¡¾Emergency Message¡¿ Regarding the Tohoku Pacific earthquake Message from the President(3)

March 22, 2011

¡°Too shocking for words, a tragedy beyond belief¡±

I wish to express my heartfelt thanks to all those offering support and encouragement following the Tohoku earthquake and tsunami.
It is now approximately a week since the disaster struck, and the situation at Iwate Medical University has calmed down to a degree. On Saturday March 19 I visited some of the worst affected areas and was able to observe the situation in the evacuation centres and talk directly to the directors of the core hospitals and the doctors involved.

1. Situation in the affected areas.
During the last week I have talked directly with those who have visited the affected areas, talked via satellite phone with those who are there, and seen the images broadcast by the media, so I felt able to grasp the reality of the situation to some extent. However, the scenes I saw first-hand in the affected areas far surpass anything imaginable.
Leaving Morioka and travelling via Tono and Sumita, I visited the coastal area including the heavily affected cities of Rikuzen-Takata, Ofunato, and Kamaishi. The journey of just under 120km to Rikuzen-Takata took 3 hours. Travelling on the mountain pass towards the city of Rikuzen-Takata, facing Hirota bay, I passed the sign signaling 7km to the scenic spot Takada-Matsubara before either the sea or the town became visible. The Kesen River flowing to the right was still some 8km from the sea here, yet was filled with a mountain of wood and debris from destroyed houses, and the houses on its banks had been destroyed. It is an unbelievable sight in a mountain area from which one cannot even see the sea. I fear for the safety of those who were living there.
As we reached the point from which Hirota bay and Rikuzen-Takata city are visible, an even more shocking scene appeared before my eyes. A town with a population of over twenty thousand has simply disappeared. With the exception of a few buildings, the vast plain between this point and the sea is one giant mass of debris. The area where Takada-Matsubara forest and the tsunami barrier once stood is now part of the sea. The size of the contrast between the beauty of Hirota bay and the destruction of the town and Takada-Matsubara forest is too shocking for words.
Ofunato and Kamaishi are comparatively large ports that were home to some fifty thousand people. In both, the town centre was adjacent to the port, and has been almost completely destroyed. The steel factory warehouse retains the shape of a building, but has also been destroyed. The sight of large ships sitting atop buildings far inland from the port underlines the sheer scale and difficulty of the task of rebuilding these towns.
The scenic inlets between Ofunato and Kamaishi are dotted with settlements at places such as Okirai, Yoshihama, and Toni. Following historical experiences with the Meiji Sanriku-oki tsunami (1896) and the Chile earthquake tsunami (1960), tsunami barriers had been constructed, but it¡¯s said that this tsunami reached over 24 metres in height, such that even the giant 10-metre barrier was powerless to stop it. These settlements, where many houses once jostled for position, have been razed to the ground and replaced by nothing but flat earth.

2. Delays in supplying gasoline and power.
When the disaster struck, the most urgent request from the affected areas was for gasoline and power (see 1st and 2nd Message from the President). Banri Kaieda, the Minister of Economy, Trade and Industry was swift to announce on the evening of March 14 that energy would be supplied even if it meant using up all the nation¡¯s oil reserves, but it did not start reaching the affected prefectures until March 19, and it has still not reached the evacuation centres, hospitals, and treatment facilities in the worst-affected areas. As of March 21, the few gas stations that are open are facing lines of 300 or more cars. This delay, combined with the worsening situation in the evacuation centres, has resulted in the deaths of a far from small number of victims. The government¡¯s slow initial response to the disaster must be deemed wholly inadequate, and the increase in the number of victims that has resulted from this delay of several days should lead to serious reflection. The threat of a further sharp increase in the number of victims will depend on what action is taken from now on.

3. Restoration of essential communication lines.
At present in Iwate, 49,454 people displaced by the tsunami are being housed in some 400 evacuation centres (figures from the Prefectural Disaster Response Centre). However, there are still some evacuation centres that have not been identified or for which figures are not available. Relief supplies are being delivered. However, the necessary supplies are not reaching the evacuation centres and hospitals that need them most, and the situation is still very unstable at some evacuation centres. The establishment of communication lines would allow need to be conveyed, and together with the improving transport network would enable supplies to go where they are needed. However, with (in most cases) no means of communication, the situation in the evacuation centres is appalling. Even core hospitals, limited to one satellite phone, are restricted in their communications. Averting a further disaster depends on establishing temporary cellular phone base stations and the swift restoration of land lines.

