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Dialysis Discussion => Dialysis: News Articles => Topic started by: Meinuk on March 31, 2011, 01:22:17 PM
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Kidney International advance online publication 30 March 2011;
http://www.nature.com/ki/journal/vaop/ncurrent/full/ki2011106a.html#top
Diary of a Japanese nephrologist during the present disaster
Masaomi Nangaku1 and Tadao Akizawa2
1. 1Division of Nephrology and Endocrinology, University of Tokyo School of Medicine, Tokyo, Japan
2. 2Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
Correspondence: Masaomi Nangaku, Division of Nephrology and Endocrinology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail: mnangaku-tky@umin.ac.jp
11 MARCH 2011
I (M.N.) was at the ward on the third floor of University of Tokyo Hospital for consultation of a patient with acute kidney failure following chemotherapy of ovarian cancer. I suddenly felt shaken, and looked around. All the doctors, nurses, and patients looked baffled, and then someone shouted “Earthquake!” Computers started to slide on the desks, and the doors of the patients' rooms opened and closed, making loud noises. I grabbed the desk not to fall down, and we shouted to the patients to stay in the rooms.
After what seemed like a long time, the shaking subsided. We learned later that the earthquake had lasted 5 minutes; this is incredibly long (the duration of the Kobe earthquake in 1995 was 15 seconds). We first checked to make sure the patients were safe, then I left the ward to check the rest of the floor. All the fire doors were closed, and elevators stopped. I found cracks in some windows and floors, and a number of people were out in the parking lot.
You can never use cell phones in such a situation. We checked the Web and television and found out that there had been a giant earthquake in the Tohoku region. Sendai, the capital of Miyagi prefecture, is about 350 km away from Tokyo and had the most severe intensity. The Japan Meteorological Agency named this earthquake the 2011 Off the Pacific Coast of Tohoku Earthquake and reported its magnitude as 9.0. The total energy released was calculated as 3.9 × 1022 joules, which is equivalent to 600 million times the energy of the atomic bomb used in Hiroshima. Every television station, radio station, and website commanded emergency evacuation from the coastal areas because of possible tsunamis. Japan has had many previous earthquakes and tsunamis, and we were prepared—or at least so we thought. The tsunami breached the largest breakwater in the world in no time, and we were horrified to watch the news of this event. As evening came, the government’s chief cabinet secretary reported malfunctioning of the cooling mechanism of the nuclear power plants in Fukushima at 7:03 p.m. By then we had learned that none of the Tokyo railways and subways were running. I found out that our night-shift doctor was not coming, because she had no means of transport. I had to stay in the hospital all night long. Our hospital, and other government facilities, announced that they would provide space for one night’s stay for the people who could not go home. People with blankets slept in chairs or on the floors of our hospital. That night I saw fewer patients coming by ambulance and more patients coming with their own cars; no ambulances could be called, owing to failure of phone lines. We had aftershocks every 10 minutes and could not sleep.
12 MARCH
We read the morning newspapers, but it was clear nobody really knew what was happening. The numbers of dead and missing reported at that time were only 133 and 530, respectively, but we knew that this was merely due to lack of information.
In the Tohoku area, electricity was unavailable, and there was no water supply. Dialysis patients who could get the information went somehow to the few facilities that remained relatively intact. We heard that Toshinobu Sato at Sendai Shakaihoken Hospital and his group performed 2.5-hour hemodialysis six times a day for four days without sleep until other facilities recovered some functions. Doctors with Disaster Medical Assistance Team licenses (regulated by the Japanese Health, Labor and Welfare Ministry) rushed to the afflicted areas. They found that, unlike after the Kobe earthquake, when many patients had crush syndrome and dialysis was life-saving, the tsunami had caused many fatalities by drowning.
News of partial meltdown of the fuel rods in reactor 1 of the Fukushima nuclear power plant kept trickling down to us, and by 3:36 p.m., reactor 1 exploded, releasing hydrogen gas. The government ordered evacuation of those who lived within 20 km (12.4 miles) of the plant and advised those within 30 km to stay. Now, not only were there a large number of evacuees, but there was a shortage of electrical power in large areas.
