March 12th, 2011
On behalf of Japan Society of Disaster Nursing, I would like to offer my heartfelt condolences to the victims of this disaster. I understand many people, including our fellow members, are suffer heavy damage from the earthquake and tsunami. On March 11th, we decided to send the advance parties for Miyagi and Ibaragi with observing the rules of Japan Society of Disaster Nursing. Both parties have already started for the quake-hit areas after completing arrangements. They will cooperate with nurses working in the rural area and start to provide emergent medical services.
Satoru Yamada
Chairperson, Japan Society of Disaster Nursing
Saturday, March 12th
In heavy traffic conditions everywhere, we visited the shelters in the devastated area. There are many evacuees in the shelters due to the liquefaction and the disruption of lifeline service. The refuges closely related to Kanto area, have faced with the serious shortage of aid, because most of relief items have been preferentially delivered in Tohoku area where the damage was extensive. Especially, there are not enough blankets and there is no (hot) water for protection against cold. In case people try to procure those necessities, the stock of supermarkets is depleted already and they cannot purchase a commodity essential for daily life. In the areas we visited, those who are prioritized in time of disaster such as the elderly could enter the welfare facilities in early time, because there is a good cooperation with local health nurses. (They make contact with local nurses before the earthquake.) Confused by the disaster, local health nurses attentively care for quake survivors even though this is the first time to experience. After tsunami disaster, we need to establish the continuous supporting system, since it will take long time to recover so that health care providers will be exhausted.
Chizu Usui, Misako Seto
Saturday, March 12th
We prepared relief items and started to move to the devastated area.
Akiko Sakai, Yuko Kuroda, Tatsue Yamazaki
Sunday, March 13th
Since there is a heavy traffic jam in Tokyo and it will take half a day to move, we asked some questions about the condition of Health Center in Chiba prefecture.
Chizu Usui, Ohara Mariko
Sunday, March 13th
We, four members, loaded the tank of gasoline and daily necessaries into the car in each location, and met at the Fukushima prefectural office building in the evening. It is very difficult to access to the devastated area, due to the landslides, road closures and restrictions to enter emergency vehicles only. Thanks to the efforts of the President of Fukushima Nursing Association, we could obtain the emergency vehicle permission for our van provided by the Japan Society of Disaster Nursing.
In Fukushima prefectural office, the Atomic Energy Group is already constituted, and they need more support from the experts of nuclear energy because of the increase in the number of official evacuation announcements and in the number of people who are exposed to radiation. The staff members have wasted much time to establish the supporting system at the initial stage and citizens can call for relief supplies directly, so that they have faced with a problem of the serious shortage of commodity essential for daily life. Now, in this city hall, there is some hardtack and water, and all gas stations are closed. It is very difficult to receive relief since they cannot go outside.
Lastly, we would like to express our deepest appreciation to Fukushima Nursing Association to their consideration in this hectic time.
Akiko Sakai, Yuko Kuroda, Tatsue Yamazaki, Sumi Misawa
Since we started the mission by the advance parties, we gradually grasp the situation that there is not abundant supply of relief for even Tohoku areas. Quake survivors have faced with a problem of the shortage of gasoline, commodity, food and water. Plus, they are unable to access to the information so that they cannot request support by themselves. It is difficult for them to procure commodity essentials for daily life.
Moreover, according to the news, the devastated area is so extensive and there are some areas which our dispatching parties cannot enter, because there is a risk of liquefaction, fire by gas explosion, effect of radiation by exploding nuclear power plants, and impact of tsunami. Also, some areas have multiple risks, and therefore we need the supporting system for each local area in accordance with the regional characteristics and the damage situation.
Although everyone did their self-help efforts because of the unprecedented disaster we have never experienced, it is absolutely necessary to gather relief supplies from outside. The Japanese media reported "Death Wave", but we need to create the new wave of support to surmount the difficulties and need to discuss its framework.
In order to understand health needs, our advance party for Miyagi and Iwate will enter the shelters from Monday, March 14th, by cooperating with Miyagi Nursing Association. We may request our fellow members and organization members to do logistics support and relief operations in the devastated areas, so please visit our website regularly.
Monday, March 14th
We cooperated with Miyagi Nursing Association and entered the shelter. Although we need to piece out the situation, we don't have any access to get information. There are no major transport links such as bus and there is not enough gasoline for the rural areas. Also, there is not enough number of homevisit nursing care stations. We need group homes to serve children, elderlies or adults with chronic disabilities in time of disaster. Continuous strong aftershocks alarm the survivors. Therefore in order to organize supporting system and to improve their living standards as quickly as possible, we need vigorous human resources from out of quake-struck areas. In the end, we would like to express our deepest gratitude for the cooperation of Miyagi Nursing Association working in the chaotic situation after the disaster.
