Picture report about water contamination
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Number of casualties rises, as health risks increase
6 February 2004
The people of Guyana refer to it as ‘the Flood Disease’. Leptospirosis is at this moment the biggest concern in Guyana. So far, 43 people were being treated as in-patients in several Georgetown hospitals as suspected leptospirosis cases. Two deaths are confirmed to be related to leptospirosis. Another nine are suspected to be related to leptospirosis. Samples have been sent to CAREC for final confirmation. The total number of casualties directly or indirectly related to the floods, has now risen to 19. Other deaths were caused by drowning and acute dehydration and delays in accessing treatment due to flood waters.
PAHO is actively monitoring new cases of leptospirosis and collaborates closely with the Ministry of Health in Guyana to prevent a further increase in cases. Prophylaxe is being distributed on a master scale in the flooded areas. 120.000 persons have already received the weekly preventive dose of 200 mg. doxycycline. People coming from the flooded areas to the mobile clinics with symptoms of leptospirosis receive treatment. Blood samples are taken to the hospitals for further testing. If they are tested negative, blood is tested for other possible diseases such as dengue or malaria. All mobile health units now use the special form that has been developed by PAHO in order to monitor the health situation. These forms are tools for indicating the most common symptoms and syndromes. Furthermore, PAHO distributes prevention messages through the newspapers, radio and posters.
According to Dr. Cummings , Chief Medical Officer of the Ministry of Health in Guyana this monitoring of diseases is highly appreciated. “I believe it is very important and it has been very useful in our reply to the flood”.
The rapid increase in suspected cases of leptospirosis leads to an overburden of the Georgetown Public Hospital, which is the only public hospital for Georgetown and the East Coast. All day people where lined up to get doxycyline as prophylactive treatment. The emergency unit at Georgetown Public Hospital was overwhelmed by people complaining of nausea, headaches and fevers. A number of these patients have been admitted to hospital with suspected Leptospirosis. Dr. Hedwig Goede, Health Systems Advisor at PAHO Guyana, says she is worried about the capacity of the hospital to deal with this.
Picture report about Leptospirosis
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Situation Report Water Supply
The three pumps in zone 4 have been temporary repaired and operate on a shoestring. Shock chlorination will be done to disinfect the damaged wells. Rehabilitation of these three pumping stations remains an objective for the medium term, with a price tag of US$ 247,000.
19 out of the 20 pumping station operated by GWI are servicing the affected population. GWI installed some 50 standpipes where possible along their distribution system. In addition GWI still has to use tanker trucks to serve 128,000 people in the affected areas with potable water. The aim is to at least provide a minimum of 2 gls per day or in total 256,000 gls per day. There is still a shortage of storage capacity of some 20,000 gls (or 50 four hundred gls tanks) and 10 more trucks are required. To speed up the filling of the tanks 26 additional 2” water pumps are required. PAHO will purchase the remaining 400 gls tanks, while advertisements have been placed to invited tenders for contract for the delivery of water.
These 400-gallon water tanks need to be put on trestles or sand bags to raise the bottom tap and allow buckets and other water containers to be placed under these taps. Further improvements are suggested to mount 4 taps to one tank to reduce the waiting time at these stations.
Chlorine gas containers have arrived from Brazil on 31 Jan. and have been put into operation for the public supply system. This shipment was critical to gap the delay in supply from Trinidad, expected later this week. However, the boild water notice will remain in place, because of the long distribution network and the limited capacity to deliver res chlorine to the furthest point in the distribution net work. The trucked water has a varying level of residual chlorine and only 30% of the samples had a Res. Chl. level of >0.5 m/gl (the recommended minimum). E-coli testing indicated that none of the samples were positive. The GWI claims that the water is safe to drink, but safety chlorination is required to disinfect likely contamination while the water is stored in buckets in the household. Continuous residual chlorine testing is required, and also of E-coli in the end of the distribution lines as well at the temporary distribution stations along the west and east coast roads. Collaboration with CEHI in this area is recommended.
In addition the GWI distributes bottled drinking water (donated by OXFAM) as well as 2 gls collapse-able water containers (donated by UNICEF) filled with water with logistic support by the GDF.
One hundred water marshals will commence their training on Monday 7 Feb. and assume their duties to control the temporary water distribution facilities set up along the west and east coast road. Training for these marshals will be conducted by PAHO, including the purchase of res chl testing kits.
