PCAT Activity Report 2011

Japan Primary Care Association/Primary Care for All – Team:PCAT  Activity Report 2011


Starting up PCAT
- Basic Policy of PCAT
- Special Features of PCAT (1,2,3 )
- Activities
- PLAN for 2012



Starting up PCAT 

11th March 2011
An earthquake of magnitude 9.0 occurred.

12th -13th March
Japan Primary Care Association established  a new branch, Primary Care for All Team (a.k.a. PCAT), to conduct medical relief work.

17th March
PCAT sent doctors to investigate and provide support in the south of Iwate Pref. They settled in Fujisawa town hospital in Fujisawa town, a hub for northern  Miyagi Pref. and for southern Iwate Pref.Investigated and confirmed the situation of the medical institutions, the medical personnel, and the damage of  Kesennuma city.Started to support medical personnel who were to tired from treating the sufferers though they were victims themselves.

19th March
PCAT sent a doctor and an investigator to Fukushima Pref. and settled a hub in Yumoto clinic in Ten-ei village for operation in Fukushima.Investigated and confirmed the situation of the medical institutions in Tamura city, Iwaki city and the area within 30 km of the nuclear plants.Continued the investigation there and started treatment in several small shelters.

21st March
PCAT sent two doctors to the northern part of Miyagi Pref. and settled in Wakuya Hospital in Wakuya town, a hub for northern Miyagi Pref.Investigated and confirmed the situation of the medical institutions in northern Miyagi Pref. (Ishinomaki city, Higashi-matsushima city, Minami-sanriku town), and southern Iwate Pref. (Rikuzen-takata city, Ohfunato city, Tohno city).Went around regions and gathered information on expecting & nursing mothers to find out about their safety.

In this way, PCAT expanded its activities from <Fujisawa hub> in the southern part of Iwate & the northernmost part of Miyagi, to <Wakuya hub> in northern Miyagi, to <Ten-ei hub> in Fukushima.


Fundamental Policies of PCAT

Through research and support of earthquake victims from March to early April 2011, we decided on the following basic policies for  our relief work. They are based on five fundamental ideas: Accessibility, Comprehensiveness, Coordination, Continuity and Accountability.

- Develop a bottom-up medical and health support system which emphasizes continuity, permanency, and the respect for local people and culture.
- Involve various kinds of professionals to meet the diverse needs of the victims and provide comprehensive support to the stricken areas.
- Educate people on medical and health care to prepare for possible future disasters.

We put emphasis on continuity and accountability, and drew up a plan that would support victims for at least two years until the local medical and health care system is stabilized.


Features of PCAT Activities 1
Organized support for neglected groups.

One of the special features of the PCAT’s support is its Accessibility to the group/society/service who are neglected by Social Accountability.

Examples of the neglected groups that PCAT supports -
The physically vulnerable
the elderly,the individuals requiring long-term care, the physically/mentally handicapped.
The socially vulnerable
the victims at home (who did not take shelter), women(expecting and nursing mothers).
The suffered aid workers: medical  professionals(private clinic doctors, doctors, nurses and clerks of municipal hospitals), public officers(policemen, firemen, emergency life-saving technicians).
Absolute lack of the medical care service
Qualitative (night duty of doctors, obstetric medical care, palliative care and autopsy). Quantitative (The depopulated area which is difficult to access and which initially lack medical  care – Motoyoshi district Kesennuma city, Ogatsu district Ishinomaki city, and Kitakami district Ishinomaki city. The area – Iidate village, Minami-Souma city etc., where many of the medical personnel and the youth were left despite the nuclear reactors and residual radioactivity.

— The support for these neglected groups led to discovering unseen problems. It furthered communication between supporters and neglected groups, involving individuals who can also cooperate with the groups. This enabled larger scale activities and activities which are truly necessary.

e.g.) The development of aid work in Kesennuma.

Medical personnel, who were disaster victims themselves, worked on autopsies that were neglected by external medical supporters. The PCAT substituted for these autopsies so that they could rest.

