Exploring the dynamics and consequences of long-term volcanic activity for the healthcare system in Montserrat, West Indies

Ongoing volcanic eruptions generate hazards of varying intensity over time, where more pervasive hazards include ashfalls, gases and acid rain. These hazards can generate widespread losses across societies and essential services in urban areas, constituting environments of extensive risk. Yet, the complexities of such environments are little-understood and the effects of ashfalls on complex systems that support societies are under-explored. This research applies a systems approach to explore the consequences and dynamics of long-term volcanic activity for the healthcare system in Montserrat, West Indies, where the long-duration eruption prompted relocation of the population further from the volcano. A case study methodology and qualitative methods are used to explore healthcare system recovery, dynamic interdependencies and complexities of healthcare system function in an ongoing eruption environment. The relocation presented significant challenges as well as opportunities to develop healthcare services, and the process of recovery for the healthcare system is ongoing. Development is hindered by legacies of the relocation that include a smaller population, resource shortages, and temporary infrastructure that became permanent. Consequences of ashfall exposure are wide-ranging, affecting facilities, services and staff. Yet, adaptations and capacities are identified across the system, and the interacting network of essential services contributes cascading disruptions, as well as capacities to respond to heightened volcanic activity and to reduce effects at vulnerable sectors. For healthcare staff, complex influences on decision-making, adjustment and balancing work and life are identified. Influences on healthcare function are found to be complex, interacting, and stem from external and internal factors as well as the wider development context. This thesis concludes that holistic approaches for exploring the function of complex systems in extensive risk contexts should account for the history of the system, the dynamic interactions of the system within its context and the complexities of the social context in which it operates

Unpacking Long-term Disaster Recovery Processes: A Case Study of the Healthcare System in Montserrat, West Indies

Long-term disaster recovery processes are poorly understood, yet there is a growing imperative to improve knowledge of their complexity and timeframes to inform policy and post-disaster decision-making. This empirical study explores post-disaster change and recovery processes for the healthcare system on the island of Montserrat, West Indies. Taking a systems approach, we adopt a qualitative case study methodology to explore post-disaster changes over an extended timeframe (1995-2012). We identify many different aspects of change, which lends a new perspective on post-disaster change types for complex systems, and an alternative classification for analysis of their recovery. Recovery of the healthcare system is ongoing. We find that recovery is not a uniform process. Different elements of the system show signs of recovery at different times. This exploratory study documents the complex and long-term nature of disaster recovery in this context, which brings new understanding of change and recovery processes and raises important considerations for future studies