy of the
Organization.
The designations employed and the presentation of the material in this publication do not imply the expression
of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning
the legal status of any country, territory, city, or area of its authorities, or concerning the delimitation of its
frontiers or boundaries.
The mention of specific companies or of certain manufacturers' products does not imply that they are
endorsed or recommended by the Pan American Health Organization in preference to others of a similar
nature that are not mentioned.
This publication was made possible by the financial support of the Canadian International Development
Agency (CIDA) and the Office of U.S. Foreign Disaster Assistance of the U.S. Agency for International
Development (OFDA/AID).
Photographs: Carlos Gaggero/PAHO
Prologue
There is no doubt that disasters can yield valuable lessons. These lessons, when shared with other countries
with similar vulnerabilities, are an important step toward avoiding costly mistakes in the future. Yet
postdisaster data is perishable. If it is not collected and analyzed soon after a disaster, valuable information
will quickly disappear.
With this in mind, the Pan American Health Organization commissioned the University of the West Indies to
collect information and data in the wake of Hurricane Gilbert and prepare a report for the Organization's
Disaster Reports series.
The report that follows was compiled under the competent, dedicated supervision of Dr. Wilma Bailey of the
Department of Geography of the University of the West Indies, Kingston. We wish to thank Dr. Bailey and the
University for their efforts.
Part of the material contained herein originated in a report prepared by a team from the Pan American Health
Organization (June, 1989) at the request of the Ministry of Health. The team was comprised of Dr. Norma
Andrews, PAHO/WHO Representative at the time of Hurricane Gilbert, Ms. Sybil Brooks, Mr. Ernesto
Dobrovsky, Mr.James Murray, Mr. Cortez Nurse, Dr. Homero Silva and Mr. David Taylor. This group
acknowledged the valuable cooperation provided to them by the personnel of the Ministry of Health both in
Kingston and in the parishes.
The Emergency Preparedness Program thanks Mr. Taylor and Dr. Silva for their review of the final
manuscript.
1
Background
Jamaica is a small tropical island with an area of roughly 11,310 sq. km. Much of the island is hilly or
mountainous and there are large areas of volcanic rocks in the east in the Blue and Port Royal Mountains
which rise above 1000 m in altitude. The mountains of the west are lower and composed largely of limestone.
The island's rainfall derives from four weather phenomena. Cold fronts moving southwards from North
America bring rain in the period November to April. Convective activity also results in localized showers. The
third source comprises troughs and waves of low pressure related to local and regional atmospheric systems
such as the Intertropical Convergence Zone. Perhaps the most important weather phenomena, however, are
tropical disturbances−depressions, storms and hurricanes. Fig. 1 shows the monthly distribution of hurricanes
in the period 1900 through 1988.
In 1988 the population of Jamaica was just under 2.3 million. There was a marked decline in fertility in the
intercensal period 1970 to 1983 when births per woman declined from 5.6 to 3.3. The birth rate is now
estimated at 25 per 1000. The death rate is aproximately 6 per 1000 and official estimates of infant mortality
13.2. There is reason to believe, however, that infant mortality is grossly underestimated. The decline in the
fertility rate is reflected in a decline in the proportion of the population in the age group less than 15 and an
increase in the over−65−year−old age group. The dependency ratio is 83. That is, there are 83 persons in the
dependent age groups (less than 15 and over 65) for every 100 persons in the working age group.
Figure 1. Monthly distribution of hurricanes in Jamaica (1900−1988).
Administratively, the island is divided into fourteen parishes. Two parishes, Kingston and St. Andrew, form the
capital region. The Kingston and St. Andrew Metropolitan Area (K.M.A.) has a population of 586,930 which
represents 28 percent of the island's population. The population of the K.M.A. is declining, however, and the
area of growth is in the neighboring parish of St. Catherine. The only other parishes to gain population
between 1970 and 1983 were St. James, where tourism is important, and St. Elizabeth.
The island has a well−developed system of primary health care based on a network of 377 interlocking clinics.
These clinics deliver maternal and child health care, dental care, and curative and family planning services.
Secondary and tertiary care are provided by 25 public and seven private hospitals. The island appears to be
2
experiencing elements of epidemiological change which are bringing its morbidity and mortality pattern in line
with those of more developed countries. This involves changes from acute to chronic ailments as causes of
morbidity and mortality. To some extent, however, an uncomfortable balance has been reached, since
infectious diseases remain important causes of ill health among young children. Moreover, there has been an
increase in hospital admissions for malnutrition and an increase in the case fatality rate [Landman and
Walker, 1987]. Marchione [1984] relates this to the fact that while the primary care programme relies upon the
increasing use of health centers, the epidemiology of malnutrition tends to be linked to access to income and
social support systems.
Moreover, economic stabilization programmes imposed as preconditions for International Monetary Fund
assistance have led to demoralization of health personnel, widespread migration and underfunding of the
health system. There was a serious manpower shortage when Hurricane Gilbert struck the island. It is
estimated that between 1987 and 1989, nurses left the service at the rate of seventeen per month. In fact the
only health sector group for which there was adequate staffing was porters and other ancillary staff
[PAHO/WHO, 1989].
The hurricane and its effects
At 5.00 a.m. (EST) on Friday September 9, the National Meteorological Service issued the first level of
warning, the Hurricane Alert. The Warning was issued on Sunday, September 11 at 3.00 p.m. Collymore
[1988] argues that, given the fact that the majority of the island's population had never experienced a major
hurricane and the severity of the threat, there was undue conservatism and caution in the nature of the
forecasts. The time between the issuing of the Warning and the impact was inadequate for preparation in view
of the fact that only three hours of daylight remained. Many felt that preparations could be suspended until the
following morning, but work was impossible since storm force winds extended 200 miles in all directions from
Gilbert's colossal eye.
The storm made its first landfall on the east coast of Jamaica at 10.00 a.m. on Monday, September 12. As it
began its passage over the island the eye measured about 15 miles across. Wind speeds averaging 75 mph
gusting to 127 mph, were recorded in the Kingston Metropolitan Area. As the eye exited western Jamaica at 6
p.m., it intensified further (888mb) and was identified as a Category 5 Hurricane, the most severe.
