Ishinomaki, Sayonara Itsuka

I have completed my medical relief work and left Ishinomaki yesterday.  I feel I have done something useful, while I have not done enough… It’s a mixed feeling.

Over 100 days after the devastating earthquake/Tsunami, temporary houses are being built at a rapid pace.  People living in the shelters are now thinking about and planning for their “post-shelter” lives.  Medical social workers have a lot of work cut out for them.  Most of the shelters, including Yugakukan, will be closed out in coming months.  I will miss the people I met there, but it will be a good thing for people to be back to their normal lives and move on to their new endeavors.

I hope the day will come soon when a music stand will be used as a music stand…

My job is done for now.   

Ishinomaki, “Sayonara Itsuka” (Good bye, see you again someday…)

 

Mite Busters

Ms. Y is a PCAT staff and a physical therapist.  She is one of those dynamos.  Shortly before I arrived, she started a new mission called Mite Busters.  As some of you may know, we have a rainy season or Tsuyu, which spans most of June and July.

The problem of Tsuyu is, of course, humidity.  Since the rainy season is in the early summer, the temperature reaches 80-90 degrees F and humidity of 95-100%.  This is an ideal condition for mite and mold to thrive.  Most of the shelters are places like school gyms without air-conditioning or adequate air circulation, exacerbating the situation.  And the residents of these shelters sleep on the floor with Futon mattress.

I think you get the picture.  During the rainy season, damp Futon mattresses become ideal culture media for mite and mold.  Ms. Y, seeing the potential health problem for the shelter residents, started Mite Busters.  Making rounds of tons of shelters, she and her troops vacuum and dry Futon mattresses.  Some of the large shelters house over 100 people and it takes more than a few days to clean the shelter floor and Futons.

You may not understand Japanese, but you can see what the Mite Busters are doing.  Many medical students and college students came up to Ishinomaki during the week and over the weekends for the Mite Buster project.  It is true labor of love.   

Praise to you, Ms. Y…

Team bonding

Team building or bonding is critical in this kind of volunteer work.  We have never met each other, but are supposed to function as a professional medical team right away.  We do not have the luxury of having much time for team building retreats or exercises.  We need to get to work immediately and perform our tasks as a team.

I am participating in this medical relief operation as a Project HOPE registered physician.  Project HOPE (http://www.projecthope.org/where-we-work/humanitarian-missions/japan.html) is a healthcare NPO that provides medical care to disaster areas globally.  It started the service in 1958, initially by operating a volunteer hospital ship (SS HOPE).  After the Tohoku earthquake, Project HOPE’s hospital ship (now it is a part of the US Navy) arrived at the disaster area and offered its service.  The local government requested medical staff to be fluent in Japanese so that he/she can easily communicate with the Tsunami victims as well as with local healthcare personnel.  At about the same time, the Japan Primary Care Association started the program called “Primary Care for All Team” or PCAT.  As you may have heard in various news media, international disaster medical relief teams (Disaster Medical Assistant Team or DMAT) have arrived to Japan to assist in providing acute and life-saving medical care immediately after the earthquake.  However, these teams left the area within a week or two.  The PCAT provides primary care to the disaster area communities on a longer term basis until an access to local healthcare resumes.  Project HOPE and PCAT decided to join their medical relief efforts.

Both Project HOPE and PCAT recruit MDs, RNs and other healthcare personnel.  Project HOPE requires volunteers to be able to participate in an 18 day rotation (door-to-door) which is 14 days of service and 4 days of traveling.  Another requirement is fluency in Japanese, though a Japanese medical or nursing license is not required as long as he/she has a US license.

In my rotation (ROT #5), there are 3 MDs (including me) and 3 RNs from Project HOPE.  I am from San Diego, 2 other physicians are from Los Angeles, and one nurse each is from Seattle, Maryland and Pennsylvania.  We are all Japanese nationals living in the US.  PCAT has also recruited additional MDs, RNs, pharmacists and midwives.  They came from various parts of Japan and usually stay in Ishinomaki for a week or less.  It is challenging to recruit medical staff in Japan for over a week of volunteer assignment since it is extremely hard to take many days off from their regular job.  In providing chronic care at a shelter like Yugakukan, it is highly desirable to have some level of continuity.   Project HOPE volunteers provide some continuity by being there for 2 weeks.

As I wrote in my previous post, our day is rather reasonable, 8 am-6 pm, though nurses have night shifts and MDs are on call 24/7.  After returning to our housing, which is 25-30 minutes’ drive from our volunteer sites (Yes, I am driving the opposite side of the road very carefully.), we are welcomed by gourmet dinner made by our wonderful housekeeper, Mrs. K.  It is such an unexpected treat!  She also cleans the housing and does laundry.  PCAT program managers have taken great care of us volunteers as well.

There is no shower or bath in our housing: however, there is hot spa right next door. 

