¡¾Emergency Message¡¿ Regarding the Tohoku Pacific earthquake Message from the President(4)

Iwate Prefecture has received an unseasonably large quantity of snow. We are still experiencing cold weather, and spring appears to be a long way off. First, please allow me to extend my heartfelt greetings and good wishes to the nearly 200,000 [two hundred thousand] people, including 50,000[fifty-thousand] in Iwate alone, who are still living in evacuation centers. I pray that you may remain healthy and well.

The disaster-affected areas are experiencing changes on a daily basis. On April 5th, I traveled around 350[three hundred and fifty] kilometers to meet with the mayors from Miyako, Yamada, and Ozuchi, doctors from affected hospitals private practices whose clinics were damaged, and people still living in the evacuation centers. Today I would like to share with you what I heard and saw on my journey, and also to provide you details concerning the current conditions at my university.

Late last night (11:32 pm on April 7th), the largest aftershock to date struck, measuring more than 6 on the Japanese magnitude scale. As of this morning (April 8th), Iwate, Aomori, and Akita Prefectures remain without power, although all other vital supply lines are functioning. Damage to university facilities is still being assessed.

1. Characteristics of the Disaster

The national government has named the disaster the ¡°Great East Japan Earthquake,¡± but this is a major misnomer. The massive tsunami that occurred after the earthquake caused far more destruction and loss of life. The list of casualties backs this up: over 8,000 [eight thousand]people have been reported dead or missing in Iwate Prefecture alone, accompanied by a relatively small number of 200 [two hundred]or fewer people injured. On the day the disaster struck, we received information that several hundred casualties would be transported from the coastal areas to the advanced emergency medical center of our university, which was designated as a key disaster-response hospital by the prefecture. Members of the medical staff were on emergency standby, but very few emergency patients were brought in. The most serious part of this disaster was not the earthquake; the disaster should have been called an ¡°Earthquake-triggered major tsunami disaster,¡± at least from the perspective of ground zero. The name of the disaster better reflects the distance that was present between the disaster sites and the national government, who were not able to accurately assess the circumstances.

2. Daily Changes in Disaster Site Medical Care

Due to the incredible circumstances of this disaster, the first stage emergency medical response, including the deployment of DMAT, was extremely limited. Efforts quickly shifted to the second stage, which consisted of medical teams making rounds to evacuation centers. Healthcare activities began through the DMATs and JMATs from Hokkaido all the way to Okinawa, plus medical teams who had joined medical organizations, hospitals, and universities from around the country. At this point, the conditions in the evacuation centers were poor and resources for medical treatment were severely lacking. Despite the efforts on-site of medical teams, it must not be forgotten that lives were lost that day as a direct consequence of delays in the initial response. The national government¡¯s disaster response headquarters were too far detached from the disaster sites and, as a result, they failed to understand the facts and pleas coming from the affected areas. It should be said that this detachment and failure to understand what was happening on the ground led to further delays in the execution of the emergency response.

At that time, the prefectural disaster-response medical headquarters, medical teams, evacuation centers, and hospitals had no central ¡°command center.¡± No horizontal alliances had been set up, and thus all the various teams were forced to operate independently. Confusion reigned and all health care related matters were abundantly inefficient. Therefore, the Iwate Disaster Medical Support Network Center (Director: Satoshi Takahashi, Associate Professor, Neurology Dept.) was established within the prefectural medical headquarters. A broad alliance formed to enable integrated management and efficient operations of the medical teams assembled from around the country. This alliance included the prefectural government, Iwate Medical University, the physicians¡¯ association, the nursing association, respective medical institutions, prefectural police headquarters, and self-defense forces. This public-private alliance dramatically improved the organization of medical teams for treatment at evacuation centers in the second stage.

We are now in the process of shifting towards the third stage. The transfers of affected citizens both within and without of the prefecture have reduced the number of evacuees. However, nearly 50,000 [fifty-thousand] remain camped at the nearly 350 [three hundred and fifty] evacuation centers along the coast of Iwate Prefecture. Focusing on areas in which hospitals have been destroyed and can no longer operate, we have opened aid stations (temporary clinics) at evacuation centers mainly in Rikuzen-Takada, Ozuchi, Yamada, and Taro, and efforts are underway to make these stations the hubs of medical treatment for their respective areas. If a reduction is seen in the number of medical facilities at the evacuation centers, outpatients will flock to key hospitals in Kuji, Miyako, Kamaishi, and Ofunado. That would be a heavy burden for these hospitals, as their capacity to operate under normal conditions has yet to be restored.

