According to the plan, we should be well along the path to rebirth, but in reality, foolishness has continued, and nihilism and despair have only spread.

Hayao Miyazaki: Nausicaä of the Valley of the Wind (1994)
(Translated from the Japanese by Matt Thorn)

In the afternoon on the 11 March 2012, I was standing on the tsunami-hit coast in Iwaki, Fukushima prefecture, gazing alternately at the Pacific Ocean and the ruins of the town. The Pacific looked beautiful. On the opposite side, however, there spread a vast expanse of bare land, where, on the first anniversary of the disaster, several people came to pray for those who were killed by the Great East Japan Earthquake, and in particular the victims of the ferocious tsunami which hit there on the 11 March 2011. It seemed to me that several of them were still looking for some shred of evidence that would make them believe their loved ones were not dead after all. One year on, how far—if at all—have we progressed towards full recovery? How much have we accomplished in terms of the reconstruction of our society?

According to a national police agency tally as of the 21 March 2012, in the three most affected prefectures in the Tohoku region: 4,671 people were killed in Iwate, 9,512 in Miyagi, and 1,605 in Fukushima. 1,237 people were missing in Iwate, 1,688 in Miyagi, and 214 in Fukushima. 20,185 houses were totally destroyed in Iwate, 84,749 in Miyagi, and 20,194 in Fukushima; and 4,562 houses were more than half destroyed in Iwate, 147,165 in Miyagi, and 65,733 in Fukushima. The reconstruction headquarters reported on the 26 January 2012 that there were still 341,411 people living in evacuation shelters, in the houses of relatives or friends, or in temporary accommodation far away from their home towns.

Although Fukushima has fewer victims compared with Iwate and Miyagi, we probably have the largest number of evacuees, who now live in and outside the prefecture but who used to live along the coastal areas of Fukushima. A series of accidents at the Fukushima Daiichi nuclear power plant have rendered homeless the people from 7 towns and 2 cities. It seems too difficult for most people in Fukushima, as perhaps in the rest of Japan, to get a balanced understanding of the long term risk from low dose radiation. Even many doctors, nurses, and their families have left Fukushima, afraid of the possible fatal effects of radiation. Emotion beats scientific evidence.

Let me share an episode that happened last summer to illustrate people’s irresistible fear of the invisible threat. Obon is one of the Japanese folk customs to honour the departed spirits of one’s ancestors, who are believed to revisit their home towns during Obon. It has both Buddhist and Shinto influences. Obon was originally celebrated on the fifteenth day of the seventh month of the lunar calendar, but in modern Japan it has been varied among the regions of Japan. It is now most commonly around the 15th August. During the Obon holiday, people return to their ancestral home towns and, together with family/and friends, hold reunions with their ancestors’ spirits. At the end of Obon, we light Okuribi (send-off fire) on the ground to send off the spirits of deceased family members, who are believed to return to the spirit world. The most famous Okuribi must be the Daimonji, or the Okuribi at Gozan (the Five Mountains) in Kyoto on the 16 August. Last summer, however, many people in the Tohoku region had watched the Daimonji on TV with mixed feelings. Pine trees from Rikuzentakata, in the Iwate prefecture, where 1,487 were killed by the disaster, were supposed to be sent and burnt as firewood for the Okuribi fire at Gozan in Kyoto by invitation. However, the local people in Kyoto got so anxious about possible nuclear contamination of the firewood, its smoke and ashes, that they refused to use the wood from Rikuzentakata, even though the city is located some 200 km from the Fukushima Daiich reactor. Complaints, criticism, and controversy continued for months.

Several plans for reconstruction following the disaster have been proposed in vain due to poorly-collaborating stakeholders in our society. A large number of medical professionals, researchers, politicians, musicians, and even restaurant chefs came to the affected communities and tried to help us, encourage us, entertain us, and heal us. But sadly, the hidden agenda of some of them seemed just to become famous for the sake of their own interest. Their visits and thoughtless behaviour threw the communities into confusion. Their priority seemed to be to undertake highly visible projects no matter how little they met people’s needs in the affected communities. I myself would like to rebuild a community-based primary care system, a more sustainable one than before, along the affected coast of Fukushima through programmes of capacity building and social networking. However, it has been difficult for long-term human resources projects like this to attract the support of policy makers and academics.

The quotation at the beginning of this blog is from the popular cartoon by the acclaimed animation director Hayao Miyazaki entitled “Nausicaä of the Valley of the Wind.” It is a story of reconstruction over 1000 years after a foolish series of wars devastated much of our planet. Humanity clings to existence at the fringes of a vast, polluted forest inhabited by monstrous insects. The struggle for existence escalates into another series of wars between humanity and the insects, as well as among the humans. Only Nausicaä, the princess of the tiny kingdom of the Valley of the Wind, knows the environmental significance of the forest. She turns her caring gaze towards all the creatures in harmony with the healing power of the forest. In Nausicaä, Miyazaki seems to explore how we have to pay for our mistakes after we have destroyed our environment.

As early as two weeks after the disaster we had found ourselves somehow insensitive to what was happening around us. Daily tragic news and reports came and went, passing in front of us like a silent slide show. After several months of an active reconstruction phase, it seems to me that we are now experiencing a second apathetic phase around the first anniversary of the disaster. It seems easy for the media and journalists to tell anniversary stories, and they eventually broadcast and published a lot of them worldwide. But for most of us people in the affected areas, the scenery remains rather the same; nothing much has changed.

After becoming a disaster victim myself, I now understand that it was not hard to care about the events in Fukushima. They just happened in front of us. What is more difficult, however, is for us now to feel a doctor’s compassion toward people’s sufferings in other parts of the world. Tragedy can happen anywhere and at any time: the big earthquake in China, the flooding in Thailand, the cyclone in the Philippines, and the riots in several areas of the world. The information comes to us continuously through the internet, emails, Facebook, Twitter and so on. If we are not sensitive enough, they too appear just as a series of silent slide shows. We need to survive the apathetic phase again by keeping our medical caring gaze turned towards what is happening to people elsewhere in the world, as well as in Fukushima.

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.