Proposal for Future Reconstruction and Disaster Prevention Measures Following the Great East Japan Earthquake

Japan Association of Kidney Disease Patients (Zenjinkyo)

Introduction

On March 11, 2011, a major earthquake hit a broad area of East Japan, which resulted in damage not only from the earthquake but also the subsequent tsunami, nuclear accident, and power outages, etc. There were various incidents related to dialysis patients and dialysis facilities; even now, almost one and a half years since the earthquake, some areas have not recovered yet. The Japan Association of Kidney Disease Patients (Zenjinkyo) is working to figure out what type of activities are necessary on a trial-and-error basis. In this report, I look at efforts Zenjinkyo has taken so far and examine issues for future disaster prevention response measures.

Damage incurred on March 11

We are end-stage renal disease patients who require dialysis and generally receive dialysis three times a week, four hours each time. This is considered an internal physical disability. The Great East Japan Earthquake hit at 2:46 p.m. on Friday, the time between dialysis sessions or when afternoon dialysis sessions started. The timing of the earthquake was very significant for us. Our response is completely different depending on whether a patient is in the midst of a dialysis session or not. The time the earthquake hit is one of the major differences between the Great Hanshin Earthquake and Great East Japan Earthquake.

Immediately following the earthquake, medical facilities that provide dialysis in the disaster area were cut off from both water and power. However, dialysis treatment requires large amounts of water and electricity. With no water or electricity, it was difficult to continue treatment. Luckily, only in a few areas did buildings sustain major damage from the earthquake; areas where buildings did sustained major damage were mainly on the coast, which was hit by the tsunami.

Several patients lost their lives due to the tsunami, including ones who had completed their treatment in the morning or had stopped midway through the treatment and returned home and ones who just happened to be at their home on the coast or did not evacuate in time.

Importance of emergency dialysis

Dialysis patients must receive treatment three times a week as discussed above, which is true during the Bon and new-year's holidays (regardless of season) and when disasters or typhoons hit (under all natural conditions). Because of this, a major issue is how dialysis facilities can continue to provide treatment to patients after an earthquake subsides.

(1) If a disaster hits during treatment

Because the Great East Japan Earthquake hit before 3:00 p.m., several facilities were in the midst of dialysis treatment. Some facilities followed the emergency manual while others did not, and there were various decisions and responses - some places waited for the earthquake to subside, suspended the treatment, removed needles (needle for extracting blood from the body to purify and the needle to return it the body), and stopped the bleeding as they normally do but others detached the connections after closing the route the blood travels outside the body. They then immediately fled. There have been no reports of dialysis equipment being knocked over or patients beds being damaged.

However, there were places where facility staff and patients moved en masse looking for emergency shelters because of the tsunami.

For patients at facilities, they and staff evacuated together, which made it possible to share information regarding subsequent emergency dialysis with facility staff. This is extremely reassuring for patients. Following the earthquake, there were cases when whole hospitals evacuated from Fukushima to neighboring prefectures such as Niigata and Yamagata.

(2) For patients who were somewhere other than the facility, such as their home, when the disaster hit

After patients protect themselves, if it is possible for them to immediately contact the dialysis facility they normally use, it is important that they confirm whether it is possible to receive dialysis. If possible, they should confirm the next treatment time. If it is not possible, they must search for a facility that can accept them immediately. Following the Great East Japan Earthquake, entities, mainly the Japan Broadcasting Corporation, notified people by TV and radio of facilities that could provide emergency dialysis. Compared to the past, people are more aware of dialysis and know that dialysis treatment must be continued no matter what disaster hits.

In Miyagi, patients concentrated at several facilities, and there were cases after the earthquake when dialysis was provided twenty-four hours a day for several days.

Issues related to evacuation

When a disaster hits, local governments open emergency shelters and call on residents to evacuate. Dialysis patients must be careful when staying at emergency shelters. Patients need to be careful of drinks and food that are distributed at emergency shelters. Much of the food provided at shelters consists of items such as bananas, milk, instant noodles, and rice balls, but dialysis patients have food (nutritional) and water (for weight control) restrictions. Patients must take these restrictions into consideration and refrain from eating and drinking the above items if possible. Following the Great East Japan Earthquake, there were some patients who did not notify the emergency shelter that they were dialysis patients and continued to eat the same food that healthy people ate, which ultimately undermined their health and caused their death.

