This page is adapted from the original transcript of NHK’s TOMORROW, broadcast on December 1, 2014
Many people lost their homes in the 2011 Great East Japan Earthquake.
Evacuees struggled to survive at evacuation sites or in temporary housing. But then they had to face a new threat.
It is a disease called “Disuse Syndrome”, which is caused by a major change in a person’s daily lifestyle. Due to a lack of opportunities to move, the functions of the whole body deteriorate.
It is potentially dangerous because it can lead to dementia or rendering a sufferer bedridden.
“I used to walk every morning and evening, but I can’t do it now.”
One town was a pioneer in recognizing the existence of this disease. It carried out a survey on the lives of the residents in consultation with a doctor and then started working on countermeasures.
Jason Hancock visits the town to find out what they did.
“Medical professionals have identified a debilitative condition that is known to significantly increase in times of natural disasters. If left untreated the patient’s bodily and mental functions will shut down. In this episode, I will take a look at some of the preventative and rehabilitative efforts by both the givers and receivers of care for this disease.”
(Jason Hancock: Reporter)
This was the situation at one of the evacuation sites two months after the disaster. Many of the evacuees did not have to move much, except at the three times a day when meals were served. The number of people complaining about their health condition gradually increased.
“My back was functioning before, but I’ve been driven to mostly lying down. I can hardly move my body so it’s become hard to get up.”
“My legs are getting weak, so I can’t walk or stand up.”
Jason visits Minamisanriku in Miyagi Prefecture, where more than 60% of the houses were destroyed by the massive tsunami.
Immediately after the disaster, over 50% of the residents were forced to live at evacuation shelters.
80-year-old Isao Watanabe, stayed at various shelters for five months.
“Is your house near here?”
“Yes. I’m here because of the tsunami.”
Before the disaster, Isao worked hard as a farmer out in the fields. He lived a busy life and hardly spent any time at home. The tsunami, however, washed his house away. As he was moved from one evacuation site to another, he fell into a state where he could not move his body as he wanted.
After two months, he was moved to a new evacuation site, which was this seaside hotel. Around the time he arrived here, he was starting to have difficulty walking.
In a short time, his condition got worse. He was getting so weak that those around him were worried, suggesting he should start using a wheelchair.
But it was not only at the evacuation sites that symptoms like Isao’s were observed.
Some of those whose homes had escaped damage were also experiencing changes in their health. Yoshio Sugawara is a fisherman. Before the disaster, he used to leave home at 5 o’clock every morning to go out to sea, and return home around lunchtime. After that, he was moving his body all the time, busily working on preparations for the next day’s fishing and other tasks.
But after 3.11, he had to stop fishing because his boat and all his fishing gear had been washed away. He began staying inside his house all day long.
Idling his time away at home, Yoshio was developing Disuse Syndrome without realizing it.
“How long did you stop fishing after the earthquake?”
“Well, I had a long break... About three months, I suppose... I did nothing for about three months.”
(Yoshio Sugawara (85))
His elder daughter Ryoko, who was living in the neighborhood, remembers his condition around that time very well.
“How did the earthquake change your father’s life?”
“I think he felt very low because he’d devoted himself entirely to the sea.”
One day, Ryoko realized something unusual. Her father went out to fetch some water because tap water was not available.
“I always thought he was strong. But when I saw him struggling to carry water like this, I realized he’d aged.”
“So, you thought he was getting weaker?”
“Yes, I did.”
“At one time, I couldn’t move my body. I couldn’t climb up the hill to here.”
“Your mobility range had narrowed?”
“Your mobility range had narrowed?”
Yoshio’s house is on a hill, about 20 meters above the port. He used to walk up the slope with ease, but suddenly he could not get up it without stopping several times to rest in the middle.
Changes in the physical condition of many elderly people started appearing after the disaster. The Town Office also noticed that was happening.
“It was obvious that many elderly people were aging very fast. At first, I just assumed that they had been mentally and physically devastated by the disaster, and that’s why they had turned into such a state.”
(Jin Sato: Mayor of Minamisanriku Town)
The town immediately decided to seek the help of an expert. For around 10 years, Dr. Dr Yayoi Okawa has been helping to improve life at evacuation sites by focusing on health issues at the time of disasters. She visited the stricken areas right after the Great East Japan Earthquake and conducted a survey.
“I went to the evacuation sites first of all and found that most of the elderly people were lying down.”
(Yayoi Okawa: PhD in Medicine, Advanced Industrial Science And Technology)
The unusual phenomena related to physical condition that were noticed everywhere in the stricken areas were, in fact, symptoms of ‘Disuse Syndrome’. The functions of the whole body decline as the result of an inactive lifestyle.
The initial symptoms include: ‘painful to walk’,
‘hard to get up’,
and ‘tiring to go up and down stairs’.
Although it is a common disorder amongst the elderly, age is actually irrelevant.
For example, if you have found it painful to move your body after staying in hospital for a while or having caught a bad cold, that is also ‘Disuse Syndrome’.
This disorder is rather frightening because the symptoms steadily get worse and worse. They appear when you do not move your body, and once you have the symptoms, it becomes painful to move, which discourages you from moving at all. So it often becomes a vicious circle.
