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Japan beyond 3.11 Stories of Recovery

GREAT EAST JAPAN EARTHQUATE PROJECT NHK WORLD
Pharmacists' Innovative Approach

This page is adapted from the original transcript of NHK’s TOMORROW, broadcast on October 6, 2014

Tomorrow Logo
Elderly people exercise

Japan is a country known for longevity.

Medicine

Many elderly citizens rely on medicine to support their health and their daily lives.

“Here’s your medicine.”
(Pharmacist)

Patient A

“I really depend on my medicine.”
(Patient A)

Patient B

“I can only keep going like this because of my medication.”
(Patient B)

Medicine

However, when a disaster strikes, many people find themselves left without any medicine.

In the earthquake and tsunami that hit Northeast Japan in March 2011, a huge number of elderly citizens lost their medication.

Patient C

“All of my medicine was washed away in the tsunami.”
(Patient C)

Elderly lady

“It was very tough without my medicine, really.”
(Elderly lady)

Team of pharmacists

The loss of both medicines and prescriptions soon created a situation of chaos. However, a team of local pharmacists sprang into action to restore order and resumed their dispensing operations in just four days.

How exactly did the pharmacists respond to the crisis?
American journalist Morley Robertson, who has covered many stories about the March 2011 disaster, visits Kamaishi City in Iwate Prefecture.

Morley Robertson

“This town was hit hard by the tsunami and as a result many lost their homes. They were forced to live in evacuation shelters. And there, they needed water, food and blankets just to keep warm in order to ensure their own survival. Additionally, there was a critical need for medical supplies. I’ll be interested in how local pharmacists responded to this crisis.”
(Morley Robertson: Reporter)

Morley in Kamaishi

We take a close look at the pharmacists’ efforts to discover how they were able to provide life-saving medication during the post-disaster chaos.

Pharmacists' Innovative Approach
Kamaishi population

Kamaishi has a population of 36,000.

Elementary school students greet morley

“Konnichiwa”
(Elementary school students)

Sakie Kokubun

74-year-old Sakie Kokubun is a resident of Kamaishi. For the past ten years, she has been participating in a program that keeps an eye on young children on their way home from school.

Sakie Kokubun: Kamaishi resident

Sakie Kokubun: Kamaishi resident

Sakie goes about her daily business with vigour, but in fact she suffers from an auto-immune disease, high blood pressure, and severe insomnia.

Sakie is dependent on her medicine

She is on six types of medication which she takes three times a day.

“I don’t think that I could survive without my medication.”
(Sakie Kokubun)

Sakie's medicine

On the day the disaster struck, Sakie only had a three-day supply of her medicine left.

She was just thinking of visiting the pharmacy to refill her prescription.

March 11, 2011 Great East Japan Earthquake

3.11 disaster scenes in Kamaishi

“It’s 3:21 p.m. This is the port of Kamaishi. The water’s gushing into the city!”
(TV Announcer)

Sakie's home

Sakie lives in the coastal area of the city, and the tsunami struck her house.

Flood damage

“The house was flooded. The water came all the way up to here.”
(Sakie Kokubun)

Second floor window

The first floor was completely flooded. Sakie narrowly escaped by going up to the second floor.

There was a power blackout and the earthquake aftershocks continued to worry Sakie. But she also had another concern, her medicine. She did not have much left.

Morley speaks to Sakie

“I really need my insomnia medicine and always keep some with me. After the tsunami, I was very worried about it running out.”
(Sakie Kokubun)

Sakie's medicine

Fortunately, Sakie was able to get her medicine the day after the disaster. Someone from her local pharmacy came by and delivered it to her.

“Someone from the Nakata pharmacy brought me my medicine. Everything around here was damaged, and there were no pharmacies left open. I felt so thankful.”
(Sakie Kokubun)

How did the local pharmacists respond and get medicine quickly to people in need?

Pharmacy locations

There were seventeen pharmacies in Kamaishi before the disaster. The tsunami badly damaged half of them.

Pharmacy locations

Five of the remaining pharmacies were operated by the same company.

A pharmacist personally delivered Sakie's medicine

It was a pharmacist from that company who delivered Sakie’s medicine.

Yoshihito Nakata: Pharmacist

Morley visits Yoshihito Nakata, the general manager of the pharmacies.

Pharmacy in disarray

The massive earthquake sent products flying from the shelves at the company’s pharmacies. The shops were left in a total mess, with medicine strewn all over the floor. But fortunately none of the employees were injured.

Nakata checked all five pharmacies

Immediately after the earthquake, Yoshihito went to check all five of the pharmacies. He felt a sense of relief to see that there was no tsunami damage at his shops, which are all located inland.

However, at the time Yoshihito was unaware that the coastal area had been devastated by the tsunami.