Jamaica's last experience of a direct hit by a hurricane was in 1951—Hurricane Charlie. Hurricane Gilbert
differed from Charlie in several respects. Unlike Charlie, Gilbert, in its eight hour rampage, traversed the entire
length of the country. Fig. 2 shows the path of the eye across the island. The eye passed over the Kingston
Metropolitan Area around noon. Moreover, Gilbert was the largest cyclonic system ever observed in the
western hemisphere [Eyre, 1989]. It was also one of the wettest synoptic systems experienced although,
fortunately for Jamaica, most of the precipitation generated fell on the sea [Eyre, 1989]. Between 200 and 250
mm of precipitation fell on September 12 and this reached more than 400 mm in central areas. Most of the
rain, however, fell between 1.00 p.m. and 7.00 p.m. (EST) after trees had been defoliated and uprooted and
so surface wash and soil erosion were widespread [Barker and Miller, 1989].
Figure 2. The track of the eye of Hurricane Gilbert.
3
The impact of Hurricane Gilbert was devastating on all sectors of the society and the economy. Damage was
estimated at US$4 billion, with the damage to agriculture accounting for over 40 percent of this total. Ninety
five percent of all health facilities suffered damage. Of the 25 public hospitals only two escaped with minimal
damage. Two were destroyed and eleven suffered severe damage. There are 377 Health Centers in the
island and more than half of these (55 percent) were severely damaged. The cost of emergency repairs was
estimated at US$13 million with roughly 55 percent of this representing the cost of repairs to secondary care
facilities. As Fig. 3 shows, the parishes of Kingston/St. Andrew and Hanover sustained the heaviest damage
to health facilities.
Figure 3. Cost of repairs to health facilities.
The storage and distribution of domestic water are managed by the National Water Commission. The
hurricane damaged over 50 percent of these facilities to a degree which varied from minor to complete
destruction. Pipelines, storage tanks, pump and chlorinator houses were all affected. There were instances in
which rivers changed their courses, threatening supplies and facilities. The Kingston Metropolitan Area is
supplied with water from four water treatment plants and one spring. Only one of the treatment
plants−Mona−was fully operational after the storm. This plant, described as the best equipped surface
treatment plant in the island [Barrett, 1989], was able to generate its own electricity and supply over 30
percent of the water demand of the city. For the other plants the problems of high turbidity, poor filtration and
the lack of stand−by generators in the face of the total loss of power supplies were particularly urgent in view
of the fact one, the Hope Treatment Plant, supplied water to the University Hospital.
Although the Ministry of Social Security was responsible for distributing relief supplies, this task, initially, was
taken over by the Office of Disaster Preparedness (ODP). Before relief supplies arrived in the island, the ODP
had made purchase agreements with several large distributors in the island for the purchase of food for the
parishes [Carby, 1989]. The largest of the distributors, however, was looted and supplies drastically cut.
Attempts were then made to distribute incoming supplies directly from the support. However, distribution of
relief supplies was soon taken out of the hands of the ODP.
The responsibility for distribution was taken over by the Prime Minister's Office and, eventually, by an
interdenominational group Project Accord−which was funded by international and local donor agencies. This
was seen as one means of avoiding charges of political interference in the distribution of relief supplies. The
ODP paid for and organized the clearance of goods from the wharves and airport and the expenses of
distribution were borne by Project Accord [Bent, 1989, Carby, 1989].
In addition, supplies received by the government were controlled by the Jamaica Commodity Trading
Company. The supplies—food and building—were sold to the distributive sectors. Those in need were issued
with food and building stamps with which to purchase the donated items. Much time was spent in
4
implementing these procedures and crucial supplies remained on the wharves, incurring storage fees and
plagued by theft [Bent, 1989].
The response from the international community was immediate and large quantities of supplies flooded the
country. Daily meetings were coordinated by the UNDP in an effort to coordinate donor response and the
needs of the country. This achieved some measure of success [Bullock DuCasse, 1989]. However, it was felt
that pre−arranged needs lists would have speeded up the process of acquiring necessary supplies [Bullock
DuCasse, 1989].
Moreover, the major part of the relief effort centered around the transportation of goods. The cost of mobilizing
distribution was, at times, greater than the value of the goods [Bent, 1989]. A great deal of time was also
spent in clearing, documenting and sorting goods. There was a shortage of warehousing facilities in urban
areas and a lack in rural areas. Some of the goods sent were inappropriate. There were problems with drugs
which required refrigeration. The Project Manager of Operation Accord was of the opinion that it would have
been easier to handle cash donations than goods.
The surveillance system
Background Information
The Office of Disaster Preparedness and Emergency Relief Coordination has the overall responsibility of
co−ordinating the relief effort and response. They are assisted in this task by the National Disaster Committee
comprised of representatives from the security forces, government ministries, voluntary agencies and the
ODP. The Prime Minister is the Chairman of the Committee. It was convened for the first time since the
issuing of the Hurricane Alert in June 1989.
Within the Ministry of Health there is a Health Action Committee for Disaster Preparedness involving Medical
Officers of Health in charge of parishes and hospitals. Hospital management teams were trained in disaster
preparedness activities which included developing and writing hospital plans. In addition, disaster plans were
developed for parish health teams and, in a few parishes, the process extended to the district/community level
[Bullock DuCasse, 1989].
These disaster plans were never implemented. "The impact of the hurricane .... overwhelmed many health
workers as they sought to cope with damage to and loss of Ministry of Health facilities, equipment and records
as well as personal shelter and belongings" [Bullock− Du Casse, 1989]. Health workers had suffered heavy
losses as a result of the storm and were expected to assist in the task of restoring order in the public sector.
Yet they enjoyed no advantage in terms of personal relief [PAHO/WHO, 1989]. A Command Post was
established at the Ministry of Health with the announcement of the Hurricane Watch on September 10 and
efforts made to contact Medical Officers of Health to activate disaster plans. Because of inadequate
communication links, these efforts were not all successful. The Ministry issued a press release on Sunday,
September 11 urging all facilities to finalize patient discharge. The Command Post was manned until 11.30
a.m. on September 12 when health workers left to look after their homes and belongings.
