Earthquake in El Salvador
Health Services
17 January 2000

General Description

A preliminary assessment of major El Salvador hospitals-Rosales, Maternidad, San Rafael, Neumológico, San Juan de Dios in the town of San Miguel, and San Pedro in the town of Usulután-suggests that the situation in general is critical and requires prompt measures to restore normal services to the population. The facilities have been evacuated, and patients needing assistance are being attended in the hospital grounds, out in the open or in makeshift tents, or in hallways. A great deal of structural damage has occurred, as well as non-structural and functional damage.

Those injured by the earthquake who were in need of emergency services have had to be referred to other hospitals. With the exception of orthopedic patients, as well as those with lesions that will demand extended hospital stays and those requiring mental health care, most victims have been taken care of. The acute phase of the disaster is over.

All 2,021 beds inspected (43% of the national total) are out of service, either due to actual structural or non-structural damages or preventively, until the safety of the health facilities can be established. Employees are very reluctant to re-enter the hospitals.

Structural problems

• In the surgical area of Rosales Hospital, 15 of its operating rooms, which used to perform an average of 600 surgeries per month, are out of service. A considerable amount of surgical medical equipment must be evacuated in order to prevent further losses should a new earthquake take place.
• The historical wing of the San Rafael Hospital has suffered structural damage.

Non-structural problems

• The San Juan de Dios Hospital has suffered significant non-structural damage. So have San Rafael Hospital's new and old wings. Although the old wing was no longer being utilized for medical purposes, it did serve as an access to the new wing, making entry and exit hazardous.
• The San Pedro Hospital in Usulután suffered less severe damage.
• The Neumológico and Maternidad hospitals suffered minor damage, as did the remaining areas of Rosales Hospital.
• Problems have been detected with the water supply and oxygen supply systems. Several oxygen tanks are out of order due to faulty manometers. There have also been power cuts and problems with the elevators and the communication system, as well as with the latrines for the patients who remain on the hospital grounds.

Functional problems

The greatest difficulties are functional. Since all of these hospitals were evacuated, and the patients transferred to the hospital grounds or hallways considered safe in the event of new tremors, the situation remains far from normal.

• There is overcrowding of patients in the improvised outdoor and indoor shelters.
• Hygiene is poor out of doors and even in the internal areas that have been provisionally habilitated, such as the operating rooms in auditoriums or emergency rooms, or the hallways in the outpatient area.
• The management of pathogenic waste in those areas is very deficient.
• Confusion and disorganization affect those staff members who, due to the suspension of certain services, have been temporarily laid off or left without a clear function.
• Outpatient services have been suspended almost completely.
• All elective surgery has been suspended.
• X-rays, laboratories and other support services are operating deficiently because they have had to be relocated in a hurry. The cannot process all the tests that have been carried out, in some cases due to radiation, in others because of difficulties setting up the processing and culture equipment.
• There is little control over the equipment and inventory. The items needed for operating in the improvised areas have been extracted from the hospitals, but no control or follow-up procedures have been set up, leading to potential losses, damages, or deterioration of the equipment. In addition, a great deal of equipment remains unused inside the facilities because of the fear of returning to get it.
• The lack of a patient referral system makes it impossible to establish a network of service providers based on care complexity or the availability of beds.
• The information system is very poor, both in terms of finding out the whereabouts and condition of patients and of providing the authorities and other bodies with the data the need for decision making.
• No clear guidelines have been issued to deal with the emergency. There is a lack of hospital contingency plans in the short or medium term, so that officials and staff have no idea of what they are supposed to do over the next month or even the next few weeks.
• The hospital emergency committees have not functioned effectively, in some cases because they have not been able to meet at all, in others because their written plans have proved inapplicable. It is also likely that staff behavior would be much more effective if they had benefited from a disaster reduction training program.
• Requests for drugs, equipment, wheelchairs, and other items are not the result of a true plan or an assessment of the population's needs. The same is happening with field hospitals.
• International relief assistance so far has not been the result of an assessment of real health care needs.
• Unsafe conditions make staff members reluctant to enter the facilities or follow other orders by hospital administrators.

Required Actions

A national-level plan setting out clear policies for the recovery of health facilities is badly needed. Among the actions it might call for:

• Rehabilitating urgently hospitals such as Maternidad and Neumológico that were not substantially damaged, in order to offer the comprehensive services which other hospitals cannot yet deliver. Repairs could take place almost immediately.
• Initiating an intervention in hospitals such as San Rafael, by sealing off the historic wing while it is demolished and establishing other points of entry and exit, and repairing the non-structural damage. Services could be back to normal in no more than a month. The same is true of the San Pedro Hospital in Usulután.
• In order to provide health care in the San Miguel Area (San Juan de Dios Hospital), proceed to habilitate a local hospital, New Guadalupe, which has 90 beds and was not affected by the earthquake, as an alternative surgery center or a referral hospitalization facility.
• Reorganize temporarily the ambulance fleet to facilitate patient referral.
• After an engineering assessment of those services that definitely cannot be provided through outpatient care, habilitate mobile or field hospitals to provide the services in question. Most affected hospitals have large enough grounds to make this feasible.
• Secure immediately the proper hospitalization of patients who are currently outdoors and may spread nosocomial infections. One option would be to distribute the hospital beds that were not affected and redistribute the patients. Another would be set up field hospitals for patient admittance, but with the understanding that this should be as temporary as possible. Surgical field hospitals are not required, since elective surgery must be carried out in safe conditions, with the provision of post-operative care that can only be offered by proper hospital facilities.
• Carry out an urgent assessment of the need for specific drugs and other medical supplies.
• In those places where patients remain out of doors, organize urgently the proper management of pathogenic waste, while bearing in mind that the only true solution will be the readmission of patients or their transfer to hospitals that have beds available.
• Develop a mental health care plan for health personnel and patients.