2.46pm 11th March 2011. The time in which thousands of Japanese peoples lives drastically altered forever. The question is, was Japan ready for the sudden medical needs of a population rocked by an earthquake of such large a magnitude? And do leading world politicians have an obligation to provide help? It also leaves the question of whether there is a place for emergency medicine as an elective for UK students. Firstly we must look at how to deal with, as prime minister Naoto Kan put it Japans ‘worst crisis since the war’.
It is not the first time Japan has been hit by such ground breaking tremors. The Kobe earthquake of 1995 killed 6,433 people, and that only had a magnitude of 7.2, in contrast to this months which reached 8.8. The crucial difference between the two earthquakes can be observed in the succeeding tsunami of the second quake washing away any hope of a quick recovery. So far, over 10,000 people have been confirmed dead with a further 17,440 people missing and with half a million people still homeless, medics have their work cut out in keeping the medical surge at bay.
There is then, of course, the unprecedented threat of radiation escaping from Fukushima nuclear plant, possibly burdening a generation of Japanese doctors with the aftermath of disease caused by the nuclear fallout. Iodine-131 will cause cancer within a few year if ingested or inhaled. If the Iodine-131 does escape, oncologists will be overawed with new challenges for decades to come.
Prophylactic measures have already been taken for those in high risk areas. Previously, the Japanese government had stockpiled potassium iodide pills for this eventuality. These are in limited supply though, and are only being distributed to those at greatest risk.
Furthermore, help is being received from the British government which has deployed 63 ‘relief specialists’ to help with the search and rescue across Japan. The problem is, according to the BBC, only 4 of these people are doctors. With an estimated 20,000 injuries, are such a small number of specialists able to even begin to scratch the surface in helping this small but hugely significant country recover?
International financial support is no doubt evident, with close neighbour China providing $4.5 million worth of humanitarian aid. Moreover even countries with their own political and economic problems have jumped at the opportunity to support Japan, with Afghanistan pledging $50,000 to support relief efforts. It seems the nation described by the UN as ‘generous in its support to others’ is reaping the benefits of its past generosity. The main problem is that there are simply not enough medics and nurses to administer the medical supplies which are arriving.
This opens the debate of whether it is feasible to create electives in disaster medicine to support the currently minuscule specialty of disaster medicine. Many physicians offer assistance in these situations, but are they equipped to deal with the situation? Although no specialist in disaster medicine ever wants to use their knowledge to its full potential, disasters will always occur.
Disaster consultants do have a role in preparing countries such as Japan for these situations. Without their work, the damage would have been significantly larger. Thanks to their work, Japanese people are in a constant state of preparation for ‘the big one’. Everyone knows what to do should the earthquake alarm go off, and with thanks to ingenious engineering, they can cope with smaller quakes. It was not possible to have foreseen and prepared for the tsunami in the same way though, due to our lack of knowledge on how they work.
The specialty of disaster medicine is a competitive one, and with UK medical students finding it difficult to gain experience through electives, maybe it could be introduced as a BSc. This would allow students to get a grasp of the specialty, and gain experience in what is often an inaccessible branch of medicine.
Then again, it is an inaccessible specialty for a reason. In a world where AIDs is killing 1.8 million people per year (2009 figures published by UNAIDS), is it justifiable to increase spending on what an epidemiologically insignificant cause of death? Although everyone has sympathy for Japan and all loss of life is significant, it makes you wonder whether there are bigger fish to fry first.
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