Map of the affected area
Jimaní's main street
Main hall at the emergency department of Jimaní's Hospital
Fence surrounding Jimaní's Hospital
Soleyl river bed
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Situation in the
Dominican Republic
Santo Domingo, the capital of the Dominican Republic, has
been severely affected. The Dominican Republic National Emergency Commission
has declared a red alert in the region around Jimaní, the capital
of the province of Independencia, and a yellow alert for the rest of the
country.
The rising waters from the Jimaní River swept away
homes, cut utility lines and prevented rescuers from reaching the hardest-hit
regions. Civil defense officials in both countries have been evacuating
families to higher ground. The hospital in Jimaní was flooded and
patients were transferred to another facility. Telephone communications
with Jimaní have been severed and the area has no access to drinking
water or electricity.
Health Situation
In Jimaní, the municipality most affected to date, the Melenciano
General Hospital was flooded, equipment was damaged and there was a substantial
loss of medical supplies. Patients had to be transferred to La Fortaleza.
The municipality has been left without telephone service, drinking water,
electricity and to date, is only accessible by land through La Descubierta.
Rescue personnel, small aircraft and ambulances have arrived from nearby
provinces and Santo Domingo. The water supply is expected to be reestablished
in five days and presently, water is being distributed to the affected
population by tanker trucks.
Potential public health risks from a disaster of this type include changes
in existing patterns of morbility, potential changes in the ecosystem
(vectors), population displacement and deterioration in drinking water
and basic sanitation systems and health infrastructure.
The epidemiological surveillance system must be strengthened to allow
quick detection of disease outbreaks among the affected population and
initiate control measures. Entomological surveillance must also be strengthened
to reduce risk factors leading to vector-borne diseases and appropriate
control measures must be defined.
Currently, the most pressing tasks involve strengthening the capacity
of the provincial health authorities and health centers to deal with potential
disease outbreaks common to this type of disaster and implementing health
promotion, information, education and communication initiatives directed
at the population in temporary shelters and those living in affected areas
in order to reduce health risks.
Summary of the health situation in the province
of Independencia
The province of Independencia, together with the province of Pedernales,
forms part of the southeast border of the Dominican Republic with Haiti.
Jimaní is the municipal seat of this province and has a population
of 42,538. Fifty-eight percent of the population lives in urban areas
and 42% in rural areas. The province covers 2,000 km2, with a population
density of 21.2 inhabitants per km2. In Independencia, 82% of households
are classified as living in poverty; 32% of the population over 12 years
of age is illiterate.
Prior to the disaster, 72% of the population had easy access to water,
with 78% having access to drinking water. However, only 47% were serviced
by regular garbage collection—a figure considered extremely low
and a high-risk factor for human health.
Through April 2004, the province of Independencia had reported 37 cases
of malaria, compared with 17 during the same period in 2003—a rise
associated with an outbreak shared with several neighboring provinces.
Thanks to appropriate interventions, the incidence of malaria was reduced,
however, flooding increases the risk of transmission of the disease.
There was a very low incidence of dengue in the province of Independencia
during 2004—only three cases of classic dengue were reported. During
2003, 33 cases were reported.
With regard to vaccine-preventable diseases, only one case of diphtheria
was reported in 2004. Coverage for the DPT vaccine reached 95.6% for the
first dose; it dropped to 81% for the second and only 53% received the
third dose. As for the polio vaccine, 98.5% received the first dose, 72%
the second, and only 34% the third. Vaccine coverage for measles is 95%
and the BCG is 97%.
In 2003, there were 31 reported cases of tuberculosis, similar to morbility
during the previous two years. Detection rates, however, are low, and
given the current post-disaster conditions, efforts should be stepped
up to detect the disease in patients presenting respiratory syndromes
so they can be treated and transmission can be halted. No cases of meningococcal
meningitis or leptospirosis have been reported in 2004, although the risks
of the emergence of both diseases are increasing.
The Health Services Network in Region IV of the
Dominican Republic
Health reports and statistics originate from UNAP to the reference
hospital, where there is a person resposible for receiving, verifying,
consolidating and forwarding them to the corresponding regional
network administration, responsible for its fuctioning.
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Four provinces make up Health Region 4 in the Dominican Republic: Independencia,
Pedernales, Barahona y Bahoruco. These provinces contain eight service
provider networks, called gmicronetworksh that link the Primary
Care Units (UNAPs, denoted in yellow) with their respective reference
hospitals. Jimani belongs to the gLago Enriquilloh micronetwork,
made up of 12 UNAPs and the Jimani Hospital (40 beds) and the La Descubierta
Hospital (20 beds—a hospital that currently has no medical specialists
available). Both of these general hospitals are ill suited to resolve
complex health problems. These cases are referred by the micronetwork
hospitals (Jimani and La Descubierta) to the Jaime Mota Regional Hospital
localted in Barahona
Analysis of Resources and Needs for the Health
Response
Following are the most important aspects considered in the evaluation
of local capacity and needs for the health response:
- Health services: access to services, human resources
available, redistribution of personnel, preparedness of services, communications
and radiocommunications systems, ambulances, movil units, equipment,
information systems, service networks, references and counterreferences.
- Control and surveillance: vector control, epidemiological
surveillance, immunization program, zoonoses, foods, communicable and
noncommunicable diseases, etc.
- Education: health promotion, community participation
and development, hygiene, communications, etc.
- Risk management: contingency plans, hospital plans,
early warning systems, SUMA.
- Mental health: psychosocial support to affected population
y health personnel.
- Environmental health: water supply, surveillance
and control of water quality, excreta disposal, solid waste management;
management of corpses, shelter assessment, primary environmental needs.
- Supplies and medicines: inventory of supplies, biological
needs, supplies and medicines, diagnostic and reactive equipment, according
to epidemiological profile.
The Dominican Republic's National Emergency Commission's website
has additional information in Spanish.
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