3. Victims Supporting Disaster Area Medicine

Local medical practitioners are also victims of the disaster. They have also lost family members and seen their homes washed away. They are performing medical care and treatment while spending their days at hospitals and their nights at evacuation centers. Nearly one month has passed since the disaster, and these medical practitioners may find themselves collapsing from the burden if these severely miserable conditions continue much longer. Therefore, we have been requesting construction of temporary quarters for medical personnel to aid the maintenance of their health, but the administrative government is painfully and decidedly slow to act. However, these arrangements are mandatory, even as a transitional measure, in order to sustain the adequate provision of regional health care. The lives of private-practice doctors in affected areas have been lost, too. Many clinics are damaged, and thus some doctors have been forced to reopen their practices on the second floor of their buildings.

Let us now look ahead to the fourth stage. The restoration of normal operating conditions and capacity will be necessary at Kuji, Miyako, Kamaishi, and Ofunado, key hospitals where operations are currently curtailed. A fifth stage remains further ahead. Health care is not necessary in uninhabited areas. The recovery of local towns and economies will require new health care delivery mechanisms that address the revitalized communities. The road to the fifth stage will be long, perhaps lasting 10 to 20 years.

4. Disaster-Response Community Health Care Support Office

This university has an additional function as a key prefectural disaster-response hospital. The governor has requested the university to control the organization of health care across the entire prefecture in the event of a disaster. As a result, the Disaster-Response Community Health Care Support Office (Director: Keisuke Hida, Lecturer, Surgery Dept.) was established to run parallel to the organization of emergency medical teams for evacuation centers and provide support to the key hospitals within the prefecture. With the support of the Ministry of Education and Science, we are recruiting independent personnel and those from universities and hospitals nationwide who can assist with the provision of long-term health care. International offers to provide assistance have also been received. Presently, six individuals have been acquired who are able to provide such long-term support at key hospitals in affected areas.

5. Additional Support Request

As of April 6th, 3,668 [three thousand, six hundred and sixty-eight] people from Iwate Prefecture had been reported dead. The Iwate Prefecture Physicians Association, accompanied by support from the police and Forensic Science Department of the university, is in charge of identification of the victims. Thus far, aided by the cooperation of university physicians across the prefecture, we have nearly completed a full search for victims in the disaster-affected areas. However, approximately 50 [fifty] new bodies are found every day, and this is expected to continue in the foreseeable future. Furthermore, as time elapses since the disaster, identification becomes increasingly difficult. Preservation of samples for DNA authentication is proceeding, as well as identification work through dental records under the auspices of the Iwate Prefecture Dentists Association.

6. Conditions of Affected Areas: April 5th

In the city of Miyako, the disaster headquarters is operating with great energy. The mayor is taking charge on the top floor of City Hall, which sustained damage up to the second floor. Fortunately, prefectural Miyako Hospital is located on elevated ground and was not damaged. It is currently open and accepting daily visits. However, outpatient visits are fewer than expected, perhaps because the tsunami carried way a large number of automobiles, and thus patients are having trouble finding alternate means of transportation to the hospital.

Yamada-cho was reduced to piles of rubble and is in an especially tragic condition. I cannot forget those residents, who seemed to be in a state of shock while standing in front of the empty spaces where their homes once stood. Yamada-cho was truly stuck by three major disasters: first, the earthquake; second, the tsunami; and finally, the fires through the night that broke out from oil burning on the surface of the water. There is nothing left of the building adjacent to town hall; it burned down and its steel frame was completely melted. Otherwise, signs of fires are evident everywhere. I can hardly imagine how residents felt that first night without any electricity, the only light coming from the flames that were engulfing the town.

Yamada Hospital, Ozuchi Hospital, and Takada Hospital have all completely stopped functioning. Except for one clinic on relatively high ground, every clinic in Yamada-cho and Ozuchi-cho was decimated. All dental clinics were also destroyed. However, the morale of affected medical personnel remains high, and they are applying all their efforts toward opening temporary clinics, despite the horrid conditions. I also know a doctor who is targeted on opening a temporary clinic by mid-April.

7. There is No Revitalization of Medical Care Without Revitalization of the Community

The town and its residents both have to come back in order for health care to recover. The indented Rias coast of Sanriku has little level ground. Shopping and residential districts formed towns in concentrated developments, which were devastated. Nobody wants to be considered a fool and rebuild on ground that is susceptible to another tsunami; however, schools, public halls, and other homes already occupy the little land available on higher elevations. There is not even space for temporary housing, which means that a necessary quantity of housing may not be able to be built. Civil engineering technology available today allows for the creation of level ground by cutting into the mountains. No other foreseeable route is apparent if these towns are to be restored.

