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Earlier this year, on the Bahamian islands affected by Hurricane Dorian in 2019, life was improving.
“Honestly, I thought things were starting to come along really nice,” said Jim Hull, a doctor who operates a mobile medical bus on the island of Great Abaco.
Clinics were being rebuilt. Cleanup and some construction were underway.
It wasn’t going perfectly. Dr. Hull and Rob Sweeting, a Direct Relief staff member in the Bahamas, both said that some areas still lacked power or running water.
But overall, “things felt like we were making progress,” Dr. Hull said.
Dr. Delon Brennen, deputy chief medical officer at the Bahamian Ministry of Health, wasn’t sure precisely how many had returned to the Abaco Islands and Grand Bahama, but “people were moving back home and trying to reestablish their lives as a whole,” he said. “A lot of the infrastructure in Abaco and Grand Bahama had been leveled…While it was nothing like it used to be, it was definitely improving.”
A New Threat
Then Covid-19 swept around the world.
NGOs with presences in the Bahamas began to pull out, multiple sources said. “If you think about it, we’re at the most vulnerable we’ve ever been,” Dr. Hull said.
The Bahamian government, determined to avoid widespread transmission, locked down international and domestic travel. The measures largely worked – despite active testing, case counts have remained low.
Although travel related to construction on damaged islands was designated essential and encouraged to continue, many people were hesitant to return to the islands or continue construction work.
“Of course persons who were concerned about their health [were] not necessarily going to open up construction, because they wouldn’t be able to practice social distancing,” Dr. Brennen said.
Health Care Interrupted
Due to Dorian, when large supplies of personal protective equipment had been donated to the island nation, the Bahamas didn’t suffer the shortage of protective gear common throughout the rest of the world.
Nonetheless, the interruption to health care was considerable.
“People had a fear of coming into health care facilities, and we discouraged people from coming into health care facilities unless they had symptoms that indicated Covid-19,” Dr. Brennan explained.
While the government swiftly implemented a widespread telehealth program for both public and private health care providers – telehealth was not widely used in the Bahamas before Covid-19, according to Dr. Brennan – many people weren’t taking advantage of the services on offer.
Telehealth use has been actively encouraged, and there has been some improvement, but not enough to equal the rates at which people used to access health services in person, Dr. Brennen said.
And for many who had lived through Dorian, health was already a concern, said Dr. Graham Cates, medical director of the Family Medicine Center in Nassau, the Bahamas’ capital city, where large numbers of people fleeing Dorian had evacuated last year.
Immediately after Dorian, Dr. Cates said, many patients hadn’t been able to access chronic-care medications or keep up with their regimens. Many also had post-traumatic stress, anxiety, depression, or other mental health conditions “associated with the trauma of going through such a devastating storm,” he said.
While chronic care management had largely stabilized, Dr. Cates was concerned when lockdowns began and people were discouraged from visiting health care facilities.
“All the messaging at that point in time was, ‘Stay home, stay home, stay home,’” he said. “While we can look back and say with hindsight it was a good message, it was a double-edged sword.”
Temporary shelters on Great Abaco. (Photo courtesy of Dr. Jim Hull)
And for many who had experienced Dorian, mental health concerns never really went away.
Dr. Cates said that many continued to experience post-traumatic stress or other symptoms. Feelings of displacement and transience, for people living far from their homes, became a problem.
Covid-19 exacerbated those issues.
“There were definitely people who had been displaced by the storm [and who] almost saw this as reliving another type of life-changing event,” Dr. Cates said. “There was this increased anxiety that we were seeing in people who were already in a state of post-traumatic stress.”
Opening Borders
The economic impacts of the lockdown – the Bahamian economy is heavily dependent on tourism – caused further problems.
“I think the issue for us in the Bahamas is that we are truly a tourism-dependent economy,” Dr. Brennen said. It’s a “fine balance between protecting ourselves but then cutting ourselves off from the rest of the world.”
Those economic impacts had an effect on mental health as well, Dr. Cates said. Many of his patients were “worried and having anxiety about the economics” as well as the disease itself.
The Bahamian government plans to open up the country to international travelers in July. “We were lucky enough from a public health perspective that [the lockdown] was allowed this time…but that cannot be the approach going forward,” Dr. Brennen said.
Instead, to control the spread of the coronavirus, the Bahamian government plans to focus on what Dr. Brennen calls “good detection, good case investigation, good contact tracing” – measures he said are nothing new in the Bahamas.
“We’ve dealt with the issues around dengue and malaria and chikungunya and Zika,” he said. “These are issues we have addressed using the same approaches.”
“It’s not as scary as it was here,” said an aid worker stationed in the Bahamas, who asked to remain anonymous. “We don’t know what will happen when we open up the borders in July, but I think just generally there’s not a lot of fear.”
Direct Relief has donated more than $6.5 million in aid to the Bahamas thus far.
The organization recently funded an operating room container to be installed at Rand Memorial Hospital on the island of Grand Bahama. It is also funding substantial renovations to the hospital and donating a variety of medical equipment.
In addition, Direct Relief will provide funding for the repair or rebuilding of a number of damaged medical clinics on Grand Bahama and the Abaco Islands. The organization is committed to strengthening the Bahamas’ health system as recovery continues.
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