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Impact of the Floods in Guyana on the Health Sector
Situation Report - 3 February
Since the previous situation report, the water level has receded more than a foot in most areas. However, the level still reaches 2 to 3 feet in some areas of Region 4, where water cannot be pumped out or drained into existing channels.
All five shelters on the west Bank of the Demerara River (Region 3) are now closed and being cleaned and disinfected or functioning as schools.
More than 2,000 persons still remain in shelters in Region 4 (East Coast ). The epidemiological situation in all the shelters, which last week was very stable and showed little prevalence of the diseases associated with these conditions (thanks to the level of hygiene and the periodic visits of the Medical Teams), is now becoming a bit more precarious. This change in the epidemiological situation in shelters can be attributed to the prolonged length of time that the shelter population has been in contact with contaminated waters. There is an increase in cases of diarrhea, fever, and abdominal pain.
There has been one confirmed death due to leptospirosis and other cases in hospital are awaiting laboratory diagnosis. With this situation, the Ministry of Health has opted to take an aggressive approach to the problem. They have issued advisories to the general population to seek medical attention if they present any potential symptoms of leptospirosis (fever, headache, muscle pain) and medical practitioners have been alerted to the situation.
Under the supervision of the Ministry of Health, a prophylactic campaign is underway. Volunteer medical teams as well as NGOs are going house to house to assess the situation in the affected areas where the population is exposed to contaminated waters and distribute Doxycycline in a prophylactic dose. Persons exhibiting symptoms as well as pregnant and lactating women, and children under eight were advised to visit health centers.
PAHO continues to actively collaborate with the Ministry of Health in epidemiological surveillance, coordination of health teams, water and sanitation, vector control, laboratory testing (CAREC), disease and environmental surveillance in shelters, and public information campaigns (preparing posters and flyers for public education), and providing technical advise on disease management as the epidemiological profile changes. PAHO has also been charged with coordinating the technical input of other agencies..
PAHO has prepared a proposal for the reconstruction of the Health Centers that were damaged. The Ministry of Health approved the proposal and funding is being sought.
One SUMA team continues to be deployed at the airport. To date, only two planes have brought unsolicited relief supplies, mainly blankets, water tanks, generators, some food supplies and other miscellaneous items. Another SUMA team was deployed to a warehouse where relief supplies are stored.
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Health Sector Situation Report
The floods that began on January 15, 2005 have affected at last 192,000 people in and around Georgetown, East Coast, East Bank and West Demerara. The flood level rose to 7 feet in the worst affected areas (Enterprise) and the level is dropping at the slow rate of 1½ inch (or nearly 4 cm) per day. Approximately 50 pumps have been installed or re-activated to drain the floodwater, but their limited capacity and the poor conditions of the drain channels (overgrown, filled in, culverts blocked by garbage) prevent rapid discharge. Also the flooded area was has numerous dyked neighborhoods to keep flood water out. These dykes have been overtopped and the water cannot drain out. At the present rate, flood condition will persist, but the areas affected will decrease. Clean up can begin in those areas where the floods subside. The estimates vary from one to seven weeks. Engineers from the Guyana Defense Force estimate that the floods will persist at least for another 2-3 weeks in certain areas. In Enterprise, the water level is still 5 feet.
Health facilities have been severely affected, as most septic tanks and latrines were flooded and are unusable. Their contents have spilled into the flood water, making this water hazardous to health. In the absence of available facilities, indiscriminate disposal of excreta in the surrounding floodwaters is a common practice.
The floods had impact on the health facilities is Regions 3 and 4. Surveys conducted by PAHO revealed that in Region 3, 25% of the 12 health centers are closed and have some damage. Region 4 (population of 75,000) is the most affected, where 22 of the 36 health centers (61%) were flooded, 12 health care facilities (33%) are out of operation, 3 (8%) have limited functional capacity and 7 (19%) are fully functioning. The damage reported includes loss of supplies (needles, drugs, vaccines, cotton, bandage, etc) and damages to water pumps, refrigeration units (Cold Chain), furniture, and electrical wiring.
