Ministry of Health
AITUTAKI HEALTH CYCLONE ASSESSMENT REPORT
AitutakiHospital, Doctor’s Residence and Community Health - Public Health Inspectorate
Prepared by: BH Sinclair, Tata Vaeau and Charles Ingaua, Thursday 11th February 2010

AITUTAKI HEALTH CYCLONE ASSESSMENT REPORT

Departed Rarotonga at 9.45am enroute to Aitutaki via Mauke. Arrived Mauke at 10.35am and had to await clearance before flight could proceed for Aitutaki. Met by Dr Tauraii and staff and he took us on a brief visit to the Mauke hospital and dental clinic.

We returned to the airport and departed for Aitutaki at 2.05pm arriving Aitutaki at 3.45pm. Picked up by Dr Koko and Tereva and driven to the AitutakiHospital.

Tropical Cyclone Pat has left the people of Aitutaki shattered with this disaster. A lot of people left homeless with nothing, some residing with families and friends, some still in shock trying to get over the disaster.

We began the assessment of the AitutakiHospital and took notes and photos of damages sustained to the Exterior part of the HospitalBuilding and continued with assessment of damages sustained to the Interior part of the HospitalBuilding.

Time did not permit us to carry out a complete assessment of the Doctor’s residence and photos were taken on Thursday morning. We assisted the staff with the cleaning of the inside of the hospital to ensure that hospital services are maintained,despite the circumstances.

Government Agencies Meeting

All representing agencies from Rarotonga gathered on Thursday morning at 9.30am at the Aitutaki Power station for a quick overview of the overall situation on Aitutaki. Agencies from Red cross, MOW, Infrastructure, Telecom, Police, Health etc were split into teams of 4 to conduct a full initial assessment of Aitutaki infrastructure, water and sanitation and report back to the Disaster Team co-ordinated by Charles Carlson. This assessment took days to complete and covered the entire island. Priorities outlined in the meeting

-Shelter

-Power and communications

-Water and Food

-Sanitation

-Safety centres and schools

The following representatives inspected the hospital property and they included:

  • Deputy NZ High Commissioner Ms J Afleck
  • Mr Charles Carlson, Disaster Management
  • Mr Patrick Arioka, Disaster Management
  • Mr Charlie Numanga, Red Cross
  • Hon Minister of Health
  • Hon Prime Minister and Cabinet Ministers
  • Eusenio – Representative from CIIC
  • OMIA, MOWEPP
  • Mr Bob Standby, Australian Red Cross
  • Mr Tai Herman, Mayor

Red Cross Water and Sanitation

Health and the Water Work personell (Tukua) met and conducted site inspections with Bob Standby – Water and Sanitation Manager for International Emergencies. A main concern for Bob’s visit was to identify solutions to water safety in terms of drinking water and also help assist in sanitation. However Health together with Bob conducted a site visit to the Water Well, where we identified Vaipae Gallery as the main source for palatable water for the people of Aitutaki.

-collected water samples from Vaipae Gallery Well (Sample 1)

-collected water samples from Vaipae Storage tank (Sample 2)

-collected water samples from VaitauSchool.

The above samples will be tested for bacteriological and salinity and the results will determine the plan of action highlighted below.

Bob had also advised us that a report had been conducted in late 2004, on water resource management on Aitutaki prepared by Sarah Davies, Marc Overmars and Tasleem Hason.

The above named sample collection area was the only easy access to get samples as power was not on during our time of visit. Based on our findings, Bob has recommended that Redcross will need to import into the country a water treatment system (ultra violet disinfection) for treating water as the need for drinking water is of a high priority.

Possible chain of water distribution are = pumping of water from main water well source (Vaipae Gallery) to the storage tank whereby water will be channelled through the treatment plant onto a storage water tank mounted on the truck, and has to be carted or distributed throughout the island every 2 days.

Risk Assessments findings

Assessments was conducted throughout Aitutaki and our findings are as follows

Water Supply

Inadequate water supply on the island for each individual households. There is no running water from the main reticulation system as the electricity is completely out. Water is dirty with regards to individual water tanks(mostly plastic approximately 3,000lts) and is used for daily chores as well as drinking. People have been advised to boil the water to prevent gastro-enteritis infection.