Early the next day, a city official informed Yoshihito that the tsunami had damaged a large part of the city. He was asked if he could provide help to the evacuation shelters.

Yoshihito Nakata

“That was the first time I knew that shelters had been set up and that people from the coastal areas were evacuating to them.”
(Yoshihito Nakata)

Reconstruction

At the time, Yoshihito’s pharmacies still had ample supplies of medicine.

Pharmacy staff

He and his employees split up into teams and headed out to the evacuation shelters.

To make people notice that they were pharmacists, they all wore matching company jackets.

Disaster guidelines for pharmacies and pharmacists

Disaster guidelines for pharmacies and pharmacists

Yoshihito followed the guidelines in a disaster management manual based on the 1995 Hanshin-Awaji earthquake, which he kept in case of emergencies.

It suggested taking ointments and medicines for treating physical injuries. The pharmacists gathered the supplies recommended by the manual and headed for the shelters.

No doctors at most evacuation centers

But when they arrived at the shelters, they realized that there were no doctors at most of them.

According to Japan’s Pharmaceutical Affairs Law, pharmacists are not allowed to dispense prescription medication without first receiving a prescription written by a doctor.

Reminder from the goverment

However, Yoshihito received a reminder from the health ministry.

When a doctors’ prescription is difficult to obtain, pharmacists may dispense medication

When a doctors’ prescription is difficult to obtain, pharmacists may dispense medication

It stated that during natural disasters when a doctors’ prescription is difficult to obtain, pharmacists are allowed to dispense medication without receiving a written prescription.

Pharmacists at hand

Yoshihito took the initiative and instructed his team to deliver medicine to as many people in need as possible.

When his team began asking evacuees what kinds of medicine they needed, they realized that the situation was rather different from what they had expected.

Differing reality

“We had imagined that there would be many people at the shelters who were in need of antibiotics and pain killers, and items for treating injuries and administering first aid. But when we got there, we quickly realized that most people needed medication for conditions like high blood pressure and other long-term diseases.”
(Yoshihito Nakata)

Medicine

There was not so much need at the evacuation shelters for the medication to treat injuries listed in the manual. But there was a huge need for medicine to treat high blood pressure and diabetes. In other words, the illnesses and conditions that existed before the disaster needed treatment urgently.

Essential medicines

“Many elderly people have trouble sleeping, especially in evacuation shelters, so we gave them sleeping pills. We mostly gave out those, along with medication for blood pressure and also diabetes.”
(Yoshihito Nakata)

Elderly patients forgot the medicine names

The pharmacists faced another major hurdle at the evacuation shelters. Many of the evacuees who had fled there did not know, or could not remember, the names of the medicines they took regularly.

Morley and Nakata

“So the evacuees couldn’t remember the names of their medication?”
(Morley)

“Right, but they remembered the color and shape. ‘They’re red and round.’ In many cases that was all they could remember.”
(Yoshihito Nakata)

“I’d be like that!”
(Morley)

“Or ‘It’s blue on the outside and white inside.’ We tried to figure out which medicine it was from their explanations.”
(Yoshihito Nakata)

“Could you guess correctly?”
(Morley)

“Yes. You see, certain kinds of medicines are used in this region. By asking the patients about their condition, such as high blood pressure, we were able to narrow down the name of the medicine. Then when the patient heard the name, they would usually say ‘Yes! That’s the one.’”
(Yoshihito Nakata)


The pharmacists distributed medicine at the evacuation shelters and at the same time helped patients who came directly to the pharmacies.

Tsunami damage

The tsunami had damaged nearly half of the pharmacies in Kamaishi. Within days of the disaster, more and more people fled inland from the coastal areas. The demand for medicine grew day by day.

Pharmacy

The number of orders coming to the Nakata Pharmacies was triple the usual amount. The pharmacists were overwhelmed.

Kosano branch became the HQ

Yoshihito decided to designate his largest pharmacy, the Kosano branch, as the headquarters for preparing medication.

Power cut

This photo was taken three days after the disaster. They were still out of power. The pharmacists had to use flashlights during the night to prepare the medicine.

Kazutoshi Machida: Pharmacist

Kazutoshi Machida: Pharmacist

“Do you remember the shelters’ names?”
(Yoshihito Nakata)

“Yes, I do.”
(Kazutoshi Machida: Pharmacist)

At the time of the disaster, Kazutoshi Machida was in his first year of employment at the Nakata Pharmacies. Looking back he says the team was really determined to help and save people in need.

Power cut

“We could work through the night, even without power, because we knew there were patients and people in evacuation shelters who desperately needed their medication.”
(Kazutoshi Machida)

Nakata's mother provided meals for staff

The team of dedicated pharmacists was supported by Yoshihito’s mother and their neighbours.

Even though there was no gas or electricity, they prepared meals every day for the pharmacy’s 30 employees using kerosene stoves and portable burners.

