So we have just finished all of the cermonies. We gave the keys of the clinic to our Japanese collegues. The new hospital will start in our clinic as of tomorrow, with all of the Israeli equipment. The experience was amazing. Tonight at 03:30 we are heading to Tokyo. We have a few hours to see the cherry bloosoms, then a 16 hours flight, and on Tuesday we will finally be home!
Friday, April 8th, 2011
It has now been two weeks since we left Israel. Yesterday at close to midnight we had a major earthquake. It measured 7.4.
Last year a quake of lesser magnitude completely destroyed Port-au-Prince, Haiti, killing more than 250,000 and wounding more than 300,000. The difference in the infrastructure here in Japan saved us. It is amazing, that there was almost no destruction as a result of the earthquake.
We are starting to pack to go back to Israel. After visiting the local hospital which was totally destroyed, we now understand that we are the only clinic in the region. I have included some of the pictures of their Hospital above. Upon request from the locals, we have decided to leave our entire clinic here, including our x-ray machine, laboratory and all our equipment.
They have decided that the temporary hospital will be established in our clinic.
In our last days here we are training the surviving hospital staff in how to operate our equipment.
One more Shabbat here and then Sunday night we are heading to Tokyo.
A 7 hour drive, another 18 hour flight and on Tuesday back home.
Shabbat Shalom
Ofer
As time goes on, we are adapting our work to the needs of our patients.
Our efforts are taking place on two fronts:
1) The clinical work done in our facility, which is comprised mainly of local physicians coming to us with their patients for our expertise
2) In the last days we have had two teams who go around daily to the other refugee facilities, offering consults, taking lab tests, etc.
My feeling is that our work here goes way beyond the specific number of patients we are assisting. The media coverage and visits we are receiving gives Israel credit, but beyond that, the main importance is a global one. The world is facing frequent mass disasters, with extreme needs and situations where the countries cannot cope by themselves . Our pioneering work here, opening the gates in Japan, will hopefully bring better cooperation between countries during these devastating events. We who are here in Japan representing Israel believe that it is a great privilege to belong to this small group.
Regards to all,
Ofer
Thoughts from Dr. David Raveh
Shaare Zedek Specialist in Internal Medicine and Infectious Diseases
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Thursday, March 31st, 2011
I think to myself, “Does she have pertussis?” Will she infect all of the survivors of the tsunami who are living in the community center, which is now about 1500 people?” It is good that she has a mask on her nose and mouth, like many in Japan, but still… I am trying not to expose my thoughts. Fortunately, she is accompanied by a translator and not by one of the young devoted Japanese doctors who were mobilized to work here. They would have understood what was behind my medical questions, trying to define the type and pattern of cough. I examine the patient. She came on a special transport from about one hour from here. You have a “tiny” heart murmur, I softly suggest, downplaying it. Does she know anything about it? She works in a fish factory, partially in the office and partially with the fish. Her hands look and feel much better than those rugged hands of the few fishermen I have seen here. No, she was seen a while ago in a local clinic and nothing was said about a murmur. Behind the surgical mask, most of her face is not seen, but there is a clear sense of gentleness in her manners and her soft talk. Probably this gentleness and shyness are typical to so many Japanese. Clear lungs, some prominent infiltrates on her soft palate, both sides. I don’t dare asking her about family, house and work situation around the earthquake and tsunami. I wonder how many are still alive. I prescribe an antibiotic which will also treat pertusis, just in case, and a cough medication. I Escort her to our pharmacy, watch over the pharmacist, making sure that instructions are well understood by the translator who came from Southeast Japan to help. I tell her to please not hesitate to come back if things don’t get better in three days. We bow to each other.
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Friday, April 1, 2011 - Morning, a sunny day, but chilly. On Sunday it might drop below freezing, they say.