PAHO has organized and guides the mobile health teams, visiting the shelters and communities in the affected areas, mostly by boat. Every day about 35 health teams composed of 7-10 persons deploy to conduct epidemiological surveillance and to treat diseases, mainly skin rashes. PAHOWHO has prepared and disseminated epidemiological surveillance forms, trained personnel in epidemiological and disease surveillance in shelters and in the communities. PAHO/WHO also does the data analysis and coordinates the response to outbreaks in collaboration with the Ministry of Health.
PAHO/WHO has also prepared models for providing medical care in disaster situations, shelter care and school health and has developed clinical protocols and guidelines for different skill mixes, all for use by the mobile teams
All 80 villages along the affected east coast of Guyana are being visited and thousands of people have received medical treatment. On Sunday, 30 January 2005, the turnout of health workers was very low, and only 8 teams could be dispatched. There is also a shortage of medical doctors to accompany the mobile teams. It might be difficult to maintain such a labor intensive operation for the long duration
To date, 4302 person live in 43 shelters, up from 3300 a week ago. This increase is likely due to an improved surveillance and counting and not necessarily due to an actual increase in persons. These shelters are located on the second floors of schools and other higher buildings as well as in many domestic residences accommodating other victims of the floods. One concern is the number of people living in crowded and congested spaces, with limited facilities. The GDF manages 20 of these shelters with a population of about 3065. It was reported that in some shelters the flush toilets on the higher floors are still working. Some shelters do not have this facility.
There is an increase in skin rashes (42% of the cases) and fevers (30%) but the number of diarrhea cases is stable at around 15%. Vigilant monitoring and active case detection will continue. Since 22 January, epidemiological data is being collected daily and made available to the Ministry of Health.
Needs for shelters:
Removal of garbage, mosquito nets (long-lasting, pre-impregnated), food for babies, diapers, sanitary napkins, provisional sanitary facilities.
Needs for health centers:
When the water recedes and the affected population begins to go back to their homes, the priority will be to recover the health system capacity in these areas, continue the disease surveillance and give medical assistance to these communities. Some of the activities required to reopen the health centers affected include:
- Clean up and disinfect the infrastructure (floor, wall, etc)
- Clean up and sanitize furniture and medical materials
- Collect and disposal the solid waste
- Restock drugs and medical supplies, as well office supplies
- Clean up septic tanks, water tanks, toilets, latrines
Needs for epidemiological surveillance:
Lab technicians, testing materials and reagents.
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Water Supply Situation Report
Guyana Water Incorporated (GWI) has about 75% pumping capacity remaining in the affected areas in Zone 4, due to the flooding of its pumping stations. Three of these pumps, supplying water to 12,000 people, remain out of operation at this moment in Zone 4. The GWI attempts to keep the operational pumps 24-hours-a-day to maintain appositive pressure on the system to reduce infiltration by flood water. This effort is not always successful. Due to the very low stock of chlorine gas, the public water supply receives a very low dose 0.4 mg/l, which is inadequate. Warnings have gone out that the water from the pipes should be disinfected (by cooking or using bleach) before drinking. The piped water, though, is suited for bathing and washing. The PAHO Environmental Health Advisor was able to source 1.4 tons of chlorine gas in Brazil, which arrived late Saturday night in Georgetown from Boa Vista. This supply will bridge the gap before the regular supplier from Trinidad can deliver in the beginning of February.
PAHO officers provide technical support to and are coordinating all public campaigns related to health, water and sanitation to ensure that a clear and consistent message reaches the communities in relation to drinking water, water for washing and the dangers of the flood water.
Together with the Guyana Defense Force (GDF), a trucking system has been set up to supply the drinking water depots that have been set up along the east-west road in the affected areas. A total of 50 depots have been established consisting of one or more 400gallon PE tanks. A fleet of 14 tankers trucks, some of them improvised flatbed trucks with 400-600 gallon tanks and a pump deliver water to the affected communities. Truckers are contracted and paid by the GDF and 7 truckers work voluntarily, but their services are not consistent and reliable. At maximum capacity these trucks deliver a total of 120,000 gallons a day in three round trips. The GWI, with support from OXFAM, is planning to hire at least 10 trucking services to guarantee reliable capacity. In the absence of chlorine gas, the GWI use bleach to disinfect the water in the trucks before distribution. PAHO assisted in the dosage protocol for the disinfection of this trucked water delivery system. Together with the Environmental Protection Agency (EPA) of Guyana, PAHO conducts daily monitoring of the water in the distribution depots and found the residual chlorine levels were very low or absent except one.
