FUKUSHIMA Lives on the Line

222Identifying 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 March 11 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 power 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 podcastFukushima One Month On