Based on Shinpei Goto¡¯s restoration plan for the Imperial Capital after the Great Kanto Earthquake, the responsibility for organizing the social fabric lies with the nation and the national government. The most important mission for the national government is to aid the victims who have lost their families, homes, jobs, and livelihood and to prevent them from becoming disaster refugees, and to aid them. It is also the duty of the government to revitalize the affected communities. I urgently request that the government lends a full ear to the conditions and circumstances in the local communities, keep an eye on their efforts, and make policy decisions quickly and efficiently.

8. Long Road to Community Restoration

The restoration of towns and communities will require time, perhaps decades. Providing health care for the affected people during this restoration period must continue unabated. Health care is expected to be needed at evacuation centers and temporary housing sites for a number of years. During this time, I ask everyone in Japan to do their best to help provide extended health care support at evacuation centers, temporary clinics, and key hospitals in the affected areas.

9. Request for Medical Assistance

Medical assistance in Iwate Prefecture is under integrated management and coordination. Please contact the following organizations if you are interested in helping.

(1) For dispatch of medical teams to evacuation centers and temporary clinics:

Iwate Disaster Medical Support Network Center (Director: Satoshi Takahashi, Associate Professor, Neurology Dept.)

c/o [¡°care of¡±] Iwate Prefectural Medical Headquarters

Phone: 019-625-3113

E-mail: iwatedmc@gmail.com

(2) For dispatch of physicians to key hospitals:

Disaster-Response Community Health Care Support Office (Director: Keisuke Hida, Lecturer, Surgery Dept.)

c/o Disaster-Response Community Health Care Support Office, Iwate Medical University

Phone: 019-651-5111, extension 7021

E-mail: saigaishien£Àiwate-med.ac.jp

10. University Activities

Logistics operations across the three most heavily damaged prefectures in the Tohoku Region, Iwate, Miyagi, and Fukushima, have improved considerably. Nonetheless, full recovery has yet to be achieved, and the relocation of approximately 360 freshmen who were to enter medical, dental, and pharmacy schools has been delayed. In addition, an integrated, reorganized curriculum was planned for the basic course of study across the medical and dental schools. Fundamental medicine and dentistry were combined into an integrated curriculum for second- and third-year students. To accomplish this, the practice laboratory needed to be transferred from the old building at Uchimaru to the new building at the newly established Yahaba campus, but work has been postponed since March 11. The entrance ceremony and new school year schedules are now set forth as follows, based on recovery forecasts.

The entrance ceremony will be held on April 28th (Thursday), and the new school year will begin on May 9th, after the holidays for first-year medical, dental, and pharmacy, and second- and third-year medical and dental students. Other classes will begin during the new school year at the beginning of April. Among all the negatives that surround such a major disaster, I consider these circumstances the most fortunate.

As I reflect upon the numerous disaster victims who are unable to rebuild their daily living environment, I strongly ask our students, who have the privilege to continue their studies in a good environment, to recognize their good fortune and commit even harder to their studies.

11. Students Affected by Disaster

The university has a current enrollment of over 2,000 [two thousand] students within the medical, dental, and pharmacy schools. Fortunately, no students or faculty members were victims of the disaster, but more than 100 [one hundred] students have been affected by loss of their family members or homes, or the loss of employment or livelihood of their parents. We are currently surveying the magnitude of damage on an individual basis, but without economic assistance, a significant number of students may find it difficult to continue their studies. The university intends to extend maximum support. I urge students who need assistance to consult with the student support office (phone: 019-651-5111, extension 5513).

12. Request for Donation Funds

Revitalization following this major disaster will take a number of years. We have already substantial donations, and for that, I wish to extend my deepest gratitude. However, donations are still needed for the following purposes:

(1) Economic assistance to disaster-affected students who face difficulty in continuing their studies

(2) Funding to support long-term community health care in affected areas

(3) Restoration of educational facilities within the university that were damaged by the disaster

Most fortunately, the university suffered no damages to its structural facilities. However, even though relatively small, damage to the newly installed 7T MRI scanner, ruptured piping, and numerous light breakages combined into a fairly large sum. As I previously mentioned, the need for community health care in affected areas is expected to continue for some time. Support in the form of economic assistance that allows affected students to continue their studies is necessary and of the utmost importance. Although the university and alumni association are planning to extend maximum support, the magnitude of the disaster and the fact that many students are affected mean that this extended support may not be enough to handle the amount of assistance required. That is why I am now earnestly asking for support from everyone across Japan. I would be immensely grateful if you could find the time to refer to the page on the university¡¯s website entitled, ¡°Acceptance of Disaster Donation Funds.¡±

Sincerely,

Akira Ogawa, CEO, Iwate Medical University