If the syndrome is left untreated, your heart and lung functions deteriorate and you get short of breath. In the worst cases, it can lead to abasia, inability to walk, and eventually force you to become bedridden.
Minamisanriku Town Office decided to address the issue immediately.
“We asked Dr. Okawa to deal with this issue thoroughly, and told her she could use our staff to help her if necessary. What is ‘Disuse Syndrome’? We wanted to share the information with everyone at the office, so first we held a seminar that was attended by all our staff.”
Dr. Okawa explained the causes and countermeasures of Disuse Syndrome to the town office staff.
She also visited the scattered evacuation sites and temporary housing units and held seminars for residents. She told them that Disuse Syndrome could be prevented or treated depending on your attitude.
“Every possible function of the body deteriorates in Disuse Syndrome. You have to regard it as something completely different from a normal cold or stomach disorder which you may be familiar with. ‘Lifestyle’ is the keyword.”
(Dr Yayoi Okawa)
The treatment method is simple. All that is required is to move your body in your daily life. But that is easier said than done.
This is the hotel where Isao was living as an evacuee when it became difficult for him to walk.
The hotel opened it doors to many people who had suffered from the disaster.
Dr. Okawa came up with an unexpected request to the hotel staff. She asked them to refrain from providing service to the evacuees.
“For us, offering good service to customers is something we regard as a matter of course. But various services we provided up till then, such as preparing meals and cleaning up the rooms, were not actually required of an evacuation site. We were asked to do completely the opposite by leaving the residents to do as much as possible themselves instead of us offering them service. That was important.”
(Shun Ito: Hotel Staff, Minami Sanriku Hotel Kanyo)
So what should they do? The answer was…
“This is normally our banquet hall, but at that time it served as the dining room for the evacuees.”
The staff stopped carrying meals to the rooms but asked the evacuees to come down to the hall to eat instead. Following the suggestions of Dr. Okawa, they increased the opportunities for the evacuees to leave their rooms.
“We continued an approach that encouraged the evacuees to step out of their rooms regularly: for going to the toilet, taking meals, and coming down here to collect the water which was being distributed around that time. We tried to find different tasks to keep them moving around as much as possible.”
Isao had been recommended to use a wheelchair. Dr. Okawa met him at the hotel and gave him advice in person.
“It’s true that you can move around more quickly in a wheelchair if it’s pushed. However, if you spend every day like that, you may end up unable to walk at all. That’s what I told Mr. Watanabe and his caregivers. He had to decide whether he wanted to move around in a wheelchair or walk with a stick with someone in attendance.”
(Dr Yayoi Okawa)
In the end, Isao decided to walk around without using a wheelchair. By moving little by little in order to do things like getting meals three times a day and taking a bath, he gradually regained his usual physical condition.
Just over three years since then, Isao’s physical condition has completely recovered and he can now work in the fields again.
“You’ve really regained your health.”
(Dr Yayoi Okawa)
“I must stay healthy and make a living by doing something.”
“That’s the spirit!”
(Dr Yayoi Okawa)
Yoshio Sugawara was suffering from ‘Disuse Syndrome’ even while living at home.
Although it was becoming difficult for him to go to and from the port, his passionate desire to resume fishing never changed.
“I actually gave up going out fishing once. But I really missed the sea, and I wanted to go out again. Yes.”
After around six months, Yoshio slowly started preparing for fishing again.
Understanding his health condition, his daughter Ryoko did not attempt to stop him.
She was working at the town office, so she knew all about ‘Disuse Syndrome’.
“Making nets and things like that, I could see he was returning to his previous lifestyle little by little.”
Backed by the support of his family, Yoshio was able to restart fishing in Spring 2012. By moving his body, he was gradually recovering from Disuse Syndrome and regaining his physical condition.
“After I started fishing again, it took me six months to get back to normal. It was a long time before I could walk and go out to sea.”
These days, Yoshio goes out to sea almost every day.
For a while, he found it painful to move around, but now his life has returned to normal.
Amazingly, he had fully overcome Disuse Syndrome, and the community newsletter included an article about his recovery.
“My father appeared on the cover. This smile showed he’d got back to the way he was before.”
The strategy to overcome Disuse Syndrome is spreading in Minamisanriku.
Another part of the effort is the ‘Kagayaki supporter’ system created by the town with Dr. Okawa. The idea of the system is to ask residents to come up with ideas for encouraging evacuees, who tend to stay inside their temporary housing units, to come out and move their bodies.
“Basically, we ask everyone how they could use their particular field of expertise; for example, if you like dancing, you could invite residents out to dance with you, or show them how to dance. Or if you like singing, you could invite residents to join you and enjoy singing together. We are working on ways to bring all those who are suffering from Disuse Syndrome to come out and do something with other people.”
(Jin Sato: Mayor of Minamisanriku Town)
A dancing class was one of the ideas that emerged from these efforts.
Chikako Abe is playing the role of instructor. Before the disaster, she used to teach Japanese dance, but she was forced to stop her classes for a while after her house was washed away by the tsunami. But she heard about the Kagayaki supporter system and decided to start teaching again.