13–15 MARCH
The news got worse. On 13 March, a partial meltdown was reported to be possible at Fukushima unit 3; on the 14th, reactor building 3 exploded. On the 15th, a fire broke out at reactor 4. The explosion in reactor 3 also resulted in severe damage to reactor 2. As roads were under reconstruction, and thanks to the continuous efforts by mass media as well as partial recovery of personal communications, real news started coming to us from the afflicted areas; a shortage of water, dialyzers, reagents, electricity, and gasoline became more evident. We heard that perhaps 500,000 people had begun to leave their homes. We were expecting 15 patients to be transferred to our hospital from Fukushima by helicopter on 15 March, but the bad weather delayed the flight.
16 MARCH AND THEREAFTER
There are three kidney societies in Japan: the Japanese Society of Nephrology, the Japanese Society of Dialysis Therapy, and the Japanese Association of Dialysis Physicians (JADP). We also have a Web-based crisis information network, managed by Chikao Yamazaki of the JADP, where, during a major crisis, doctors record their current status and voice the needs of their facilities so we can check them in real time. Each prefecture has a physician responsible for crisis control. Because Yamagata prefecture, located west of Miyagi and Fukushima prefectures and not on the Pacific, suffered less damage, 153 dialysis patients were transferred there, and Minoru Ito and Ikuto Masakane did a great job of accommodating this sudden influx.
Four hundred sixty dialysis patients moved to Tokyo metropolis, where Takashi Akiba and Yasuhiko Iino were responsible for controlling this difficult situation. Those patients whom we had expected to arrive by helicopter the day before came to us by land first thing in the morning of 16 March, accompanied by one doctor and one nurse. We assigned one or more doctors to each patient and, after a preliminary examination, dialyzed them. All the patients weighed less than their dry weights and were hypokalemic because of shortage of food and water. They looked really sick on their arrival, but the next day we found them in a much better condition. They said that shortage of food and lack of sleep in the evacuation center had been a tough experience. Although Tokyo is a huge city with a number of hospitals, we had a “rolling blackout,” an intentionally engineered electrical power outage in which electricity delivery is stopped for non-overlapping periods of time over geographical regions, which raised concern about transfer of more evacuees to Tokyo and nearby areas.
Niigata prefecture east of Fukushima was well prepared for the disaster, having had a big earthquake in 2004, and 152 dialysis patients were transferred there to the care of Jun-ichiro Kazama and Ichihei Narita. But many patients hesitated to leave their homes and changed their minds often, resulting in some confusion about the number of people arriving. Many people were frustrated and scared at the crisis centers, and they did not really know which facility could potentially accept them or which might have space. It is very important in such cases to identify one person as the source of genuine information. Narita and Kazama got the news that the patients would come the next day, 17 March, at 11:00 p.m. They talked with the prefectural government, set up lodgings, talked with the dialysis facilities, and went to the prefectural government with other doctors to pick up the patients on 17 March.
On 22 March, special airplanes of the Japan Self-Defense Forces transported 80 hemodialysis patients from Miyagi to Hokkaido, the largest and northernmost island in Japan. Mariko Miyazaki of Miyagi and Shuhei Tozawa and Atsushi Wada of Hokkaido managed the transfer and treatment via the crisis information network of JADP. All the patients needed in-hospital dialysis, and 11 hospitals in Hokkaido admitted and managed them.
In contrast to hemodialysis patients, peritoneal dialysis (PD) patients seemed to have fewer problems, as they could continue their therapy as long as they had a place to change bags and an uninterrupted supply of PD fluids. Four PD patients are missing, and although shortage of supplies of PD fluids was a problem, it is getting solved thanks to efforts by involved persons.
21 MARCH
By now we have had 262 aftershocks with a magnitude of 5 or more, 49 of a magnitude of more than 6. We are seeing and hearing of a new syndrome, “earthquake sickness,” in which people feel that the land is shifting under their feet. The police said 8649 are dead and 13,262 missing. I am sure the numbers will increase. The Nuclear and Industrial Safety Agency estimated the International Nuclear Event Scale of the Fukushima nuclear power plant as level 5, equivalent to that of the Three Mile Island accident in 1979.
Under these extraordinary circumstances, the dedication of the people has been beyond description. Those in the afflicted regions and in the evacuation centers were caring for each other. Much kind help from other countries has been really encouraging. The situation in the afflicted areas is finally beginning to improve, but the prospect of the nuclear power plant accidents remains the most worrisome. We will hang in there until the evacuees can go back home safe and happy. And we hope that we can learn important lessons for the future from this tragic disaster. We need to go over what went wrong and what went right and report it—in the future, but not now.
DISCLOSURE
The authors declared no competing interests.
*Thank you to Kathleen Egan for sharing this resource.
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Wow!