Atsushi Irisawa, Preparatory office for Aizu Medical Center, Fukushima Medical University, 10-75, Shiromae, Aizuwakamatsu, Fukushima 965-8555, Japan. Email: email@example.com
A catastrophic undersea megathrust earthquake of magnitude 9.0 off the coast of Japan occurred at 14:46 JST on Friday, 11 March 2011. The earthquake triggered powerful tsunami waves, and the tsunami precipitated Fukushima nuclear accidents. After the terrible earthquake, many people fled from the nuclear accident and arrived at places far from the nuclear power plant. In this article, I present a story of one measure devised to deal with the problem of the Fukushima nuclear accident at a regional hospital of Fukushima prefecture, Aizu General Hospital, which is located far from the Fukushima nuclear plant. In addition, I briefly report the current situation of Fukushima prefecture after the 2011 Great East Japan earthquake. In our hospital, the countermeasure headquarters was established to supply medical care for those who had been injured by tsunami waves and the Fukushima nuclear accident. Especially, the screening for radioactive exposure using a dosimeter to take decontamination measures for cases of external exposure was extremely important task. Nevertheless, because the accurate knowledge related to radioactive contamination didn't provide, most medical staff fell into confusion. Fukushima prefecture has been ‘shrinking’ since the nuclear accident. However, today, although some hot spots remain in residential areas, the radioactive contamination is decreasing little by little. Many people in Fukushima Prefecture advance as one, facing forward. Recently, decontamination projects started. Efforts must be continued over a long period.
A catastrophic undersea megathrust earthquake of magnitude 9.0 (Mw) off the coast of Japan occurred at 14.46 hours Japan Standard Time (05.46 hours Coordinated Universal Time) on Friday 11 March 2011, with the epicenter approximately 70 km (43 miles) east of the Oshika Peninsula of Tohoku and the hypocenter at a depth of approximately 32 km (20 miles). The earthquake triggered powerful tsunami waves, a series of water waves caused by the displacement of a large volume of a body of water, which reached heights of up to 40.5 m (133 feet) in coastal areas of Iwate, Miyagi and Fukushima prefectures. The tsunami precipitated several nuclear accidents, primarily the ongoing level 7 meltdown/melt-through at three reactors in the Fukushima Daiichi Nuclear Power Plant complex. The associated evacuation zones accommodated hundreds of thousands of residents. Radiation levels near the plant peaked at over 400 microsieverts/h (µSv/h) after the earthquake and tsunami, caused by the damage that the reactor buildings had sustained. After the terrible earthquake, many people fled from the nuclear accident and arrived at places far from the nuclear power plant. In this article, I present a story of one measure devised to deal with the problem of the Fukushima nuclear accident at a regional hospital of Fukushima Prefecture, Aizu General Hospital, which is located far from the Fukushima nuclear plant. In addition, I briefly report the current situation of Fukushima Prefecture after the 2011 Great East Japan earthquake.
Fukushima Prefecture, the third largest prefecture in Japan, is located in the northeastern region (Tohoku) on the largest island, Honshu (Fig. 1). The capital is the city of Fukushima. It takes approximately 1.5 h from Tokyo to Fukushima City by Shinkansen. The population of the prefecture is approximately 2 million. Fukushima is divided by mountain ranges into three regions: Aizu, Nakadori and Hamadori (from west to east). The Aizu region, with mountain slopes and foothills, has many natural sightseeing spots and historical monuments. The Nakadori region, in central Fukushima Prefecture, includes the administrative and economic center and prefectural capital, Fukushima city. The Aizu and Nakadori regions are the agricultural heart of the prefecture. The coastal Hamadori region, abutting the Pacific Ocean, is the flattest and most temperate region.
AIZU GENERAL HOSPITAL AND AIZUWAKAMATSU CITY
Aizu General Hospital, which includes a preparatory office for Aizu Medical Center and Fukushima Medical University, is located in Aizuwakamatsu city. Aizu General Hospital is a middle-scale hospital with six floors, with 17 departments, with approximately 300 beds. Aizuwakamatsu city, located in Aizu region, is quite distant from the Fukushima Daiichi nuclear plant, approximately 100 km. Therefore, many refugees came to the Aizu region, escaping from the nuclear accident. Aizuwakamatsu city has many historical monuments. Therefore, many elementary school and junior high school students visit this city from various parts of Japan for school excursions every spring and autumn. However, in the spring of 2011, very few students visited Aizuwakamatsu city because of the nuclear accident, despite the fact that its level of radioactive contamination was lower than in many areas in the region (0.16 µSv/h on grass in July 2011; Fig. 2). After the 2011 Great East Japan earthquake, people living in Fukushima Prefecture suffered various problems including actual damage and compounded harm associated with unfounded rumors related to the Fukushima nuclear disaster, irrespective of the level of radioactive contamination.