Akiko Sakai, Yuko Kuroda, Tatsue Yamazaki
We could cooperate with Miyagi Nursing Association from March 14th.When we looked back on our rescue in Miyagi and Iwate so far, we understood how crucial it was to ask permission for emergency vehicles, as well as having general rescue kit, in order to enter the damaged area. Our early dispatching party did not prepare for granting permission beforehand since we started right after the earthquake. However, those who are heading for the quake-hit areas from now need to secure the means of transport by consulting with city administration. Moreover, the damaged area faced difficulties procuring gasoline, so it is very important to load it into your spare tanks.
In the afternoon on March 14th, we have a teleconference with the Japanese Association of Nursing Programs in University, Japan Association of Nursing Academies and representatives of both WHO Collaborating Center for Nursing in Disasters and Health Emergency Management and Japan Society of Disaster Nursing. We have a discussion on our future emergent medical services. Japan Society of Disaster Nursing proposed the idea that the dispatch of the advance team takes the main role to cooperate with related organizations and continues to provide emergency medical services.
Furthermore, in other affected areas in Kanto such as Ibaragi and Chiba, some evacuees in shelters said that they have no water and blanket as well as the shelters in Tohoku. So, it is significant to keep the balance of aid since the damage was so extensive.For your information, Professor Aiko Yamamoto, University of Hyogo, who is member of our Society, contribute to an article: "Nursing volunteer work in time of disaster"
Please visit the following
website: http://www.coe-cnas.jp/keaken/
Tuesday, March 15th
We visited shelters by the cooperation with local nursing associations and health centers, and did health counseling for disaster victims such as measuring vital signs and carrying out mental health care. The health problems of quake survivors are as follows: high blood pressure (hypertension), insomniac, bad symptoms of digestive apparatus (diarrhea), fracture, surface wound (cut) and dermatitis. There was a case that a pediatrician had to counsel a child with fever.
Clinics in the damaged area were flooded about 10cm above the floor level so that physicians could not engage in medical treatment due to the disruption of electricity. Those who attend the hospital regularly request medicines for internal use, but first the staff members have to search for their medical records.
The conditions of the shelter have problems, too. Temporary toilets, for example, are narrow and insanitary, and have a high step but do not have handrails, etc. Plus, the number of toilets is not enough.
In order to protect against cold, evacuees endure the cold conditions by spreading a carpet and tarpaulin on the vinyl floor tiles. There is a case that they use the fitness room equipped with training machines as their shelters, and some of evacuees felt anxiety that those machines may fall down to the floor by continuous aftershocks. The maintenance of the shelter facilities is the matter in hand.
As for the meal of shelters we visited, although all evacuees are provided with three meals a day, the contents are either a rice ball or a slice of bread. For our future relief operations, as we wrote above, it is necessary to maintain the shelter facilities, to guide health condition, and to relieve the traumatic stress.
Akiko Sakai, Yuko Kuroda, Tatsue Yamazaki, Sumi Misawa
Four days have passed since we sent our advance party for Miyagi and Iwate from March 12th. Rescue and relief operations in the devastated area are attended by traumatic stress. Even though the members are expert for disaster nursing, they have to protect their lives from many risks. Since the damage from the earthquake and tsunami was enormous, we have just started relief operations in the shelters and have not been ready for supporting systems in the affected areas.
Taking this situation into account, we, the Japan Society of Disaster Nursing, concluded that the activities of advance party are still necessary and we are planning to rotate the members. It is still difficult to enter the devastated areas, but by using our previous experience to advantage, we will take over their job without a hitch.
Lastly, two members, Tomoe Watanabe and Yuko Tategaki, will be sent in relays from March 17th, and our advance party for Miyagi and Iwate will enter the damaged area. We will update our report on a daily basis, so please visit our website.
Wednesday, March 16th
We visited Iwanuma health center, daycare center, Natori city office, etc. Our main activities are as following four points: First, we exchanged our opinions of future medical services with public health nurses at Iwanuma Health Center, and reported the situation we grasped so far on March 14th and 15th. Second, we provided relief (food and a commodity essential for daily life) from Japan Society of Disaster Nursing to two shelters, which Health and Welfare Department of both Iwanuma and Natori city are taking charge of. Third, we had a meeting with the director of daycare service center, who accepted elderly quake survivors evacuated to the Sendai Airport terminal. The staff members seemed to be exhausted for working 24 hours a day. They said they need additional humanitarian support. To increase the number of evacuees causes a shortage of food, so staff members bring their own food materials and receive offers of frozen food from grocery shop. Fourth, we visited Natori city office and had a discussion with deputy mayor and chief executive of countermeasures for disasters and public health.
With our mission as the advance party has completed, we would like to express our deepest gratitude for many of those who supported us under the severe conditions. Without your cooperation, we could not report our activity in the affected areas.