Because of the lack of road−worthy vehicles and damage to radio equipment, there was no contact between
the Ministry of Health and the parishes until September 14. Neither was the Ministry able to assist in damage
assessment or the distribution of relief supplies. In fact, the emergency found the island's health service so
short of medical supplies that the Salvation Army made supplies available to medical personnel. While in
some cases the shortage was absolute, in others it stemmed from the poor distribution system [PAHO/WHO,
1989]. The few health centers that were not damaged were besieged as relief centers, so priority was given to
the restoration of services in the hospitals to enable them to offer emergency care.
Emergency Surveillance for Infectious Diseases
One week after the impact, the Caribbean Food and Nutrition Institute was requested by the Ministry of Health
to co−ordinate teams for a health and nutrition surveillance of the island. The instructions were to visit parish
Medical Officers of Health and obtain information on health and nutrition and to make a rapid assessment of
public health concerns. Under normal conditions epidemiological data from sentinel stations, which may be
either hospitals or health centers, are supplied to the Ministry of Health once per month. This system was
expanded to allow for the inclusion of disaster−related data as well as data from three hospitals that are not
normally sentinel stations. Forms A (disease surveillance) and B (public health) were distributed during the
5
visits. (See Appendix 1 and 2).
Four teams visited l2 of the parishes during the week of September 19, while ten parishes were visited by
three teams in the week of September 26. Each parish was visited at least once. Nine were visited twice. The
teams were composed of physicians nurses and other members of the staff of the Epidemiological Unit of the
Ministry of Health. A report was made to the Ministry at the end of the first week and a surveillance report was
subsequently published [Patterson, 1988].
This system operated for ten days, from September 19 through 29. Data were collected from what was, in
effect, a non−random sample of sentinel stations and relief centers and this must be borne in mind when
considering the number of reported cases. The surveillance report that was produced [Patterson, 1988]
recorded the occurrence of specified diseases in "selected sentinel stations, three other hospitals and a few
reporting shelters." A breakdown of the numbers of cases by the type of facility was not given. Neither were
the number of sentinel stations, shelters and their locations known. In any case, as Patterson recorded,
sentinel stations established in normal times are not appropriate in times of disaster. Key hospitals such the
University Hospital of the West Indies are not designated sentinel stations although the U.H.W.I. was among
the locations treating a large number of injured and ill persons.
In addition, as mentioned earlier, the vast majority of shelters used during the emergency period comprised
what was termed "unofficial shelters" without identifiable managers. Few parishes were able to give an
accurate number of the shelters that had been established. Moreover, by the week beginning September 19
when the surveillance teams were mobilized, many of the centers had been closed. In two parishes all the
centers had been closed by September 26. To these one must add the fact that many rural areas were
inaccessible and a large number of persons isolated in these areas would have been unable to seek medical
attention outside of the local areas [Patterson, 1988].
Data were collected during the two weeks beginning September 19 and September 26. Different centers, and
in some cases, parishes, reported during those two weeks on occurrences commencing September 13. Only
the findings of the second week were available for inclusion in the surveillance report. Original data had been
given to the Ministry of Health because of an expressed urgency and had been misplaced and unavailable for
inclusion. Discrepancies between the surveillance report and the figures subsequently produced by the
Ministry of Health [Bullock−DuCasse, 1989] create problems of interpretation. Although the Ministry's figures
for the second period are identical to those given in the surveillance report, the two weekly reports are
represented as a "trend" over the two−week period [Bullock− DuCasse, 1989]. Patterson stressed that even if
the report of the first week should become available, the fact that the figures came from different centers
means that the data are not comparable. There are other reasons why the suggestion of a trend should be
avoided. The figures presented for the earlier period relate to 12 parishes−those for the second week, ten
parishes. The number of days covered by the two reports also differed.
As the surveillance report concluded, "Accurate surveillance data were very difficult, if not impossible, to
obtain during the emergency period ...." Unfortunately, the results of the Ministry of Health's hospital survey
which, under the circumstances, could have been most useful, and was reported as being "underway" in April
1989, were not available in August.
No significant increase in the rate of communicable diseases was noted during the period [Bullock−DuCasse,
1989]. There were, however, isolated outbreaks of gastroenteritis and an increase in the number of cases of
trauma immediately after the hurricane.
Table 1 provides the data collected during the two weeks during which the surveillance system operated.
Table 1. Number of cases reported during the weeks beginning September 19 and September 26.
Sept. 19 Sept. 26
Trauma
551
142
Fever
112
120
Gastroenteritis
60
14
Skin rash
65
17
Fever and cough
175
82
Wheezing, SOB
37
41
6
Because of the shortcomings of the surveillance system already noted, no meaningful analysis of these
figures could be undertaken.
A retrospective analysis of attendance at three hospitals in the K.M.A. during the month of September 1988
was undertaken by the author. For the Bustamante Hospital for Children (BHC ) where disruption was
minimal, both Casualty Department and Admissions records were studied. Analysis was restricted to the
records of the Casualty Departments of the University Hospital of the West Indies (UHWI) and the Kingston
Public Hospital (KPH). However, the PAHO/WHO study looked at hospital admissions in these two as well as
in the Cornwall Regional, among Type A hospitals. Their sample also included Type B and C hospitals.
The Bustamante Hospital for Children
Casualty Department Gastroenteritis is, numerically, the single most important complaint seen at the BHC in
normal times and this was true of the immediate post−disaster period also. As Fig. 4 shows, the number of
cases of gastroenteritis treated at the hospital on September 19, that is, one week after the storm increased
sharply. The number treated on that day was 2.5 times the average for the seven days which preceded
Hurricane Gilbert. From September 14, when near normal casualty services were restored, through
September 30, about 324 cases were seen. As a percentage of total attendance, gastroenteritis increased in
the same period (Fig. 5). The PAHO/WHO report also noted increases in Casualty attendance at the Spanish
Town Hospital among children and adults. Vigorous treatment, which included administering of intravenous
fluids and holding patients for twenty−four hours observation, reduced the number admitted to the wards.
