Monika Asnani and Lesley King | Hurricane Melissa and sickle cell disease

Hurricane Melissa barrelled across Jamaica on October 28 leaving behind a trail of destruction unlike anything the island has ever experience, particularly in the southern and western regions of the island.

The damage to homes, infrastructure, and livelihoods is extensive, and recovery and rebuilding efforts are expected to take years. For many, the emotional scars of this disaster might last a lifetime.

For individuals living with chronic illnesses, such as sickle cell disease (SCD), the post-disaster environment presents additional challenges. Disruptions to healthcare services, medication access, and support systems can significantly increase the risk of complications, morbidity, and even death.

While chronic conditions, such as diabetes and hypertension are widely recognised and frequently prioritised in disaster response efforts, we must not forget those living with SCD. Their needs are equally urgent and deserve deliberate attention in all phases of disaster preparedness, response, and recovery.

SCD is a genetic disorder of red blood cells. Persons with SCD get abnormal genes from both parents. This results in their red blood cells changing from a soft, disc shaped cell to a rigid, sticky sickle-shaped cell.

These sickle red cell have a short life-span (10-20 days compared to 120 days for a normal red cell) and can clump together, leading to blockage of blood vessels and poor delivery of oxygen to body tissues. This can lead to various complications, some of which might be severe or even life-threatening, while others can be chronic and long-lasting.

The most common include bone pain crises, acute chest syndrome, stroke, eye damage, leg ulcer and kidney damage. Psychosocial complications, such as depression, anxiety and suicidal tendencies are not uncommon, but are often less discussed and inadequately addressed. There are an estimated 18,000 people living with SCD in Jamaica.

HEALTH IMPACTS OF NATURAL DISASTERS ON SCD

• Temperature extremes such as wet, cold conditions can trigger bone pain crises. Likewise, high temperatures leading to sweating and fluid loss with dehydration can also trigger pain crises.

• People with SCD have a weakened immune system and are more vulnerable to infections. Unsanitary conditions and stagnant water can increase the likelihood of infectious diseases, such as gastroenteritis.

• Additionally, the proliferation of mosquitoes can lead to a rise in mosquito-borne diseases like dengue. Dengue poses a particular threat to people with SCD, as it can lead to severe complications, resulting in significant morbidity and even death.

• Dehydration can also result from disruptions in water supply and access to clean drinking water.

• The post-hurricane environment especially where there is significant infrastructure damage can lead to increased levels of air pollutants (such as dust and debris). This poor air quality can exacerbate respiratory issues and increase the risk for lung complications, such as acute chest syndrome (like a pneumonia, but much more).

• The disruption in healthcare from damaged hospitals and clinics, and transportation can limit access to medical care, medications and resources. Patients might be unable to access their usual care centres and medications for pain leading to severe, unmanaged pain crises.

• Disruptions in supply chains can also lead to shortages of other essential medications like hydroxyurea, monthly penicillin injections and life-saving vaccines.

• Hydroxyurea has been a game-changer for many people living with SCD, decreasing complications and improving quality of life. However, its effectiveness depends on consistent daily use. Significant periods of disruption means that their disease might revert to its natural, more severe state with increasing pain crises and other complications.

• Persons with SCD need a healthy, well-balanced diet to manage their condition. A disrupted food supply can negatively impact this.

• Psychosocial complications of SCD, in the aftermath of a disaster, such as Hurricane Melissa, might be further exacerbated by stress, displacement, and the disruption of usual support networks. Additionally, the stress and anxiety post-disaster can trigger sickle bone pain crises.

MANAGING SCD AFTER HURRICANE MELISSA

Hurricane Melissa has passed, but it leaves in its aftermath the setting for another “perfect storm”, increasing the risk for severe complications, and even death in people living with SCD. Here are some tips to stay healthy and safe:

• Stay hydrated, avoid extreme temperatures, and keep a supply of commonly used medications.

• Try to maintain a balanced diet as far as possible. Daily folic acid and multivitamins might be helpful for those whose food availability is poor or limited.

• Use recommended methods to ensure drinking water is safe.

• Avoid environments that increase risk of infections, such as crowded places and mosquito-ridden areas.

• Avoid disruptions in daily/routine medications that you might be taking, such as penicillin, hydroxyurea and pain medications.

• Be attentive to your emotional and mental health. Activities, such as light exercises, breathing techniques, yoga, and proper sleep might help you to relax and stay calm. Mental health support is available through different channels. Maintain your social support network, providing emotional support to others even as they support you.

• Keep informed through all communication platforms, such as radio, television, social media, personal networks on which hospitals, primary health centres, pharmacies, and other health facilities are operational in case you need urgent care.

Prof Monika Asnani is the director of Sickle Cell Unit and Dr Lesley King is head of clinical services at Caribbean Institute for Health Research, UWI. Send feedback to monika.parshadasnani@uwimona.edu.jm and lesley.king@uwimona.edu.jm

The Sickle Cell Unit at The University of the West Indies, Kingston stands ready to assist the Sickle Cell Disease community in this difficult period. They can be contacted via landline (standard working hours) on 876 927 2471; WhatsApp (messages only) on 876 808 2026; and Instagram @sicklecellunitja