REVIEWThe Medical Association Activity and Pediatric Care after
the Earthquake Disaster in Fukushima
Shintaro Kikuchi1,3 and Tatsuo Kikuchi2,31Koriyama City Post-disaster Childcare Project, Fukushima, Japan
2Koriyama Medical Association, Fukushima, Japan
3Kikuchi Pediatric Clinic, Fukushima, Japan(Received for publication on December 14, 2011)(Revised for publication on January 12, 2012)(Accepted for publication on January 12, 2012)

On March 11, 2011, a gigantic earthquake struck eastern Japan. Utilities such as electricity, water,
gas and telecommunication were interrupted. In Koriyama, the City Hall collapsed and government
administration offices had to be moved to a nearby baseball stadium that had been designed to include
facilities for use during a pandemic. An operations center was set up in this stadium. As members of theKoriyama Medical Association, we following the disaster protocol and set up our operations center inthe Koriyama Medical Care Hospital. One large hospital with 280 inpatients and another hospital with
150 inpatients had been heavily damaged. Transfer of those patients to other hospitals without the useof telecommunications was extremely difficult. Many doctors in member hospitals and clinics went outof their way to cooperate throughout the crisis. Up to 5,000 people from the radiation evacuation zone
were rushed to Koriyama. They stayed in schools and community centers, where we provided them withhealthcare. Even in Koriyama, which is 60 km away from the Fukushima nuclear power plant, radiation levels were high, especially for the first few weeks. Citizens were advised to stay at home and keep
their doors and windows closed. These drastic measures and frequent earthquake aftershocks werevery stressful, especially for children. To help prevent children from developing posttraumatic stressdisorder (PTSD), a project team composed of various groups caring for children was developed, and thisteam took action to protect children. Through these efforts we hoped to provide children with an appropriate environment to grow normally, even in a zone of persistent low-level radiation. We demonstrated
once again that our members’ long history of mutual assistance and cooperation with the administration was the main cornerstone to overcome the crisis. (Keio J Med 61 (1) : 23–27, March 2012)Keywords: medical association, child, radiation, Koriyama, Fukushima

Introduction

embarked on an unprecedented journey without a map
or guide. We needed to make prompt decisions and takequick actions. Nine months have passed and we can now
look back on what we have achieved for our community.
Summarizing what we learned in this crisis and presenting it in this article will help provide a guideline for dealing with unforeseen disasters in the future.

The ability to cope with an extremely severe disaster that completely destroys the community healthcare
system depends on the efforts of, and daily cooperation between, regional medical associations and local
government. On March 11, 2011, a massive earthquake
struck eastern Japan, followed by a tsunami and radiation exposure from the damaged nuclear power plant. As
part of Koriyama Medical Association, we immediately

Reprint requests to: Shintaro Kikuchi, MD, Kikuchi Pediatric Clinic, 1-14-21, Motomachi, Koriyama, Fukushima 963-8874, Japan, E-mail:taro-man@wit.ocn.ne.jp
Copyright © 2012 by The Keio Journal of Medicine
2324Kikuchi S and Kikuchi T: The Medical Association Activity and Pediatric CareFig. 1 Shelters were incorporated into the plans of the baseball stadium when it was rebuilt.

Collaboration with the Local Government in theImmediate Aftermath of the Earthquake
Koriyama City, located at the center of Fukushima
Prefecture, 60 km west of the nuclear power plant, has
a population of 340,000 and is a relatively large city inthis area. We experienced a large flood in 1998, and atthat time we tended to the medical needs of patients inshelters and accepted many displaced patients. Whenthe new strain of swine influenza became pandemic in
2009, we discussed with the local government our role inany future pandemics. The Koriyama Kaiseizan baseballstadium is located in the center of the city, has a large
parking area and is near the City Hall. We identified itas the main shelter for patients. When the stadium wasrebuilt, our concept was reflected in its design. For example, rooms for shelters were located in the space under
the stadium seats in the left and right wings, and the floorof the stadium was at road level so that ambulances could
easily enter or leave via the playing field (Fig. 1). Our
experiences during these disasters have brought us faceto-face with some of the most acute medical emergencies
at a community level.
Eastern Japan was struck by a severe quake of magnitude 6 on the Japanese earthquake scale (approximately
9.0 on the Richter scale) at 2:46 pm, when the authors
were working in their pediatric hospital. Soon afterwards,
the sky became covered with dark clouds, and it became
dark and cold as if it was evening, and snow began to fallwith wind. The authors’ building was seriously damaged
with large cracks in the walls. The rooms and halls werelittered with the many objects that had fallen to the floor.