“Listening to Dr. Okawa, I thought I should get myself back in shape. I tried various things, but dancing was the best thing for me after all.”
(Chikako Abe: Kagayaki Supporter)
Some of Chikako’s students had almost fallen into Disuse Syndrome.
“Sleeping or awake, I try to move my arms all the time! But even after doing it 100 times, my movements still aren’t perfect.”
81-year-old Sachiko Sugawara is the oldest student.
Sachiko lives on her own in temporary housing. Her unit is very small, with a 4.5 mat room, a kitchen, and bathroom and toilet.
“This is the bathroom... and this is the toilet.
I used to live in a place like this...”
“In a house?”
“Yes, I ran a shop.”
Before the disaster, Sachiko lived in a two-story building which was a combined house and shop. She had run a bag shop for more than 50 years and lived a very busy daily life there.
Her house stood in a busy shopping street.
“I think it was around here... There was a road over there, and here as well… Ah, it’s changed so much it’s difficult to tell now.
Purchasing, meeting wholesalers, receiving goods, displaying them on the shelves…
I managed everything by myself.”
Every day was fulfilling, totally free from Disuse Syndrome.
However, her life was drastically changed after she started living in the present temporary housing unit in August 2011. There were few of her friends and acquaintances in the neighborhood, so she found herself surrounded by strangers.
“I knew the faces of my next-door neighbors, but I didn’t know their names. I knew the neighbor across the way by sight, but we never talked. I ended up fixing or mending things I was given and stayed at home. That’s how I spent my whole day, just wondering what I should do.”
Sachiko had not only lost the lifestyle she had before but also the relationships with the people around her. It naturally discouraged her from going out. That was her situation when she learned about the dangers of Disuse Syndrome at the seminar conducted by Dr. Okawa.
“When I heard the talk given by Dr. Okawa about Disuse Syndrome, I realized it was no good staying like this, and I should go out and be more active.”
One year after the earthquake, she decided to participate in the dancing class. As a result, she fully regained her energy. There was a secret behind that.
It was the performances the class presented several times at places like a local home for the elderly. The sense of purpose inherent in performing for an audience is in fact associated with a sense of satisfaction.
“When I performed, I had a real sense of achievement and it felt so good!”
(Dance class member)
“Dancing is something to live for. It’s so fulfilling.”
“Presenting a performance actually provides several benefits. It involves not just dancing, but also communication with those who are living in the venues, including a home for the elderly, increased connection with society, thinking about the significance of your role, and a sense of fulfillment. That makes a big difference.”
(Dr Yayoi Okawa)
Sachiko overcame the danger of falling into Disuse Syndrome through the dance performances and the encounter with new friends.
One popular initiative of the Kagayaki supporter system is growing vegetables. Many Minamisanriku farmers had their fields destroyed by the tsunami, so they are keen to restart farming in the hope that they may be able to recover something of their daily life before the disaster.
“What are you harvesting now?”
“This is spinach.”
“Spinach? I love spinach!”
“I give it to those who don’t grow anything and have them eat it, and I give it to my friends and have them eat it, too.”
“I enjoy farming, so I have no pain at all. Coming here cures me amazingly. I’m in finer shape being out in the fields.”
“Ah, you feel better if you work.”
The fields were provided by Motoko Endo, a Kagayaki supporter. She sees elderly evacuees regaining energy every moment.
“Just after the disaster, some elderly people were muttering, ‘I should have been washed away’. But now they’re gradually recovering their vitality and working earnestly saying, ‘My vegetables grew this big!’, and feeling the joy of harvesting they say, ‘I can have these for dinner!’ They also gradually communicate more with each other, asking, ‘When did you add the fertilizer?’ or ‘When did you sow them?’ They’re kind of competing with each other in terms of recovering their vigor!”
(Motoko Endo: Kagayaki supporter)
This farm also implemented another way to prevent Disuse Syndrome.
This field was left lying idle and covered with weeds. It had to be properly prepared before it could be used again for cultivation.
After the disaster, many volunteers from outside came here to help with clearing land ready for cultivation, but their support was limited to that.
The farm turned down offers from volunteers to actually cultivate the fields so that it could all be done by the evacuees themselves. The reason was that if everything is done by supporters, the evacuees could lose opportunities to move their bodies.
“When a disaster occurs, you shouldn’t just think the victims are weak. In fact they may be strong in many ways. It’s important to create situations in which they can enjoy doing fun things or whatever they want to do.”
(Dr Yayoi Okawa)
Minamisanriku has been a pioneer in dealing with the unfamiliar Disuse Syndrome. Three years and eight months since the disaster, the town’s recovery is still ongoing, but many of its residents are managing to restore their health condition to what it was before the disaster.
That’s what Jason has felt.
“Not only an issue for those living in evacuation sites or temporary housing. Not only for the Japanese, and not only for the elderly. Disuse Syndrome can affect anyone. As we found, to prevent and treat this condition, returning to an active and normal lifestyle is essential. I was very glad to meet those who have a comfort and health in the fields with each other in this area.”