Ryuki Kassai: Update from Fukushima – the second seven days of the disaster

Ryuki KassaiFirst of all, I want to express my sincere gratitude to those who provided us with useful information, who kindly donated to us, who warmly encouraged us, who thoughtfully conveyed our messages abroad, and who continue to pray for Japan after the disaster.

“(…) what he had been thinking about was the earthquake. Images of it had come to him one after another, as if in a slide show, flashing on the screen and fading away. Highways, flames, smoke, piles of rubble, cracks in streets. He couldn’t break the chain of silent images.”

Haruki Murakami: After the Quake (2001)
(Translated from the Japanese by Jay Robin)

In the second week of the disaster, we have had freezing weather in Fukushima and the Tohoku region as a whole, which has made our life even harder, especially without much fuel and petrol. The daily minimum temperature in Fukushima City has been below freezing point three days out of the seven. We normally begin to expect the cherry blossoms at this time of the year, but that is not the case this year. Ironically a view of the snowy white chain of mountains including Mt. Azuma (2,035 meters) and Mt. Adatara (1,700 meters) is very beautiful.

The number of casualties hasn’t stopped rising. According to a National Police Agency tally, as of 9 p.m. on Friday 25th March, at least 10,102 (6,911 – the figures in the brackets are the ones reported one week before) people were killed and 17,053 (10,316) were missing. In Fukushima Prefecture, at least 855 (602) people were killed, 5,934 (3,844) are missing, and 61,998 (45,826) people have been forced to live in 356 (426) evacuation shelters in the prefecture. The full extent of loss of life is still unclear, as search efforts in Fukushima Prefecture have been hampered by the accidents at the Fukushima No. 1 nuclear power plant.

The acute disaster period has been followed by a period of uncertainty, especially in Fukushima Prefecture. Our largest concern for now is the unstable condition of the nuclear power plant. Despite several trial operations, bravely carried out by dedicated squads of the self defense forces, the fire and disaster management agency, and the riot police, to cool down the crippled reactors, they still seem active and uncontrollable with radioactive leakage. In the last day of the second week, three workers were exposed to radioactive water on the basement floor of the reactor’s turbine building, two of whom were brought to the Fukushima Medical University (FMU) Hospital and then transferred to the National Institute of Radiological Sciences (NIRS) Hospital. It was reported that they had external contamination of their feet, not direct exposure. However, the implication of this accident was immense. A numbers of rumors about possible detonation spread by telephone, e-mail, TV, radio, the internet, etc. Many foreign officials, company employees, and international students were urged, through their diplomatic channels or by their families and friends, to get out of Japan immediately.

We need to understand that the information/knowledge gap about nuclear medicine, especially in terms of crisis management, is so big between specialists and lay people. Many health care workers are not aware of the distinctions in terminology about radioactivity e.g. the Becquerel(Bq), absorbed dose (the Gray, Gy), equivalent dose (the Sievert, Sv), and effective dose; and the one between direct exposure to ionising radiation and contamination with radioactive materials. The media, politicians, and the public at large are also uncertain about what these terms mean. Sometimes they have confused these terms, including mistaking millisievert for microsievert, in national government announcements, and the media have confused these in news stories.

Moreover, the general public in Japan may not be good at explaining or thinking about risks relatively or in depth. At a press conference the government said, “We urge people not to drink milk, not to give tap water to infants, or not to eat vegetables such as spinach, broccoli, (…) in Fukushima and neighboring prefectures, because their radioactivity has exceeded the state’s recommended safety standards.” This was confusing and the Japanese people don’t understand well what the risks really are, what they should or should not do, or for how long.

The academic and financial year starts in April in Japan, which is increasing the uncertainty. Most graduation ceremonies in March, including FMU’s, were cancelled. FMU has decided to postpone our entrance ceremony in April by one month. We have heard that a few freshmen and registrars may decline their offers and not come to FMU or its hospital, because they and their families are so anxious about the uncertain conditions here in Fukushima. I understand them, but there is something very important for doctors of the future that can only be learnt under these circumstances. Luckily I expect all three new GP registrars and one trainer will come and join my department in April. The first lesson that they have to learn in Fukushima may well be “how to deal with uncertainty.”

  • 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.