|Disaster Reports Number 5: Hurricane Gilbert in Jamaica, September, 1988 (PAHO-OPS, 1988, 42 p.)|
Jamaica is a small tropical island with an area of roughly 11,310 sq. km. Much of the island is hilly or mountainous and there are large areas of volcanic rocks in the east in the Blue and Port Royal Mountains which rise above 1000 m in altitude. The mountains of the west are lower and composed largely of limestone.
The island's rainfall derives from four weather phenomena. Cold fronts moving southwards from North America bring rain in the period November to April. Convective activity also results in localized showers. The third source comprises troughs and waves of low pressure related to local and regional atmospheric systems such as the Intertropical Convergence Zone. Perhaps the most important weather phenomena, however, are tropical disturbances-depressions, storms and hurricanes. Fig. 1 shows the monthly distribution of hurricanes in the period 1900 through 1988.
In 1988 the population of Jamaica was just under 2.3 million. There was a marked decline in fertility in the intercensal period 1970 to 1983 when births per woman declined from 5.6 to 3.3. The birth rate is now estimated at 25 per 1000. The death rate is aproximately 6 per 1000 and official estimates of infant mortality 13.2. There is reason to believe, however, that infant mortality is grossly underestimated. The decline in the fertility rate is reflected in a decline in the proportion of the population in the age group less than 15 and an increase in the over-65-year-old age group. The dependency ratio is 83. That is, there are 83 persons in the dependent age groups (less than 15 and over 65) for every 100 persons in the working age group.
Administratively, the island is divided into fourteen parishes. Two parishes, Kingston and St. Andrew, form the capital region. The Kingston and St. Andrew Metropolitan Area (K.M.A.) has a population of 586,930 which represents 28 percent of the island's population. The population of the K.M.A. is declining, however, and the area of growth is in the neighboring parish of St. Catherine. The only other parishes to gain population between 1970 and 1983 were St. James, where tourism is important, and St. Elizabeth.
The island has a well-developed system of primary health care based on a network of 377 interlocking clinics. These clinics deliver maternal and child health care, dental care, and curative and family planning services. Secondary and tertiary care are provided by 25 public and seven private hospitals. The island appears to be experiencing elements of epidemiological change which are bringing its morbidity and mortality pattern in line with those of more developed countries. This involves changes from acute to chronic ailments as causes of morbidity and mortality. To some extent, however, an uncomfortable balance has been reached, since infectious diseases remain important causes of ill health among young children. Moreover, there has been an increase in hospital admissions for malnutrition and an increase in the case fatality rate [Landman and Walker, 1987]. Marchione  relates this to the fact that while the primary care programme relies upon the increasing use of health centers, the epidemiology of malnutrition tends to be linked to access to income and social support systems.
Moreover, economic stabilization programmes imposed as preconditions for International Monetary Fund assistance have led to demoralization of health personnel, widespread migration and underfunding of the health system. There was a serious manpower shortage when Hurricane Gilbert struck the island. It is estimated that between 1987 and 1989, nurses left the service at the rate of seventeen per month. In fact the only health sector group for which there was adequate staffing was porters and other ancillary staff [PAHO/WHO, 1989].