With all our best wishes for your good health and prosperity,
Akiko Sakai, Yuko Kuroda, Tatsue Yamazaki, Sumi Misawa
At 9 a.m. on March 17th, the advance party for Miyagi and Iwate has safely arrived in the affected area. Tomoe Watanabe and Yuko Tategaki continue to work as the second advance party. They said their flight was delayed and arrived late in the Yamagata Airport. Moreover, it snowed in the rural areas. They received reports from the member of Yuko Kuroda and Sumi Misawa who had done with their activities, and were heading for the shelters in damaged areas.
Headquarter of Japan Society of Disaster Nursing received a report that in the heavy snow and bad traffic conditions (massive reservation of car rental, etc.); they may spend some nights in the shelter where they arrived in. For future problems in the quake-hit areas, quake survivors need mental care as well as those who are engaged in support works. Disaster Medical Assistance Team (DMAT) and relief squads have already returned, but they need debriefing. Those who are engaged in disaster medical assistance have questioned whether or not their contributions are enough even though they played an important role. To be honest, many of those who support survivors share the same experience. It is necessary to ask them questions and to exchange what they think. More importantly, it is necessary for those who are dispatching person to listen to what they say.
For more information on radiation exposure, we obtain the article of Japan Society of Obstetrics and Gynecology through Japan Society of Maternity Nursing. If you have any interests, please visit the following website (Japanese):
http://www.jsog.or.jp/news/pdf/announce_20110316.pdf
Notice: For pregnant and nursing woman anxious about radiation exposure by the accident of Fukushima nuclear power plant. (Especially for breast milk and Potassium lodide)
Thursday, March 17th
Our fellow members of advance party, Yuko Kuroda and Sumi Misawa, who have already entered the devastated area, shared the information so far and engaged in the relief operations.
After conducting information-gathering activities in Watari town office in Miyagi prefecture, we visited one first-aid station, where a thousand of evacuees are living, out of six refuges provided by Watari town, and asked public health nurses on duty about the current situation. (The total number of evacuees is about 4,500 people.) Some residents already have the cold/flu symptoms or diarrhea (caused by drinking muddy water or negative effects on reservoir performance) since they did not prepare for winter clothes.
Evacuees felt they do not have an individual relationship with others because of the shortage of nursing staff. Moreover, we asked a family living in the shelter about their life. They replied that "we need accurate information about radiation leak from Fukushima nuclear power plants, since we feel strong anxiety about the negative impact on human health."
Lastly, we visited the Miyagi Nursing Association and Health and Welfare Division in Miyagi prefecture, and reported the condition of the shelters so far and exchanged our opinions with the staff members. Although quake survivors are faced with a problem of the shortage of aid and personnel, what is worse, they restrict the distance by driving a car, one of major transports, because of the shortage of gasoline and heavy snowfall conditions. Therefore, the situation is becoming clear that it is very difficult to continue to be engaged in relief operations.
Yuko Kuroda, Sumi Misawa, Tomoe Watanabe, Yuko Tategaki
On March 17th, four members of the second advance party for Miyagi and Iwate continue to be engaged in relief operations. Yuko Kuroda could not return to her home due to unavailability of flight, and Sumi Misawa drive the vehicle till March 17th. The ground was covered in snow, and therefore without having a special vehicle adapted to snow and driving technique, it is difficult to move in the heavy snowfall district. Local citizens are prohibited from renting cars because of the shortage of gasoline. So they have to use the transit bus from Today. Also, we have heard that they could not book the accommodation in Sendai yesterday so that they came back to Yamagata taking two hours and half from Sendai. Those who will be engaged in rescue and relief efforts there, please consider the countermeasures against disaster.
Professor Kusama, Tomoko at Oita University of Nursing and Health Sciences, serving as a Board of Trustees member of Japan Society of Disaster Nursing, opens the website of "Counseling on radiation exposure." The breakdown of the nuclear power plants in the aftermath of the Tohoku-Pacific Ocean Earthquake escalates the anxiety of residents about negative impacts on radiation. It releases radioactive contamination into the environment, and peripheral residents start to take shelter and to be evacuated from their homes. We, as nursing staff, are expected to have correct information about impacts on radiation and to relieve the anxiety of residents. Through this website, therefore, I will inform you of the background of radiation and its effects, which we need to share. I will update the information regularly, but if you have any questions, please feel free to e-mail me at the following e-mail address.
Website: http://www.oita-nhs.ac.jp/rad/top/
E-mail address: rad-soudan@oita-nhs.ac.jp
Friday, March 18th
We visited the shelter in Rifu-cho, Miyagi-gun where it is located in the relatively inland areas. This shelter accepts many evacuees from different city, town and village including stranded commuters. There were fifteen shelters right after the earthquake, but only two are available after integration and reduction of shelters due to a gradual recovery of the electricity.