Figure 4. Casualty attendance—Bustamante Hospital for Children, September 5−30,
7
Figure 5. Casualty attendance−−−Busbmante Hospital for Children, % of all case seen (3−day period).
The number of cases of fever and skin ailments is shown in Fig. 6. The numbers are given for three−day
periods except for the last two days of the month. Three cases of conjunctivitis were treated between
September 21 and 28.
Figure 6. Casualty attendance—Bustamante Hospital for Children (3−day period).
Hospital Admissions Fig. 7 shows the number of admissions to the BHC over the 26−day period. The only
unusual feature was the sharp drop in admissions on September 12 and 13 when only emergency cases were
seen. The discharge rate for gastroenteritis for the month of September was 14.6 percent. This compares with
a rate of 15.1 percent for 1986, the most recent figures available [Social and Economic Survey, 1988]. The 56
cases of gastroenteritis admitted during the month compares with a six−month average of 57.6 for the K.M.A.
in 1983 [Bailey, 1988].
8
Casualty Departments, UHWI and KPH
Analysis of the records of the Casualty Department of the UHMI is hampered by the fact that all or a part of
the records of four days in September were missing (Fig. 8). However, in both institutions there was a rise in
the number of injuries treated immediately after the hurricane.
Figure 7. Admissions to Bustamante Hospital for Children (3−day period).
Figure 8. Casualty attendance−Univesity Hospital of the West Indies (3−day period).
Fig. 9 shows the cases of asthma and trauma as a percentage of all patients treated at the KPH. In addition,
at KPH, the number of gun−shot wounds (10) seen on September 12, the day of Hurricane Gilbert, was five
times the average treated in the seven days preceding the hurricane. These were mainly wounds inflicted by
the security forces on looters.
9
Figure 9. Casualty attendance—Kingston Public Hospital (3−day period).
There were no significant increases in communicable disease patterns in the post−disaster period. The
PAHO/WHO report [1989] sees this as the result of the rapid institution of preventive measures which
included the prompt attention to water quality monitoring and waste management, emergency measures for
vector control, the focused activity in typhoid endemic areas, the rapid clearance of shelters, intensification of
health education activities and the provision of funds to meet emergency needs at parish levels.
Surveillance of Environmental Health and Water Quality
With the assistance of PAHO, a surveillance system was put in place to monitor water quality and the water
distribution system as well as sewage treatment plants and environmental conditions at hospitals and
shelters. Teams composed of two members each visited water supply and treatment plants where samples for
bacteriological analysis were taken and free residual chlorine determinations made. These activities continued
until the end of October.
There was also surveillance for vectors, especially the Aedes aegypti mosquito. Routine surveillance
continued especially in known typhoid endemic areas.
Except for those systems that were fed by gravity, all water systems were affected by the hurricane. Priority in
restoration was given to those systems in which hospitals were located. Within two days, 30 percent of the
service in the metropolitan area had been re−established an intermittent basis [PAHO/WHO, 1989]. Within ten
days of the hurricane, about 50 percent of the country's normal water supply had been restored. There were
delays in rural areas largely because of the shortage of transportation and problems of access to plants in
rugged localities [Barrett, 1989b]. Assistance with transportation was given by the Jamaica Defence Force
and the USAID. In addition, PAHO and Medecins sans Frontieres provided 22 portable water tanks which
helped to free up the hard pressed water trucks. The tanks were placed at central locations in rural
communities and were filled by the water trucks. Canada donated two portable treatment plants which were
located near Maggoty in St. Elizabeth and in Duckenfield in St. Thomas [Barrett, 1989]. These two areas
have, in the past, had a high incidence of typhoid [PAHO/ECD].
Initial results indicated that water was unsafe for human consumption and monitoring began on September
14, with assistance from PAHO [PAHO/WHO,1989]. Tests were performed by four teams, first, in Kingston,
and later in the rural areas. In the first round of sampling (September 26−30) a very high percentage of
samples were found to have high bacteriological content and a low concentration of chlorine (Table 2). The
Nwc was advised to increase and ensure continuous chlorination, to initiate sanitary surveys at points of high
coliforms concentration and to recommend that the public boil water and use chlorine products.
10
Purification tablets were made available to members of the public by the Ministry of Health and the Jamaica
Red Cross since the boiling of water was impossible in many cases. Considerable effort had to be exerted to
counter alternative and ineffective suggestions in the news media for purifying water.
In the second round of sampling, eight of the fifteen hospitals sampled had unsafe bacteriological water and
nine low chlorine content [PAHO/ECD, Oct. 3− 6).This represented an improvement in the bacteriological
quality of the water (Table 2). However, at three hospitals the quality had deteriorated while at two others the
quality, though improved, was still unsafe. Purification tablets, chlorine comparators and manual filter pumps
were given to the ECD for distribution to the most needy hospitals. The third round of sampling found
improved conditions and tests in November and December indicated that the water quality was back to normal
[PAHO/WHO, 1989].
Table 2. Variation of Bacteriological Quality (bq) (% Pos.) and Low Chlorine Concentration (Ic) (%
Low).
PARISH
SEPT.26−30
(bq) (Ic)
Clarendon
−
−
Hanover
100
0
Kingston/ St. Andrew 50
50
Manchester
50
50
Portland
88
100
St. Ann
69
69
St. Catherine
30
70
St. Elizabeth
90
40
St. James
70
50
St. Mary
67
78
St. Thomas
82
45
Trelawny
90
80
Westmoreland
56
78
Source: PAHO/ECD, Oct. 11−21.
OCT.3−6
(bq) (Ic)
−
−
57 83
40 48
33 33
53 56
100 100
50 67
49 67
14 71
60 68
50 50
29 67
60 60
OC1.11−21
(bq) (Ic)
50
38
57
67
27
16
14
0
9
36
25
14
43
29
0
8
88
88
67
33
40
50
67
67
60
60
With regards to excrete disposal and sanitation, many latrines were destroyed and sewage treatment plants
made inoperative by a lack of electricity. There was, therefore, an increase of pollutants reaching water
bodies.