The patient presents with a dog bite, ten days ago he says sadly. And from a friendly dog, he adds gloomily. It must have been a tsunami terrified dog, I thought. A relative’s dog that was well used to people and to earthquakes, but not to tsunamis. The waves swept away the entire bay, with its inhabitants, its town hall, and its local hospital, in just seconds. He showed me his hand with two ugly swollen bite signs. “I gave him two advanced antibiotics,” his primary doc added, “but it looks bad now.” I have had thirty years in medicine, twenty two in infectious diseases and three in Harvard. This doctor was doing his second year rotating internship. The patient looked miserably at his open wounds. Rabies, I asked. No rabies in Japan, said the doc with pride and I was caught by surprise. Tetanus shot? No, we did not have that, he admitted sadly. So we gave the patient a tetanus shot. “Have you heard of pasteurella or capnocytophaga, both from a dog’s mouth?” I asked the young doctor. He had not. I had never heard of them even as a senior resident in medicine, I admitted. Let us open the “Sanford Guide”, I humbly suggested. He agreed, but on his smart-phone it was a Japanese edition only. So I pulled out mine, on paper, but the latest edition. We read together about those two bacteria. I suggested we should now follow Sanford’s instructions, and change course. He agreed. We understood that we had possibly taken a wrong path. “Any need for follow up?” the patient asked through the translator. Yes, I said, but please come to your doc, and he will consider if there is any need to bring you to me at all. Did I pay enough respect to that young second year intern, I wondered. Will he bring more patients to us?
Sayonara. We bowed.
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Friday afternoon. April 1, 2011.
We had to close early for the coming Shabbat, and patients are not really coming at this time anyway. Most of the mission boarded the two small buses. Most of the lights and computers were off.
Then, an elderly patient came in.
He had a chronic skin disorder. Mild spots or limited rash, occasionally. Shower and ointment, that is all he needs on a daily basis. But since the day of the tsunami he has had it all over his body, and he looked horrible now. His body expresses the enormous stress he is undergoing, but his face remains expressionless. The diagnosis was clear. We prescribed two medications, and he asked if he could get a good shower to help him. In the community center, where 1,500 hundred refugees are sleeping, there is limited shower ability or he is ashamed to show his body to other refugees. It is not clear and we don’t dare ask. We promised that tomorrow morning we would take him to have a real good shower in the hotel we are staying, in one of our rooms.
The first bus left long ago, and we take the second bus and start the ride back to greet the Shabbat.
I keep thinking about the patient. Even though several of us decided together to prescribe that medication, I am not sure. After the traditional Shabbat eve meal, I asked for a cellphone to call a senior dermatologist in Jerusalem. Wrong approach, he said from across the globe. He suggested we give him a different drug. My restlessness soared. I had to do two things at the same time: 1) Locate the patient in his cardboard box in the refugee center, 1.5 hours away, at night, among the other 1,500 refugees, to stop the drug we gave him, and 2) Start to get the new drug for him from a pharmacy around here somehow.
They never say “no”, we were told. The thoughtful delicate Japanese lady from the embassy thought about it. I suggest you talk to the patient in the morning, rather then calling him now at night in the refugee center, she said. It might create some panic, she suggested very gently. I accepted her subtle suggestion.
The next day I dealt with the challenge of how to get a prescription medication in Japan on Sunday, and how to get a local doctor to sign off on it? A Japanese nurse looked for this drug name in her index and found nothing. I invited her to my hotel room so search the internet. Not knowing if staying alone together in a room in Japan is polite enough, I left the door wide open. We searched the internet. Nothing came up. Confused, she tried to search in Japanese. After a long search, and confused expressions, still nothing was found. Then she said, apologizing, that the Japanese ministry of health has not approved this drug yet. I can order this drug from Israel in no time, but that would be a violation of the local law. How to proceed, then?
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Saturday Afternoon, April 2nd, 2011.
They rolled her in on a wheelchair. An 80 year old lady, quite puffed, with an IV bag on a pole, obliquely tied to the wheelchair. She has been weak for two days, though she has always been an active lady, said her son and his wife. Two Japanese journalists were taking pictures all the time. I verified they had permission from the family to take pictures. They did. Chest X rays, blood count and blood gases were done before she came to me. All that I had to do was to collect info and examine the patient. I asked the two journalists to wait outside while I examined the patient. Her son and his wife stayed with her.
Her young Japanese doctor came in at last. I showed him the X ray and the blood results, and we negotiated the treatment, paying my sincere respect to allow him the lead. They left.