By supporting doctors in the affected areas to restart at-home diagnosis,  we discovered that the victims dependent on residential care have been neglected. For the elderly victims who require long-term care, PCAT established a home-visiting supporting group called JRS, and launched a service which offers at-home diagnosis.

In the Motoyoshi district which originally was neglected medical care, PCAT found that there are many people who require long-term care and who are seriously ill. JRS cooperated with the new director of the Motoyoshi Hospital, and started a system to support Motoyoshi Hospital by sending resident doctors.


Features of PCAT Activities 2
Understanding people’s needs and extending support through the efficient communication of information.

A feature of PCAT activities is  that victims in the disaster areas are seen and treated comprehensively. Through the coordination of a multidisciplinary health team, we were able to fully grasp the needs of victims. This also enabled us to effectively exchange information with external associations  and further extend support.

e.g.) The cause of an increase in pneumonia among the elderly population and the solution.

The increase of pneumonia among the elderly was reported to the headquarters for disaster control. The reported cause was the abuse of antibiotics by supporting physicians . New bacteria that are strongly resistant may have bred and caused infections to expand. For treatment, disaster countermeasures office gave instructions to prescribe stronger antibiotics.

The problems observed by PCAT’s multidisciplinary health team -
The meals consumed in evacuee shelters. The lack of consideration for individual needs―the elderly people, pregnant women, children, and those having chronic illness
Dentists, dental hygienists:
Malfunctioning of artificial teeth caused by the life in shelters, the problem of intraoral hygiene,  and the environmental restrictions which made it difficult for evacuees to brush their teeth (the lack of water, tools, and the places).
Physical Therapists, Occupational Therapists:
the decline of ADL(Activities of Daily Living)  caused by insufficient exercise for those who require long-term care in shelters or at home. Posture problems caused by taking  meals where there were shortages of chairs, beds, and people for aid.
Victims as well as aid workers and local medical personnel got stiffness in their whole bodies. Medical personnel who were victims themselves were extremely fatigued.

Solution for the problems.
- The doctors on night duty walk around the shelter, and see the elderly patients with aspiration pneumonitis.
- By communicating and collaborating with the multidisciplinary health team, PCAT let the people understand the high risk of pneumonia.
- PCAT reported the possibility of an aspiration pneumonitis to be higher than the possibility of a spread of drug-resistant pneumonia.
- To PCAT executed these measures and also  reported to the disaster countermeasures office to call for aid by other professionals .


Features of PCAT activity 3
Extending continuous support by multidisciplinary professionals and volunteers.

It is difficult to carry out the basic idea of Primary Care and to maintain ‘Continuity’ in the practice. However, PCAT has been aiding the stricken areas by valuing the concept of “Kizuna”, which means the ‘link’ between people.

The organizations that we have linked together -
The administration and the local medical associations:
Ministry of Health, Labor and welfare, Tohoku Branch office. Ichinoseki city, Fujisawa town, Toono city, Rikuzentakata city (Iwate prefecture). Kesennuma city, Minamisanriku town, Onagawa town, Ishinomaki city, Higashimatsushima city, Wakuya town (Miyagi prefecture). Minamisouma city, Iidate town, Kooriyama city, Shirakawa town, Ten-ei town (Fukushima prefecture).
The medical institutions in the stricken area:
Fujisawa Municipal Hospital, Kesennuma Municipal Hospital, Wakuya Municipal Hospital, Kesennnuma city Motoyoshi Municipal Hospital, Shizugawa Munisipal Hospital, Onagawa Municipal Hospital, Ishinomaki Municipal Hospital, Ishinomaki Ogatu Clinic ,Ishinomaki Red Cross Hospital, Higashimatsushima Royal Hospital, Abe Obstetrics Clinic, Narita Clinic, Yu Home Clinic Ishinomaki, Kesennuma Otomo Hospital,Mori Obstetrics Clinic, Muraoka Surgical Clinic.
Academic and professional groups:
The Japan Dietetic Association, Japan Dental Association, The Japan Society of Pediatric Surgeons, Japan Pharmaceutical Association, Tokyo Medical Association, The Japan Academy of home care physicians, National Center of Neurology and Psychiatry, Japanese Midwive’s Association, Chronic care nursing laboratory – Hiroshima University, Rehabilitation nursing – Hiroshima University, School of International Health – The University of Tokyo etc.
NGO, enterprises and others:
Bare foot doctors, Health and Global Policy Institute, Project-HOPE, AmeriCares, NPO Cannus, ETIC, Care Pro, Care Net, Project Yui, The disaster acupuncture and moxibustion project, NPO JEN, Mediva co, Leading Aging Society Forum, Fujitsu co. etc.