Of the 42 treatment plants visited by PAHo/EcD, only fifteen were fully and two partially operating. Fourteen
samples were analyzed for Biochemical Oxygen Demand (BOD) and Suspended Solids (Ss). None of the
discharges met the recommended discharge limits for BOD and only two met the discharge limits for SS. It
was recommended that monitoring should continue until the end of 1988, expanded to cover all parishes and
monthly reports on the characteristics of the effluent made. Maximum discharge limits were set at:
BOD
SS
Total Coliform
Free Chlorine Residual
Source: PAHO/ECD.
20 mg/1
30 mg/1
200/100 ml
0.5 mg/1
The surveillance report found that few areas had addressed the problem of garbage disposal and that the
numbers of vectors, especially flies and mosquitoes, were increasing [Patterson, 1988]. Some parishes had
started oiling and fogging.
PAHO/WHO [1989] recommended that an environmental health activities plan should be elaborated for public
health inspectors based on water systems, sewage plants and dump sites. Survey and sampling forms should
be created and the importance of reporting on these forms emphasized. They also recommended that
equipment for monitoring, such as pH meters and chlorine comparators be acquired as soon as possible.
They saw a need for the approval and gazetting of regulations for drinking water, soil and air pollution. Finally,
11
they emphasized the need for co−operation and co−ordination of activities between ECD and the PHC Unit
and for a disaster plan involving public health inspectors.
Routine Surveillance
Routine surveillance based on operative sentinel stations and reports from physicians on the occurrence of a
number of infectious diseases continued. Endemic areas for typhoid and leptospirosis were closely monitored
and a close check was also kept on the incidence of malnutrition in children.
Gastroenteritis: The reported incidence of gastroenteritis increased sharply in October. In fact, the figure for
October was almost 26 percent that for the same month in 1987. The Surveillance Report [Patterson, 1988]
maintains that there were almost as many cases among adults as among children. PAHO/WHO [1989], in a
study of selected conditions in seven parishes, also reported an increase in admissions to hospitals in the
period October 1988 to March 1989 (Table 3) over the period October 1987 to March 1988, despite a decline
in annual totals between 1987 and 1988. This increase took place in all the institutions studied except the
University and Noel Holmes hospitals where there has been a consistent decline, and in the Spanish Town
Hospital for reasons previously mentioned [PAHO/WHO, 1989]. The parishes covered by the survey were
Kingston/St. Andrew, St. Thomas, St. Mary, St. James, Hanover, Manchester and St. Catherine.
Table 3. Admissions from a sample of hospitals, 1987−1988.
TOTAL TOTAL %
OCT '.87
OCT ' 88
%
1987 1988 CHANCE MARCH 88 MARCH 89 CHANCE
819
736
−10
402
442
10
Source: PAHO/WHO, 1989.
In view of the declining trend in admissions for gastroenteritis prior to Hurricane Gilbert, and the damage to
hospitals which would have discouraged admissions, the increase in admissions is significant
[PAHO/WHO,1989].
Febrile Illness: Figures for febrile illness for 1987 are incomplete and this makes comparisons difficult.
However, the figure for October 1988 was, roughly, 5 percent below that for 1987. The figures for early 1989
were also below those for the corresponding months of 1988.
One suspects that the decrease in the post− Gilbert period is not so much a reflection of an overall
improvement as the dislocation in the health system and the inadequacy of the reporting system based on
sentinel stations in situations such as these. The case of typhoid provides an excellent example of the
problem.
Typhoid: Seventeen cases of typhoid were reported between April and December 1988, nine in the period
following the storm. Up to September 1989, the Epidemiological Unit of the Ministry of Health had no case on
record for 1989. Yet, there was an outbreak in the parish of Westmoreland. It occurred in areas where the
disease is endemic [Silva, 1989]. However, the first case, on November 23 was diagnosed as a viral illness
[Dalina, 1989]. It was not until January that the disease was identified and by the end of March eleven of the
suspected thirty−six cases had been confirmed by laboratory. The outbreak occurred in three subdivisions of
the Savanna−la−Mar Health District: Savanna−la−Mar, Smithfield, on the outskirts of the town, and
Petersfield, to the northeast. It has been associated with the destruction of pit latrines by the hurricane and
open defecation which followed.
In so far as hospitalization was concerned, the number admitted has always been small and this makes the
interpretation of the data difficult [PAHO/WHO, 1989]. Thirty cases were admitted between October 1987 and
March 1988 in the hospitals visited. Only 12, however, were admitted between October 1988 and March 1989
[PAHO/WHO, 1989]. The emphasis on the rapid improvement in water quality, especially in endemic areas,
and public education undoubtedly kept the situation under control.
Immunization: There was a small increase in the number of BCG immunizations done in the post−Gilbert
period in most parishes. The increase in this activity in St. Mary, as shown in Table 4, was marked and
involved health centre staff and volunteers including school principals who had previously received training in
identifying and motivating families who could benefit from this programme [PAHO/WHO, 1989].
12
Table 4. BCG Immunization by Parish
Oct. 1987 March 1988 and Oct. 1988−March 1989.
PARISH
BCG
IMMUNIZATIONS
(1)
(2)
Kingston/St. Andrew 5,694
7,311
St. Thomas
1,052
924
St. Mary
1,404
2,770
St. James
2,420
2,332
Hanover
682
773
Manchester
1,733
1,923
St. Catherine
4,115
4,359
TOTAL
17,000 20,392
(1) Oct. 1987 −
March 1988
(2) Oct. 1988 −
March 1989
Source:PAHO/WHO, 1989
% CHANGE
+/−
28
−12
97
−4
13
11
6
19
There was a decline in all other immunization programmes ranging from 10 percent in the case of measles to
21 percent in the case of polio. Here, too, the achievement of St. Mary was outstanding, it being the only
parish to show an increase in the number of immunizations done in the post−Gilbert period [Table 5].
Table 5. Changes in the level of Immunization against OPT, polio and measles by selected Parishes
Oct. 1987−March 1988 and Oct. 1988 − March 1989.
