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515 In the following 2-3 days, hundreds of patients came to the FMU hospital, either by themselves or in chartered buses from community hospitals and nursing homes in the severely damaged tsunami hit areas. Our hospital was even busier, treating the emergency patients, and triaging the other patients who had a wide range of problems needing primary to secondary, even tertiary care. Many of the patients were frail, demented, bedridden elderly, often without a clinical history and context. Some patients needed oxygen, IV fluid, tube feeding, or dialysis. Others were suffering from hypothermia, aspiration, or pneumonia. A major lesson from this second period was the need for a good collaboration between specialists in the hospitals and primary care physicians even in the acute disaster period. If many patients with primary care problems had not rushed into secondary/tertiary care hospitals after the disaster, the function of the hospitals would not have been affected so much. On the other hand, care of the weak (frail elderly, children, pregnant/nursing mothers, people with chronic illnesses, mental illnesses, or multiple co-morbidities) can easily fall behind in an acute disaster period without well functioning primary care providers. Along with these "normal" disaster recovery activities, we had to face the third disaster after the earthquakes and tsunami, namely, the series of hazardous accidents at the nuclear power plants located on the Pacific Coast in Fukushima prefecture. Even though the FMU hospital has well trained dedicated nuclear medicine specialists who had prepared for potential nuclear accidents and who could provide us with information, there was a high level of anxiety amongst the care teams, as well as patients and their families, that had increased like a cascade after rain. Sometimes it became difficult to keep our st­rong Fukushima tradition of endurance (gaman) and non blaming culture. The mental well being of the caregivers who were under constant demanding pressure is an ongoing issue. A video clip on YouTube entitled Pray for Japan: be strong deeply moved us into tears. That was a good example how music and narrative can heal us. I wish people in the evacuation shelters could personally listen to their favourite music anytime they want without bothering others. Watching a TV repetitiously reporting the disaster news all through days and nights must be harmful for their mental well being. I believe that the prevention of thyroid cancer of children should be a top priority. But we still do not have high quality standardised evidence based information to assist us. We experienced the disasters in Hiroshima and Nagasaki, but despite this there are many misunderstandings regarding radiation. We are now busy sourcing potassium iodide for the children in the Fukushima prefecture and constructing systems to deliver the medicine and to provide parents with pertinent information on timing, duration, doses, and adverse effects of its administration. We need information on immediate, short, and long term effects of radiation, and interventions and strategies to alleviate the effects. Also, we want to know how better we can give that information to the parents, to support them emotionally, and to follow up beyond the acute disaster period. As we have many farmers and fishermen in Fukushima, we are very much concerned about risk of potentially contaminated foods (milk, meat, fish, vegetable, rice, buckwheat, sake, etc.). I cannot predict what will happen next. I cannot estimate how long the recovery from the disaster will take us, either. "After all, tomorrow is another day," might be true, but I want to humbly add to say that tomorrow is another day we could make a difference.• Listen to Ryuki Kassai talk about the situa­tion in Fuku­shima in a BMJ podcast