The two journalists came in with two translators for an interview. They work for the most popular newspaper in Japan, so we sat to talk. The initial questions were simple – my age, years in medicine, my medical training, my experience with disaster areas. Then came the tough ones. It is uncommon in Japan to allow a family member to listen to the lungs of the patient after the doctor, they said, why did you do that? They peeped through the curtains, I realized. It is my way to get better understanding and cooperation and compliance from the patient and family, I explained. I am used to examining little kids only after playing with them on the floor and while holding them on my arms, to make friends, I said. Their faces lit with sympathy. Have you been to Japan before, they asked me. No, I said. What image of Japan and our people did you have before? Internet, books, newspapers, films. Hard working, maybe working too hard, highly educated, industrious, famous for electronics and cars and martial arts etc. Famous for hiding feelings, for concealing pain and suffering and emotions, for keeping an expressionless face. And what you think about us now, they asked. I lowered my head and breathed in. Then I looked at him and answered. I love you, I said.
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Sunday, April 3rd, 2011
What floor was she on, when the tsunami swept through the Institution for the Aged she used to head? What strength she had, to overcome the wild shearing force of waves, holding on to a pole. She was left with a minor laceration only below her knee, and continued to work for survivors, applying her skills. Ten days later she came to see one of the young Japanese doctors in the nearby refugee center. There was some jaw stiffness, she said, and a bit of difficulty chewing and swallowing. Too stressed, they concluded, anxiety. Prescribed medications for agitation, and she continued to work for survivors.
Three days later she came again to a doctor here. It got worse, she said. She also started to have neck stiffness. Her head was somewhat tilted backwards.
They understood I was in infectious diseases. At this point, someone asked to present a case to me, standing among the Israeli clinic pavilions here. I cut him short after his second sentence, my eyes widening. Tetanus, I said decisively to her doctor. She needs an urgent transfer to a tertiary care hospital with ICU to treat her tetanus. Large doses of specific anti toxin antibodies, IV penicillin, probably ICU settings with muscle relaxation and mechanical ventilation, and debridement of the so-called little superficial wound. The doctor became confused. Please, send her right now, I said, as we don’t have the IV antibodies and the ICU abilities needed.
His English was better then most; he was a resident in a good hospital in the US. Did I make him a friend or foe, I wondered. Sayonara. We shook hands and bowed to each other.
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Saturday morning, April 2nd – A small medical team visiting the nearby high school, a refugee center.
On the bus ride to our clinic, I was asked to head a small team to visit the only high school nearby. It was located on top of a small hill and thus avoided the tsunamis; now it is functioning as a refugee center. An experienced nurse joined me, a Japanese-English translator, a Hebrew-Japanese translator, and a female-sergeant from our operation center. She was carrying a special tough-book computer with GPS and communication devices, so we could be seen on the screens of our operation center and also at the same time in Israel, across the globe, in case we disappear or get swept away somehow. The van driver was Japanese.
It was just ten minutes of a slow ride across the bay, on another hill overlooking the rubbles. Once it was a lovely town, a picturesque small sea port, and an esplanade along the shore.
I had an amazing talk with one of our translators on Friday afternoon. She said:
“We are in a small countryside community here. Probably the last time that foreigners were seen here was World War II. According to Japanese law, non-Japanese cannot treat Japanese people inside japan. This law was changed last week for the Israeli team. This is the first and only time in history that Japan allowed non-Japanese to have medical delegations”
This is a big privilege for us. - Ofer
Friday, April 1st, 2011
This is our fifth day here.
We are starting the phase of a routine schedule.
I wake up every morning at 5:15 am for a one hour morning jog along frozen rice fields. It is mainly a countryside landscape, which makes a nice start to the day.
At 7:00 am we leave by bus to our clinic one hour away.
Every day we start with a morning ceremony. It is exciting to be part of this small Israeli group standing here in a small village in the northern part of Japan which was completely devastated. With all the cynicism in our life, I still find it moving to stand here every morning in front of the Israeli and Japanese flag, and to sing the Israeli national anthem.
The amazing change is that people are really starting to hear about us. The word is around.
Our medical work is playing out in two ways:
Firstly, we are now gradually turning into the local “referral” center so that either local physicians send/come with their patients, or the patients come on their own.
We just received a patient who was initially treated in a place an hour away, and asked to come see us. Since the local hospital collapsed, we are the only ones who have an x-ray machine, and laboratory facilities.
