Disaster Response Irma – Dialysis in Caribbean Islands
“During September 2017, three hurricanes passed through the Caribbean. Two of these, Irma and Maria were category 5 storms, some of the most powerful ever recorded. In the islands in their path, almost all buildings were damaged, the majority made uninhabitable, power, communication and transport infrastructure was destroyed.
I had a specific interest in the BVI as my parents live there and there were 55 CKD patients depending on dialysis in the territory. It was difficult to get information from the Islands, but I learned that the dialysis unit was out of action due to flooding. With support from the ISN disaster relief task force, I was able to travel to the BVI between the 2nd and 3rd hurricanes.
I found the local dialysis unit staff had made the dialysis unit functional again without outside help and all patients had survived. However, conditions were extremely difficult. Many of the dialysis staff and patients had lost their homes, some sleeping in the hospital. All related harrowing experiences during the passage of Irma as their homes disintegrated around them. The nephrologist who visits the BVI was based in Puerto Rico, also devastated by one of the hurricanes, and has not been able to get to the BVI until now. The islands were stripped of all vegetation, most of the population were living without power or refrigeration. Supply of drinking water and cooking gas were limited. The dialysis patients had at least a similar burden of co-morbidity as the ones we have in Leeds. Patients missed dialysis sessions due to closure of the dialysis unit during hurricanes, transport difficulties and some interruptions in generator power. I also reduced frequency of sessions to reduce the burden on staff. Hyperkalaemia was a concern as there was limited availability of food other than tinned. Few dialysis-specific supplies or aid was able to reach the BVI during the first few weeks due to the regional transport and communication chaos. It is to the BVI staff’s credit that they were able to keep the dialysis unit open during this period. Dialysis patients in the United States Virgin Islands have been evacuated to the US mainland. Several dialysis units in Puerto Rico are closed and the patients evacuated. Dialysis units in Anguilla and Dominica were closed for a while but now functioning, again mainly through the efforts of local staff”.