Sanitation and Waste Management

About 70% of households on the island have crippled and inadequate sanitation. Toiletfacilities haves been damaged structurally with no physical indicator of damaged septic tanks or leaking sewage and people had somehow managed to use the same toilet or in worse cases their neighbors. Currently sanitation in terms of sewage is not a priority problem. Septage pond is not flooded, and a lot of debris from the cyclone are currently in the pond.

Vector Control

A total of 4 stagnantwater has been identified as potential breeding sites for mosquito. Another significant breeding places for mosquito are the low lying area around the island whereby flooding is very evident. It is anticipated that mosquito larvae infestation will erupt in 5 days time, however there is insufficient stock available for the whole island to complete.

Safety Cyclone Centres and Schools

Cyclone centres around the island has been damaged, roof tops blown off by the wind, broken windows and doors including walls. The ArauraCollege is also damaged and currently not safe for occupation.

Food Safety

Food Outlets although appears to be damaged but they have resumed selling products again from their intact side of building. The products are still good and fit for human consumption especially canned, dry products. In terms of food hygiene in the homes people were advised during our initial assessment to be aware of cleaning and washing hands (personal hygiene) and cooking utensils.

RECOMMENDATIONS

  • Hospital Electricals to be thoroughly checked. Especially to areas that sustained damages, ceiling ripped and exposed, and in some places have buckled. Power points were also wet as a result of the leakage from the ceiling and rain that came through from the windows
  • Hospital plumbing to be thoroughly checked and repaired, especially the repairs and leaks to the water tanks, solar panels system and plumbing that run inside the ceiling area of the hospital.
  • Tarpulins – in the interim to cover the outside walls that have been ripped. However, the Outside Walls will need building materials to be repaired to avoid further damages.
  • Electrical appliance such the washing machines and air condition units to be tested and ensure that it is working.
  • Medical, laboratory and IT equipment that were thoroughly wet and confirm whether they are workable.
  • Meanwhile, urgently liaise with RarotongaHospital to provide a Steriliser, an autoclave and a haematology analyzer .
  • Request for an xray – service engineer to carry out servicing to xray equipment that was wet. Dark room will also need to be checked.
  • Ensure sufficient supply of domestos, janola, sterile gloves, cleaning gloves, handwash, paper hand towels, windowlene, etc
  • Request for crutches
  • Order stocks for larvicide
  • 2 drums of diesl oil
  • 24x500g Vectobac

Equipments

  • 1x15lts knapsack
  • 1x15ltr mistblower

Safety Apparel

  • 4xoverall size Large
  • 4prs of gumboot size. 2x Size 11 and 2x Size 12
  • 2xrespirator
  • 2xfacemask
  • Request extra resource(2) personnel to help with Aitutaki
  • Health Aitutaki to continue to notify Public Health of any communicable or notifiable disease for further monitoring and surveillance to prevent an outbreak from occurring.
  • Liase with environment the disposal and management of fibrolite
  • Continue to implement awareness and hygiene to prevent further occurrence of disease.

TEMPORARY MEASURES PUT IN PLACE UNTIL ELECTRICALS ARE CHECKED

  • Refer all hospital laundry to Snowbird until electricals and power points are checked by electrician, including checks to the Washing Machine
  • Refer all deliveries to Rarotonga
  • Refer all X-ray patients to Rarotonga

ANTICIPATION

As discussed with resident Medical Officers Dr Koko and Dr Lwin they anticipate an increase in pharmaceuticals and consumables due to a rise in gastroenteritis infection, and an increase in patients presenting with cuts, puncture wounds, abrasions and falls. We will also anticipate an increase in patients presenting with diarrhea, vomiting, stress etc.