Gourmet dinner, a hot spa, and beer/sake, everyone sleeping in a huge Tatami mat room and NO TV… 

Team building is instant!  

Lobby of our housing

Kitchen/dining hall/lounge/study hall

Bonding essential #1: Good food

Bonding essential #2:Good Sake

Bonding essential #3: Hot spa

Bonding essential #4: One Big bedroom

Bonding accomplished!

Yugakukan (遊楽館)

My working site in Ishinomaki is Yugakukan (遊楽館).  Yugakukan is situated about 7 miles inland from the coastline and a half way up on the hill.  Yu (遊) means to play, gaku (楽) means to relax and kan (館) means a pavilion.  It is a multipurpose community center with a swimming pool, sports arena, a concert hall (even with a pipe organ!) and several lecture/conference rooms.  It must be a community gathering place filled with laughter and cheers prior to the earthquake.  Now it is a quiet shelter without basketball games or pop concerts.  But I do see people’s smiles are returning…

There are some, but minor structural damages from the earthquake, but electricity, water supply and sewage are all resumed and fully functional.  Hot meals are prepared in the kitchen by a catering company.  It even provides free WiFi connection and air-conditioning if needed. 

Yugakukan

Arena

Pipe organ -you can see the glass wall was damaged behind it

My "colleagues"

Yagakukan is categorized as a “welfare shelter”, which means a shelter that provides primary care to its residents: however, it is not a hospital.  It is similar to nursing homes staffed with healthcare providers and social workers.  Its residents are expected to move out when temporary housing along with home care support become available.

All the residents are housed in the arena.  Its medical staffs (nurses and physical therapists) are primarily from the Ishinomaki Municipal Hospital (IMH).  IMH was a 200-bed secondary and tertiary care hospital located downtown Ishinomaki City by the coast line.  It was severely damaged by Tsunamis.  IMH is still standing, but non-functional.  To date, there is no plan to repair or restore IMH.   

Downtown Ishinomaki with IMH in the background

Severe damages at IMH

Yugakukan’s medical director is Dr. A., who is a cardiologist at IMH.  Some of the Yugakukan residents are his patients from IMH.  We are the MDs on duty (24/7) since Dr. A can come to Yugakukan only twice a week.  Our main responsibilities are to stabilize (or improve) medical condition and daily activity levels of the residents.  Most residents are elderly people with chronic illnesses such as hypertension, diabetes, cognitive impairment, post-stroke and post-cancer condition.  Fortunately no one requires acute and intensive medical intervention beyond primary care level.  

Our typical day starts at 7:50 am with a volunteer briefing in our lodging.  Then we depart to our work sites – MDs and RNs split to two locations including Yugakukan and mid-wives do home visits.

Our day ends around 6 pm and back to our housing.  Dinner, bathing (there is a hot spa right next door to our lodging) and socializing (talk, talk, talk, often over some beer or sake – there is no TV!).

I will talk about our living quarters and our “team-bonding” in my next blog post...

(photos: courtesy of the Japan Primary Care Association, also copied from other public web sites, plus my own photos)

Ishinomaki

I arrived in Ishinomaki city last Saturday.  I will be a volunteer physician for the Project HOPE’s medical relief team for the next two weeks.

Ishinomaki is one of the cities in northern Japan where the Tsunamis hit on March 11^th right after the M9.0 earthquake.

The city had a population of 160,000 prior to the Tsunami.  Over 40,000 people lost houses and were displaced to the shelters.  In addition, over 3,000 were confirmed dead and 2,770 are still missing.

Early yesterday morning, I visited the Tsunami affected areas in and around Ishinomaki.  Devastating, overwhelming, tragic…there is no single word that can appropriately describe the scene.

There are a chain of small towns and fishing villages spanning hundreds of miles along the coast line.  They have something in common: complete destruction and silence.  The only signs of life are seagulls and flies even over 100 days after the event.

The medical shelter I am working at is not situated in the area directly affected by Tsunamis.  It is a peaceful and quiet safe haven for the unfortunately affected.

I will report what I am doing here in my following blogs.  Until then… 

Why "Why not!" ?

“You see things; and you say, ‘Why?’ But I dream things that never were; and I say, ‘Why not?’".  
(from Back To Methuselah, George Bernard Shaw)

This phrase is better known as the statement of Robert F. Kennedy who quoted it in one of his eloquent speeches.  To me, it does not matter who said it.   The essence is, some people see things and ask "Why?"  Other people say "Why not?"  The reaction is a little bit similar to the "glass is half empty" or "half full" argument.  Everyone sees the same thing and someone tend to find opportunities to do something better.

In my life so far, I have seen and acted on various "why not!" opportunities and met many wonderful people who think, say, and act "Why not!".  Yes, you may have noticed that "Why?" ends with a question mark, while my "Why not!" ends with an exclamation mark.  When I say "Why not!", I am ready to tackle the challenges.  Are you?

Cheers,

Dr. Taka