Creating a link among the various organizations resonates with the five fundamental ideas of Primary Care:
Accessibility, Comprehensiveness, Coordination, Continuity, Accountability. The examples are as follows.

e.g.1) The project of perinatal medical care in the northern part of Miyagi prefecture.

Through the research conducted in Minamisanriku town, it was revealed that there was no information on the safety of maternity women. PCAT, Primary Care obstetricians and maternity nurses started a search to care for pregnant women. PCAT established a team called PCOT (Primary Care Obstetricial Team) consisting of the gynecologists and maternity nurses, and began health consultations for pregnant women in shelters and at home. PCAT cooperated with Japan Midwives Association and Tokyo Midwives Association to establish the ‘Tohoku Sukusuku Project’, which aims to ensure that women are able to give a birth in safe places.

The public health nurse in Higashi-Matsushima city asked PCAT to visit newborn babies.  PCAT started health consultations for the pregnant women, puerperants, and newborn babies.

PCAT launched a mobile phone website for pregnant women and childcare.
It was discovered that over 60% of the facilities for childbirth in the northern part of Miyagi prefecture did not function. PCAT sent obstetricians and gyneocologists  to Abe maternity clinic where childbirths concentrated.

In Kesennuma area,  childbirths  concentrated in Kesennuma City Hospital. To avoid the concentration of childbirths in one hospital and to enable reconstruction in the area, rebuilding the Mori maternity hospital became necessary.

Since PCAT cannot support this alone, our association asked the medical management consultant Mediva to help. ‘The group for protecting the local medical care in the Tohoku earthquake stricken area’ was established and has started work.

e.g.2) The project to aid people who requiring special care in Ishinomaki city.

From previous experience in Kesennuma city, we expected that people requiring long-term care at home are neglected. Thus, we made our decision to intervene in Ishinomaki ciy. We cooperated with the JIM-NET (NGO) which had already started the search for people requiring long-term care and investigated with them.
To gather those who require long-term care in one place, we cooperated with the Ishinomaki City Hospital team which was finally rescued to establish the largest evacuee’s facility for long-term care.

In association with the social welfare conference, we started to move the individuals requiring long-term care from the shelters to general nursing facilities. However, the lack of the nursing facilities were realized.

Because the Ishinomaki City Hospital was damaged, the patients suffering from terminal cancer concentrated in Ishinomaki Nisseki Hospital. It pointed out the lack of palliative care services.

To offer medical and palliative care in temporary housing, we cooperated with Leading Aging Society Forum (NGO), to establish Home-health-care services for temporary housing. PCAT continues to introduce professionals to this Home-health-care services for temporary housing. We also conduct health consultations in temporary housings and diagnostic visits for victims who requiring long-term care or who are terminally ill.



