By John Sparrow in Tokyo
The wall of water had been travelling at the cruising speed of a jetliner before it hit north-eastern Japan, destroying virtually everything in it’s path along a 600 kilometres stretch of coastline.
When the statisticians complete their review of the records the March 11th tsunami broke, they will document one of the greatest destructions of healthcare systems seen in a single calamitous event. Clinics, care homes, hospitals and doctors’ surgeries were demolished. Physicians, nurses and patients died and the elderly drowned in their wheelchairs.
Surveys suggest that as much as 40 per cent of medical infrastructure may have been disrupted in the three worst affected prefectures of Iwate, Miyagi and Fukushima, and many clinics, nursing homes and even hospitals remain closed or are in limited operation. Most of Fukushima’s hospitals are shut, either because of tsunami damage or restrictions related to the troubled nuclear plant.
All this would be grave enough in the wake of any large-scale disaster but the disaster wrought havoc in an already challenging situation. Even before the tsunami, shortages of both full-time doctors and institutions in these prefectures, meant that the level of medical service was below the standard enjoyed elsewhere in the country.
Today, the JRCS announced it would begin a 100 million US dollar programme to restore crippled healthcare systems in Ishinomaki – one of the worst-hit areas of Myagi prefecture where only 40 of the 70 local medical institutions are still working.
Dr Tsunesaburo Ando, senior technical advisor to the Japanese Red Cross Society’s operations sector, said: “No matter who you discuss the situation with, it all comes down to the same thing: the welfare and medical care systems have suffered catastrophic damage.”
“It would be difficult enough if only primary care had been so seriously affected but we lost a 200-bed municipal hospital which was a hub of secondary care. This has caused a complete breakdown of the former system for a whole region.”
The hospital will be rebuilt in another location but the municipality has said that this will take at least three years. Ishinomaki’s Red Cross Hospital – a centre of specialist tertiary care – remains the only functioning hospital in a municipality of 130,000 people, and it now has to cover all the gaps. Today it provides every level of service, primary and secondary as well, which Dr Ando describes as an ‘extremely ill-balanced state of affairs’ that threatens the area’s entire tertiary structure.
And there are other complications. According to 2008 statistics, almost 26 per cent of the population is 65 or older. Re-establishing the welfare system to cater for their needs, especially after hospital treatment, is considered a major issue.
This week, Red Cross and Red Crescent partners from around the world gathered for a three-day conference to review the response to the disaster so far and to discuss plans to aid long term recovery. The Japanese Red Cross intends to invest over 62 million US dollars (5 billion yen) in the reconstruction and development of medical infrastructure, and 37.2 million US dollars (3 billion yen) in social welfare and support for the elderly.
Among other things, it will build a prefabricated 150-bed welfare and medical centre for Ishinomaki to bridge the gap until a new municipal hospital opens. Run by the city, it will be set up with all the necessary medical equipment that can be transferred to the permanent hospital later. A welfare hub for the elderly is also planned on the site of the prefabricated hospital. An emergency medical centre that is open at night and during holidays will be built, and the emergency capacity of the Red Cross hospital in Ishinomaki hospital will be expanded.
Close to the hospital, there are plans to construct a training centre for disaster medical care, and rebuild a Red Cross nursing school destroyed by the tsunami. The school would serve as a base from which to develop disaster nursing.
Since the tsunami struck the Japanese Red Cross has focused its operations on health and care. Medical teams have assisted survivors in a network of Red Cross hospitals, in evacuation centre clinics, and through mobile units that bring care to both smaller and more remote centres and to the general public cut off from state services by disaster disruption. Lonely and house-bound elderly people in particular are being targeted. So far 733 medical teams have been mobilized and more than 58,000 people have been assisted. Psychological support services are also being scaled up.