To control the operations at water storage depots, OXFAM will hire 100 water marshals who, in two shifts, will man these 50 depots. Their task is to regulate the water collection by the residents, ensure that only water from certified truckers are filling these tanks, and measure and adjust the residual chlorine levels. PAHO will train these water marshals in their task. The marshals will be provided with mobile phones to remain in communication with the GWI and three supervisors who will patrol the depots on motor bikes.
In addition to trucking water, also GWI also distributed bottled water to communities not able to reach these depots, with the help of the GDF. The GWI has run out of funds to pay for the bottled water and OXFAM, is now donating 1000 cases of 12 one-liter bottles for distribution. The GDF was able to reach by boat the backlands of Saphia, Buxton, Paradise, Enmore and others, to distribute water, foods, and to evacuate people (with priority given to the most vulnerable: pregnant women, babies and mothers, children, the elderly). Only eight boats are available and many more are needed.
The Red Cross has available 8,900 water jerry cans, and will make these available to the GDF for distribution. UNICEF has donated jerry cans and one 1500-liter bladder tank. The GDF will coordinate the distribution of these jerry cans and bladder tanks.
Needs in water and sanitataion:
Residual chlorine testing kits (100 pcs plus 10,000 reagents pillows)
Laboratory facilities to assess the water quality parameters, including: E.Coli, Fecal and Total Coliformes, pH, Iron, Turbidity.
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Sanitation Situation Report
Sanitary facilities have been severely affected, as all septic tanks and latrines in the 80 assessed areas in East Coast Demarara have been flooded and are unusable. Their contents have spilled into the flood water making this water hazardous to health. In the absence of available facilities, indiscriminate disposal of excreta in the surrounding floodwaters is a common practice.
Given the present situation, it is necessary to provide temporary toilets for those areas. An public education campaign is also necessary to stimulate the population in the flooded areas to use plastic bags to dispose of excreta and place it on static tanks located in surrounding dry areas.
Garbage removal remains a problem in the affected areas, especially in shelters where many hot meals are being distributed in styrofoam containers.
There are still a large number of rotting carcasses along the roads to be disposed of. Many areas still have no solid waste collection, including areas east of the city in the Greater Georgetown area, from Sophia, Lodge Housing Scheme and Meadow book Gardens (W) to Cummings Lodge (E) and South areas of the older city, including Albouystown, north East and East La Penitence, West and East Ruimveldt, South Ruimveldt Park and the northwest corner of the city – Kingston. Through Friday, January 21, solid waste collection was reduced to 30%. Today it is expected to rise to 80% in Georgetown.
Since Friday, 21 January, the SWM Georgetown is accepting for disposal at Mandela dumpsite all wastes, including carcasses from areas external to Georgetown that are associated with the flood situation.
At the present the SWM is requesting 200,000 plastic bags and boats to improve collection capacity. In the East Coast, the Ministry of Local Government is preparing an assessment of the solid waste situation.
Plastic garbage bags, intensified garbage removal,especially from affected areas and shelters, carcass removal;
Clean up in schools and clinics, and cleaning materials;
Temporary provisional sanitary facilities (trench latrines).
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Guyana has been experiencing an excessive amount of rainfall in. Normally, rainfall averages seven inches per month. However, by mid-January, 27 inches of rain had already fallen. This has caused considerable flooding along the coastal regions which are the most densely populated areas of Guyana. It is estimated that more than 70,000 persons in the Georgetown area are seriously affected by the floods. Along the coastal regions, the number is estimated at a minimum of 100,000.
The Government of Guyana has declared several regions of the country as disaster areas, and if the rain continues, conditions will deteriorate. Most of central Georgetown remained under water from Jan 17 – 19, until a lull in the rainfall allowed a significant amount of water drained from higher ground in central Georgetown; however, some areas in central Georgetown still remain seriously affected, with residents unable to return to their homes. On the east coast, the situation has not changed. Water levels remain high and continue to rise as water drains from higher ground and more and more families have been forced to evacuate their homes and take shelter in multi-story school buildings.