Local governments must establish and operate fukushi emergency shelters, but during the chaotic conditions after a disaster, there is a need for patients not to rely on others but protect themselves, such as being careful to manage their own health on a regular basis.

As for securing access to dialysis treatment, starting from one week after a disaster hits, dialysis has to be secured in a different way. It is not necessarily always a good choice to stay in the disaster area. From one week to one month after the disaster, for several months in some cases, it is necessary to receive dialysis treatment at the place they take refuge for rather a long time, until the medical facilities in the disaster area are able to recover to a certain extent.

This time, patients moved en masse from Fukushima to Kanto, mainly Tokyo, and from Miyagi to Hokkaido and Yamagata and continued to receive treatment. Medical practitioners collected information on facilities that could accept patients (it was also necessary to secure a place for them to live) through a nation-wide network and made effective use of the information.

Activities and support by Zenjinkyo

When the earthquake hit on March 11, the president, one vice president, and executive director happened to be participating in a conference being held near Tokyo Station. The conference was cancelled, and the three confirmed what direction the response should take for the time being.

• Establish a response headquarters within the Secretariat (Sugamo, Toshima-ku, Tokyo) with President Miyamoto serving as director of the headquarters on March 12.
• Collect donations from throughout Japan.
• Submit requests regarding ensuring the safety of patients and access to dialysis during a disaster to the Ministry of Health, Labour and Welfare (MHLW).

On March 12, the above were decided upon and undertaken and prefectural organizations were notified of this. After that, Zenjinkyo continued to submit various requests related to the Fukushima nuclear accident, such as planned power outages, to related organizations, including the MHLW.

In April 2011, President Miyamoto took relief goods along with him on a visit to the disaster area, encouraged patients, and expressed his appreciation to medical practitioners. In the same month, a local Zenjinkyo response headquarters was established in the Secretariat of the Miyagi Association of Kidney Disease Patients, and using this headquarters as a base, directors implemented various response measures, such as providing support to organizations in the prefectures hit by the disaster.

Donations collected from throughout Japan surpassed 70 million yen, which was delivered to members through organizations in Iwate, Miyagi, Fukushima, and Ibaraki. Members in the disaster area expressed their appreciation for the support.

With a disaster condolence money system, Zenjinkyo pays condolence money in various situations such as the death of a member or the full or partial destruction of a member's house. Following the Great East Japan Earthquake, condolence money was paid to 1,472 members. It was sad time, and many members said that the money was a great a help.

The Zenjinkyo Secretariat and local response headquarters provided various forms of information, such as conditions after the disaster, to organizations throughout Japan when necessary and played an intermediary role between members throughout Japan and the disaster area.

Issues that came to light through the disaster

Until now, the response to disasters has been modeled on the response to the Great Hanshin Earthquake and Chuetsu Earthquake. For the Great East Japan Earthquake, the tsunami caused substantial damage. Furthermore, typhoons and volcanic eruptions have caused damage since the Great East Japan Earthquake. Disasters can occur anywhere in Japan. Responding to disasters, therefore, is an important issue. It is necessary to provide members with detailed information related to several issues such as how they should respond when a disaster hits and what preparations they should make before disasters.

It also took time to confirm the safety of members in prefectures since a proper list of members had not been created. It is important to create such a list in the future.

Future responses

Following the Great East Japan Earthquake, other major issues were shortages of gasoline and the poor communication. Securing gasoline for transportation and communication methods for emergencies have been added to response measures taken until now.

The foundation of the disaster response that Zenjinkyo can provide is probably devising ways for members to survive disasters and how to restore their original life after a disaster. We would like to flesh these ideas out.

Summary - What must we do?

Even now, recovery is still impossible in Fukushima. Many people in the disaster area have lost the foundation of their lives and are being forced to live under difficult conditions in temporary housing. Even in areas hit by the tsunami, reconstruction is not progressing. Starting now, the disaster area will need both extensive material and psychological support. Working with the disaster area, we must move forward with efforts to create a new Japan.