DAMAGE TO AIZU GENERAL HOSPITAL
Just after the earthquake, all inpatients were carried to a safe area outside of the building by all hospital staff. Fortunately, because Aizu General Hospital is distant from the earthquake epicenter, we had no human suffering and no general water or power supply trouble. Consequently, we were able to perform endoscopy for patients several days after the earthquake. (In contrast, at Fukushima Medical University Hospital located in Fukushima city, endoscopic procedures were completely restricted because of the failure of general water supplies.) However, the water supply to the fifth and sixth floors of the hospital was partially damaged. They were not usable for several months. Consequently, the available area was reduced and constrained (Fig. 3).
ACTIVITIES FOR REFUGEES IN AIZU GENERAL HOSPITAL
Disaster relief team
The countermeasure headquarters were established to supply medical care for those who had been injured by tsunami waves and the Fukushima nuclear accident. Many people evacuated themselves from the Hamadori region to the Aizu region, and were accommodated in several evacuation centers that had been adapted from local school buildings (Fig. 4). Therefore, we made a team for disaster relief (the team comprised four members: one doctor, two nurses and one pharmacologist). The disaster relief team visited each evacuation center to provide medical care. We provided medical examinations and consultations to 100–300 people per evacuation center for 2 months after the earthquake.
Screening for radioactive exposure for refugees
The problem that the refugees and evacuees of Fukushima Prefecture confronted was radioactive contamination and fear of it, unlike those of the other prefectures, Miyagi and Iwate. Therefore, we performed screening for radioactive exposure using a dosimeter (Fig. 5). Why was radiation screening necessary? One reason was to take decontamination measures for cases of external exposure. In addition, we issued certificates verifying a lack of exposure to radiation, which was a very important purpose of radiation screening because area residents were restricted from access to hotels, taxis and medical examinations at some clinics without such a certificate. It was considered that this policy was discriminatory. However, most people had no accurate knowledge related to radioactive contamination.
A nuclear emergency was declared by the government of Japan on 11 March 2011. An explosion occurred in the reactor building at Unit 1 at 15.36 hours Japan Standard Time on 12 March. The sidewalls of the upper level were blown away, leaving in place only the vertical steel-framed grid works. On 13 March, many refugees and evacuees came to the Aizu region, making a long line wanting for radiation measurements outside of the Aizu General Hospital to assess radiation exposure. The line remained until 22.00 hours. All radiological technologists and nurses performed radiation measurements all day and during the cold snowy night (Fig. 6). If the dosimeter indicated a high level of radiation, then the person was required to undergo decontamination.
However, many medical staff were afraid of radioactive substances that might have adhered to the people; nevertheless, we had to give some medical care to all who needed it. Therefore, the flowing line of people seeking consultation was separated according to residential area. All those from locations near the nuclear plant underwent radiation screening before clinical examination. Some were indignant about the measures. We believe that the measures were correct. Nevertheless, we simultaneously realized again the importance of the problem. Discrimination and distinction are separated by a hair's breadth, and can be difficult to distinguish and justify.
CURRENT SITUATION IN FUKUSHIMA PREFECTURE
Table 1 presents data related to Fukushima's agriculture and manufacturing. The population has been ‘shrinking’ since the nuclear accident, July 2011. Approximately 36 thousand people left Fukushima to escape the radiation. Children wore long sleeves and masks in hot weather and have been limited in terms of outside playing. Many parents have considered temporary refuge during the summer to decrease the cumulative radiation dose. Those who stay in Fukushima face numerous difficulties such as that ‘shrinkage situation’ and radiation issues every day during the summer. Soon after the nuclear plant disaster, the Japanese government issued instructions that people within a 20 km (12 mile) zone around the Fukushima Daiichi nuclear plant must leave, and urged that those living between 20 km and 30 km from the site to stay indoors. Those of the latter group were also urged to evacuate on 25 March. Even now (December 2011), many refugees cannot return to their home towns.
Table 1. Shrinking Fukushima: changes after the earthquake
Excerpt from the Asahi-shinbun, 10 July 2011.
2 024 089 (1 March 2011)
35 776 outside the prefecture refuge (4 July)
532 000 000 kW/h
311 000 000 kW/h
Production index of manufacturing sector
18 381 (March–June 2010)
46 017 (March–June 2011)
No. of schools visiting Aizuwakamatsu for excursions
However, today, although some hot spots remain in residential areas, the radioactive contamination is decreasing little by little. Many people in Fukushima Prefecture advance as one, facing forward. Recently, decontamination projects started, using brushes and high-pressure water cleaners to decontaminate some areas. Efforts must be continued over a long period.
Regarding the Aizu region, which includes Aizuwakamatsu city, many tourists including children who are taking school excursions, visit for sightseeing. In addition, many rice fields are safe for rice production and distribution. Nevertheless, all agricultural producers ship crops with an attached document, a ‘Certificate of no radioactive contamination’ (Fig. 7), as a measure to deal with harmful rumors.
We continue with inspiration from many sources, perhaps best exemplified by the following hopeful remark by Martin Luther King Jr: ‘We must accept finite disappointment, but never lose infinite hope.’
The author appreciates Dr Motoyuki Munakata and Mr Ikuo Watanabe (radiological technologist) of Aizu General Hospital for providing some photos, and Ms. Tomoko Harada for writing assistance.