Author: Dr. Colin Michie FRCPCH – American University of the Caribbean Medical School, Cupecoy, St Martin.

The day after Irma, 31-year-old Akeem was helping his family and neighbours in Middle Ground to clear the road outside their home. There was debris everywhere.

A piece of fencing slipped as Akeem picked it up and he sustained a long deep laceration to his lower leg from a protruding rusted nail. His brother helped wash the wound with water and disinfectant, but the gash was deep and continued to bleed.

Neighbours carried him down to the main road and over the next two hours moved him to a local hospital. His wound was washed and dressed; a small artery was treated to stop the bleeding, and he was given some pain killers – that was the easy part!

Akeem had not had a tetanus vaccine since his early childhood. The hospital did not have any tetanus vaccine, so Akeem was taken by aeroplane to another island for this. The return flight was delayed; he did not get home for two expensive days.

Tetanus remains a problem for those sustaining deep or “dirty” skin injuries. Bacteria that cause the illness tetanus, once called lockjaw, are found everywhere, particularly in soil.

Tetanus is much more common after disasters: many deaths have been documented following tsunamis in particular. Most of those who die after disasters are older males with no good history of vaccination. No antibiotic or herbal treatment will prevent tetanus; the best management is preventive with vaccination.

The disease causes painful muscle tightening, including the muscles of the neck and chest. This restricts swallowing and breathing. Death is reported in 10-50% of cases. After a disaster, hospitals may not always have vaccines available because disrupted power supplies can cause refrigeration systems to break down.

What is the best plan? Ensure your tetanus vaccine is up to date, as well as that of the elderly in your community. All adults should have a vaccination every 10 years to keep them protected. When was your last vaccine? It is hurricane season – now is the time to boost your tetanus!