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第4章患者救済に奔走した活動記録〈論文・研究発表〉FUKUSHIMA いのちの最前線525how a generalist approach fares in one of the most high-tech hospital dominant countries in the world.6,8 In the subsequent days after the first earthquake, trainees in family medicine at Fukushima Medical University, spread around the small communities of the prefecture, were communicating again by teleconference. They have been working hard in the forefront of care at community-based hospitals and clinics. At their regular teleconference sessions, the forum in which they normally meet for teaching sessions, family medicine trainees shared the common challenges faced in the aftermath of the earthquake. These included the difficulties of providing communities and local government with pertinent advice about ionising radiation, triaging frail older people in order to evacuate them to institutions inland, and maintaining their clinical facilities without enough information, water, electricity, and petrol. For observers around the world, the tragedy left many people who have friends and family in the affected areas desperate for information and keen to help however they can. For those with a less tangible connection to Japan the news of the earthquake perhaps poses a more general dilemma. The distance from Fukushima to the UK is over 9000 kilometres yet the images of the earthquake, the tsunami, and the failed nuclear reactors for the wider international audience are only centimetres away. Within minutes to hours video footage was freely available on YouTube, blogs, Twitter, and rolling news stations. Tragedies around the world are now part of the modern consciousness, such as the recent mud-slides in Brazil, the earthquake in New Zealand, and the upsurge in conflicts in the Middle East. How does one — from a distance and proximity — make sense of such events ? When Michel Foucault coined the term the 'medical gaze' in the 1960s, it related to the way in which doctors in the 18th century learned in hospitals to see beyond the surface of bodies, to see organs and pathophysiology, and to distance themselves from human suffering.9 Now the 'medical gaze', increasingly cultivated in general practice, has a holistic focus10 with a greater emphasis on patient experience and community orientation in contrast to the 18th century teaching at the Hotel-Dieu; the factors influencing the 'medical gaze' change with time. As the default exposure to world events increases, it is important that the 'medical gaze' is mindfully international, so that it can better harness this exposure, even if at times solutions and meaningful words will be hard to find. For example, it would be helpful for the international community to construct a database of evidence-based information/references on immediate, short-, and long-term effects of ionising radiation, as well as the impact of other kinds of disasters, looking at interventions and strategies to alleviate their effects, especially from the viewpoint of primary care. Appropriate teaching tools would also be useful. In the UK, it is encouraging that GP trainees are now invited to spend more time overseas with Out of Programme experience.11 A more global view of health may be further facilitated as arguments for an international curriculum gather momentum.12Figure 1 Registrars and medical students at the Family Medicine Resident Forum, Fukushima Med-ical University, 23 April 2011. The Forum provided the first opportunity to listen to what each attendee had experienced in person (not by teleconference) since 11 March.TRAGEDIES IN MODERN CONSCIOUSNESS

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