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Department: COMMUNITY CARE

Reflecting on two generations of hurricane relief

Kiser, Erin DNP, RN, FNP-BC, WHNP-BC

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doi: 10.1097/01.NURSE.0000662256.40752.c8
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TWENTY-TWO YEARS apart, two category 5 hurricanes devastated local communities, leaving thousands displaced and in need of care. In response, two NPs from different generations, a mother and a daughter, provided assistance in the days and weeks to follow—one as an activated Army reservist, the other as a volunteer with a nongovernment organization (NGO). With a shared desire to serve, albeit in different capacities, each nurse's experience highlighted the ways in which nursing is vital following a natural disaster. In this article, the author shares her mother's experiences in the aftermath of Hurricane Andrew in Florida and her own experiences years later following Hurricane Dorian in the Bahamas.

Hurricane Andrew

In the morning hours of August 24, 1992, Hurricane Andrew made landfall in Southern Florida as a category 4 hurricane. It was later upgraded to category 5. With wind gusts of approximately 175 mph, the storm was responsible for the deaths of 35 people in Dade County and the displacement of approximately 250,000 others.1 Estimated to have caused nearly 25 billion dollars in damage in both Florida and, later, Louisiana, Hurricane Andrew had the grim distinction of being the costliest natural disaster in US history at that time.1 It would later be surpassed by Hurricane Katrina in 2005 and Superstorm Sandy in 2012.2

My mother, Susan McGann, was an NP working in a private clinic in South Florida and a Lieutenant Colonel in the Army Reserve. When Hurricane Andrew reached the Florida peninsula, she was called to assist her unit with aid and rescue efforts in Dade County and the Everglades National Park. The Everglades encompasses more than 1 million acres of sawgrass marshes, wetlands, and forests in Southern Florida, necessitating large military vehicles for travel.3

The facility where my mother was usually assigned, the 324th Combat Support Hospital in Perrine, Fla., was inoperable due to damage to both the building and the homes of several others in the unit. She was subsequently reassigned to the 7/9 Field Artillery unit and spent the next 29 days leading a team of activated Army Reservists through debris and destruction to reach those in need. Each day, the team transported supplies, food, clothes, water, and medicine from Fort Lauderdale, Fla., to the areas most affected by the storm.

The unit located camps of migrant workers, offered aid, and searched abandoned buildings for potential evacuation. By the time they were found, many survivors had gone without food for several days and some of the migrant families had only a tarp for shelter in the summer heat and humidity. The medical team treated injuries and administered roadside tetanus vaccines. Calling upon her years of training as an Army nurse, my mother provided first aid and managed dehydration.

Her unit also worked with the Humane Society to rescue pets and livestock, giving the animals food and water until they could be relocated. Due to its tropical climate in the US, South Florida has the highest number of exotic animals in captivity, both legally and illegally.4 Thousands of these exotic animals had been released after their enclosures were damaged by the hurricane. In the days and weeks that followed, hundreds of primates, exotic birds, reptiles, nonnative deer, snakes, and even a lion were seen roaming neighborhoods.4 The ongoing problem of invasive Burmese pythons in the Everglades originated from damage to a breeding facility during the storm.5

While on patrol one day, the team encountered a woman and her child in a remote area. She had been setting fires around the property to scare off “the monkeys and apes” that had been circling her house in an effort to protect herself, her child, and her home. In doing so, she had nearly burned her house down. Another memorable moment came when the unit found a woman holding her child and sitting atop a pile of debris—the remains of her home. She tearfully showed the team a small area beneath a few mattresses where she and her child had sought refuge as their house collapsed around them.

Once she finished her service in the recovery efforts, my mother visited local high school students to discuss her role as a nurse following the storm. Her talks would inspire a future generation of nurses. More than 2 decades later, I would serve as an NP in the wake of a different storm.

Hurricane Dorian

On September 1, 2019, Hurricane Dorian made landfall on the northwestern islands of the Bahamas as a category 5 hurricane. With maximum sustained winds of 185 mph, it was the strongest storm ever to hit the Bahamas. The slow-moving hurricane continued for more than 2 days with the most significant destruction predominantly affecting the islands of Grand Bahama and Great Abaco.6

More than 200 residents of Grand Bahama and Great Abaco are still missing but have not yet been declared dead.7 Reports from the first months after Hurricane Dorian estimated the number of missing persons to be more than 600.8 The official death toll in the Bahamas rose to 70.7 Of those willing to leave during the storm, some residents made their way to the US to stay with family, but most refugees were evacuated to neighboring Nassau, which sustained very little damage.

Hurricane relief efforts in the Bahamas, a member of the British Commonwealth of Nations, relied on various national and foreign aid organizations. The government's National Emergency Management Agency (NEMA) was responsible for coordinating volunteer efforts and constructed temporary shelters in conjunction with the Bahamas Gaming Operators; the Ministry of Social Services worked with national and international aid organizations to distribute food; and national and international aid organizations provided medical relief.9 I volunteered as an NP with a US-based NGO.

Bahamian social services were supplemented by community churches and their pastors. My organization coordinated clinics with a pastor originally from Haiti, and clinics were held in Haitian churches throughout Nassau. Another NGO was granted access to the shelters to provide relief. A team of 5 to 12 nurses, NPs, medical assistants, and an emergency medical technician treated patients in these clinics for 3 weeks following the storm. The pastor and his wife served as clinic interpreters and were able to minister to patients in Creole.