4. Activities of evacuation centre medical teams.
From the outset, Iwate Medical University has been dispatching up to five medical teams each day to evacuation centres. In addition, assistance has been provided from all over the country, for example in the form of DMAT and JMAT teams. Their activities are also being hampered by problems with communication. A few days ago a team of 30 left the IMU base in Tono for various evacuation centres. Their first problem is that they have no means of communication between leaving in the morning and returning at night, putting their safety in danger and making it impossible to convey new instructions. A second problem is that they are unable to contact evacuation centres in advance, making it difficult to ascertain needs and plan accordingly. A third problem is that medical teams from different areas sometimes converge on the same evacuation centre, making it necessary to move to another evacuation centre, and thus resulting in a highly inefficient division of resources. Furthermore, a fourth problem is that in a situation with limited numbers of doctors, advance parties (reconnaissance parties) are having to be formed and sent ahead for reconnaissance missions at unconfirmed evacuation centres. The inefficiency could be significantly reduced by the restoration of communication lines (cellular phone networks and land lines).
In order to smoothly regulate the supply of medical assistance, Iwate Medical University is taking the leading role in holding discussions with Iwate Medical Association, the Japan Red Cross, and Iwate Prefectural Government, and within the Iwate Prefectural Disaster Response Center has been established the Iwate Disaster Medical Support Network. This is allowing for improved coordination of medical relief efforts from different areas. Medical support groups are being coordinated through Iwate Medical Care Promotion Office.

5. Provision of medical treatment in affected areas.
A week has passed since the earthquake and tsunami struck, and we have moved beyond the stage of emergency medical response. We must recognize that a long battle still lies ahead.
The scale of this disaster exceeds that of anything we have experienced before. Even more than the 50,000 people in evacuation centres (in Iwate alone) do not even have homes to return to. I expect that temporary housing will be constructed, but this alone will not solve the problem. The issue is how best to help the many people who have lost their families, jobs, and possessions, seen their homes swept away, and now stand to become ¡°disaster refugees.¡± The problem is far greater than the problem of ¡°medical treatment.¡± The solution must be determined by politicians. Finding that solution is an enormous task that has been entrusted to the current government.
The immediate problem is how to provide medical relief to the disaster-hit areas from tomorrow. Building temporary housing for tens of thousands of people is no simple task. Life in the evacuation centres will not be over soon. Thus after the first phase of disaster medical relief focused on emergency medical treatment, we are now moving into a second phase that will focus on the temporary provision of treatment for chronic illnesses, and the management of health and sanitation in order to prevent a secondary disaster occurring. The issue now is how to provide temporary medical care in an efficient and organized way in the evacuation centres. In Iwate alone the disaster area spans a coastline stretching 200km from north to south. The prefectural governor has entrusted Iwate Medical University Hospital, the core disaster medical hospital for the whole prefecture, to operate as a centre for disaster medical treatment and coordinate efforts throughout the whole prefecture. Dr. Kobayashi, Director of Iwate Medical University Hospital, is acting as Director of Iwate Medical University Hospital Disaster Response Centre, and has been visiting evacuation centres in the affected areas, working to establish coordinated provision of medical care in evacuation centres, and starting up the aforementioned Iwate Disaster Medical Support Network.
In addition, as the third stage will involve a long-term battle, fixed temporary treatment centres will need to be established at the core evacuation centres.
On the other hand, in the near future when sufficient provision of gasoline, food, and daily necessities becomes possible, it will become possible to move people around and the core hospitals will see an influx of patients requiring treatment for chronic illnesses. This is the fourth stage. In the fourth stage, we will require both the reconstruction of treatment centres in the devastated coastal regions, and the renewal of the core prefectural hospitals.

6. The future
This disaster of unprecedented proportions represents a crisis that cannot be overstated. We must realize that the rebuilding process will be a long-term challenge surpassing that faced after the Great Hanshin Earthquake. However, even thought the recovery is slow at present, we are moving forward and the situation is changing day-by-day. It goes without saying that the medical requirements are changing as well.
There are not enough doctors or medical staff, and the staff on the front line are working at the limit of their capabilities. However, while the desire to offer support is an extremely welcome one, if too much support is offered at once the result is chaos. At the request of the Prefectural Governor, enquiries are being handled as follows: regarding medical support at evacuation centres contact Iwate Disaster Medical Support Network (tel 019-629-5407); regarding medical support via prefectural hospitals please contact Iwate Medical University Disaster Zone Medical Support Centre (tel 019-651-5111 ext. 7021).
The situation is evolving rapidly, and further details will follow about the relief effort.
The most important thing is to give ¡°long-lasting¡± support. I ask for your understanding and cooperation in the face of this unprecedented disaster.
It may sound demanding and repetitive, but again I hope that the provision of gasoline (energy) and the restoration of communication lines (cellular phones and land lines) will be given top priority, as this is the wish that has been conveyed to me by those in charge at all areas of the disaster zone.
The situation in the affected areas is thus still highly unstable. Once again I express my strong desire for the government to implement effective crisis management measures.

Akira Ogawa
President, Iwate Medical University