Our second task is to send out small teams. As gasoline is still an issue, patients have a problem getting around. This morning we sent a small team of a nurse and pediatrician with a car to examine children in the other evacuation centers.
Although the Japanese are amazingly efficient, we do bring expertise which they don’t have around. Gynecologists with a portable ultrasound, E.N.T., ophthalmologist, Urologist, these are specialists which they don’t have in the region. Again, from this point our work here is very gratifying. We have really done some good deeds for these unfortunate people.
Radioactive material was found yesterday in the water in our region. So from today, we are forbidden from eating fresh fruit or vegetables. Unfortunately back to canned food. Nothing fresh any more. We are continuously monitored and our personal exposure is low. I will not come back with any horns.
Today is Friday and our Rabbi has already been preparing our Shabbat dinner for days. Challot are being baked in a place 4 hours away and will be ready for the Shabbat.
Shabbat shalom from Minamisanriko, Myagi region, Japan.
Ofer
Wednesday – March 30th
Another day here in this devastated village.
Our main goal from the medical perspective is to gain the trust of the Japanese people and physicians.
Israel is the only foreign team on the ground. Generally both at the people level and the municipality, there is restraint from foreigners. Still we are gaining popularity here, which is a bit surprising. We are seeing more and more patients, and it seems we are turning out to be the local referral center. Physicians from all around are coming with their patients for consults with our specialists, for blood tests and x-rays. Pregnant women are coming for ultrasound as well, as this is a service they don’t have.
As always, the personal stories are the interesting ones. Learning how the patients heard about us … hearing about the elderly lady who walked a long distance to reach us … Gasoline is still a major issue.
We are getting excellent coverage from the media here, so the feeling is that we are on a humanitarian mission while also providing good PR for Israel.
We do have daily earthquakes, but like everything in life, you almost get used to them. We assembled the hospital close to the shore on one hand but in an elevated area. In this, way if G-d forbid another tsunami will occur, it will not reach us. It is amazing There are houses which are 100 meters above the sea level which were not damaged by the quake, but everything below was destroyed.
On a personal level this is another amazing experience. Although a very different mission than last year in Haiti, it is a challenge to run this clinic efficiently and to be able to merge with such a different culture. I am very satisfied so far with our achievements.
We can all learn a lot from the Japanese about preparedness for these mass casualty events, and this is another personal gain.
Warm regards to all
Ofer
Dr. Ofer Merin, Deputy Director-General of Shaare Zedek Medical Center, is currently directing the surgical operations at the IDF Field Hospital dispatched to Japan. He sent the following report soon after his arrival in the tsunami-ravaged zone:
Tuesday, March 29th, 2011 – 10:15 pm:
At 5 AM, after a 14-hour flight and another 7-hour drive, we finally reached the small town in Northern Japan called Kurihara. This city was largely saved from any real damage.
After my morning jog (in 0 degree weather) we left about two hours later for a small village near the ocean, called Minamisanriko.
In comparison to the relative calm we saw upon arrival, in Minamisanriko we saw before us an area that looks like the aftermath of an atomic bomb. EVERYTHING is destroyed.
The village is gone. Half of the 17,000 people died from the tsunami. The damage from the earthquake itself was barely anything, but the tsunami caused the devastation. The people who survived are the refugees you read about on the news - completely homeless. These are the ones we came to assist.
With light snow coming down, we were able to assemble our “medical center” in 4-hours. This is essentially a clinic, but with both imaging and laboratory abilities.
Overcoming the cultural barriers is a formidable issue. The Japanese are not easy about letting foreigners treat them. But this morning after an opening ceremony with the ambassador and the mayor of the town, the mayor himself who was injured from the tsunami, asked to be seen.
He was injured in the chest so I was given the chance to see him, and after x-rays and an exam he was discharged. He is fine, but all the local media took pictures, and so the patients are now beginning to stream in.
We are seeing patients in our clinic, but also sending small teams around the affected area. Our OBGYN travelled with a nurse and an ultrasound, to visit pregnant women. These are facilities they simply don’t have.
It is very different from Haiti. We have arrived at a later phase, and it is a very different culture, with different injuries. But it does seem that we can help, and they are very grateful we are here.
Our personal safety seems fine. We are checked twice daily and I don’t think radiation is a real issue at this time.
I will write more when I have the chance.
Regards to all,
Ofer