Yoshihito Nakata's mother

“It was very hard. But we followed the instructions of one of the members of our team who was keen on cooking.”
(Yoshihito’s mother)

Nakata works to restore the community structure

March 15th, four days after the disaster. As the situation began to stabilize, Yoshihito set out to start restoring the community structure.

Gathering information

He gathered information on all the hospitals in the city that were in operation and created a handout listing their current hours to distribute to the local residents.

Hospital exterior

He wanted everyone to know where they could go for medical help.

Medication handbooks

Medication handbooks

He also started handing out Medication Notebooks to his patients.

Prescription

The patient’s prescriptions are all recorded in the notebook. This way, patients have a record of their prescriptions handy and can quickly receive the correct medicine.

Morley with Nakata

“The patients who had their medication notebooks with them were able to receive their medicine quickly.”
(Yoshihito Nakata)


However many patients had fled from the tsunami without their Medication Notebook. Yoshihito gave out new ones along with the medicine. This made the process of refilling prescriptions more efficient in the months following the disaster.

Pharmacists

Thanks to medicine being prepared around the clock and the sharing of medical information, the situation in Kamaishi gradually became smoother four days after the disaster.

However, another problem awaited Yoshihito and his team.

Otsuchi-cho

Otsuchi-cho is located right next to Kamaishi. The two municipalities are in the same medical district.

The two municipalities form one medical district

In Japan, neighbouring cities and towns are teamed up to form medical districts and cooperate to provide healthcare. At the time of the disaster, healthcare workers considered these two areas as one region.

Disaster scenes

This is Otsuchi-cho two days after the disaster. Every hospital and pharmacy in the town had been badly damaged by the tsunami.

Staff from each district cooperate

Five days after the disaster, healthcare workers in Kamaishi and Otsuchi-cho banded together and set up a disaster management headquarters to handle medical care in the region.

Naohiro Terada

Naohiro Terada, a local doctor, directed the disaster management headquarters. He knew that pharmacists would be needed in the field.

Naohiro Terada

“I wanted to set up a system that ensured medicine would be distributed to the evacuees in the shelters and to patients who had lost their local pharmacy. Without having pharmacists on the team, our operation would not have worked. From the start, I knew that they would be a vital part of our team.”
(Naohiro Terada: Doctor)

Dr Terada recruited Nakata

Dr. Terada recruited Yoshihito from Kamaishi to join the region’s disaster management headquarters.

As a pharmacist who had been lucky to escape damage from the tsunami, Yoshihito was eager to help the residents of Otsuchi-cho.

Nakata

“When we heard that Otsuchi-cho had been completely destroyed by the tsunami, I knew that it was my duty as a pharmacist to do everything I could.”
(Yoshihito Nakata)

Otsuchi scenery

The evacuees in Otsuchi-cho were facing a severe situation.

Hideji Kurosawa

Hideji Kurosawa ran a general store just fifty meters from the coast. He suffers from a severe case of asthma.

“My asthma attacks trouble me. It’s very tough.”
(Hideji Kurosawa: Otsuchi-cho Resident)

He was unable to take his medication with him when he fled from the tsunami.

Kurosawa receives medical attention

Three days after fleeing to an evacuation shelter, he suffered an asthma attack. With no medication available, he was transferred by a Self Defence Force helicopter to a different evacuation shelter where a doctor saved him by administering an intravenous drip.

“I might have died without my medicine.”
(Hideji Kurosawa)

Dr Mamoru Michimata

At that time, Hideji was treated by Dr. Mamoru Michimata.

Dr. Michimata was also a disaster victim. He lost all his medical equipment in the tsunami.

Evacuation center

He evacuated to a disabled people’s center. There were more than 100 evacuees there in addition to the fifty facility residents.

Throughout the disaster, Dr. Michimata continued to examine patients at this center on his own.

Stethoscope

The only items of medical equipment at the center were a stethoscope and a blood pressure gauge, plus a three-day supply of stored medicine for the facility users.

Dr Michimata's medicine supply

Dr. Michimata knew he had to limit the use of the medicine. He was pressed to take desperate measures when treating patients to make the small amount of medicine last longer.

Dr Michimata

“Most of the patients were suffering from hypertension. I could only give medicine to those whose blood pressure was higher than 180. If it was lower than that, and they seemed alright, I told them a lower figure! That way they could get some temporary relief.”
(Dr. Michimata)

When Yoshihito began his work in Otsuchi-cho, the situation was beginning to turn desperate.

Nakata

“There were additional evacuation shelters being set up, and the situation kept changing every day. It was a real challenge figuring out what needed to be prioritized for that day.”
(Yoshihito Nakata)

Meeting

The Disaster management team had to stabilize the distribution of medicine in Otsuchi-cho. Yoshihito set out to achieve this by re-examining the traditional system of dispensing prescription medication.

