Great East Japan earthquake - fourth report
Dear international colleagues,
This report is a summary of the records of how the Japan Primary Care Association (JPCA) has responded to the Great East Japan Earthquake (GEJE) and subsequent disaster so far, following our previous three reports. 1, 2, 3
At midnight on the 12 March 2011, the very next day of the earthquake stroke, the president of the JPCA decided that the association would support assistance activities emerging in the affected areas and act as a main hub to coordinate medical support. The practical headquarters for this support project was set on March 13 and the support team, namely the "Primary Care for All Team (PCAT)" was formulated with the emphasis on the need of continuous support throughout the period of sub-acute to chronic stage. 1 On March 17, the first group of selected doctors was sent to the affected areas for on-the-spot investigation and helping ongoing assistance activities. Based on their report, three hubs were launched: Fujisawa Hub which covers southern part of the Iwate Prefecture and northern end of the Miyagi Prefecture which includes the Kesennuma City; Wakuya Hub which covers the northern part of the Miyagi Prefecture which includes the Ishinomaki City; and Teneimura Hub which covers all the Fukushima Prefecture.
The previous experience of the Great Hanshin-Awaji Earthquake made our counter-measure system of medical care to an earthquake disaster (particularly in the acute stage), improved enormously and it made a significant contribution to the response rallied after the GEJE. However, the affected area by the GEJE was much more widely spread and the devastating damage caused by the tsunami and the subsequent radiation leak from the damaged nuclear power stations were never experienced before. It was apparent that the short-term assistance during the acute stage alone would not be sufficient for the restoration and reconstruction of the affected areas and that the assistance would involve a wide range of activities from reconstruction of their healthcare and welfare system to providing individual care for injured and sick people in various evacuation centers. Therefore the capability of the PCAT (as the representative of the JPCA for this counter-measure), to provide primary care service under this circumstance was truly put to the test.
In response to this, the following values were redefined as the five core principles of the JPCA, the national primary care organization in Japan: accessibility, comprehensiveness, coordination, continuity, and accountability.
Also the following three directions were set as the mottos for the assistance activities:
- Radically-improving medical and healthcare assistance with emphasis on continuity and permanence, and respect for local human resource and their culture;
- Comprehensive assistance involving various medical and healthcare professionals in order to respond to various needs in the affected areas;
- Academic activities of medical and healthcare assistance to prepare for inevitable future disasters.
The PCAT took especially the value of continuity and accountability into account and decided to continue its support of the assistance activities until the local medical and healthcare systems in the affected areas regained their stability.
Slow deterioration of the healthy
The first team the PCAT sent to the Kesennuma City immediately after the earthquake consisted of medical doctors and pharmacists and it provided support in delivery of care of injured and sick persons, in the evacuation centers. These doctors also served as a substitute doctor and encouraged the local doctors, who are also victims of the disaster, to have a rest. As time went on, the team frequently encountered elderly persons who had been relatively healthy at first, who then began to show changes in their physical condition. These issues included deteriorated bedsores due to the change from a care-bed life to sleeping in a crowded gymnasium; aspiration pneumonitis because they had to eat supplied foods instead of food prepared for their individual needs, due to lack of man power and resources. These situations exposed more people to become socially vulnerable, not only in the evacuation shelters, but those in their own houses came under the same or worse conditions.
Originally, Kesennuma City had only a few doctors who could provide medical care at home, and most of immobile patients were taken to a clinic by their family members. Hence, patients who lost their family members and those who could not contact their family members had to remain in their houses. This situation could not be recognized by the administrative authorities at first. The PCAT had immediately to set up a team consisting of doctors, nurses and other professionals, and implemented door-to-door visits in the city in order to investigate the presence of these isolated patients, in cooperation with official personnel from the local administrative authorities. This led to the identification of about 20 persons in need of nursing care who were left home. The “Kesennuma Medical Treatment Patrol Team” was formulated in order to offer medical and healthcare service at home in close cooperation with the PCAT with other organizations including the local government. The local doctors, who were also victims whose clinics and houses had been swept away by the tsunami, took up the roles of captain of the Medical Treatment Patrol Team.
At the beginning, we had no clue where the patients were. But shortly after, the number of patients in caseloads gradually increased by the efforts of volunteers and local officers, and a total of six (later seven) teams were treating more than 70 patients per team. To enact the motto of the JPCA, "assistance involving various medical and healthcare professionals," the PCAT organized dentists, nurses, pharmacists, registered dietitians, physical therapists, acupuncturists, etc to be sent to the city, in order to make a significant contribution to the activities of the Kesennuma Medical Treatment Patrol Team. Initially, only slow progress was evident in the restoration of referral hospitals and medical facilities, so the PCAT itself provided care for the critically ill - in patients’ own homes in some cases.
