Disaster Relief Information

Disaster Relief Information


June 5th, 2011

One of the most poignant moments for me at the PAS meeting occurred when we received a briefing by John Takayama about the earthquake/tsunami disaster in Japan. This natural disaster left many children homeless or orphaned. Dr. Takayama stressed the likelihood of the enduring need for social and psychological support for these children. Victor Frankl wrote about the ability of people to survive and adapt to the most extreme circumstances. Children will adapt, but the expertise of our finest minds in helping to mitigate the long term psychological impact has been requested, and will be needed to optimize psychological adaptation to this disaster.

Since the PAS meeting, another natural disaster occurred much closer to home: killer tornadoes in Alabama and, most recently, Joplin, Missouri, which is located only a bit over 200 miles from my home in St. Louis. President Obama talked about unexpected heroism during his recent visit to Joplin. I received a first-hand account written by a heroic emergency physician, Dr. Kevin Kitka, who was in the St. John's Hospital in Joplin when it was hit by the tornado. "We heard a loud horrifying sound like a large locomotive ripping through the hospital. The whole hospital shook and vibrated as we heard glass shattering, light bulbs popping, walls collapsing, people screaming, the ceiling caving in above us, and water pipes breaking. We suffered this in complete darkness. The whole process took about 45 seconds, but seemed like an eternity." Dr. Kitka described the work he did subsequently. He put in chest tubes, intubated people on the brink of death with no drugs, and described this child he treated: He was 3-years-old, and "had a large avulsion of skin to his neck and spine. The gaping wound revealed his cervical spine and upper thoracic spine bones. I could actually count his vertebrae with my fingers. His eyes pleaded with me to help him. We could not find any pediatric collars in the darkness, and water from the shattered main pipes was showering down upon all of us. We were able to get him immobilized with towels, start an IV with fluids and pain meds before shipping him out."

These events remind me of the importance of disaster planning and my responsibility as a pediatrician to ensure that the needs of children are not forgotten. Trucks filled with blankets, new underwear, flip-flop shoes, nonperishable canned food and commercial cash cards collected in our St. Louis community are being dispatched to Joplin as I write this column. Knowing that the hospital in Joplin was destroyed in 45 seconds of tornadic fury, I think about what that would be like at my children's hospital. Have I done what I can to make us prepared? Would I be ready to respond as Dr. Kitka and the many other heroes did in Joplin?

Electronic and social media have made communication of needs and ways to help in response to disaster more precise and rapid than in the past, although my experience is that communication is still a major challenge in disaster response. As the days pass, needs may change, but I remind myself to find ways to reach out, to fill in the spaces between us and to help, even in small ways, to ease the burden of the children and families affected by disaster.

- David Jaffe

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June 3rd, 2011

Nearly 3 months have passed since the devastating 2011 Tohoku Earthquake struck northeastern Japan on Friday, March 11. Related to the magnitude 9.0 earthquake and the massive (up to 50 feet high) tsunami that followed, over 15,000 have died with an additional 8,000 still missing (June 2, National Police Agency). Over 100,000 homes have been completely destroyed. Nearly 250,000 survivors initially required shelters. Aftershocks have continued as far as Tokyo (population 13 million), 250 miles from the epicenter. Over 100,000 have been evacuated from the vicinity of the damaged Fukushima Daiichi Nuclear Power Plant. In spite of the continuing uncertainty about radiation exposure, however, life has slowly begun to normalize in most of Japan.

In contrast to the constant airing of tsunami videos and nightmarish images on front pages of newspapers in March, there is hardly a newspaper article or any television coverage in June. What has happened to all the victims? What is going on? In Tokyo, the rolling blackouts, gasoline shortages and scares about contaminated dairy and vegetables have receded. According to NHK (government sponsored) news, lifelines (i.e., electricity, water) have been reestablished in nearly all affected communities; and more permanent and private housing have been identified or constructed. Businesses in Japan have slowly begun to recover. In April and May, the new school year started, bringing at least a semblance of normalcy to children and adolescents.

For the people of Tohoku, however, the nightmares continue. The most affected areas of Iwate, Miyagi and Fukushima prefectures are rural and impoverished, far from large urban centers. Most of the population is elderly and their remaining lives have been changed forever. While those with means have quickly relocated, those who are left have no homes to return to, nor permanent places to live. Classes have commenced, yet adjustments have been necessary for students; with over 7,000 schools destroyed or damaged, many have had to use borrowed space in other schools. Fear of radiation is haunting residents of the nuclear evacuation zone; some communities have refused to accept evacuees, fearing their community might somehow become contaminated.

Many Japanese are facing the most difficult stages of response to a complex disaster. The natural grieving process has been continually interrupted by stressors, initially food and water shortages, later aftershocks and radiation fears. The public and international support, almost overwhelming in the beginning, have now waned. As sporadic photographs illustrate, scattered debris have not yet been removed nor reconstruction started. Those who live in or near affected sites are beginning to fear that they are being abandoned. Their patience as they wait for long term support and direction is wearing thin. Addressing the mental health of survivors has become a key issue.

Physicians in the U.S. are continuing to play important roles in ensuring recovery for survivors. David J. Schonfeld, Director of the National Center for School Crisis and Bereavement at Cincinnati Children's Hospital Medical Center (www.cincinnatichildrens.org/school-crisis) has been collaborating with the National Center for Neurology and Psychiatry in Japan to provide written and translated resources to assist parents, teachers and pediatricians to address bereavement issues. Dr. Craig Van Dyke, Director of the Global Mental Health Program at the University of California San Francisco, has been invited to Tokyo to train pediatricians in identifying and addressing stress reactions and PTSD. As disaster relief continues, professional and nongovernmental organizations in Japan recommend collaboration, especially with pediatric and mental health experts, as natural and effective steps to meet critical needs.

- John Takayama

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