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After Hurricane Dorian, What’s Next? A Conversation with Dr. Duane Sands, Minister of Health of the Bahamas

"While we still need the support, the love, the prayers of the rest of the world, we also need people to come to the Bahamas and allow us to entertain you, allow us to make a fuss over you, so that we are able to be self-sufficient..."


Hurricane Dorian

Abaco Island, Bahamas, post-Hurricane Dorian. (Peter E. Howard/University of Miami)

Hurricane Dorian, one of the most powerful Atlantic hurricanes in recorded history, struck the Bahamas nearly two months ago, causing more than 60 deaths, inflicting at least $7 billion in damage, and devastating the island’s health infrastructure.

The Bahamas Minister of Health, Dr. Duane Sands, spoke to Direct Relief last week about the public health situation on Grand Bahamas and the Abacos Islands, his biggest concerns about the future, the impact of climate change, and his suggestions for how people can help the Bahamas recover.

Direct Relief: How would you describe the current situation in the Bahamas, from a public health standpoint?

Dr. Duane Sands: I think the situation from a public health standpoint is stable, but guardedly so. I think nobody is under any illusions. We are managing, but we have acknowledged that things can go sour, or can turn, without absolute vigilance.

So notwithstanding the massive blow, I think that we have, with the assistance of a number of international partners, managed to cobble together a pretty workable health system in both Abaco and Grand Bahama and it is holding.

It is actually holding well, and the perception on the ground is that things are okay and the surveillance data that we continue to get doesn’t show any worrisome themes or trends.

Let’s just say I’m keeping my fingers crossed.

Direct Relief: When you said that things can go sour without vigilance, what specific things are you most focused on? Or what specific things are you most vigilant towards at this point?

Dr. Sands: Well, there are a few things that we’re really concerned about.

One is the psychological stress, the risk of anxiety, depression, post-traumatic stress, that’s the major concern.

The second thing is obviously any waterborne or vector-borne illnesses that can crop up over time.

And then finally, the other big concern is the consequence or complication of unmet chronic care needs.

So what we find is that, you know, people are worried about rebuilding their houses and dealing with their losses. And the management of high blood pressure, diabetes, pregnancy, etcetera is a secondary issue. So, we’ve got to be very aggressive in terms of making people understand that, you know, yes, you’ve had a major blow, but you still need to take care of yourself.

Direct Relief: How is your office managing that (outreach campaign)? What is the most effective way of communicating that issue about chronic care in particular?

Dr. Sands: I think one of the best ways of communicating it is using social media. Being redundant, being repetitive being in your face, but also seizing opportunities to make captive populations feel comfortable. Hey, if I just take two minutes, I can get my pressure checked or I can get my blood sugar checked.

This is now very much about taking health care to the community. And community is loosely defined because a lot of the rudiments of community have been damaged or destroyed.

Direct Relief: You also referenced surveillance data that you’re looking at. I’m curious to learn a little bit more about that—what is this surveillance data in particular? Where is it sourced from and how are you using it?

Dr. Sands: We have our surveillance team augmented by a number of individuals from PAHO (Pan American Health Organization) and other agencies. For instance, we have entomologists on the ground specifically looking at mosquito populations. We are paying attention to prodromal or syndromal reports.

Today, for instance, I would have gotten a specific report or specific question about whether or not we were seeing any respiratory ailments due to mold exposure. So the response from my epidemiologic team was that (in Grand Bahama)… we have no evidence of an increase in fever or respiratory cases or influenza-like illnesses.

Now, that’s hard data that they are getting. What it is suggesting is that even though we are in tents, even though we are in field hospitals, the reporting mechanism is still working. So it is very reassuring to know that the rudiments of public health are still functioning even in makeshift infrastructure.

Direct Relief: And what do you credit for that?

Dr. Sands: Oh, I mean, I think it’s a multifactor thing. We have had the ability to resume services and we have partnered with organizations, teams, stakeholders that understand the importance of an holistic approach to health, not just simply the provision of health services, but careful monitoring, evidence-based decision making and interventions.

So you know, the behind the scenes management, surveillance, activity monitoring, reporting, etcetera has been critical in terms of people paying attention more to other aspects of the post-Dorian reality than health.

