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.

· 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.