PARISH
IMMUNIZATIONS (
%+/−)
DPT POLIO MEASLES
Kingston/St. Andrew −19 −26
−15
St. Thomas
−20 −33
−22
St. Mary
51 52
66
St. James
− 40 − 41 −12
Hanover
−34 −35
−23
Manchester
−17 −19
−19
St. Catherine
−15 −22
−13
Source: PAHO/WHO, 1989
The PAHO/WHO report warned that, in view of the decrease in the number of post−disaster immunizations
and the fact that the percentage of the 0−11 target population immunized against these diseases by the end
of 1988 was well below expected levels (Table 6), a special effort should be targeted on Kingston and St.
Andrew, St. Catherine and Hanover. A measles epidemic began in December 1989 and by January 31, 1990
more than 5,000 children had been infected and eight had died. [Epidemiological Unit]. The parishes that were
most affected were Kingston and St. Andrew where the epidemic began and St. Catherine. Few cases have
been reported from St. Mary.
Table 6. Percentage of 0−11 year−old age group immunized against DPT, polio and measles, 1987 and
1988.
PARISH
DPT
1987 1988
Kingston & St. Andrew 85.2 61.2
St. Thomas
70.0 88.8
St. Mary
88.6 96.8
13
POLIO
1987 1988
84.8 62.8
73.3 90.8
90.3 95.7
MEASLES
1987 1988
23.3 36.6
49.3 68.6
62.7 63.7
St. James
93.8 104.6 92.8 104.3 59.4 76.3
Hanover
92.2 78.6 90.4 79.8 66.7 65.3
Manchester
77.4 101.2 78.2 91.1 60.3 69.0
St. Catherine
73.4 74.6 74.8 70.7 38.6 53.0
Thus, there was no significant increase in communicable diseases in the immediate post−disaster period. This
was due to the rapidity with which the surveillance of the environment was initiated, the attention given to the
management of waste and vector control as well as an intensification of health education activities
[PAHO/WHO, 1989]. Parishes were provided with the means to meet their emergency needs. An important
element also was the fact that the population in relief shelters very quickly returned to their homes.
Malnutrition: Fig. 10, based on figures obtained from the Nutrition Division of the Ministry of Health, shows
the trend in moderate and severe malnutrition (Gomez Grades 11 and 111) ¹ It is clear from the figure that the
upswing occurred well before the hurricane. The survey of seven parishes [PAHO/WHO, 1989] revealed a
total of 5,900 reported cases in 1987 and 7,809 in 1988, an increase of 32 percent (Table 7). These figures
refer to mild and moderate malnutrition (Gomez Grades I and 11). The increase in the period October 1988 to
March 1989 over October 1987 to 1988 was marked in most of the parishes surveyed, but was particularly so
in the parishes of St. Mary (134 percent! and Kingston/St. Andrew (72 percent). The average for the seven
parishes was a 51 percent increase for the 1988 −1989 period. This could have resulted from increased
vigilance in the wake of Gilbert or from improved record keeping [PAHO/WHO]. However, the level of the
increase demands attention, especially since clinic statistics tend to underestimate parish wide prevalence
[Rainford, 1987].
1. The Gomez Classification is used to evaluate the nutritional status of children. It compares a child's actual
weight, at a specific point of development, with the weight he/she should have, or normal weight, according to
his/her chronological age. This determination is based on standardized international values. According to this
classification, the severity of malnutrition is classified by grades:
Grade I − 75−85% of normal weight
Grade II − 60−75% of normal weight
Grade III less than 60% of normal weight
Figure 10. Jamaica −children severely malnourished (Gomez Grades II & III).
14
There was no corresponding increase in hospital admissions, however. The reduction in available beds and
the necessity for greater selectivity may could have contributed to this decline.
Table 7. Reported cases of malnutrition in selected Parishes: 1987 and 1988; Oct. 1987 March 1988;
Oct. 1988−March 1989.
PARISH
TOTAL
1987
Kingston/ St. Andrew 2,009
St. Thomas
556
St. Mary
392
St. James
478
Hanover
305
Manchester
752
St. Catherine
1,408
TOTAL
5,900
Summary
TOTAL
1988
2,290
621
670
856
633
1,060
1,679
7,809
% CHANGE
+/−
14
12
71
79
108
41
19
32
OCT.87
MAR.88
799
276
217
300
233
380
780
2,985
OCT.88
MAR.89
1,376
422
508
452
279
591
886
4,514
% CHANGE
+/−
72
53
134
51
20
56
14
51
There was an upward trend in the reported cases of gastroenteritis and malnutrition. The size of the increase
in the cases of malnutrition was cause for concern and it was strongly recommended [PAHO/WHO, 1989] that
further investigation be targeted on the parishes of St. Mary, Kingston/St. Andrew, Manchester, St. Thomas
and St. James.
In addition, the decline in the number of immunizations done post Gilbert suggested that special effort be
targeted on Kingston/St. Andrew, St. Catherine and Hanover.
Relief shelters
A bout 44 percent of the housing stock in the island suffered some form of damage. Nearly 40 percent of the
damage was sustained by the three populous southern parishes of Kingston/St. Andrew, St. Catherine and
Clarendon. But Kingston/St. Andrew had, in fact, the lowest but one percentage damage to its stock [Ministry
of Social Security]. It has been estimated that over 800,000 persons sought shelter, (Fig. 11) some as a
precautionary measure before the storm [Reese, 1989].
15
Figure 11. Number of persons in shelter September 14,1988.
In the K.M.A. alone there were about 104 shelters [PAHO, Sept. 19, 1988] and 1,135 island−wide (Table 8)
[PAHO/WHO, 1989].
Table 8. Number of shelters In Parishes.
PARISH
13 SEPTEMBER 1988
NO. OF
SHELTERS
Kingston/St. Andrew 120
St. Catherine
50
St. Thomas
30
St. Mary
25
Trelawny
45
Clarendon
55
St. James
30
Hanover
35
Manchester
20
Westmoreland
40
St. Elizabeth
50
St. Ann
20
Portland
35
TOTAL
555
Source: PAHO/WHO, /989.