As for the relief system, the person in charge, from the administration, is permanently stationed. Moreover, in total seven public health nurses patrol once in a day and continue to care for the person with high risk. In refuge, partitioned rooms are utilized for those who need aid and quarantine in accordance with their size. We need to recognize the necessity to prevent group infection and to care for mental health because of the increase in the number of people who complain of cold symptoms. Also, the health conditions of those who have chronic illness are unstable due to the lack of medicine, and communal living is indispensable for compromised hosts. Therefore, local health nurses and we recommended environmental control and counseling to medical institutions. "Although we understand the necessities of an individual visit to the home of victims with high risk factors, we work under difficult conditions," one of local health nurses said.
"Logistical disaster," which means that necessary relief (such as medicine, food, commodity, gasoline, etc.) cannot reach the damaged area, is a big problem. It undermines health conditions of victims and prevents recovery from earthquake and tsunami. For instance, residents in the damaged area have to wait for a long time to fill in the gasoline. It makes it impossible to do nursing care (needing two people such as excretion, meal, daily activities, etc.) of families with paralyzed patients. As the result, they refrain from drinking water, and thereby it increases the risk of bedsore, urinary tract infection, and etc.
Moreover, health care providers cannot commute due to the lack of gasoline, so that office hours of clinic and pharmacy have to be shortened and it continue to damage the function of medical work in public health. It is predicted that plenty of relief will come to the devastated area in the aftermath of the disaster, but even if the survivors are healthy, without supporting aid, they may worsen the health conditions because of eating cakes or sweets instead of meals, the outbreak of infectious disease by the cold, and so forth. Furthermore, young people can readily access to the necessary information of opening medical institutions, gas station, and etc. However, it is said that the elderly people are tardy in gaining information so that they cannot purchase anything even though they wait in long lines.
We consider that it is necessary to establish the efficient system of relief distribution to the devastated area such as giving priority to the elderly or handicapped in case of disaster. In order to keep on surviving we need to overcome the complex disasters, and it is indispensable to support victims both physically and mentally; otherwise their happiness would be fleeting.
Tomoe Watanabe, Yuko Tategaki
"Logistical disaster" undermines health conditions of survivors, and what is worse, it prevents recovery from earthquake and tsunami. In addition, there is a "digital divide" even in the same shelter, and the elderly people are difficult to access the information. Thanks to our fellow members' effort, we continue to support relief operations in each field, but we need to cope with the disaster nursing by recognizing "what we must do now" and "what we can do now."
The second advance party for Miyagi and Iwate (Watanabe, Tategaki) continue to be engaged in the relief operations until Monday, March 21st. On Sunday, March 20th we have decided to send the third advance party for Iwate (Mariko Ohara, Takako Ito), since there are still needs in Iwate according to the reports from the first and second parties. We carry on with the preparation by cooperating with local universities.
Saturday, March 19th (Tomoe Watanabe, Yuko Tategaki)
We provided relief efforts in Shichigahama-town, Miyagi Prefecture, located along the Sanriku coast where tsunami struck. There are bumps in the road, cars flooded by tsunami along the streets, and much dust on the way to the damaged area. They explain the extensive damage of the area. We visited two shelters placed in the town after we asked the current situation at the headquarters for disaster control established in the town hall of Shichigahama.
In the first refugee, there are about 400 evacuees living in the room partitioned by each region and utilizing six rooms in the building as a shelter. We visited each room one by one, and asked questions of their sleeping conditions, health concerns, and etc. As for sleeping conditions, one said that "I usually wake up before morning due to the coldness in the room," and "I often wake up when every time people passed by the entrance." The other said that "it can't be helped," and "I was thankful to have escaped without harm." It was often heard that they tried to take the current situation as positively as possible and showed great perseverance in the face of difficulties. Evacuees were assembled in the same local district and therefore have known each other. There is a good environment that they have opportunity to share what they have experienced. For the elderly people, second or third-generation residents or relatives stood by them and supported to accommodate to the new environment. Also, there are some volunteers who are engaged in the relief operations right after the disaster, but they got ill through overwork in providing care, support and treatment day after day. Therefore, there is a nurse hailing from this town to be newly involved in this work. This is the first time for the nurse to provide relief operations in case of disaster, so he/she wanted to know more about mental care. So, we explained psychological process of victims and care support. However, we needed to consider modest relief operations together since the nurse is also the victim, so we explained the necessity to take repose and how to maintain a psychological distance as a nursing care provider by confirming one's thoughts.
