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June 15, 2011

'Medical vacuum' slows Japan disaster relief

Daily Yomiuri Online

JAPAN — Three months after the Great East Japan Earthquake, coastal areas in Fukushima, Iwate and Miyagi prefectures are suffering from a severe "medical vacuum."

Many hospitals and other institutions were hit by the March 11 tsunami and still cannot resume operations. Members of the medical profession in Iwate and Miyagi prefectures are discussing how to alleviate the problem, but rebuilding the wrecked facilities is not an easy task.

Prefectural governments and medical professionals now generally believe the only way to deal with the situation is through cooperation and the reorganization of medical institutions to handle patients more efficiently.

Moving to inland hospitals
The functions of Shizugawa Public Hospital in Minami-Sanrikucho, Miyagi Prefecture, were suspended due to the March 11 tsunami, which flooded the hospital. On June 1, it began accepting inpatients for the first time in about 2-1/2 months, using 39 hospital beds at a medical institution in the neighboring city of Tome.

Last Wednesday an 82-year-old man with a cerebral infarction "returned" to Shizugawa Public Hospital and was reunited with his wife, 81, who lives at a shelter in Minami-Sanrikucho. He had been transferred to a hospital in Yamagata after the disaster.

In Iwate and Miyagi prefectures, eight hospitals were destroyed. Many opened temporary clinics, but Shizugawa Public Hospital is the only hospital to regain beds for inpatients. There is no easy, quick way to rectify the lack of beds.

Three hospitals in Ishinomaki, Miyagi Prefecture, including Ishinomaki Municipal Hospital, were destroyed. This caused the loss of 469 beds, or about 20 percent of all hospital beds under the jurisdiction of the Ishinomaki Public Health Center.

Even if beds are available, it is not easy for patients to be admitted to a hospital these days. A 60-year-old man in Ishinomaki had to take care of his 85-year-old mother, who was suffering from advanced colorectal cancer, at an evacuation center for two months. In late May, she was admitted to Japanese Red Cross Ishinomaki Hospital for one week after her symptoms worsened.

She was later transferred to an inland hospital about 20 kilometers away, and her son must drive an hour to visit her from an evacuation center in Ishinomaki.

The lack of hospital beds in quake-hit areas is expected to last for at least three years or so, until facilities to replace the destroyed hospitals are completed, according to local governments.

The Ishinomaki municipal government has considered building a temporary hospital with about 100 beds, but the plans are still in the conceptual stage due to the enormous construction and other costs involved.

As emergency measures, patients who need surgery are now sent to Tohoku University Hospital in Sendai and other institutions.

Localities need help
Three prefectural hospitals were destroyed in coastal areas of Iwate Prefecture, and patients still have to be sent to inland institutions in places such as Morioka and Hanamaki.

Even before the March 11 disaster, there were only 160.3 doctors per 100,000 people in the coastal areas of the three prefectures as of 2008, far below the national average of 224.5.

More than 100 medical relief teams were working in Miyagi and Iwate prefectures at one point after the disaster, to cope with the shortage of doctors and medical staff. However, as of June 6, only 46 teams were operating there.

When all the teams eventually leave, municipalities will have to fend for themselves.

Local governments are now planning to construct temporary clinics in areas where medical institutions were destroyed, and they hope doctors associations and university hospitals will send physicians.

"We'll consult with doctors associations on the matter," said Susumu Satomi, director of Tohoku University Hospital.

Difficult problems remain
The reconstruction of hospitals in Iwate Prefecture, which the prefectural government plans to complete in about three years, will be even more difficult.

Many doctors were killed by the tsunami or resigned from disaster-hit medical institutions. Securing full-time doctors, therefore, is expected to be rough going.

Many doctors and other members of the medical profession are calling for disaster-struck hospitals to be rebuilt as long-term care facilities and clinics that can be administered by fewer doctors. This would allow more doctors to be concentrated at hub hospitals.

Motoaki Sato, director of Iwate Prefectural Miyako Hospital, agrees.

"Returning hospitals to their original state will only re-create the lack of doctors that existed even before the great quake and many hospitals would collapse at the same time. It is indispensable to create a new medical network," Sato argued.

Iwate and Miyagi prefectures began discussions in mid-May on how to reconstruct medical networks and hospitals in areas where medical institutions were damaged by the earthquake and tsunami.

Defining the role of hospitals in quake- and tsunami-hit areas is closely linked to overall reconstruction plans.

Some experts argue for a break from the current medical network, saying that from a mid- and long-term viewpoint, it is important to establish powerful "core hospitals" that service wide areas.

The central government's support is essential to realize such a broad concept.

Fukushima left alone
Meanwhile, the crisis at the Fukushima No. 1 nuclear power plant is still not under control.

As a result, no meetings have been held yet concerning the reconstruction of the prefecture's medical facilities as a whole.

In Minami-Soma, for instance, there are not enough facilities to accept emergency patients. The risky practice of sending such patients to hospitals in Fukushima city continues.

Copyright 2011 The Yomiuri Shimbun
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