14 SEPTEMBER 1988
NO. OF
SHELTERS
250
100
50
60
100
100
75
60
50
100
80
50
60
1,135
However, many whose homes had not been affected or who were able to find accommodation with relatives,
left immediately after. Within three weeks of the hurricane, most shelters had been closed. In Port Maria, for
example, of the 4,250 persons in shelters on September 13, 575 remained on September 25 [PAHO/WHO,
1989].
This action, it was felt, averted a potentially grave situation [Patterson, 1989] for the schools and churches
which served as shelters were not, for the most part, designated as such and had neither the services nor the
managerial staff to cope with the large numbers seeking shelter. Even where shelters were designated,
16
shelter managers did not report for duty because of personal losses [Reese, 1989] or impassable roads. The
high level of vandalism to shelters and the unsanitary conditions which prevailed at so many can be directly
attributed to the absence of trained managers at the shelters [Collymore, 1989]. TWO days after the storm
PAHO engineers− and the staff of the Environmental Control Division of the Ministry of Health made a rapid
survey of shelters. They found sanitary conditions at the shelters critical as a result of the lack of water. Open
defecation was common. They recommended that Public Health Inspectors be assigned to organize shelters
for the digging of pits for the disposal of both excrete and solid waste. An assessment of environmental health
problems in 23 shelters in urban and rural areas is given in Table 9. Nearly 61 percent of shelters in the
metropolitan area visited during the first week had serious environmental health conditions. Rural shelters
were worse with respect to water quality, refuse collection and disposal [PAHO/WHO,1989].
Table 9. Environmental conditions in shelters.
URBAN SHELTERS RURAL SHELTERS
VISITED SEPT.13−17 VISITED SEPT. 21−24
Adequate amount of water
59%
53%
Adequate quality of water
49%
30%
Excreta disposal through water closets 82%
93%
Adequacy of disposal
71 %
66%
Adequacy of refuse disposal
58%
40%
Collection of refuse
42%
46%
The condition of those families which remained in relief centers was the subject of numerous reports in the
news media. A tent settlement at Poor Man's Corner in St. Thomas and a number of families in the National
Arena in the K.M.A. remained until April 1989. They were made homeless by the storm.
The earliest occupants of the National Arena arrived on the evening of Sunday, September 11 from the
nearby communities of Mountain View Avenue and Vineyard Town. In the days that followed, the homeless in
those shelters, both within the K.M.A. and nearby parishes, (Fig. 12) that were either damaged by the
hurricane or needed for their normal activities, were sent to the Arena. On September 19, a PAHO/ECD report
put the number of victims in the Arena at 160. On January 21 there were 32 families being housed at the
National Arena comprising 131 individuals [Department of Geography, 1989].
17
Figure 12. Origin of hurricane victims at National Arena, February 1989.
There were twenty−one reported cases of illness in the two−week period ending January 21, 1989, eighteen
of which were in the under−fifteen population [Department of Geography, 1989]. This amounted to an
incidence rate among children of 300 per thousand. This compares with a rate of 108 per thousand for the
same period in Enumeration District (ED) 73 of the nearby low−income community of Swallowfield. Colds,
asthma and gastroenteritis were the most common complaints. The average family size in ED 73 was almost
identical to that in the Arena at 4.1. The survey here was restricted to those households that had suffered loss
from the hurricane. A similar survey of ED 73 in February 1987 [Department of Geography, 1987] revealed an
incidence rate among the under−fifteen population of 162 per thousand. Thus, the incidence of disease in
low−income Swallowfield was lower than one year earlier and less than one−third of the rate reported for the
National Arena.
Preparedness and response
The PAHO/WHO [1989] survey of seven parishes revealed an information gap with regard to disaster
management in the health sector. At the primary care level, 17 percent of the staff knew of the disaster
management structure at the Ministry Headquarters. Fifty−seven percent knew of the structure at the local
level. The situation was better in the secondary care system in that 50 percent of staff knew of the structure at
Ministry Headquarters and 75 percent in their own institution.
18
Other serious limitations were identified.
• emergency medical and non−medical supplies were inadequate and irregular
• there were serious deficiencies with regard to medical equipment
• serious deficiencies with regard to transportation and communication existed
• there was a shortage of manpower and an inadequate mix
The relative lack of preparedness of the health sector was underscored by the fact that the Disaster Plan at
the Ministry of Health had not been completed. Where one existed at the parish level, it could not be brought
into operation because of a resource gap. Disaster plans for some hospitals existed but they had not been
activated. In addition, simulation exercises had not been carried out.
Devolution of authority was seen as being necessary in a disaster. There was the feeling among field staff that
they had to await directives from the central level before taking administrative actions. Devolution, however,
would call for access to emergency funds, clear guidelines as to the type of responses that were appropriate
at the local level and close co−ordination with the Parish Disaster Preparedness and Response Programme.
The survey also emphasized the need for greater speed with initial damage and needs assessments and for
greater accuracy in identifying real emergency needs.
Backup systems for water supply, power and radio communication should be provided at all hospitals and
health centers.
The report recognized the dedication of health service personnel who, though lacking the necessary support,
proved an important resource in the wake of Hurricane Gilbert. The will to continue in the face of adversity
should be encouraged by the development of local self sufficiency.
Lessons learned
This hurricane has taught us all that a system that is unable to cope in normal times should not be expected to
work in disaster situations" [Bullock DuCasse, 1989].
The Caribbean region has had to cope with the effects of several tropical storms, surface flooding and
landslides in recent decades. These events have sensitized leaders to the need for disaster planning and
emergency management. As Collymore [1989] observes, Hurricane Gilbert has provided the region with a
number of lessons which can inform the character of disaster planning in the region.
• Epidemiological surveillance is of fundamental importance in any program of disease control following a
disaster. Since the hurricane affected the entire country, data collection was difficult. The emergency
surveillance of infectious diseases started late and ended far too early. Leus believes that the system should
continue at least two months after the disaster, "or at least as long as disaster relief activities take place on
any scale." The system following Hurricane Gilbert lasted barely two weeks, ending before the admittedly
tardy relief program got off the ground. This was all the more regrettable in view of the inadequacies of the
normal surveillance system in disaster times and the fact that limited resources prevented its strengthening.
