Are You Ready for The 'Big One?' — Lessons From a Relief Doctor in Haiti and Japan

Japan has suffered the perfect storm: the strongest earthquake, the tallest tsunami, the worst nuclear disaster. Whole cities were washed away with a 6-story wall of water rushing in at 150 mph.

I'm a parent like many of you and worry every time we have a major temblor, worrying if this will be the "Big One."

Well, Japan suffered it and more, with a triple threat a month ago, the worst within recent history. It was the strongest earthquake, the tallest tsunami, the worst nuclear disaster — a perfect storm  The country most prepared for natural disaster initially fell flat in responding to each of the three crises, but its resilience and civility has shined a light through the rubble. We can learn much from the charitable character of the Japanese but also learn how their culture has limited help offered to them. I'm hoping that through their story, you'll be inspired to prepare your family for disaster.

It reminds me of Haiti, where last year 300,000 perished in a moment, and 2 million remain displaced. I'm the medical director of Jordan International Aid, a 501c3 nonprofit that sent nine teams of more than 200 physicians, nurses and supporters to help this last year. We found Haitians who had never seen a physician in their lives and had the privilege of caring for them. Although the Japanese disaster led to fewer casualties, the destruction is even more vast.

The Japanese have devoted a hundred-thousand troops to help in the recovery, but they found that to be but a drop in the face of the needs. Two million were stripped of water, electricity and utilities, twice as many as in Katrina and as many as in Haiti.  The supply chain disintegrated, leaving those in shelters and those sheltering in their homes to depend on the sparse resources deployed by the military. Many are homeless due to the six-story wall of water that washed away their homes with a 150 mph tsunami. Complicating aid efforts are the fears about radiation release from Fukushima nuclear reactors and the lack of fuel since the refineries along the coast were damaged. Sadly, due to the radiation fears, most medical relief groups, even the US government's DMAT team, have not been deployed to help. I say fears, because the dosimeters my team wore show no significant radiation exposure. My hopes are that those interested in going to help may be encouraged by our experience.

We arrived one week after the disaster, with the flight there empty, but Narita was jammed with expatriates fleeing the country worried about the reactors melting down. The roads were limited to emergency transport vehicles, and our bus cost $1,200 USD per person to get to Ishinomaki. Although a lot of aid had reached Sendai, we brought the first physician, hot food, baby formula, and energy bars to Ishinomaki. It was still very cold, and many illnesses we saw were due to crowding in the shelters as folks tried to sleep close together, conserving heat, since kerosene was in short supply and is even now, six weeks afterwards.

The famously civil Japanese kept the peace in shelters, but survivors privately shared their frustration that blankets were inequitably distributed, leaving many shivering. Many stories showed the charity of the Japanese: young giving up their food rations for the frail and elderly, people patiently waiting half a day in line for supplies, and an example of their civility: After a grocery store generator ran out, disabling their registers, the customers restocked the shelves with the contents of their carts and left in an orderly manner.

Due to the crowding, we were surprised to see pneumonia and gastroenteritis also predominated in Ishinomaki, just as was common in Haiti. There wasn't cholera in Japan, but many symptoms reminded us of Haiti and Katrina, such as conjunctivitis, pharyngitis and bronchitis, due to irritation from the dust from rubble and silt left by receding floodwaters.

The close quarters in shelters provided the opportunity for respiratory particles to get past face masks, as they became soaked with moisture from breathing. Only dry masks filter out infective organisms; when they're wet, air seeps in around the edge of the mask. The fastidious cleanliness of Japanese was limited by the lack of running water, and fecal oral transmission of viral and bacterial causes of diarrhea spread. Our teams were surprised by the odor of urine in shelters, then realized that the elderly, toddlers and infants hadn't bathed in a week and hadn't had a change of clothes — some of them incontinent of urine, which fortunately is sterile, but also stool. Alcohol hand rub was in high demand, but no water was available to rinse the residual that accumulates after 20 applications.

Helping out in Japan is much easier in some ways than past disasters and more difficult in others. The Japanese are rightfully very proud of their excellent preparations for disasters, and the relative low death rate speaks to the success of executing on those plans. It was heartening to hear from many survivors who shared how they followed their disaster plan and made it to higher land. It has compelled me to make a plan with my own family. It was heartbreaking to hear how many who followed the plan had died, since the inundation was of such greater height of water that many who evacuated to elevated tsunami shelters also drowned.  

As we cared for patients, it was great that we could ask for transportation for sicker patients to get to the just-set-up Red Cross Ishinomaki Hospital. It's great that the hospital is coordinating volunteer physicians and nurses to care for shelter residents. What's difficult is that unlike in Haiti, where we were welcomed, in Japan, shelter after shelter was unwilling to let us care for survivors, even though we carried with us a letter from an Ishinomaki City Council member asking the shelters to allow us to help. It wasn't regulatory issues of credentialing — our physician was give permission just as in Katrina, as the Japanese government allowed volunteer physicians to practice. It wasn't for lack of need, as many were suffering from respiratory illnesses and exposure. It was more about the cultural reticence of seeing a foreign physician using a translator. Fortunately, we will return with Japanese-speaking physicians, but it speaks to the difficulty of those under duress to accept help even when in great need.