It felt as if the end of the world had arrived.
Koriyama City Hall had partially collapsed and wasunsuitable for use. Administrative services were moved
to the baseball stadium, which is located nearby on theopposite side of the road, and a temporary administration center was established in the rooms that had beenoriginally prepared for use during pandemics. As part of
the Koriyama Medical Association (KMA), we set up ouroperations center in the Koriyama Medical Care Hospital(KMCH), which we run, according to our protocol andconsistent with the annual public exercise for emergency
in disasters. We started our operations in collaboration
with the city administration and our member hospitals
and clinics.
Soon after the earthquake, as many as 1000 people
rushed to the baseball stadium seeking shelter. The pitchers’ bullpens in both wings were opened to the people
as shelters (Fig. 2). The Self Defense Force stationed in
Koriyama Camp arrived and started the supply of waterand meals. Many volunteers also came forward to help
the people in need. Doctors and nurses were stationed
around-the-clock in the health care room and played arole in relieving the anxiety of those seeking shelter.
In Koriyama, infrastructure such as electricity, water,
gas and telephone systems were damaged. Big aftershocks occurred frequently. Many people went to originally designated shelters such as regional community
centers and schools, and we asked staff at nearby member
hospitals and clinics to visit these shelters. Visits by pediatricians were especially appreciated by the parents ofbadly affected children.

Keio J Med 2012; 61 (1): 23–27

25Fig. 2 Evacuees living in the bullpen shelters.

Cooperation of our Members to Restore
the Health Care System
Our emergency care system is composed of three stages: primary care clinics are for outpatient care, secondary
care hospitals are for those who require hospitalization,and tertiary care hospitals are intended for those who are
critically ill. However, almost all of our member clinics
and hospitals were partially or totally damaged by theearthquake and its aftermath.
One secondary care hospital, an 8-story building with280 beds, was severely damaged and had to be closed. Theelevators and stairs inside the building could not be used,
so inpatients were moved down the emergency stairs located outside the building. Critically ill patients weretransferred to tertiary care hospitals, and the remaining
inpatients were transferred to branch hospitals by buses
and trucks. Premature babies were carried out by pediatricians using the outside stairs and then transferred toanother hospital with a neonatal intensive care unit using
the private cars of hospital workers. Pediatricians fromdamaged hospitals temporarily joined the medical teams
at the hospitals to which their patients were transferred
and worked with them. To evacuate so many patients urgently to other medical facilities without telephone communication was extremely difficult.
The following day, the authorities warned that anothersecondary care hospital with 150 inpatients was at risk ofcollapse, and the inpatients needed to be transferred tosafe facilities immediately. The KMCH, where our operations center was established, arranged its rehabilitation
hall to accept the whole ward of this hospital includingpatients and the medical staff who cared for them. We
believe that the successful transfer of patients without any
casualties was achieved because of our long history of
dedicated practice for medical emergencies and the cooperation between our member clinics and hospitals.
Health Care of Evacuees from
Highly Contaminated Areas
On March 12, radiation began to leak from the Fukushima Daiichi nuclear power plant and many people
from the evacuation zone were rushed to the Koriyama
Municipal Gymnasium, which became their first shelter.
All evacuees, including children and elderly people wholived in care homes, were checked for surface radiation
exposure. The total number of examinations reachedmore than 28,000. If the surface radiation value exceeded
the limit, the person was decontaminated right away andwas then taken to the hospital. People whose exposurelevels were below the safe limit were directed to otherevacuation shelters.
The main shelter was set up in a big convention hall,

26

Kikuchi S and Kikuchi T: The Medical Association Activity and Pediatric CareFig. 3 Schema of the Koriyama City Post-disaster Childcare Project.

where a maximum of 2500 evacuees stayed. Doctors living in the evacuation zone, including the president of theregional medical association, were also evacuated to theshelter without their belongings. They voluntarily started delivering medical care to the evacuees. We set up a
medical team there and began to support its activities. We
found that cooperation with the regional medical association of the evacuation zone was crucial for providing
appropriate care in the shelter. Many doctors of the Japan
Medical Association Team (JMAT), medical coworkersand volunteers came to support us from all over Japan.
We really appreciate their support.
More than 5000 evacuees in total came to Koriyama
and settled in the many shelters. Our role was health care,with care of the children’s physical and mental wellbeing
our main concern. Pediatric support consisted of doing
the rounds of the shelters, running a primary emergency
clinic on weeknights and holidays, and supporting pediatricians in the secondary care hospitals. Pediatricians inKoriyama worked very hard throughout this period.
Care of Children in an Environment of
Persistent Low-level Radiation
In 2006, to counter the declining birth rate, the Koriyama City government organized a committee composedof experienced persons to discuss the problem and makesuggestions. The following year, they proposed establishment of a facility to support parents who were raisingchildren, especially those who had children with mental

