FUKUSHIMA Lives on the Line

206origin is simply not an issue in Japanese health care. In free societies, including post-war Japan, all kinds of subjects are open to political debate, including entitlements. So be it. But people attracted to the caring professions in Japan consider it a privilege to serve others. I believe this is true around the world.Question: How was triage implemented at FMU?Ohto: A general screening process was introduced to ensure optimal care with limited resources. Greeters welcomed every visitor to our hospital. Those whose only concern was radiation exposure were directed to the Fukushima Gender Equality Center in nearby Nihonmatsu, where a dedicated radiation screening team was assembled. Patients with specific urgent care needs, who incidentally may have been exposed to radiation, were screened immediately at FMU with a hand-held Geiger counter, in much the same manner as passengers are wanded with a metal detector at airport security checkpoints. A whole body radiation counter, installed in a motor coach, was also deployed outside our hospital. We discontinued special screening procedures after one week, by which time it was clear that people were not being exposed to significant amounts of radiation. Let me stress here that I am referring to the general population. The courageous workers within the perimeter of our crippled nuclear power plant are indeed exposed to radiation beyond any acceptable standard. They are heroes in harm’s way, who deserve our thoughts and prayers now, and our grateful remembrance in perpetuity.Question: What are your concerns moving forward? How do you think the Japanese people can recover from this tragedy?Ohto: Much is made of “the Japanese spirit” in modern essays. I think we do have a sense of unity and kinship that helps us see each other through hard times. Something special about the present situation is the scope of it all. We are responding to a national disaster with international implications. Even before the full scope of our nuclear reactor crisis was appreciated, the international community was rallying support for Japan. I have been deeply moved by words of encouragement, and promises of support, from transfusion and cell therapy professionals around the world. Colleagues in other specialties report the same thing. Japanese history includes periods of isolationism, and periods of aggression. I dare to imagine that 21st century Japan, humbled and tempered by recent events, will expand the sense of unity and kinship to fully embrace the wider world, which has so generously embraced us.April 27, 2011Modern healthcare tends to err on the side of caution. Efforts to prevent transfusion-transmitted infections tend to cost more per life saved, or per infection avoided, than safety interventions in other areas of medicine. Not only science, but also, human feelings about blood transfusion guide our thinking.Human feelings about radiation also guide policy and behavior. We don’t want any radiation to leak out of a nuclear power plant. So, by design, a normally operating nuclear power plant releases less radioactivity than a coal-fired plant generating the same amount of electricity. Of course we now know that Fukushima Daiichi was not designed to withstand the earthquake and tsunami of March 11.Free speech and a free press allow open debate about what might have been done differently before and after the earthquake. This, on the whole, is constructive, although misrepresentations are disappointing and potentially damaging. The journalists mentioned in my April 21 narrative wrote an opinion piece implying that the Prefecture of Fukushima was in a State of Denial. I disagree. We understand the seriousness of our crisis. I don’t read French particularly well, but they mentioned the precautionary principle. Broadly speaking, when in doubt, play it safe. I agree.That’s what we are doing now, especially for children. Radiation monitoring is in place at schools and parks throughout Fukushima. Above an outdoor threshold that might, over a year, expose a child to 20 millisieverts of radiation, time limits are posted for playground activities, and when children come indoors, they wash their hands and face, and they gargle. To put 20 millisieverts per year into perspective, this is close to the radiation dose I get in one day of health screening, when a gastrointestinal x-ray series (“The Barium Tilt-a-Whirl”) is included. My pre-earthquake opinion was that Fukushima’s many parks and playgrounds were underutilized. That opinion hasn’t changed. A good holiday from work includes riding bicycle and playing outside with my favorite kids.April 29, 2011A magazine editor asked me to elaborate on a statement from April 6: “Educating the next generation Words to the World