FUKUSHIMA Lives on the Line

94Large-Scale Evacuation Caused by the Unprecedented Tsunami Damage and Nuclear AccidentIn the recent disaster, people from all walks of life had no choice but to evacuate because of the widespread damage wrought by the earthquake and tsunami in coastal areas and the nuclear accident. Because of the nuclear hazard, many bedridden patients who were unharmed by the earthquake were forcibly rushed into a mass evacuation without sufficient food or medical resources. With communication systems in disarray and little time for requisite medical support to arrive, over 20 souls were tragically lost in the temporary evacuation centers and the arduous process of long-distance transfers.Furthermore, unlike previous earthquakes, such as the Great Hanshin-Awaji Earthquake and the Chuetsu Earthquake, the core medical facilities of the affected areas reported that most casualties were caused by drowning, and relatively few patients suffered traumatic injuries caused by buildings collapsing as a result of the earthquake. Many disaster medical assistance teams from across the country were present in the affected areas; however, some days after the disaster, acute care for external injuries settled down. What followed were mismatches between the medical needs of the evacuation centers and the actual practices by the assistance teams that rotated among the evacuation centers. This is what those in the evacuation centers asked of us medical practitioners…Medical Confusion at the Evacuation CentersProlonged periods as an evacuee necessitate not only care for contagious diseases such as colds and transmissible gastroenteritis but also the appropriate, continued management of chronic conditions such as high blood pressure, diabetes, insomnia, and constipation. Many evacuees had multiple common health disorders, such as high blood pressure and depression, as a result of continuous restless nights from the terror of aftershocks or worries about the nuclear accident. In fact, those vulnerable to disasters—such as the elderly, those with pre-existing conditions, infants, and pregnant women—were most affected. Moreover, people who were free of medical ailments gradually began suffering health problems from living in an environment of extreme stress and an unbalanced diet.As normal medical systems were not functioning in the evacuation centers, disaster assistance teams rotated among the centers, providing medical care during the critical phase (48 h after the disaster). Undoubtedly, they contributed to the health management of the evacuees. However, 10 days after the disaster struck, some evacuees were commenting: “I’m grateful that these doctors come to see me so often, but it’s a different doctor every day and they all leave different medicines for me, so I don’t know which to take!” or “It’s a pain to repeatedly say the same thing from the very beginning.”With no end to life as evacuees in sight, the sporadic and non-continuous medical assistance was finding it difficult to cover everything. At that time, evacuees were asking for private doctors who could treat them comprehensively and uninterruptedly.We Should Put an Emphasis on the Role of Family Physicians, Especially During DisastersSometimes, in the evacuation centers, I would run into patients that I had treated before. My questions of “Are you alright?” were responded to with happy exclamations of “Doctor, you came!!!” Some private medical facilities were damaged, and others were within the areas that were possibly exposed to radiation. Thus, for many in the evacuation centers, there was no prospect of immediately receiving personalized medical assistance.If not their regular private doctor, evacuees needed physicians that could continuously treat various health issues. Wanting to fill that role, I visited as many neighboring evacuation centers as possible. As a result, even patients who I had not seen before would call out, “Doctor, you came!” and I was conscious of both the joy of being recognized as a new private doctor and the sense of the mission that it entailed.As noted above, family physicians are “specialists that can provide appropriate care for common physical and psychological ailments, considers the state of a In Times of Disaster, the Role of Family Physicians is Especially Important!Family physicians who comprehensively care for patients on a long-term basis are needed as evacuation periods prolong. (August 2, 2011)The author with patients injured by the earthquakeMessages from Fukushima Family Physicians