|Disaster Reports : The Effects of Hurricane David. 1979, on the Population of Dominica (PAHO)|
Was anyone in your household injured at the time of the disaster or since then ?
1. What was their name ?*
* A separate form was filled in for each person injured.
2. Which part(s) of their body were injured ? (Head, shoulders, back, chest abdomen, arms, hands, legs or feet)
3. What was the nature of the injury ? (Explain in your own words and tick for nail wound, blow, laceration, cut, fracture, or other)
4. Where did it happen ? (Inside home, inside another building or outside)
5. Why were they there ? What were they doing ? (This did not have to be answered by those injured inside the home)
6. What were they injured by ? (Galvanised roofing sheets, trees or, if something else, what ?)
7. When did this happen - on which day and at what time ?
8. Did they try to obtain medical aid ?
9. If not, why not ?
10. Did they get medical aid ?
11. If not, why not ?
12. If not, who looked after them ? (Family, neighbours, themselves or, if someone else, explain who).
13. If they got help, where did they go ? (Health centre, hospital or nurse or temporary medical facility in locality. Give the name).
14. What means of transport did they use ?
15. How long after the injury did they arrive ?
16. Who treated then ? (Doctor, nurse or don't know).
17. What was the medical diagnosis. if known ?
18. How long did they stay at the health centre or hospital ? (Give the number of days or, if the stay was brief, the number of hours).
Was anyone in this household pregnant at the time of the disaster ?
1. What was her name and age ?
2. Did she leave the island after the disaster ?
3. Has she delivered yet ? What was the date of delivery ?
4. Where did she deliver - in Dominica or abroad ?
5. What was the outcome of the pregnancy ? (miscarriage in the first three months, later miscarriage, stillbirth or live baby)