The following captivates a summary report of the damages sustained to theAitutakiHospital and Doctor’s residence:

DAMAGES SUSTAINED TO THE OUTSIDE OF THE HOSPITAL

AMBULANCEBAY

  • A piece of the extension to the gutter is missing. Approx. ½ metre

HOSPITAL ENTRANCE

  • Solar Panel (Solar Hart) missing including the plumbing fittings to the solar tank
  • Water leaking and running continuously off the roof
  • Outside wall ripped and torn away – approx 2.5 metres x 1 metres
  • Top outside walls ripped – not sure of roofing iron if any has been ripped away. Approx 3 metres x 1 metre (Above the storeroom and PABX room)

TOP OUTSIDE WALL ABOVE ISOLATION WARD

  • Outside walls ripped – approx. 10 metres x 3 metres
  • Spouting and gutter damaged

KITCHEN (facing Telecom)

  • Facia boards over the back of the kitchen – ripped. Approx. 12 metres length
  • Ridging on storeroom side - ripped. Approx. 6 metres
  • Missing solar panel and fittings
  • Roofing needs to be checked

LAUNDRY

  • External back door – torn apart. Require replacement hinges: 3x 4” hinges
  • Internal door. Require replacement hinges. Total: 3 x 4” hinges
  • Washing machine to be checked - power cord still in point and dripping with water.
  • Check Electricals

PUBLIC HEALTH SHED (Opposite Telecom aerial)

  • Completely destroyed and flattened

Items in storage exposed and includes chemicals, pesticides, old equipment,lawn mowers, grass cutters, drums of diesel, mistblowers, knap sacks and other accessories

KITCHEN

  • Main door – require replacement glass
  • Little room adjacent to kitchen require replacement door for one side only. Measurements TBA
  • Standing Fan – wet and base bent. Please check before use!
  • Industrial vinyl ripped
  • Flooded towards the main door
  • Main kitchen area – No damage

WATER TANK (Outside theatre)

  • Missing 4 pieces of roofing iron – blown away
  • Loose roofing iron
  • Plumbing fittings and accessories destroyed

MATERNITY WARD (AT THE BACK FACING TELECOM)

  • Gutter, spouting and brackets - damaged and missing. Approx 18 metres in length
  • Outside wall ripped 2 metres x 2 metres
  • Hot Water Solar Unit completely damaged and panel missing

OUTSIDE THEATRE

  • Water Tank Lid gone with the wind
  • Plumbing accessories and spouting from roof damaged
  • Boards damaged

BETWEEN THEATRE & ISOLATION WARD (Back door)

  • Damage to outside wall – ½ metre
  • Two benches broken and destroyed

BETWEEN ISOLATION WARD & MATERNITY

  • Damage to outside wall. Approx. 6 metres
  • Roofing iron ripped – can see 4 sheets missing (Need to check roof)

ABOVE THEATRE & MATERNITY WARD

  • Outside walls ripped in two places. Approx. 4 metres x 3 metres & 1metre x 2 metres

BACK OF THE WARD FACING MAIN WATER TANK

  • Entire gutter including the brackets destroyed and missing. Approx 54 meters
  • Mosquito screens ripped. Total replacement. Measurement: TBA

BACK OF THE PAEDIATRIC WARD

  • 4x broken lourve blades – 24” lourve blade
  • Ripped mosquito screens
  • Water Filter – ok

BACK AREA OF THE ISOLATION WARD, MALE, WOMEN’S AND PAEDIATRIC WARD

  • Mosquito screens to be replaced

MAIN WATER TANK

  • Plumbing connection requires glue for refitting
  • Small filter netting for inside the water tank – torn (Require measurement)
  • Water Pump House – back cover ripped. Approx. 1 metre x 2 metres

TOP WALL OUTSIDE SURGERY NO:1 & NO: 2

  • Outside walls ripped. Approx. 2 metres x 1 metre

OUTSIDE THE OUTPATIENT(Facing the little green water tank)

  • Outside wall ripped. Approx. 2 metre x 1 metre
  • Water tank lid gone with the wind
  • Require glue for plumbing fitting

HOSPITAL SIGNS

  • Main hospital sign gone with the wind
  • Others uprooted and can be put back into the ground

TRANSPORT

  • GA189 – Damage to windscreen and Left headlight
  • GA4436 – Damage to right hand rear view mirror