In the second refugee, evacuees made their own space partitioned by local districts in the gym. It was said that there were 2,000 sufferers right after the disaster because of the risk of explosion of gas tank neighboring the town. However, they escaped from this critical situation and now house approximately 500 people in 200 households. There is hot food distribution to the victims. In terms of the healthcare, the emergency care system in this area was already established. For instance, diagnosis by local general practitioners and mobile clinics by the neighboring general hospital are accessible regularly, and medicines for internal use are available. There are some evacuees with symptoms of vomit and diarrhea, so it is the matter in hand to prevent catching a cold and spreading the flu in the communal living. There are many activities such as doing radio gymnastics everyday leading by volunteers and those for children.
Natural disasters destroy not only our lifestyle conditions including food, clothing and shelter, but also social systems which are foundation for our life. Despite our best endeavors to rebuild the lifestyle, without any progressive recovery of infrastructure besides logistics, we would not expect to see effective improvement in our lifestyle conditions. There is still not enough food supply and volunteer workers in the evacuation shelter. We are concerned about disaster-related death of the victims and death from overwork by public officials who show signs of distress.
For further information, we recommend the following websites:
http://www.yomiuri.co.jp/e-japan/fukui/news/20110319-OYT8T00820.htm(※このサイトはありません)
http://www.jsdn.gr.jp/doc/2011.03_survivors_guilt.pdf
The first website, Akiko Sakai, Professor at University of Fukui, contributed the article to the national newspaper: "The risk of increase in the number of disaster-related death – Closer investigation in the damaged area." She participated in the relief operations in the devastated area of Fukushima and Miyagi from Saturday, March 12th to Wednesday, March 16th as the advance party of Japan Society of Disaster Nursing. This article appeared on March 19th on Yomiuri Online [now is not available].
The second is "Survivor's Guilt: Understanding the Aftermath of Disaster" written by Patricia Underwood, Emeritus Professor at University of Hyogo. This contributed paper was already on the Journal of Japan Society of Disaster Nursing in 2005.
Sunday, March 20th
We provided relief efforts in Tagajo-city located along the Sanriku coast suffered by extensive damage by massive tsunami. We visited at the Health and Welfare Office of Tagajo City Hall, and participated in the activities of prefectural nursing profession after asking the current conditions.
In the evacuation shelter, evacuees decide freely to have their own space by utilizing the lobby and room of the building with spacious hall. City officials are working systematically to have already dispatched public health nurses to the shelters and to prepare replacement members. There are sufficient medical services available such as mobile clinics by neighboring medical institutions and society, dispatch of public health nurses and medical volunteers from other prefectures, and etc. The framework was already established for residents to provide health counseling to feel free to ask questions. Also, local human resources and space have been better utilized. For instance, volunteers from local colleges and universities do child care, and kids' rooms are secured for children to play. Moreover, food supply is relatively available there.
In the patrol, public health nurses make out the list of health counseling for each resident, and individually make contact with the person required observation extracted from the list. Because of the increase in the number of people with cough, health nurses and we recommended every single evacuee to wear mask and to distribute hand sanitizers in order to prevent group infection such as cold. One week has passed after the disaster; there are those who continue to search for the missing, those who express their anger toward logistics and living conditions of shelter, which do not improve at all while they understand the situation that they need to be patient, and those who keep talking with excitement etc. Therefore, we realize once again its importance of caring corresponding with individual cases. For example, there was a case we needed mental support.
We asked individually and ended up observing the patient since there was a consultation by a local clinical psychotherapist; there was mental support of family members now; and the patient was calm. We did not have a case for child mental health, but there were residents who search for the hospital where psychoactive drugs they are taking now are available. Since one week has passed after the disaster, there was a shortage of medicine for internal use. We recognize its importance that we cooperate with mobile clinics and tried not to discontinue providing medicines with victims.
Tomoe Watanabe, Yuko Tategaki
Sunday, March 20th
We departed Haneda for Akita airport, and used the bullet train to Morioka, and finally entered Iwate Prefecture. We visited at the Disaster Prevention Headquarters of Iwate Social Health and Welfare Department and the Japanese Red Cross Iwate Prefecture Branch.
The followings are talks at the Iwate Social Health and Welfare Department: "There is a serious shortage of gasoline to use in order to ship the supplies (food, water, medicine) people needed. Overall, there were not sufficient hygiene products, medicine, and materials to do artificial dialysis at the hospitals in the quake area. There is insulin, but no hypodermic needle so some patients reuse their needle. In the area of electric power failure, we cannot use electric inhalers, so require the manual ones. In the area of the suspension of the water supply, people cannot flush their toilet, so it becomes insanitary. Especially, relief materials cannot be delivered to those who stay at home. Some people claimed that we cannot go to the soup kitchen in the shelters during the daytime, and also refrain from going. Public health nurses in Iwate keep on working even though they lost their family and home. Some nurses cannot commute due to the shortage of oil. At the gas station, "permission as emergency vehicles" is necessary, but we do not always refuel the car. Gas shortage prevents not only logistics but also transportation of people. Now, the Council of Social Welfare stops recruitment, since they did not make preparations to accept volunteers."