Around summer time, local medical facilities had appeared to regain their capabilities. Also local doctors showed more positive and confident attitudes toward providing home visits and medical care at home with our support, so as to be able to handle referred patients by themselves. This allowed the dissolution of the Kesennuma Medical Treatment Patrol Team achieved on August the 31st in 2011. Consequently, the number of patients who receive medical service at home increased to more than that before the earthquake.
An innovative evacuation center
In the Ishinomaki City, the problem of deteriorated health condition of elderly persons and those in need of nursing care was also a serious issue. The city established a "Welfare Evacuation Center" to put patients in need of a high degree of nursing care together into one place, in order to provide more intensive nursing care. The city requested the PCAT to guide and operate the Welfare Evacuation Center with the staff members of the Ishinomaki Municipal Hospital. The JPCA constitutes professionals from various medical disciplines in addition to doctors, such as nurses, pharmacists and welfare caregivers. This allowed the team (PCAT) to competently operate this Welfare Evacuation Center.
Firstly, JPCA brought in healthcare apparatus like care beds. The doctors went on medical rounds every day, and pharmacists established a simple prescription laboratory for effective drug management. Moreover, the team held a regular multidisciplinary team meetings with the various healthcare professionals every day, and quickly shared each evacuee's problems with the team members. There were no other evacuation centers to carry out such organized activities, and there had been no precedent for this sort of care, so our activities drew the attention of many other people, resulting in frequent visitors and interview requests from the media. The goal of this facility was for the evacuees to move from this facility to a better environment, and social workers were playing central role in giving support for the adjustments needed for such movement. Accordingly, this Welfare Evacuation Center was successful and achieved its natural ending, on September 30th 2011.
At the present time, all evacuation centers across the affected areas have attained their goals and dissolutions. The disaster victims have moved to temporary housing units or accommodation, but the move from the centers has not necessarily led to an improvement of the victims' health conditions. The people who moved often faced a substantial change from their previous communities, and many of the people have been forced to cultivate new personal relationships and form new communities. Many temporary housing units have been built on a hill to avoid the danger posed by other tsunamis and there are few means of transportation to a supermarket or the medical institutions which these people got used to visiting. Hence, many elderly persons who do not have their own car, tend to stay at home. Furthermore, due to lack of resources and man power, the mental health problems of the elderly and also children have not been sufficiently attended to.
The PCAT has, therefore, started activities of health consultation for people living in these temporary housing units. In the Miyagi area, there is a routine, namely the "Ochakko," in which neighbors get together and chat about nothing in particular, over a cup of tea, around a table. The PCAT named its health counseling activities after this, i.e. the "Ochakko Health Consultation Meeting," and began the meeting activities at each temporary housing unit. The shared purpose of the Ochakko Health Consultation Meeting is: to provide places for the local people to form their new communities; to identify persons in need of medical care through physical examination and health consultation and to give prompt institutional treatments accordingly; and to provide listening and encouraging to share their mental problems and trauma so as to allow the problems to become less daunting.
In order for the local people to participate in this Ochakko Health Consultation Meeting as easily as possible, some services such as provision of drinks, hand massage, and preparation of toys for kids have been provided at these meetings, which are getting a favorable reception at each meeting. It is particularly noteworthy that the PCAT is gradually delegating their operation of the meetings to the local people. PCAT has set the goal of providing backup support in the hope that this will encourage positive attitudes among the local people to recover from the disaster and emerge with new values and strength.
In conformity with the spirit of the primary care, the PCAT has also continued dispatching doctors for reconstruction of the municipal hospitals that are facing difficulty in recovering from the damage, and for providing a wide range of medical and healthcare services including support for pregnant women and mothers.
We are truly and sincerely grateful for the substantial monetary donations and support we have received after the disaster. As can be seen in this report, our support for reconstruction in the chronic stage of the disaster has just begun. The PCAT is determined to continue providing medical and healthcare assistance until aimed primary care to be provided across the affected areas. We would like to call your further support and assistance for our activities towards the reconstruction more than ever before.
Hiroki Ohashi, MD
Chief of the Primary Care for All Team, Japan
Primary Care Association
WONCA News 37(2) April 2011; 23.
- WONCA News 37(2) April 2011; 24.
- WONCA News 37(3) June 2011; 16-18.