Discussion
This case describes a skin infection in a postoperative breast cancer
patient due to an immersion of surgical site with contaminated flood
water following Typhoon Hagibis. Her discharge took place on the day
before the typhoon hit Iwaki City, and she had characteristics that
would make her vulnerable to floods, such as advanced age, breast
cancer, and post-operative status. In this regard, we believe that there
might have been some room for interventions to prevent her from
incurring such severe flood damage.
Of note, a flood hazard map covering areas that would be submerged in
floods was open access and widely available in Iwaki City. In Japan,
local municipalities usually publish flood hazard maps on its website
and on paper for community distribution. Further, the Geospatial
Information Authority in Japan, similar to the Federal Emergency
Management Agency in the United States and Ministry of Environment in
France, prepares a website called “Kasaneru (Superimposing)
Hazard Map [in Japanese]” where people can freely evaluate risks
of flooding and landslides in basically any location in Japan. According
to a municipality-based hazard map, her neighborhood was designated as a
flood-prone area, while the hospital was not. Following Typhoon Hagibis,
the patient’s neighbors were all affected by flooding, but the hospital
only incurred minor ceiling water leakage.
If we healthcare professionals had understood the information from the
flood hazard map beforehand, we could have given her more appropriate
advice when she wished to be discharged the day before the typhoon hit
the city. Specifically, we could have more strongly persuaded her to
stay at the hospital to prevent potential harm. Further, even when she
declined our suggestion, we could have alternatively advised her to
evacuate to residences of family members or friends living outside the
flooding areas. Needless to say, some medical institutions exist in
flood-prone areas, and this approach cannot always be generalizable.
For all residents including cancer patients, as is a lesson from this
case, it is important to know whether their residences are located in
flood-prone areas in ordinary times, but this may not be enough to
guarantee a safe evacuation in situations when flood damage is
anticipated. People are easily affected by normalcy bias, which is a
tendency to consider that they themselves will not be affected by
disasters or crises.5,6 In this regard, it is unclear
whether people can successfully evacuate just because they were aware of
the warning in a timely fashion. Rather, they may have been affected by
normalcy bias, and somehow considered that they would not be affected by
the flood. It is not always easy to overcome normalcy bias, but informal
and formal support and ordinary-time preparedness would help people
avoid this inherent mental tendency.6
Every natural disaster including and beyond flood is unique. In this
respect, lessons gained from one disaster are not directly applicable to
another. For instance, dozens of people died in floodwater in Kumamoto,
Japan in July 2020. The damage was not caused by typhoons, but by a
seasonal rain front, and it was obviously more difficult to predict the
occurrence, timing, and potential locations than those of typhoons.
Nonetheless, our ongoing mission is a continuous accumulation of
evidence of any kind of health issue related to flooding to establish
effective countermeasures to safeguard the health and well-being of
cancer patients and other citizens.
In conclusion, we reported a case
of secondary surgical site infection in a postoperative breast cancer
patient affected by Typhoon Hagibis.
Individualized responses based on
individual and environmental risks are crucial to alleviate damage from
disasters. In particular, an awareness of flood risks in patients’
residences are important for patients and their healthcare
professionals.
Conflict of interest : Akihiko Ozaki receives personal fees from
MNES Inc, outside the submitted work. Also, Tetuya Tanimoto receives
personal fees from MNES Inc, and Bionics co., ltd. outside the submitted
work.
Ethical approval : Written informed consent was obtained from
the patient for publication of this case report and any accompanying
images.
Funding information: None
Acknowledgements: None
Author Contribution: AO wrote the manuscript. All authors
conceptualized and designed the case report, and revised the paper. All
authors read and approved the final manuscript.
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