Ryuki Kassai from Fukushima: the first seven days of the disaster

Ryuki KassaiFirst of all, I want to express my deep sympathy for those who lost their loved ones, their houses, their work, their home towns, and their hope by this terrible disaster.

Who, in later times, will be able to understand that we had to fall again into the darkness after we had once known the light?

Sebastien Castilian: De arte dubitandi (1562)
Quoted in Kenzaburo Oe: Hiroshima Note (1965)

It is now seven days since the first earthquake and tsunami hit us in the Pacific Coast areas of the Tohoku region (the northernmost region of the main island of Japan made up of the 6 prefectures – Aomori, Iwate, Akita, Miyagi, Yamagata, and Fukushima). The disaster that we now call the “Tohoku-Kanto Earthquake” was caused by the strongest earthquake ever recorded in Japan (magnitude 9.0) followed by a 15 metre tsunami and hundreds of aftershocks which are still hitting us every day and night. According to a National Police Agency tally as of at 7 p.m. on Friday 18th March, at least 6,911 people were killed and 10,316 were missing. In Fukushima prefecture where I am (the southernmost prefecture of the Tohoku region; population 2,026,826, area 13,782.75 km2), at least 602 people were killed, 3,844 are missing, and 45,826 people were compelled to live in 426 evacuation shelters in the prefecture. We still do not know the exact numbers of casualties, because the damage is too enormous.

The first 2 days were hectic. Essential services such as water, gas, electricity, and phone networks were not working. Normally I move between 5 teaching practices in the communities (20 to 230 km apart one another) to teach 17 GP registrars in the prefecture, but I had to cancel these visits because the transportation systems and the roads were badly damaged. I tried hard to make sure all my trainees and colleagues were safe and sound. However, I was not able to contact them all until five days after the first earthquake hit. Five of them had been working in Soma and Iwaki, some of the towns that had been directly affected by the tsunami. Fortunately, they are all safe and we have been able to talk to each other using our internet network. I have also been part of the anti disaster team at Fukushima Medical University (FMU) in Fukushima city. Major trauma patients and patients with medical and surgical emergencies were brought by helicopters to the FMU Hospital, the largest teaching hospital in the prefecture. The hospital itself has been functioning well, collaborating with the prefectural government headquarters and the Disaster Medical Assistance Teams (DMATs) who came from several other prefectures in Japan that had not been hit by the disaster, but it was difficult for us to get a picture of what was going on in the prefecture overall. A major lesson from this period was the need to resume information networks as quickly as possible after the disaster, collaborating with the local/national governments, police, paramedics, telecommunication companies, and the internet services.

In the following 2-3 days, hundreds of patients came to the FMU hospital, either by themselves or in chartered buses from community hospitals and nursing homes in the severely damaged tsunami hit areas. Our hospital was even busier, treating the emergency patients, and triaging the other patients who had a wide range of problems needing primary to secondary, even tertiary care. Many of the patients were frail, demented, bedridden elderly, often without a clinical history and context. Some patients needed oxygen, IV fluid, tube feeding, or dialysis. Others were suffering from hypothermia, aspiration, or pneumonia.  A major lesson from this second period was the need for a good collaboration between specialists in the hospitals and primary care physicians even in the acute disaster period. If many patients with primary care problems had not rushed into secondary/tertiary care hospitals after the disaster, the function of the hospitals would not have been affected so much. On the other hand, care of the weak (frail elderly, children, pregnant/nursing mothers, people with chronic illnesses, mental illnesses, or multiple co-morbidities) can easily fall behind in an acute disaster period without well functioning primary care providers.

Along with these “normal” disaster recovery activities, we had to face the third disaster after the earthquakes and tsunami, namely, the series of hazardous accidents at the nuclear power plants located on the Pacific Coast in Fukushima prefecture. Even though the FMU hospital has well trained dedicated nuclear medicine specialists who had prepared for potential nuclear accidents and who could provide us with information, there was a high level of anxiety amongst the care teams, as well as patients and their families, that had increased like a cascade after rain.

Sometimes it became difficult to keep our strong Fukushima tradition of endurance (gaman) and non blaming culture. The mental well being of the caregivers who were under constant demanding pressure is an ongoing issue. A video clip on YouTube entitled Pray for Japan: be strong deeply moved us into tears. That was a good example how music and narrative can heal us.  I wish people in the evacuation shelters could personally listen to their favourite music anytime they want without bothering others. Watching a TV repetitiously reporting the disaster news all through days and nights must be harmful for their mental well being.

I believe that the prevention of thyroid cancer of children should be a top priority. But
we still do not have high quality standardised evidence based information to assist us. We experienced the disasters in Hiroshima and Nagasaki, but despite this there are many misunderstandings regarding radiation. We are now busy sourcing potassium iodide for the children in the Fukushima prefecture and constructing systems to deliver the medicine and to provide parents with pertinent information on timing, duration, doses, and adverse effects of its administration. We need information on immediate, short, and long term effects of radiation, and interventions and strategies to alleviate the effects. Also, we want to know how better we can give that information to the parents, to support them emotionally, and to follow up beyond the acute disaster period. As we have many farmers and fishermen in Fukushima, we are very much concerned about risk of potentially contaminated foods (milk, meat, fish, vegetable, rice, buckwheat, sake, etc.).

I cannot predict what will happen next.  I cannot estimate how long the recovery from the disaster will take us, either. “After all, tomorrow is another day,” might be true, but I want to humbly add to say that tomorrow is another day we could make a difference.

  • Listen to Ryuki Kassai talk about the situation in Fukushima in a BMJ podcast

Ryuki Kassai is professor and chair at the Department of Community and Family Medicine, Fukushima Medical University. He is a member of the BMJ editorial advisory board.