In Iwate Prefecture, 56 public health officials including doctors and nurses were dispatched from all over Japan. Basically, dispatching from other prefecture is composed of public health nurse, administrator, and driver as one team. In the shelter, there are public health nurses dispatched from city, town, and village, and next from Iwate prefecture, and finally from other prefectures to help. Iwate prefecture team (in three days and two nights) and other prefectures team (in four days and three nights) are conducting with a health survey of evacuees at the shelters. As a future issue, it is a matter of urgency to send nurses to support for hospitals and shelters. Now, four members of supporting nurse are engaging with relief operations at hospital in Kamaishi city.
We are listening to the following talks at the Iwate Disaster Countermeasure Office: "After the withdrawal of Disaster Medical Assistance Team, various medical teams are applying for relief operations, so we are preparing to accept them. It is necessary to react to chronic illness due to transition to the subacute period. Since local medical society was involved in the disaster and did not function, so it is necessary for more medical team in and out of prefecture to be complemented. Now, both Iwate Medical Society and Medical Care Promotion Division assign teams to ten local bases". Local bases are divided into some medical areas, and they are planned to establish the first-aid station in the shelters, and we could see the data for that project. Although there are some teams who have already offered medical care to set up the first-aid station, there are some who have provided medical care without any contact with the Headquarters. It is difficult to grasp the entire situation, but it is the matter of great urgency to establish the framework for medical care.
There are many overworked nurses even though they suffered from the recent earthquake and tsunami. Therefore, we worry about negative influence on these nurses' mental health. It is necessary to replace nursing professions and to detach supporting nurses in order to care for these local nurses.
We listened to the following talk at the Japanese Red Cross Iwate Prefecture Branch: "There are extra blankets to distribute, but there is a shortage of commodities. So, it is necessary to distribute goods offered to the victims in distress. Also, we cannot deliver relief supplies to the area needed due to the shortage of gasoline. There is a case that a patient who lost her/his bankbook and seal transported to the hospital so that could not withdraw cash and pay for the medical expenses. Therefore, nurses had better to work on evacuees to direct right places to consult.
The infrastructure is broken down in Yamada-machi, Shimohei-gun, one of the most affected areas. There are 31 shelters there and relief parties of the Japanese Red Cross Society take charge of three of them; Ohsawa Elementary School (522 evacuees: Wakayama Prefecture Branch), Yamada High School (1,277 evacuees: Tokushima Prefecture Branch), and Youth Center in Iwate Prefecture (317 evacuees: Okayama Prefecture Branch). As for medical supplies, we obtained the information that Iwate prefecture had already secured the necessary number, and the Local Medical Society (LMS) had started to restore its function gradually. Therefore, the Japanese Red Cross Society is scheduled to be there until the LMS gets back to the normal condition.
Mariko Ohara, TakakoIto
We have heard that the number of tents for the first-aid station has been decreasing in the damaged area, and medical clinics and pharmacies started to open even though we cannot say the situation gets back to normal before the disaster. A week has passed after the Great East Japan Earthquake, so health surveys in the shelters, measures against infectious diseases, and mental care including children become the mainstream as we can see the cycle of disaster aid. Moreover, as we can see the report from the quake area, there are many overworked nurses and public officials even though they were involved in the disaster. It seems that there are sufficient numbers of nurses and public officials, but they are all exhausted. The Japanese media cannot broadcast the situation of all shelters. Therefore, we need to realize that we cannot grasp the entire situation through the media. One week has already passed in the aftermath of the disaster, and there is a limitation of local relief effort. Some people have complained about the situation that we cannot see any improvement of logistics and human resources management by consideringtraffic conditions and the shortage of gasoline. We firmly hope to reach out to evacuees by providing more relief supplies from outside and more human resources. Although there are some places which have already delayed to set up the contact information for volunteer services, it is necessary to send volunteers as soon as possible to the damaged area.
We have heard that the Japan Nursing Association decided to dispatch several dozens of nurses hereafter. In order to continuously send active and cheerful nurses, although Tokyo, Hokkaido and all the other prefectures positively recruit disaster relief nurses, we, as a nursing profession, need to consider any way to support these activities.
Monday, March 21st
We visited the shelters in Yamagata Prefectural University of Health Sciences (YPUHS) and its neighborhood, and called on Professor Kyoko Sugawara, a chairperson of Nursing department, PhD, and Associate Professor Mie Aoki, Nursing department at YPUHS located in Yamagata city. We provided the current information on the conditions of shelters emerged during the activity of the advance party.
