Ironically, the annual sakura (cherry flowers) season has just come to Fukushima when one month has passed since the first earthquake and tsunami hit us. Fukushima is famous for its sakura; we have the 1000-year-old Takizakura (cascade sakura), one of the three best cherry trees of Japan, and the Hanamiyama (cherry-blossom viewing hills) wholly covered by the blossoms. Cherry trees are in full bloom everywhere in mid and east Fukushima. Beautiful, yet not many people seem to drink sake, sing songs, or dance under the blossoms this year. It is difficult for us to decide between the two options this year – to celebrate the season, or not. Sakura is the most spiritual flower for the Japanese. A few of you may recall that a sakura tree with drifting blossoms on the wind was used as the background of the last battle scene in the movie The Last Samurai, which implies the crowning glory, that is the “perfect (migoto-na)” death as the samurai.

We continue to be hit by large aftershocks day after day, night after night. According to the Japan Meteorological Agency, as of 3 pm on 22 April, there have been 429 aftershocks with a magnitude of 5.0 and above, 74 registering 6.0 and higher and five at the 7.0 level or higher since the first one. We still do not have any positive reports that the Fukushima Daiichi (No. 1) nuclear power plant is settled.

One month is long enough that people despair when the situation does not seem to improve as they had expected. Let me take one of the most tragic examples. After being destroyed by the first earthquake on 11 March, the waterworks department had worked hard to restore 97% of the water supply in Iwaki City. However, the aftershock of magnitude 7.0 smashed most of it again on 11 April, exactly one month later. Not only the workers in the waterworks department of the city but also many citizens of Iwaki City felt as if they had worked in vain, like Sisyphus.

On 4 April I was standing in the ruins of the tsunami-hit community in Minami-Soma City looking out at the horizon of the Pacific. A nursing home was in front of me. Broken chairs, tables, beds, cabinets, wheelchairs, bookshelves, and many other things were scattered with tons of mud and debris everywhere. Badly damaged cars were rolled over in the yard and were even inside the building, which had no intact doors or windows. There was no evidence of life, but a local policeman said that more than 1,000 people were still missing from that city alone.

According to a National Police Agency tally at 3 pm on 22 April, 14,172 people were killed and 12,392 were missing by the Tohoku-Kanto Earthquake. In Fukushima Prefecture, 1,432 people were killed, and 1,835 are missing. According to the Anti-Disaster Headquarters of the Fukushima Prefecture government, 25,936 people from Fukushima are living in evacuation shelters within the prefecture, and 29,833, outside the prefecture.

Since 4 April, I have been working as a leader of the teams whose mission is to find, visit and take care of the people who cannot move by themselves and still live at home in the zone between 20 and 30 km from the nuclear power plant, just next to the exclusion zone. The teams of the first week of the operation consisted of about 50 people from the Self Defense Forces (SDF), rescue squads, public health nurses from the local city/town governments, and doctors and nurses from Nagasaki University and Fukushima Medical University (FMU) Hospitals, co-organised by FMU and the Fukushima Prefecture government. In the first week of the operation, we took care of 299 persons at home in 3 cities, 2 towns and one village, with 223 persons being in Minami-Soma City.

Identifying who we needed to visit was difficult. We had to make a database of the target people by collecting information from several sources – from registers of several different health services, from making many phone calls and by going from house to house. Some had already been evacuated outside, while others had made the long journey back to Minami-Soma because staying in the evacuation centres was too difficult and their families were too exhausted to take care of them in the shelters. Some town governments had moved their whole town to other prefectures.

One of the weaknesses of Japanese primary care is that we do not have health register systems for the whole population. We cannot have an accurate grasp of the health status and needs of people in the communities without such health register systems. Although some hospitals in Japan are now making databases to show what kinds of diseases they treat in their hospitals, Japanese primary care doctors tend to be reluctant to share information on what kinds of patients they have seen.

A demented old couple whose nursing services had abruptly ceased since 11 March were taking care of each other. A family of three generations with a sick grandfather did not want to move because they cannot leave their beef cattle. An old man in wheelchair who used to be an engine driver transporting thousands of soldiers between Manchuria and Siberia after the Second World War said that life after this disaster was much better. A blind couple whose neighbours had all left for the shelters were having difficulty getting food and news to support their life. A son who was taking care of his old father with a colostomy has brought his father back from the shelters because people around them complained of odour from the pouch. These are only a few examples of the people I visited in the past 3 weeks. Rather than critical medical care in hospitals, what they need is to resume basic community-based services to support their lives at home, such as home helpers, balanced meals, bathing, rehabilitation, and oral hygiene.

The Japanese Government has just announced that it will widen the evacuation zone; people who live in the designated areas outside the 20-km no-go zone around the crippled nuclear plant must evacuate the area in one month. We need to minimise the negative impact of this evacuation, especially on those who are heavily dependent on basic community-based services. I hope that the memories of Sakura of their home towns will help them to survive the evacuation.

The country is smashed, hills and rivers remain.

The city turns to Spring, plants and trees grow deep.

Moved by the moment, flowers splash tears.

Resentful of parting, birds startle the heart.

 Du Fu: View in Springtime (757)

 (Translated from the Chinese by Paul Rouzer)

• Listen to Ryuki Kassai talk about the situation in Fukushima in a BMJ podcast and on the BMJ YouTube channel.

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.