Another difficulty is trying to get resources shipped to the disaster. Since the disaster, we've been working in partnership with a nonprofit, "Peace Builders, Inc.," to get two shipping containers full of medical supplies, new Gymboree children's clothes  and EO Products hand sanitizer, to Ishinomaki. Today, we mobilized the shipment that will take three weeks to get there. The shelter manager just called, and they just got a big shipment and don't have room for more. Now I'm scrambling to find another shelter to accept the shipment.

This is the reality of relief work halfway around the world. Things change fast, and it makes it difficult to help. The delay in shipping was due to getting the customs clearance to import it duty-free, with the proper documentation from politicians we met while we were there in Ishinomaki. Needless to say, the donor is frustrated about the destination being up in the air, and I'm working my contacts with missionaries who have been distributing goods in nearby Sendai.

A commonality to these disasters was that in each, we arrived a week after the disaster, and although the cellular voice networks were often overwhelmed, we could SMS (text) and access the Internet on mobile phones. With the rapid changes from day to day in the disaster, it was helpful to review websites that listed the latest news — in disaster parlance it's called "Situational Awareness." It helped us be able to email to coordinate with those at the shelters what they needed and where we could help. In Japan, XCom Global donated MiFi devices that gave up to five users the ability to share a WI-FI connection so we could stay connected. It was a way we could upload photos and videos live to our Facebook and Twitter feeds to let our supporters know what we were up to.  

Taking this lesson home, I've suggested that my employer, a large clinic of a thousand physicians, create a disaster situation website and add mobile phone numbers to my clinic's disaster preparation plans. That way, we can give updates via a website and do SMS blasts to give updates to all employees or alternatively be able to SMS to ask for particular specialists to come help. Right after a disaster, the voice cellular networks are overwhelmed, but texts can get through.

One frustrating thing in a disaster is that survivors often tell you they take, for example, the red pill for hypertension and a rainbow of other colored pills for a plethora of illnesses. At PAMF, I work in a multi-specialty environment where I can refer to the past medical history in an EpiCare electronic medical record (EMR). In Katrina and Haiti, we could also use mobile Internet to access and store electronic medical records. In Katrina, the US government aggregated electronic pharmacy records and allowed credentialed disaster relief physicians like my father and I to look up recent prescriptions of survivors online. In Haiti, we received a generous grant from Epocrates in order to do so with their iChart EMR on iPhones. We helped Harvard develop new disaster-relief EMR standards for the WHO last year.  

One difficulty in the Japanese medical system is that most operate in small clinics, with systems that are not integrated into larger data networks. There's no way to find out what Japanese survivors were taking. Here in the USA, our government has incentivized physicians to adopt EMR via $64,000 in HITEC incentive payments over the next four years, and in year four, there is a requirement for EMR to be tied to Health Information Exchanges, which create a repository of your health information across multiple providers of care. Four years from now, your health information will be much safer in a disaster or even in less severe trips to the emergency room, since your doctor will be able to look up your records online. You may also be interested to know that in year two, giving you access to these records via a Personal Health Record is incentivized. At PAMF, we've done that for a decade via our MyHealth online portal. Just last month, we were the first in California to launch access via an iPhone app. My personal experience is that it's a much more usable way to have electronic visits with my doctor wherever I am using my cell phone, and review my records without being tied down to my desktop PC.

You may wonder how we operated these devices while in disasters where the electrical grids are down. We had solar power thanks to donations from WeCareSolar, which builds battery-filled suitcases powered by donated Everbright Solar panels, a local manufacturer. This helps charge our headlamps so we can look down throats and see what's in front of us so we don't trip in the dark, and recharge our cell phones and laptops. Portable solar lights donated by OneMillionLights were distributed in Haiti last year, and now to Japan, which miraculously provide eight hours of light so we can see at night. There's still sun in places where nuclear reactors melt down and leave millions without power.

I'm excited to go to Japan and organize more trips of friends willing to help survivors. If you're interested in following our progress, you can "like" us on Facebook and read how our first trip went. You can donate to our efforts using Paypal: http://bit.ly/Donation2Japan or mailing your tax-deductible donation to "Jordan International Aid" at 12860 Llagas Ave., San Martin, CA 95046  Email me if you're interested in going to Japan or Haiti: enochchoi@gmail.com.

DISCLOSURE: As medical director of Jordan International Aid, I am not compensated and volunteer my time to this 501c3 non-profit, without salary or other monetary or non-monetary compensation other than the gratitude of being able to do what I believe God is asking me to do.

I'm hoping you'll consider the risks of the area we live in and become prepared. Contact your neighborhood organization and ask who is involved in your city's CERT program. Ask them what kind of training is provided and if they found it valuable.  I found our Palo Alto CERT (the artist previously known as PANDA) to be very helpful in my disaster planning. Get food, water and medicine enough to be independent for at least a month. Whenever your gas drops to half a tank, fill up. Develop a family plan for communication and how you'll meet up since phones will be out (just hope SMS still works, as it did in Japan). Think about how you'll defend yourself at home. Have what you need there, so you don't have to go out and brave the expected civil disobedience. Then when you're prepared, go bug your neighbors and friends to get prepared too!





This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

Christian Crumlish May 10, 2011 at 11:02 AM
Wow, packed with useful advice and insights. Thanks!


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