People living in the coastal strip are actually caught between the sea and the sea wall in the north and the Conservancy in the south. Conservancies are huge, many hectares of flood plains surrounded by 10 to 12 foot dykes to hold/retain water for agricultural purposes in the dry season. The dykes in these Conservancies are now over-topping an extremely dangerous situation, as this might cause the dykes to breach. Although the Army is sand-bagging these dykes to stop the overflow, engineers have expressed concern that the dykes might collapse. If this occurs, an additional three to four feet of water will flood the coastal zone causing serious risk to life in areas already flooded.
Most health centers remain closed because they are flooded and equipment and drug supplies have possibly been damaged. Although the number of casualties it is not accurately known, the population in the flood-affected communities requires shelter, food and water. At present, only 10% of the population estimated to receive food is actually receiving it and only 20% of those who need water are receiving it. This is largely due to the lack of access to the affected areas. At least 300 shelters have been established at different sites with a capacity for 3,500 people. Today, at least 2,000 persons are in shelters.
Public health programs in the area have been interrupted and there is a great demand for post emergency interventions due to the preexisting vulnerability of the population to dengue, malaria and other vector-borne diseases.
As of Friday, 21 January, both water treatment plants on the East Coast (Mon Repos and Betterhope) were out of service. All three treatment plants on the East Bank (Covent Garden, Grove and Eccles) are operating and chlorinating within their usual residual free chlorine range of 0.2-0.4 ppm.
Guyana Water Inc. (GWI) has repaired the affected pumping stations and is pumping water 24-hours-a-day, instead of the usual eight. GWI has also opened their pumping station to the public to collect water. GWI has placed 57 large 400-gallon water tanks along the east-west roads and these are being filled by tanker trucks. So far, more than 300,000 gallons of water were delivered to these tanks. However, delivery trucks are in short supply. Although water is being chlorinated, the dosage is very low and the stock of chlorine gas is nearly depleted. Bottled water has also been distributed.
The disposal of human excreta is another very serious problem in the flood affected areas, especially along the east coast in Demerara. So far, in the 80 assessed areas, 100% of the pit latrines, septic tanks or drains are flooded. Sewage is mixed with accumulated water, increasing the risk that water-related disease would become epidemic.
Many health facilities are not functional and pit latrines and septic tanks are spilling their contents into the flood water. People now commonly use buckets and empty the contents into the water.
The most common health complaints are diarrhea, skin fungal infections, conjunctivitis, and acute respiratory infections. Raw sewage in the flooded waters (due to flooding of septic tanks and pit latrines) as well as rodents and snakes are major problems. Data from mobile clinics report a substantial increase in cases of diarrhea on a daily basis. In at least one shelter, 35% of the 155 persons are already experiencing diarrhea. There are also outbreaks of scabies and other diseases. There is an increased risk of snake bites and leptospirosis among other diseases.
- PAHO/WHO is the key international partner on the Task Force on Health, chaired by the Minister of Health. The Task Force has established several mobile teams that went to the affected communities and are providing medical services, water, bleach, disinfectant and information to the worst affected communities.
- PAHO’s technical support to the Ministry of Health included providing members of their mobile team assessing the situation in the affected areas. PAHO is strengthening the leadership of the Ministry of Health in coordinating the public health response among the international technical agencies based in Guyana, primarily the US Centers for Disease Control and Prevention and UNICEF. The epidemiological system set up by three PAHO/WHO epidemiologists is focusing on monitoring in shelters and other high risk areas.
- Emergency Operations Centers have been established in the Ministry of Health as well as in PAHO/WHO. The National Emergency Operations Center is being established at the police headquarters and will be run by Defense Force. A health sector coordination meeting was organized in the PAHO/WHO Representation with key partners.
- Two SUMA staff have been requested and will be mobilized on Monday.
- PAHO is also collaborating with the International Red Cross Assessment Team and the Disaster Advisor to the US Government who are currently in Guyana undertaking assessments.
- The PAHO Disaster Response Team was strengthened with additional environmental staff from neighboring countries. The UNDAC Team has also arrived in Guyana and has begun its assessment. Staff from UNICEF and IFRC are in Guyana as well as donor assessment teams.
- PAHO has launched an international appeal for US$543,000.
Photos from the Emergency
Conservancy dyke sandbagged Provisional pumping of the flood waters
Water distribution Mobile Health Team
Residents collecting water
All the photos below are courtesy of Mr. Bryan Mackintosh. Used with permission
For additional images by Mr. Mackinstosh go to: http://www.bryanmaxx.netfirms.com/index.htm