Care structure

Usually patients go to a hospital where a doctor writes out a prescription for them.

Care structure

The patients then take the prescription to a pharmacy and receives their medicine from the pharmacist.

Care structure

However, following the tsunami, many patients in Otsuchi-cho had lost their homes and had no hospital to go to.

Yoshihito suggested an alternative system for distributing medicine.

Care structure

First, the doctors would go to the evacuation shelters to examine patients and write prescriptions.

Then the doctors themselves would take the prescriptions back to the Disaster Management Headquarters office.

Care structure

The prescriptions would then all be taken to a pharmacy where pharmacists could prepare the medicine overnight.

Care structure

The medicines would be delivered back to the headquarters the next morning, and the pharmacists would take them to the evacuation shelters and deliver them to the patients.

Care structure

Although the system sounds complex, it enabled patients in evacuation shelters to receive the correct medication and dosage without having to leave the shelter.

Volunteer pharmacists came from Osaka

The team was able to operate this new system thanks to four pharmacists who came from Osaka as volunteer workers.

Nakata with Morley

“I wanted the patients to receive their medicine directly from the pharmacist. This is because we could give them instructions about dosage and when to take it. By doing so, I think the patients felt more comfortable and less worried.”
(Yoshihito Nakata)

Osaka volunteers ran the system

From April, one month after the disaster, the pharmacists from Osaka helped run the system until it was running smoothly.

With the new system in place, the evacuation shelters in Otsuchi-cho, such as the one where Dr. Michimata worked, began to receive regular supplies of medicine.

Dr Michimata

“The pharmacists worked overnight to prepare the medicine which were brought to us the next morning. I felt so relieved to be able to tell my patients their exact blood pressure and prescribe the correct dosage instead of having to make amends. Things began to change after that.”
(Dr. Michimata)

The new system made distribution more efficient

The new system enabled the efficient distribution of medicine all over the town of Otsuchi-cho, and by April, the chaos slowly began to subside.

The alternative distribution method which Yoshihito came up with to deliver medicine to those in need is now referred to as the “Kamaishi model”.

The pharmacists’ approach to dealing with the disaster is being passed on to others today.

Disaster drill

On August 30th, 2014, Iwate Prefecture held a disaster prevention drill.

Doctors and pharmacists also participated

Doctors, members of the Self-Defence Forces and pharmacists, including Yoshihito, were on the frontline.

Nakata instructs drill participants

“Please take the initiative and use your discretion as pharmacists.”
(Yoshihito Nakata)

A booklet created by pharmacists

The pharmacists have prepared a booklet complete with photos of medicine to help patients.

They hope this will make the process of figuring out the patients’ prescriptions more efficient.

Pharmacists training with patient actors

“The package was silver. And the pill was kind of a brownish color.”
(Patient actor)

“It may be Crestor-5. The package isn’t clear and it’s brown.”
(Pharmacist)

“It’s red on the outside and white when you take it out? I see... It could be this one...”
(Pharmacist)

Pharmacists training

“This one.”
(Patient actor)

“OK, Great. Now we’ve figured it out.”
(Pharmacist)

Kamaishi pharmacists

Since the disaster, Yoshihito has used the “Kamaishi model” to actively guide other pharmacists throughout Iwate Prefecture.

And Iwate hopes to share Kamaishi’s experience in disaster management with other prefectures around Japan.

Hiromi Hatazawa: Chairman of Iwata Pharmaceutical Association

“The Kamaishi pharmacists did tremendous work during the disaster. Would you say they’re a model case?”
(Morley)

“Yes, I think our experience in Kamaishi is a very good case for others to consider. We will write up a manual for the prefecture. And I really hope that we can present our case nationally with the Japan Pharmaceutical Association so that others can learn from our experience.”
(Hiromi Hatazawa: Chairman, Iwate Pharmaceutical Association)

Temporary housing, Otsuchi

Since the disaster, a trend has been noticed among the elderly residents in Otsuchi-cho.

Elderly residents

They now carry their “Medication Notebooks” with them at all times.

Elderly patient

“I take it with me everywhere. My important phone numbers are written on it: my daughter’s, her work number, and a relative’s. So they can be notified and come to help me.”
(Elderly lady: Otsuchi-cho resident)

Medication handbook

Today, all the “Medication Notebooks” in Iwate Prefecture have an important message printed on the cover: “Keep this notebook with you at all times”.

Morley summarises

“After the tsunami struck, many local residents lost their homes and they were forced to live in evacuation shelters. As the days went on, what was needed most was not so much acute medical care as long-term medical care for their chronic illnesses, such as diabetes and hypertension. So the local pharmacists stepped in. They organized a coordinated system of efficient delivery of their required medicines. This Kamaishi model may offer important clues for future responses to disasters.”
(Morley)

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