Coping with Cyclone Heta: nurses play a crucial role following natural disasters. Cyclone Heta, which hit the island nation of Niue in January this year, was hugely challenging for the country's nurses. They coped admirably.

Nurses who live in regions hit by natural disasters are often expected to take leadership roles, to provide emergency care and aid to distressed casualties while their families take second place. (1)

On Monday, January 5, 2004, Cyclone Heta hit Niue. Waves estimated at more than ten metres high followed the high winds. The damage was the worst Niue had ever experienced. Buildings, including the once busy and efficient lord Liverpool Hospital, were demolished, Cyclone warnings had been issued on January 3 and 4, and all inpatients at the hospital were assessed. Those suitable for discharge were sent home to their families. The elder-care facility in the hospital grounds was evacuated, and those patients who were unable to go to their villages were moved to a ward near the nurses' office in the main building. All hospital equipment and medical and surgical supplies were packed, ready for emergency transfer. Niue had a cyclone alert system but on the Monday morning this had not been activated. Hospital staff were concerned for patients' safety and decided to evacuate. There was a hasty move to the Public Works Building on a plateau above Alofi, Niue's main town.

The waves damaged much of Alofi and when people emerged from their protection areas there was a stunned silence at the devastation. A young nurse and her child were missing and searches were started. They were found 24 hours later--the mother dead and her son seriously injured.

Following the cyclone, the Public Works Building became the central point for the victims of the wave devastation. The hospital equipment had not been retrieved before the waves struck, necessitating the use of the ambulance supplies. Injuries ranged from a fractured leg to head injuries and cuts.

The main nursing challenge was caring for those distressed people whose houses had been washed away. Rooves were blown away, trees uprooted, cars had been tossed up onto the cliffs like small toys, windows were shattered, precious possessions were strewn on the ground, coral boulders had been heaved up from the sea bed, trees had been stripped of their foliage--all evidence of the violent weather of just a few hours earlier.

The nurses worked for 24 hours at a stretch throughout this time, while having the safety of their own families at the back of their minds. The temporary hospital moved to the youth centre near the airport. Two days after the devastating waves, two Medivac planes arrived from New Zealand, one to airlift the seriously injured infant to Auckland's Starship Hospital and the other with much needed supplies. An Australian Defence Medical team arrived and set up a field hospital, giving the Niuean nurses their first opportunity to attend to their families' needs and to reflect on what had happened over the last hectic days.

Nurses had to cope with enormous challenges in the days following the cyclone. They conducted a fruitless search through the hospital rubble, where once the maternity unit had been, for a small child's airway. They stabilised and maintained a child's life while awaiting the Medivac plane. Distressed and bewildered homeless people needed comforting. It was very important for nurses to attend the funeral of their friend and colleague who died as a result of the cyclone and waves, while continuing to care for the injured. Her child subsequently died. Nine months after the disaster the hospital remains at the youth centre site and no final decision has been made on where and when a new facility will be built. The original 13 nurses remain employed and are rostered to keep the basic clinic functioning. Morale remains intact, however nurses feel their skills and experience are not being fully used, as all serious medical patients, those with fractures, those requiring surgery and potentially at-risk maternity patients are referred to New Zealand by one of the three doctors.

One ward with two beds and a single room is in use. The second ward, which is in a secondary building, is being renovated and will have four beds, but patients will need to be mobile, as there are steps to the bathroom and main hallway. There is no nurses' station and the principal nurse has only recently been able to move into her own office. The elder-care facility has not been replaced and the elderly who were at the hospital before the cyclone are now living with relatives. Communication systems are yet to be completed. There is only one telephone line into the hospital, no email and no access to the internet. Computerised patient records were lost; however, the old handwritten notes in personal family folders are intact. The time since the disaster seems to have gone very quickly. While there was so much work to be done to make the health facilities functional, there has been little time to reflect on the impact of the disaster. The mental health impact of the disaster is evident in the feelings of helplessness about rebuilding homes, and questions about the future of the hospital and Niue in general.

The Niuean nurses faced the consequences of the disaster with courage and fortitude. They must be honoured for their professional attitude, and the nursing care they gave to the people of Niue following the disastrous Cyclone Heta.

References

(1) Latta, L. (2004) Supporting nurses affected by floods. Kai Tiaki Nursing New Zealand. 10: 2, 3.

Ketiligi Fereti Saniteli Hetu, RN, RM, ADN, is the principal nursing officer in Niue.

Rosemary Hibbert-Foy, RN, BHSc, is a master's student at the Australian Catholic University in Brisbane, who has visited Niue.