Medical Resources Strained in Japan

Laurie Bouck

March 17, 2011

March 17, 2011 — The devastating magnitude 9.0 earthquake and tsunami that occurred in Japan's Miyagi prefecture on March 11 have caused a cascade of health and safety problems for survivors, including possible exposure to radiation from the region's damaged Fukushima Daiichi nuclear plant. The disaster has strained medical resources on the ground, but it is unclear how many resources will be needed in the future.

"This is a very complex disaster, and it's an evolving, ongoing situation," Kristi L. Koenig, MD, director of the Center for Disaster Medical Sciences at the University of California–Irvine, told Medscape Medical News.

"The recovery phase of this disaster is going to be years and years and years," she said. "They need people over the next many months to years to help, because the whole public health infrastructure is disrupted."

Japan's experience has been very different from Haiti, where a magnitude 7.0 earthquake struck in January 2010 and created a vast need for medical help. "In Haiti, the existing healthcare infrastructure was basically nonexistent," Dr. Koenig said, "and the building codes for earthquakes were not anywhere near what they are in Japan."

Unlike Haiti, Japan has well-organized civil defense teams that helped victims immediately until outside help was available, Dr. Koenig pointed out. These factors likely mitigated the injuries and deaths from the earthquake in Japan.

"Japan has significant emergency management capacity — one of the best in the world," Margaret Aguirre, director of global communications for the International Medical Corps, told Medscape Medical News in an email.

Future Clinical Assistance May Be Needed

"Nevertheless, the sheer magnitude of the disaster in Japan — first an earthquake, then the tsunami, and now the threat of nuclear radiation exposure — warrant assistance from the international community," Aguirre noted.

The International Medical Corps currently has 5 physicians and logisticians working in the region, and Doctors Without Borders/Médecins Sans Frontières has an 11-person team working in Miyagi prefecture. Aguirre said that it is difficult to predict how many healthcare providers Japan will need over the next year, although she predicts a possible need for specialists in mental health and psychosocial issues.

Japan had a shortage of physicians even before the earthquake hit. A survey released by the Health, Labor and Welfare Ministry in September 2010 stated that the country needed 24,000 more physicians to adequately serve its citizens.

The disaster survivors face numerous health problems, said Dr. Koenig, such as crush injuries, contaminated wounds, and loss of access to medications.

Both survivors and responders must also navigate the "ever-changing story" of radiation risks in the region, Dr. Koenig added.

Japan is still struggling to contain the radiation within 4 damaged nuclear reactors in the Fukushima Daiichi plant. On March 16, the US Nuclear Regulatory Commission recommended that US residents in Japan evacuate the area within 50 miles of the Fukushima reactors, which is a much wider evacuation zone than the Japanese government currently recommends.

Survivors and responders face potential psychological issues after coping with such a large-scale disaster, said Dr. Koenig. Public health issues such as providing sanitation, food, and shelter; preventing outbreaks of endemic diseases; and providing medical care for chronic conditions also need to be addressed.

"This is going to be a huge challenge," she said.


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