DAMAGES TO THE INSIDE OF THE HOSPITAL

OUTPATIENTS WAITING AREA

  • Flooded
  • Ceiling ripped

Surgery No: 1

  • Ceiling ripped. Approx. 1.5 metres x 1.5 metres
  • Room flooded
  • Computer – UPS, Scanner/Printer/fax – all wet
  • Desk – wet
  • Cupboard – wet

Surgery No: 2 (Outside wall ripped above outpatients)

  • Room flooded
  • Computer – UPS, Scanner/Printer – all wet
  • Desk – wet
  • Cupboard – wet

OUTPATIENT TOILET

  • Inside ceiling ripped. Approx. 4 metres x 1.5 metres

XRAY ROOM

  • Flooded
  • Developer room flooded
  • Xray unitto be checked by service engineer
  • Check electricals

PHARMACY

  • Flooded
  • Haematology Analyser Wet
  • Air Conditioner Wet
  • UPS – Wet

FEMALE WARD

  • Ceiling ripped. Approx. 3 metres x 1.5 metres

SLUICE ROOM

  • Flooded – no damaged

STAFF KITCHEN

  • Flooded – no damaged

PAEDIATRIC WARD (Opposite Nursing Desk)

  • Flooded
  • Ceiling (above the Nursing Desk area) is buckled and needs to be checked
  • Ceiling (across from the Nursing Desk) has ripped. Approx. 7 metres x 4 metres
  • Ceiling Fan – check electricals

EMERGENCY ROOM

  • Flooded, no damage

PATIENTS TOILETS

  • No damage

MALE WARD

  • Flooded, no damage
  • Ceiling to be checked, along with electricals

MALE TOILETS

  • Flooded
  • Ceiling buckled – to be checked, along with electricals

CLEANING ROOM

  • Flooded, no damage

ISOLATION UNIT No: 1 (Three beds)

  • Flooded, no damage

PABX

  • Ceiling buckled – to be checked

STOREROOM

  • Ceiling ripped – to be checked for leakage

STAFF TOILET

  • Flooded, no damage

STUDENT ROOM

  • Flooded, no damage

ISOLATION ROOM No.2 (Two beds)

  • 2x bedside cabinets damaged
  • Ceiling buckled – to be checked
  • Flooded
  • Electricals to be checked

ISOLATION ROOM No.3 (Two beds)

  • Flooded

PASSAGE BETWEEN ISOLATION WARD AND MATERNITY

  • Flooded
  • Check Ceiling and roofing – Open to the universe

THEATRE

  • Flooded, no damage

STERILISING ROOM

  • Flooded
  • All 3x autoclaves wet (Trident EA 625T, NT 85, HIRAKAWA
  • 1x Lourve blade broken. 27”
  • Check ceiling & electricals

MATERNITY WARD

  • No damage

ROOM BETWEEN MATERNITY AND DELIVERY ROOM

  • Check roofing as there is leakage from solar panel into ceiling

TOILET AND SHOWER FOR MATERNITY

  • Flooded - Leakage from Window
  • Check electricals

DELIVERY ROOM

  • Air Conditioner Unit wet
  • 1x broken lourve blade 23.5”

PUBLIC HEALTH OFFICE

  • Flooded, no damage

DENTAL ROOM

  • No Damage

MEN’S TOILET (At the back facing the water tank)

  • Flooded, No Damage

ANTE NATAL

  • NO KEY

DENTAL WORKSHOP

  • Flooded, no Damage, just a ripped mosquito screen. Approx. 1 metre

VICTOR’s OFFICE

  • No damage

MEALI’s OFFICE

  • No damage

REPORTON DAMAGES SUSTAINED TO DOCTOR’S RESIDENCE

  • Solar panel missing along with fittings and tank damaged

  • Carport Destroyed – Leaving a rather large crack exposed along the main outside wall
  • Spouting to the water tank – damaged

(Outside) (Inside)

  • Cracked along wall of the residence – adjacent to carport area

  • Ceiling ripped in the toilet and iron roofing above toilet was exposed

(A temporary sheet of roofing iron was placed by Dr Koko but is subject to leaks)