I've just arrived home in Tokyo. I'd like to share a brief assessment with you before I go to bed and forget everything. if you're interested...
(注：I'm just a layperson on this field. Please let me know if you have any questions or corrections.)
We joined the TMAT (Tokushukai Medical Assistance Team), a NPO which was sponsored by one of the largest hospital groups in Japan. The TMAT consists of 5-6 medical teams with about 70 medical personnel and 25 ambulances. The incident commander located in Sendai, the capital of Miyagi.
Our team including Drs. S and T, 0-2 more MDs, 2-5 RNs, 1 logistics and 1 driver (1 PharmD at the end of the period), were deployed to Kissennuma area, 70 miles northeast of Sendai-city. Then, we have run a 24/7 clinic in a shelter, one of the junior high schools in this area that has 1,200 refugees, as well as a traveling clinic in this area.
Here is a brief summary of my assessment of this area (limited to Kessennuma):
1. The magnitude of the disaster on Kesennuma-city: the population of 80K, 1/4 are evacuated secondary to tsunami and fire, 416 confirmed dead (on 3/19/11).
2. Security: No security issue. No riots or looting. That is Japan! But the radiation leak does not allow optimism.
3. Infrastructure: basically all of the lifeline was disrupted.
a. Water: 1-2L/day/person of clean water was distributed by Redcross and Self Defense Forces (SDF). Well below the minimal requirements.
b. Food: good quality, but only breakfast and dinner (with a snack later). I would guess this is less than 1,900 kcal/person/day
c. Shelter: the shelter was packed 1,200 refugees. 600 people were evacuated to a gym. I would say 1~2m2/person.
d. Sanitation: of course, the bathroom is nasty. We had only 10-15 bathrooms for 1,200 people... The number will be increasing soon. (this makes them constipated)
e. Electricity: power recovery will be late
f. communication: fixed-line and cellphone infrastructure were severely damaged. But cellphone coverage will recover soon.
g. Health and medical:
- As you probably know, this tsumami divided the victims into 2 groups roughly: black tags or green tags. The relatively small number of red tags were evacuated to the hub hospitals (the city hospitals) or triaged to other medical centers all over Japan by DMATs in acute phase. Therefore, the majority of the demands at our site was management of chronic medical illness including DM, HTN, CHF, afib and psych; fast-track stuff including URI and AGE; somewhat endemic insomnia, constipation and anxiety.(and one case of STEMI) Although the medications for chronic medical problems are limited, its transportation has been delayed partially due to gasoline shortage.
- Although no endemic diseases were appreciated in our shelter, our team are closely following possible flu/AGE cases.
- As to the local medical services, the main medical center (the city hospital) is intact and functions as a hub. However, the half of the PCPs on this area lost their clinic and evacuated to shelters. The ICS has been trying to communicate with them, and to distribute resources to them, in order to reestablish the local service.
4. Local community: the local community has been well functioning in this area. The refugees themselves are well-structured and taken care of them (the social capital of this fisherman town is very impressive). A team of public health RNs from the city-hall also run a clinic here.
5. Local health resource: see above.
6. Outside assistance being provided:
- It seems the medical care of this area has been improving dramatically. Around 10 teams from University centers all over Japan has gathered here since 3/17, the ICS seems to be getting more sophisticated (slowly). But I am not sure about the other areas especially Iwate.
- Regarding the medication shortage, we have heard several organizations would send the medications to this area. However, the information is becoming snarled.
7. Outside assistance needed: As stated on 3, the public health assistance needed in this area would be the early recovery of infrastructure, management of subacute/chronic medical problems, and transportation of medications.
P.S. I visited to Minamisanriku that is 20km south of Kesennuma where 10K people are missing or dead (more than 1/2 of the population). The entire city was just destroyed. It looks like a scene after an atomic bombing. The SDF, MSF and 2 TMAT teams have been deployed to this area.