Via The Lancet, a fascinating report: Japan's slow recovery. Excerpt:
When his hospital started to shudder violently on the afternoon of March 11, Sen Hiraizumi sensed immediately that it was an earthquake of far greater force than he had ever experienced. When the shaking failed to quickly subside, his apprehension turned to fear: he knew enough about his country's seismic history to know that a tsunami could not be far behind.
Over the course of a frantic 20 min, Hiraizumi, the deputy director of Yamada Hospital in Iwate prefecture, and his staff moved more than 40 inpatients to the roof of the two-storey building, then watched in horror as the waves roared through their town, sweeping away cars and houses and swallowing up people who had left it seconds too late to escape.
3 months later, there are few obvious external signs of damage to the hospital, a publicly run facility that had become a focal point for the ageing community in this fishing town on Japan's northeast Tohoku coast (webvideo).
Inside, the ground floor has been cleared of debris, but a line running near the top of the wall shows just how high the tsunami reached. Upstairs, the operating theatre is in permanent darkness, while wards that once housed people with cancer, pneumonia, and dementia have been turned into a makeshift outpatient clinic.
“It was the most incredible thing I had ever seen”, Hiraizumi says as he surveys the destruction from the rooftop retreat that saved his and dozens of other lives. “But our priority was to look after our patients. We tried to act calmly and the staff here worked very hard to get everyone to safety.”
The tsunami knocked out the electricity and water supplies, and filled the corridors with debris. After the water had made its journey back out to sea, staff picked through walls of mud for vital medical supplies.
Hiraizumi, a cancer specialist, spent the first 3 nights sleeping on the hospital's operating table: “I know it sounds odd, but it was strangely reassuring”, he said. “I thought that if another tsunami came and I was drowned there and then, it would be a fitting way for a surgeon to die.”
Concern quickly grew for the hospital's patients, all of whom were older than 60 years, as the sudden arrival of snow sent temperatures inside below freezing. “It was so cold that we realised that it would be difficult for some of the older patients to survive”, Hiraizumi said. By the time relief workers arrived 4 days later with emergency food, water, blankets, and medical supplies, eight of his patients had died.
About 400 of Yamada town's 20 000 residents were killed in the disaster, hundreds are still missing and more than 3600 were forced to live in cramped evacuation centres.
The devastation to Hiraizumi's hospital was repeated along a vast stretch of the Tohoku coastline. When the tsunami ripped houses from their foundations and sent cars and other debris miles inland, it also caused widespread damage to the health infrastructure in a region already struggling to fund health services for its large elderly population.
According to medical authorities in Miyagi, one of the three hardest-hit prefectures, 186 medical institutions, including three general hospitals, were destroyed or seriously damaged.
More than 50 nursing homes in Miyagi and the neighbouring prefecture of Iwate were forced to close. About 400 elderly residents died in the region, while those who survived have had to be transferred to other facilities farther inland. Local health authorities expect the resulting shortage of hospital beds to last for more than 2 years.
Devising treatment programmes for individual patients has been complicated by the loss of tens of thousands of medical records as very few hospitals had digitised the data.
But a far bigger problem is the slow pace of reconstruction, a huge task that is expected to take at least 3 years and cost more than 10 trillion yen.