PCAT Activities
Support for evacuees in shelters
- Support for evacuees at home
- Particular group/public health support
- Relief work for suffering doctors and damaged hospitals
- Relief work for the residents in temporary housing or at home
- Data









Support for evacuees in shelters:
Medical support in the shelter K-Wave ( Kesennuma city, Miyagi Pref. /Mar. – Apr. 2011 )
Medical support in the shelter Kesennuma Jr.-high school ( Kesennuma city, Miyagi Pref. /Mar. – May.2011 )
Medical support in the shelter Ohsu Jr.-high school ( Ogatsu district Ishinomaki city, Miyagi Pref. /Mar.2011 )
Health counseling in the shelters  in 25km area from the Nuclear power plant ( Iwaki, Minami-souma, Tamura city, Fukushima Pref. /Mar.2011 )
Health counseling in the shelter in Kohriyama city ( Kohriyama city, Fukushima Pref. / Apr. – May.2011 )
Medical support in the special shelter for elders requiring nursing care Yu-Gaku-Kan ( Ishinomaki city, Miyagi Pref. / Apr. – Sep.2011 )
Medical support in the special shelter, Short Stay Base a.k.a. SSB ( Ishinomaki city, Miyagi Pref. / Jun. – Jul.2011 )


                                                 ©Atsushi SHIBUYA







Support for evacuees at home:
JRS, support team of home visiting care doctors ( Kesennuma city, Miyagi Pref. /Apr. – Sep. 2011 )
Medical support for people requiring long-term care at home in Kahoku area ( Ishinomaki city, Miyagi Pref. / Apr. – Jun.2011 )









Particular group/public health support:
Search for pregnant women / Public health counseling : PCOT Project ( Minami-sanriki town, Ishinomaki, Higashimatushima city, Miyagi Pref. / Mar. – May.2011 )
RHITE Project ( Kesennuma city, Minami-sanriku town, Ishinomaki city, Miyagi Pref. / May.2011 )
Pneumococcus vaccination Project ( Kesennuma city, Miyagi Pref. / May.2011 )
Visit counseling to mothers having a newborn Project: PCOT Project ( Ishinomaki, Higashimatushima city, Miyagi Pref. / Mar. –  Dec.2011 )
Children-rise counseling Project : PCOT Project ( Ishinomaki, Higashimatushima city, Miyagi Pref. / Mar. –  Dec.2011 )
Health counseling to residents around the nuclear plant ( Iidate, Minami-souma, Souma, Tamura city, Fukushima Pref. /Jun.- Aug.2011 )
Mental counseling in SSB - Short Stay Base: Ψ Project ( Ishinomaki city, Miyagi Pref. / Jul.2011 )
Mental counseling in Yu-gakukan: Ψ Project ( Ishinomaki city, Miyagi Pref. / Jul. – Sep.2011 )
Mite Busters Project ( Ishinomaki city, Miyagi Pref. / Jul. – Sep.2011 )
Dispatch of obstetricians Project: PCOT Project ( Ishinomaki city, Miyagi Pref. / Jul. –  Oct.2011 )









Relief work for suffering doctors and damaged hospitals:
Support for Dr. S ( Kesennuma city, Miyagi Pref. / Mar.2011 )
Support for Dr. M ( Kesennuma city, Miyagi Pref. / Mar.2011 )
Medical support in Ten-Ei-Mura Yumoto clinic ( Ten-ei village, Fukushima Pref. /Mar. – May.2011 )
Support for Dr. N ( Kahoku, Ogatsu district Ishinomaki city, Miyagi Pref. / Apr. – Jun.2011 )
Medical support of the autopsy at Ishinomaki police ( Ishinomaki city, Miyagi Pref. / May. – Sep.2011 )
Mental counseling for aid workers: Ψ Project ( Ishinomaki city, Miyagi Pref. / Sep. – Oct.2011 )
Dispatch of rehabilitation specialists to Minami-Soma Municipal Hospital ( Minami-soma city, Fukushima Pref. / Sep. – Dec.2011 )
Dispatch of doctors to the person requiring long-term care in temporary housing or at home ( Motoyoshi district Kesennuma city, Miyagi Pref. / Oct. – Dec.2011 )





Relief work for the residents in temporary housing or at home:
Health counseling in temporary housing: Health Café Project ( Kesennuma, Higashimatsushima, ishinomaki city, Miyagi Pref. Minami-soma city, Fukushima Pref. / Jul. – Dec.2011 )
Medical support in Yu-Shin-En temporary clinic ( Ogatsu district Ishinomaki city, Miyagi Pref. /  Aug. – Sep.2011 )
Mental counseling in temporary housing: Ψ Project ( Kesennnuma, Higashimatsushima, Ishinomaki city, Miyagi Pref. / Sep. – Dec.2011 )
Dispatch of home visiting care doctors to the clinic for the person requiring long-term care at home ( Ishinomaki city, Miyagi Pref. / Sep. – Dec.2011 )



The numbers of volunteers ( Mar. – Sep.15th 2011 ) .