There is an evacuation shelter for residents of the evacuation zones from Fukushima nuclear power stations adjacent to YPUHS and its faculty members and students did volunteer service. When we visited this shelter, they informed us of their work. In the shelter, students actively took part in the volunteer services in many areas of daily life and took in charge of transportation and management of relief goods. Moreover, faculty members, as a nursing profession, were positively involved into management, health counseling and so on.
Evacuees of the evacuation zones from the Fukushima no.1 nuclear power plant live separately in several different places such as gym, judo hall, etc. The shelters were already organized and therefore there is no food shortage and other trouble. Moreover, residents maintained their living space in good condition and kept it clean. They discussed the issue of whether or not they offer a well-heated room for elderly people or pregnant women by considering the cool of the night. They also set up the Kids' room and nursing room for young children. Furthermore, there are several volunteers of nursing profession such as Town Healthcare Room in Yamagata Nursing Association, Japanese Midwives' Association, etc.
Tomoe Watanabe, Yuko Tategaki
Monday, March 21st
We visited at Iwate Prefectural Yamada High School, one of the evacuation shelters, and Yamada Town Hall in Yamada-machi, Shimohei-gun. It took about three hours from Morioka to arrive there, and we have seen the sight that more than a hundred cars were waiting to purchase the gasoline in several gas stations. We also have seen the devastated towns by the damage of tsunami on the way to pass through Miyako and Yamada Bay.
1)Iwate Prefectural Yamada High School
It was announced on March 15th that there are 1,277 evacuees, the largest number in Yamada-machi, in the refugee of Iwate Prefectural Yamada High School. The management has been done by staff members of Town Hall, support members from Wakayama Prefecture, four members of dispatched public health nurses, faculty members from Yamada High School, and volunteers from those students. Also, we asked a couple of questions to the following people: Public health nurses, nurses, victims, and a senior nursing officer of relief parties at the Japanese Red Cross Society.
First of all, we talked to public health nurses: "According to Yamada-machi Disaster Prevention Headquarters, the number of evacuees in Yamada High School is 739 people (there are 1,277 evacuees on March 19th; the number of evacuees fluctuates daily.), and they stay separately in three large and small gyms. It is the situation that other evacuees (especially for children and the elderly) who were received by their family move into other places. There are nice public health nurses in Yamada-machi, but I do not know where they were assigned to 31 shelters established in there. Although electric generators were used during power cut right after the disaster, the power has been restored after four or five days. Water supply, about 10 days after the disaster, was cut off except two hours in a day by water wagon of the Japanese Self-Defense Forces. From March 20, residents can receive water supplies between 9 a.m. and 4 p.m. There is no trouble for the number of rest rooms, which are still available in the gym and there are 15 temporary toilets outside of the shelter. When the toilet is clogged, a volunteer out of evacuees cleans up. As for the meal, as a volunteer, a licensed cook working at hospital serves hot soup or miso-soup. There are two meals in a day served with a small rice ball and a cup of soup. There are about two to ten patients suffering from fever, diarrhea, and vomit per day without regard to age. We transported these patients by ambulance to Iwate Prefectural Miyako Hospital due to the fear of the flu and Norovirus at first, but since the test results were negative, now we work with other relief parties of Japanese Red Cross Society stationed in Yamada High School and observe how they are going. Also, we and the relief parties set up three different rooms for fever, diarrhea, and vomit. There are three nurses in the evacuation camp here when we recruited nursing volunteers, because we needed to check temperature, to give intravenous drip, and to take blood pressure for patients. They volunteered one for hospital and two for this shelter. All of them suffer from earthquake and tsunami and lost their houses. There are almost enough commodities and provisions by relief supplies, but in order to dispose of vomitus and clean up toilet, the following items are immediately necessary: rubber gloves for domestic use, plastic bag (for containment of vomitus), bleach (disinfectant), rubber boots, sandals for toilet, etc. There are several infants (less than one year old) and more than a dozen young children. Also, all mothers have family members that can help care for her baby. Thanks to the efforts of dispatched public health nurses, parents can bathe their baby from yesterday. There is no nursing room, so mothers give their breast to the children in the bathroom or changing room for women. From today both young children and children in the lower grades can take a bath in the Child Center nearby the evacuation refuge. Moreover, bathing services with free pick-up and delivery for the elderly have started. There are ten elderly people who need to change their incontinent pads, and those bedridden elderly tend to have pressure sore. Now people who experience with Home Helpers voluntarily change them, but the elderly who have young family do them by their family. Evacuees secure their privacy to substitute their blankets or futons (a Japanese mattress) for curtain. We are not in the stage to set up another room."
We do not know the details, but no one suffers from insomnia so far since lights-out is nine o'clock. We provided public health nurses with incontinent pads, disposable protective gowns and gloves, paper towels, plastic bags, etc. from the relief supplies of the Japanese Red Cross College of Nursing. Also, a local cooperator and faculty of Iwate Prefectural University who accompanied this advance party brought sox, toiletries, etc.