• The preparedness and capability of the health sector for disaster response must be enhanced. To this end
there is an urgent need to finalize the Disaster Plan of the Ministry of Health and to prepare hospital as well as
parish disaster plans for the health sector. Simulation exercises should be conducted regularly in all parishes.
• Planning must be decentralized. The destruction of the communication system−road, radio,
telephone−meant that it was impossible for the Ministry to communicate with the field for many days after the
storm and many communities were isolated in the critical emergency period. Hence, disaster plans which
depend on communication and transportation should be avoided. The affected communities must be in a
position to respond to their own needs in the immediate post−disaster period.
• The transport capability of the health sector should be improved. Consideration should be given to a
standardization policy for the purchase of new vehicles. The appropriate staff should be trained in the use and
the maintenance of these vehicles and a replacement policy for vehicles should be introduced. Transportation
agencies within communities should be encouraged to give support to the health sector in an emergency.
19
• The building code, especially with respect to health facilities and public buildings, needs to be upgraded and
standards rigorously enforced if losses of the magnitude experienced are to be avoided. There is also a need
for preventive maintenance and the provision of mitigation devices. As Taylor [1989] observed, quite simple
precautions such as hurricane shutters proved effective in those hospitals where they were provided.
• Health facilities should be provided with standby power and backup water supply. The rainfall continued for a
number of days after the passage of Hurricane Gilbert and much of this could have been put to use if
rainwater catchments had been in place. Similarly, the effects of the destruction of the public electricity service
would have been less disruptive had all hospitals been provided with standby power and had there been
regular maintenance of units. A large percentage of the hospital generators failed either because they were
misused or because they were poorly located and flooded [Taylor, 1989].
• Buildings selected as shelters should be structurally sound, have adequate sanitation and water storage
capacities and standby power. Once a building has been designated as a shelter, efforts should be made to
inform members of the community as to its location.
• There is an urgent need to introduce measures to ensure that health workers who are victims of disasters
and who are expected to assist in the restoration of order in the public sector receive support in the post
disaster period. A special fund should be established and a senior staff member given the responsibility for
staff welfare in a disaster.
• Consideration should be given to the idea of an inter−Caribbean rapid−response team which could come to
the country immediately after a disaster to evaluate damage, organize emergency repairs and assist in the
development of projects for final repairs.
Appendix 1
REPORT SYMPTOMS OR CLEARLY RECOGNIZABLE DISEASES
MINISTRY OF HEALTH JAMAICA
Name of Health Facility or Shelter:________________ Date:__________
Location:______________________________________________________
CASES
(Deaths) CASES
0−4 5−15 15 & + 0−4 5−15 15 & +
AGE (Years)
Fever (No diarrhoea/cough)
Fever with Cough (cold)
Gastroenteritis*
Conjunctivitis
Measles
Fever with Rash
,
Skin Rash
Wheezing or SOB
Burns
Trauma
Other (Specify):
Malnutrition
−−−−−−−−−−−−−−−−−−−−−−−−
−−−−−−−−−−−−−−−−−−−−−−−−
−−−−−−−−−−−−−−−−−−−−−−−−
1. Daily Total
2. Total patients seen per day
20
COMMENTS:________________________________________________________
___________________________________________________________________
___________________________________________________________________
N S. Gastroenteritis is the presence of three or more watery stools/day.
Appendix 2
HEALTH AND Nutritional SURVEILLANCE − MINISTRY OF HEALTH, JAMAICA
(HURRICANE GILBERT)
Name of Facility________________________________ Date ______________
Location___________________________________________________________
No. of persons by age group. 0−4, 5 1 5 1 6+
Water Supply Quality
[ ] Adequate [ ] Inadequate
(Quantity−Water Purification (boil: purification tablets) [ ] Adequate [ ] Inadequate
Available
Needed
Food Supply Cereals & other starches
[]
[]
High protein
[]
[]
Fats end Oils
[]
[]
Sugar
[]
[]
Vegetables
[]
[]
Present
Absent
Vectors
Flies
[]
[]
Roaches
[]
[]
Mosquitoes
[]
[]
Remedial action recommended :
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Sanitation
Garbage Disposal
[ ] Done
[ ] Not Done
Sanitary Convenience [ ] Present
[ ] Not Present
( Type)
[ ]Satisfactory [ ] No/Satisfactory
Remarks:______________________________________________________________
______________________________________________________________________
_______________________________________________________________________
References
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Geography, U. W. I.
3. Barrett, Vernon. 1989. The Performance of Lifeline Systems: Water and Sewerage Systems. Jamaica
Institute of Engineers.
4. Barrett, Vernon. 1989. Personal communication, June.
21
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7. Carby, Barbara, personal communication, July 1989.
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Relief Measures. Pan Caribbean Disaster Preparedness and Prevention Project.
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11. Department of Geography. 1989. A Comparative Study of the Effects of Hurricane Gilbert on Two
Communities.
12. Epidemiological Unit. Ministry of Health. Jamaica.
13. Eyre, L. Alan. 1989. Hurricane Gilbert: Caribbean Record− Breaker. Weather, March.
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Perspective. Workshop on Food and Nutrition Security in Jamaica in the 1980s and Beyond. CFNI, May.
15. Leus, X. Disaster Reports Number 2. Pan American Health Organization.
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Twentieth Century. Food Nut. Bull. 2:9.
17. Nutrition Division. Ministry of Health. Jamaica.
18. PAHO/E.C.D. Reports: 1988: 14, 19, 20, 21, and 24 September 1988; 36 October 1988; 11−21 October
1988.
19. Patterson, W. 1988. Health and Nutrition Surveillance −Jamaica, 1328 September, 1988 During
Emergency Period Following Hurricane Gilbert.
20. Rainford, K. 1987. Nutritional Status and Problems − Mother and Child Workshop on Household Food
Availability and Nutritional Status. CFNI. January.
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Workshop, April.
22. Silva, H. 1989. PAHO Jamaica, personal communication, September.
23. Social and Economic Survey. 1988. Planning Institute of Jamaica.
22