I think I can say that many of our participants in the health relief program, they get it. They understand that good health care is more than just giving injections or putting on band-aids or changing dressings. It is an holistic approach that that involves many things. But the surveillance and monitoring and evaluation aspect is as important as the actual delivery of healthcare.

Direct Relief: Are any other challenges or big-ticket items that you’re particularly focused on addressing, just in terms of general health concerns?

Dr. Sands: Right now, we have a massive challenge with the restoration of elective care, elective surgical care, for instance, particularly in Grand Bahama.

So, given the interruption of services at the RAND Memorial Hospital, we can perform emergency procedures at Samaritan’s Purse, but there are a number of elective things that have had to be postponed. Something as simple as dialysis access, maintaining, taking care of arterial-venous fistula and grafts and putting in catheters and dealing with gynecologic issues and cancer diagnoses and so on and so forth.

A lot of these things have been put on hold and I think we are getting to a mounting challenge that is going to have to be deliberately addressed by some strategic intervention.

But it’s getting increasingly more difficult to tell people, “Hey, look, you gotta wait.” And the option of transfer to New Providence, while it’s always a last resort, is not exactly a good solution because of the overcrowding in New Providence.

So we’ve got to find, fairly urgently, a solution to the problem of the types of diagnoses and interventions that have been put on hold as a result of Dorian.

Direct Relief: Is there is anything you want to address that you think has been misreported or misunderstood by the general public, especially here in the United States?

Dr. Sands: Well, you know, I think the narrative that the Bahamas has been decimated is certainly one that I’d like to rebut, debunk, throw away.

Abaco and Grand Bahama are important parts of the Bahamas, but they in no way encompass the entire Bahamas. The Bahamas is still open for business.

That said, while we still need the support, the love, the prayers of the rest of the world, we also need people to come to the Bahamas and allow us to entertain you, allow us to make a fuss over you, so that we are able to be self-sufficient in the repair and rebuilding of Grand Bahama and Abaco.

These things are inextricably connected.

Yes, we’ve had a devastating storm and yes, there’s massive destruction, but in order for us to be able to help ourselves, business has to go on and there are 14 other major islands and hundreds of other cays that are looking forward to welcoming persons, so that the ability to respond to Dorian is significantly a self-sufficient exercise.

We could not have done this without the tremendous outpouring of support from so many international agencies, countries, etcetera. And yet, we realize that at some point, we are going to have to shoulder a lot of this load ourselves. So that message, I think, which has to be carefully nuanced, and it’s a recognition of the gratitude that we wish people to feel.

But our acknowledgement is that, at some point, we’ve got to get up and shoulder a lot more of this load ourselves.

Direct Relief: If you were going to reflect at this point, in terms of lessons learned, what do you think they have been so far for you and for your office?

Dr. Sands: Oh, boy. That’s a huge question. At the end of the day, I think we have learned that we are now existing in a world where this is a new normal. And the way forward now, even in the medium-term, requires us to acknowledge the impact of climate change on all of the decisions that we make, and to understand the impact of climate change on health in particular. And we are having to make decisions rapidly, but they have to be educated and informed decisions.

So, how we rebuild, how we design, how we structure, how we organize, it’s all going to have to take into account the fact that Dorian was fed by, nourished by waters that are 2.7 degrees hotter than historical norms. And that is jet fuel for a hurricane. The marrying of health informatics and meteorology is an interesting, perhaps unwanted, reality, but it is a reality that we’ve got to face.

Direct Relief: How would you assess the government’s response to the hurricane in general?

Dr. Sands: I think we have done as best as we can. If we had an opportunity to do over, I think there may be some things that we would have prioritized differently, but overall, certainly, I’m very pleased with the effort, the rapidity and, given the damage to our capacity, I think it was acceptable, even though disappointing, even for us.

You know, when you have members of your response team who have lost possessions, homes loved ones, they find it almost impossible to respond greatly to the needs of others, and yet many of them did.

And so given the real picture, given the blow that the Bahamas suffered, and then the team members, the parts of government that were to respond, and did respond. Overall, I think when the when the die is cast, or when we are placed in the balance, I doubt that a fair person would say that we were found wanting.

The transcript has been lightly edited for clarity.

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