Many survivors presented with anxiety, difficulty sleeping, and depression. Several needed refills of medications that had been lost during evacuation or ruined by storm water. In some areas, storm surges were estimated at 12 to 18 ft, giving residents few opportunities to escape the water.10 Rampant, pruritic fungal infections were common.

More than a million gallons of oil spilled into the storm surge from a damaged facility during the storm.8 Patients described being in violent waters contaminated with oil and debris for days before being evacuated.

The week brought stories of survival and loss. One patient sobbed throughout her entire encounter in the clinic after losing her husband in the storm. But many told stories of strangers opening their homes to survivors. An older patient in an “I love Jesus” baseball cap recounted how he clung to a wooden post for more than 2 hours at the height of the storm. He was staying in a stranger's home with other survivors after losing everything in Great Abaco. Despite his story, he smiled broadly and credited God with his survival.

A pair of toddlers had been left in the care of a stranger while their mother had gone back to Abaco, possibly to salvage belongings. The caregiver was unsure of their names, but the twin girls appeared well cared for.

After the clinics, my team visited homes in Nassau that served as temporary housing for hurricane refugees. Wounds and infections were treated; medications were administered; and rice, soap, wash cloths, and insect repellent were distributed. Even patients without physical complaints were grateful to have their BP or blood glucose checked or just to receive a hug, smile, and word of encouragement.

A contentious, ongoing immigration situation has complicated the recovery effort in the Bahamas. In the wake of unemployment, poverty, and political unrest, Haitians have immigrated to the Bahamas for decades in hopes of a better life. The circumstances in Haiti further deteriorated following the devastating 2010 earthquake, leaving with many now facing the precarious situation of being in the country illegally without the means to apply for proper documentation such as a Bahamian passport.11 Even temporary work visas are too expensive for many of those seeking employment. Additionally, the children of Haitian immigrants born in the Bahamas are essentially stateless without designation as a citizen of either country. Haitian immigrants also faced growing resentment among Bahamians regarding immigration.11

An estimate of the number of Haitians in the country illegally is not available, but it is believed that they comprise most of the 1,600 individuals housed in Nassau's hurricane shelters.11 The situation for these immigrants was bleak, as the Bahamian government had announced that deportations would resume in the wake of the recovery effort.11 Our patients' concerns regarding deportation were made obvious when several individuals quickly disappeared following rumors of the arrival of immigration officers. Although no immigration officers ever arrived at the clinic, the fear was palpable.

Additionally, the temporary settlements on Great Abaco Island that housed many immigrants had been razed by Hurricane Dorian. The Bahamian government was preventing any efforts to rebuild in these areas, leaving many unable to return to their homes.11

There was also a concern that international aid could have a negative impact on the community. In Haiti, an infected United Nations worker is believed to have triggered a cholera outbreak that killed 10,000 people following the 2010 earthquake.12

Mismanagement of resources during disaster relief was another concern. Following recovery efforts for Hurricane Maria in Puerto Rico, 20,000 pallets of bottled water meant for victims were left abandoned on a tarmac for more than a year by the US Federal Emergency Management Agency. They were unusable by the time they were discovered.13 In an attempt to learn from issues in prior disaster relief efforts, NEMA and collaborating NGOs continued to encourage volunteerism and coordinate relief efforts. A centralized command center was established to direct food, medical supplies, and donations throughout the Bahamas.9

The effects of natural disasters can last for decades, and the future is uncertain for many affected individuals. When Hurricane Dorian survivors were asked what message they wanted to convey to people outside of the Bahamas, one replied, “Please, don't forget about us.”

Empathy and compassion

Nurses and other volunteers can become involved in recovery following a natural disaster in various ways. Multiple nursing skills come into play, such as triaging patients, treating wounds, administering medications, and providing empathy and compassion. Nurses are afforded many unique volunteer opportunities, and these can be extremely rewarding. However, it is not what nurses ultimately take away from their experiences, but rather the legacy of care that they leave behind.

REFERENCES

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2. Victor D. Hurricane Andrew: how The Times reported the destruction of 1992. The New York Times. www.nytimes.com/2017/09/06/us/hurricane-andrew-florida.html.
3. National Park Service. Everglades National Park Basic Information. 2020. www.nps.gov/ever/planyourvisit/basicinfo.htm.
4. Fesperman D. In Andrew's wake a new wild kingdom. Monkeys, cougars still running loose weeks after storm. Baltimore Sun. 1992. www.baltimoresun.com/news/bs-xpm-1992-09-20-1992264001-story.html.
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11. Charles J. Bahamas will resume deportation of undocumented Haitians who survived Hurricane Dorian. Miami Herald. 2018. www.miamiherald.com/news/nation-world/world/americas/haiti/article235764957.html.
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13. CBS News. Possibly millions of water bottles meant for Hurricane Maria victims left on tarmac in Puerto Rico. 2018. www.cbsnews.com/news/puerto-rico-water-bottles-possibly-millions-for-hurricane-maria-victims-sitting-on-tarmac.
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