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.
References
1. Hirabayashi Y, Mahendran R, Koirala S, et al. Global flood risk under climate change. Nature Climate Change 2013;3:816-21.
2. Alderman K, Turner LR, Tong S. Floods and human health: a systematic review. Environ Int 2012;47:37-47.
3. Whiteside TL. Immune suppression in cancer: effects on immune cells, mechanisms and future therapeutic intervention. Semin Cancer Biol 2006;16:3-15.
4. Ozaki A, Kanemoto Y, Morita T, et al. Nail Wound and Cellulitis Following Typhoon Hagibis in Fukushima, Japan. Disaster Med Public Health Prep 2020:1-3.
5. Ozaki A, Leppold C, Sawano T, et al. Social isolation and cancer management - advanced rectal cancer with patient delay following the 2011 triple disaster in Fukushima, Japan: a case report. J Med Case Rep 2017;11:138.
6. Ozaki A, Leppold C, Tsubokura M, et al. Social isolation and cancer management after the 2011 triple disaster in Fukushima, Japan: A case report of breast cancer with patient and provider delay. Medicine (Baltimore) 2016;95:e4027.