health problems. It so happened that Koriyama City government took over a 6-story building from Fukushima
Prefecture at that time. The building was refurbishedand opened as the city child support center in 2009. The
children’s sections in the City Hall and the organization
which supported children with mental health problems
moved into this building. Other rooms were opened tovolunteer groups and to children as play rooms. The center, named Nikoniko Kodomokan, which means joyful
kids house, became popular among young families, with
the number of visitors reaching 600,000 in 3 years. Thiscenter later played an important role in our project to protect children.
After the earthquake, children feared aftershocks andclung to their mother whenever they felt tremors. Somechildren stayed close to their mothers all day. The Japanese government recommended the citizens of Fukushima to stay home with the windows and doors closed
to avoid radiation exposure. Due to a gasoline shortage,people were unable to use their cars and were obliged
to stay home all day, anxious about the present and thefuture. This drastic change of lifestyle was reflected inchildren’s facial expressions, behaviors and physical conditions. The authors of this article were afraid that many
children would develop posttraumatic stress disorder(PTSD). Therefore, we consulted Dr. Hisako Watanabe,a child psychiatrist at Keio University Hospital, about
the problems in Koriyama. Her advice was to secure aplace where children could feel safe, and to take action
to prevent them from developing PTSD. They discussed27

Keio J Med 2012; 61 (1): 23–27

the problem with the staff of the child support center andreached an agreement to set up a multidisciplinary teamto prevent children from developing mental health problems.
On March 29, the first official meeting of the Koriyama
City Post-disaster Childcare Project (KCPCP) was held.
The members comprised administration officers, pediatricians from KMA, public health nurses from KMCH,
clinical psychologists, and teachers and caretakers fromschools, kindergartens and nurseries. Together, they confirmed the following basic principles on promoting theaim of our project (Fig. 3). First, all members needed toshare the same concept about the current problems andthe goal of the project. Second, all members should cooperate with each other when they take actions in one
accord. Third, the project will not be short-lived but will
be a commitment over the long term. The project also
invited regional volunteer groups for children, especiallyvolunteer groups involved in reading storybooks (Fig. 3).
In Koriyama, volunteer groups who are engaged inreading storybooks to children have a long history andare very active. The members are those who have mostly
finished their busy child-rearing phase of life and haveplenty of time to spend with other children. They caneasily judge children’s state of mind while maintainingsome distance, which would allow them to notice subtle
changes in children while reading books. Thus they aregood candidates for detecting early signs of problems
in children. The KCPCP established a way for them toconsult us whenever they found anything worrying in thechildren they met.
Our activities over the past 9 months include distribution of leaflets that illustrated how to care for children
with anxieties, setting up children’s play corners in evacuation shelters, and organizing lectures by Kunio Yanagida, who is a non-fiction writer, a specialist in nuclear
power accidents and a facilitator of storybook reading,and Professor Joy. D. Osofsky, a world-renowned children’s trauma specialist from Louisiana State University. We also organized two large children’s festivals on
Children’s Day on May 5 and at the end of the summer
holiday to provide children with active indoor play andenjoyable physical exercises. The project team found thatmany pregnant women suffered from anxieties concerning radiation exposure. A volunteer group made up of
midwives visited the homes of pregnant women, listened
to their anxieties and provided them with advice to relieve their worries. The abortion rate did not increase after this disaster thanks to these home visits.
Nobody knows when our living environment will normalize and return to what it was before. The anxiety andstressful living conditions affect not only children, butalso their parents, schoolteachers and childcare personnel
in nurseries. Our project initially aimed to prevent PTSD,
but we are now obliged to take care of both the physicaland mental health of local children and their care providers. To compensate for the paucity of physical exercise inchildren, a project is underway to create a large indoor
play space, thanks to contributions from various people
in the community. We hope these acts of solidarity willbring a bright future to the children of Koriyama.
Conclusion
Although we survived the earthquake and its immediateand short-term aftermath, it has been a challenging time.
Our success in the face of this adversity can be attributed
to two factors. First, we had prepared for a large-scaledisaster by establishing the baseball stadium as a primaryevacuation facility and holding regular emergency drills
at KMCH. Those facilities were our operations center
during this disaster. Second, members of the medical
association had a good relationship with each other andalso with the administration. During this sudden crisis,
mutual support and collaboration led to greater success.
We again underlined the importance of disaster preparation and setting up a network of daily cooperation. We
are now fighting against persistent low-level radiation;
the solution has not yet been discovered. Although we
had not prepared at all for large-scale radiation exposure,the presence of a child support center provided us a basefor the promotion of activities to protect children. The
solidarity of various groups working for children will improve the situation for the children of Koriyama.