Occupational category
Physicians 169
Obstetricians and Gynecologists 14
Midwives 21
Nurses 43
Pharmacists 27
Acupuncturists 56
Medical Students 14
Mite Buster 7
Mold Researchers 6
Dentists, Hygienists 10
Physical Therapist, Occupational Therapist, Rehabilitation Staff 7
Public Health Nurses 4
Nutritionists 3
Social Welfare Workers 4
Psychologists 21
Office Stuff 15
Others 6
total 442




PLAN for 2012

Doctor Dispatch to Hospitals Lacking Medical Personnel:
PCAT continues short-term dispatch of  family doctors and general doctors, and long-term dispatch of resident doctors who specialize in home care programs.
- Kesennuma Motoyoshi Municipal Hospital
This hospital has suffered major damage from the tsunami and sections which still need repairing remain. Also, the regular doctors and nurses are burdened with a lack medical personnel. To continue treating outpatients and conduct necessary home visits, PCAT sends short-time dispatch doctors as well as resident doctors who have the intension to support and train in this hospital. They are sent for a period of one month.
- YU Home Clinic Ishinomaki
This Clinic provides home health care services to the newly constructed temporary housing in Ishinomaki city.  Doctors are dispatched here for short periods. They treat those who require home care or who are terminally ill. They also provide general health consultations.
- Minami-Soma Municipal Hospital
This hospital is within 35km from the Fukushima Dai-ichi nuclear plant.  After the explosion, the medical personnel have retreated. At this momentrehabilitation section , especially lacks medical professionals. The PCAT sends PT/OT in collaboration with the rehabilitation team of Hiroshima University.













PCOT project: Obstetrics and Gynecology Clinic Support, Mother and Child Support:
After the tsunami, many pregnant women, infants and mothers worried about their future. More than a few children also cry every night and have nightmares.  In response, the PCAT continues activities to expand its mailing service ‘KIZUNA (:bounds) MAIL’ so that mothers can share the benefits of living in their town.
- Visit to the mothers who have just given birth by obstetricians and gynecologists. 10 times/month
- Expansion of our mailing service ‘KIZUNA MAIL’ not only for pregnant women but also for mothers taking care of their children and babies, so that they can share the benefits of living in their town.
- Counseling on child raising at the health center in Ishinomaki city, Higashi-Matsushima city and Minami-Soma city.
- Cooperation with Ishinomaki city, Higashi-Matsushima city and Minami-Soma city to put these programs into effect.

                        ©Atsushi SHIBUYA














Psy Project:
- Monthly holding of ‘Psychological First Aid a.k.a. PFA’, mental care program for aid workers.
PCAT has started PFA as an obligatory training program for dispatched personnel and it is held once a month. Mental health experts, students  interested in emergency support and medical professionals participated in the first session held on November 27th, 2011. This disaster has revealed the importance of care for aid workers, so PCAT continues its activities to pass on self–care methods to the people who are starting support or who are thinking for future disasters.
- Health Counseling
The residents in temporary housings need relief from stress caused by living in a particular environment. People with chronic diseases also need care. PCAT runs weekday counseling by long-term dispatch medical team consisting of 3 staffs, and weekend counseling by long and short-term dispatch doctors. We cooperate with Ishinomaki city, Kesennuma city, Higashi-Matsushima city and Minami-soma city, to continue our medical support in providing doctors who can talk with people about their physical and mental problems.