Work and Proposals by Japanese Physical Therapy Association

Japanese Physical Therapy Association

Experience of the Great East Japan Earthquake

Having learned lessons from the Great Hanshin-Awaji Earthquake, Japan has developed various support systems. However, nobody envisioned the strength and extent of the Great East Japan Earthquake.

The largest problem is that the Disaster Relief Act is dated and does not reflect the modern grey society. Both disaster medical assistance teams (DMAT) and Japan Medical Association teams (JMAT) mainly provide support in the form of acute care surgery, and it cannot be said that they can sufficiently handle chronic phase issues related to the elderly. A typical example of this is disuse syndrome; starting with emergency shelters but also including current temporary housing, people require more nursing care, more people develop dementia, and incidence of strokes increased. A support law that is appropriate for the times would be desirable. Furthermore, we can see what Japan will be like in the near future in the area hit by the Great East Japan Earthquake, which is a super-aged society. Therefore it is necessary to carefully consider the support system from this perspective.

Another distinguishing feature of the Great East Japan Earthquake is that local governments sustained devastating damage, making it difficult for them to function. Until now, local governments were the main recipients of aid, and it was assumed that they would manage supporters from outside the area. However, it is regrettable that for a while after the disaster, support activities were extremely chaotic as many of the municipalities could not function.

After the disaster, newspapers reported the names and ages of the dead. Looking at the age of the fatalities, many were members of vulnerable groups, the elderly and infants, which made me strongly feel the need to provide these people with evacuation training.

Efforts and response by the Japanese Physical Therapy Association

Following the disaster of March 11, the Japanese Physical Therapy Association (JPTA) established a response headquarters on March 12, and on March 14, JPTA’s budget was dramatically reworked to wring out funds for support activities. During that time, it was felt that support for the elderly at emergency shelters and similar venues was important, but there was absolutely no information that would have made it possible for JPTA to launch actual efforts. Therefore, on March 20, a JPTA team traveled from Akita-shi to Miyako-shi, via Morioka-shi, and then traveled south down Iwate in order to ascertain conditions on the coast. As a result, it was decided to systematically dispatch physical therapists even though aftershocks continued to occur, and a call went out to the 70,000 members throughout Japan for people to take part in support activities. However, even at this stage it was difficult to secure places to stay and impossible to correctly ascertain conditions at emergency shelters, the team did not know who to contact, and there was no transportation in local areas. For this and other reasons, there was the possibility of secondary disasters. With the cooperation of disability organizations, the team was able to secure a place to stay, purchased a used car to get around, and resolved various issues. However, it was difficult to make contact regarding emergency shelters until the end.

For the elderly and people who found it difficult to get around before the disaster, it was important to increase the size of the area they could get around in and improve their health. Therefore, JPTA explained to the government and political parties the importance of measures to prevent disuse syndrome and worked so that people would not loose vital functions while living in emergency shelters.

For two months after the disaster, people lived in emergency shelters in many parts of Iwate, Miyagi, and Fukushima. Efforts were continually made to use radio, newspapers, and other media to inform the elderly and persons with disabilities of exercises and important points to prevent deterioration in vital functions and disuse syndrome at emergency shelters. When phone inquiries were received from residents living in emergency shelters who had heard the radio broadcasts, various measures were taken such as sending material on preventing disuse syndrome and providing advice. In areas where reconstruction was progressing, it was possible to access the Internet; therefore, JPTA set things up so that people could download material such as exercise manuals from its website and obtain necessary information.

In addition, indirect support was provided through physical therapists associations in the areas hit by the disaster. Working with local governments and NPOs, efforts were made to send, in a timely manner, not only rehabilitation related goods that were either purchased with donations from members or received from overseas or Japan but also rehabilitation shoes sold by corporations at a reduced price.

During the six months after the earthquake, JPTA provided volunteer support by dispatching 68 staff to Yamada-machi, Iwate, 280 to Rikuzentakata-shi, 120 to the Kesennuma-shi area, 60 to the Ishinomaki-shi area, and 50 to the Sendai-shi (figures are total numbers). JPTA carefully examined how to launch support without causing problems for people affected by the disaster. First, information was exchanged with several parties in the disaster areas, including related organizations, physical therapist associations, doctors working for local governments, health nurses, physical therapists, occupational therapists, speech-language-hearing therapists, care managers, and NPOs. Wakabayashi-ku, Sendai-shi, in Miyagi and Rikuzentakata-shi in Iwate were selected as the first places to provide reconstruction support. When dispatching volunteers, for people who no longer needed to do things that they regularly did before the disaster, such as house work or shopping in the local area, and people whose duties had decreased on account of support, an environment was created so that they could naturally get about.

Issues from immediately after the disaster

In the middle of April, a hospital in Miyagi suddenly requested the dispatch of physical therapists, and JPTA quickly created a team. However, the following day, the association talked to a worker at the local government who said there was absolutely no need for the team. This type of jumbled information was not limited to the period immediately after the disaster but continued for some time and had a major impact on the smooth operation of support activities. This once again showed the importance of properly ascertaining conditions, making information consistent, and establishing a method to communicate with supporters and organizations. It is sad that this remains a serious problem even after people started living in temporary housing.

The main work of us physical therapists is to at least maintain but, if possible, improve the ability for basic movement of persons with disabilities and the elderly (sitting, standing, walking, etc.). Disuse syndrome is one of the causes of a deterioration in ability for basic movements. During life in emergency shelters immediately after the disaster, many evacuees laid a sheet on gymnasium floors and just lay down there. Ensuring that elderly have beds and chairs, not just a space on the floor and a futon, will broaden what they can do in their life. People have to reflect on the fact that such preparations were not made at emergency shelters.

It sounds like even today, there have been various problems at temporary housing, such as an increase in the level of nursing need and a larger number of cases of dementia and strokes. It is fully possible to prevent these problems through appropriate exercise and the elimination of stress. This problem, which was pointed out at the very beginning, has not been resolved, and as specialists in independent living, it is difficult to allow this to continue.

Future support system

As physical therapists, the first thing we would like to do is educate people about disuse syndrome. During the hectic time after the disaster, even though people were told of the important of exercise, they did not heed the advice. Precisely because society is greying, it is vital that the importance of moving the body becomes common knowledge in daily life.

Another important type of education is survival education for medical professionals. During initial support activities following the Great East Japan Earthquake, there were high risks, such as no place to sleep, no food, and strong aftershocks. It is important to educate supporters about how to prevent secondary disasters.

It is probably also important to amend the Disaster Relief Act. It is vital to create a relief act that envisions a grey society, and establish a system to get people to live energetic lives even at temporary housing, and to provide support. While it is easy to say, a team approach of members such as numerous medical specialists is necessary to make this concrete. Therefore, it will probably be necessary to train human resources (managers) who can make the team approach possible.

The integrated community care system, which is expected to be up and running by 2025, is being examined, and it may be possible to incorporate disaster response capabilities into the system of self-help, mutual support, mutual assistance, and public support. This is because whether the integrated community care system or support for disasters, there is still the same background, a gray society.