Next, we talked to a volunteer nurse who is going to take holidays until the end of March due to the shortage of gasoline to commute. The nurse felt uneasy about living in evacuation shelters although family and home are safe: "There are several evacuees who cry or roam at night. Therefore, those who lost their loved family or discovered remains of their family were prescribed by the visiting doctor at the local mental clinic. Wakayama City and Prefecture dispatched two public health nurses in each to station at the community supporting hospital. These nurses listen carefully to the talk of evacuees as a preventive measure. The number of people who suffer from constipation is increasing. Also, public health nurses help stretching because they need exercise."
In addition, we talked to an evacuee. The person lost the home and shop, but the family was safe. "The tsunami hit about 20 minutes after the earthquake. At that time we had to drive up to the heights and evacuate Yamada Junior High School. Since there are dikes which can prevent 5 meter tsunami, those who did not escape by '3M tsunami warning' or those who survived the earthquake in Chili and failed to get out in time, swallowed up by the tsunami. I evacuated from Yamada Junior High School to Yamada High School for the night, because two fires caused by reflective heaters devastated the town and mountain. There are enough clothes and food. We wipe ourselves with a disposable medical sheet, which is distributed one per day, because we can't take a bath. However, infant can have a bath, children can take a bath at the children's hall, and today the 28 elderly people took the free pick-up bus and soaked in a hot spring in the neighborhood. There are some mentally impaired people eat food for others, stole things, wander around with underwear at night, and kick the heater. Those who are around them try to sooth and calm them down. The gym divided into four areas (from A to D), and after that, we voluntarily decided section leader and vice section leader. Those who need order consult with the principal and do volunteer work independently. Especially, high school student volunteers are doing great job, so it encourages other adult volunteers to work actively. Given no further explanation by Town Hall, there is a talk about 'an application for temporary accommodation,' and thus put in for the application. However, there is no updated information and no way to obtain information. There is no television, so we listen to the only NHK radio that repeated the safety information.
NTT had come here seven days since the disaster and KDDI had nice days after, and then cell phones were available. Those who don't have their mobile phone use the land phone for 30 seconds if they sign up at the reception desk."
Finally, we talked to the head nurse of the relief party at the Japanese Red Cross Society: "We came here as the third party and are composed of two doctors, five nurses (one head nurse and one midwife), one pharmacist, and two staff members. We stayed at the chemistry lab for the dispatching activities in five days and four nights (actual working days are three days). The first-aid station is open from 7:00 to 19:00, but actually we work from 5:30 to 20:30 pm for just in case. About 70 people saw a doctor yesterday, 9 people (fever, vomit: diarrhea, etc.) the day before yesterday, and one patient was transported to the Iwate prefectural hospital, one of the community supporting hospitals yesterday. There are many patients who lost their medicines for chronic disease by the tsunami. Prescriptions for patients complained of fever or constipation are available in the local hospitals, so the Japan Self-Defense Forces transported these patients. There are patients with diarrhea, fever, and vomit by gastroenteritis, so we treat them by dividing space into 'room for diarrhea' and 'room for vomit,' but they get better by giving an IV drip or taking medicines for internal use so far. We divided the medical squad into two teams, and visited this first-aid station and other evacuation shelters in the neighborhood. Also, there are evacuees who did not see a doctor even though they have acute cutaneous wounds by the tsunami. Therefore, we patrol the inside of the gym by cooperating with public health nurses to obtain information. Moreover, there are some patients who burst into tears while we are listening to their complaints, so it seems that it is necessary to provide an opportunity to voice their complaints as a care for mental health. We are going to send the party to the fifth one and to stay here until April 1st.
2)Yamada Town Hall
We visited the Yamada Town Hall where the building located in the heights had no damage from the fire and the tsunami. It looked safe so far, but the entire Yamada-machi was devastated by the earthquake, fire, and tsunami from the view point here. We informed the staff members of the situation of the shelter in Yamada High School and did fact-finding in Yamada-machi for the condition to accept elderly people who are in need of social aid.
First, we talked to the public health nurse at social health and welfare section: "Since welfare evacuation shelters are not available now, the elderly people who have problems both health and nursing care such as pressure sores, were transported to the prefectural hospitals. However, most of them are returned to the original place for the night. The elderly people with pressure sores appear. Now, the number of bedridden elderly is 45 people and they accommodate in the Local Government Exchange Center. Both one public health nurse and two care workers care for 24 hours a day."
We can predict that the number of elderly people who are transported to this Center will increase in future, because there are many potential patients at Yamada Minami Primary School, Yamada High School, and other evacuation shelters. It is an urgent matter to dispatch disaster supporting nurses and support care workers since there is always a lack of nursing care resources. We confirmed this matter at the Community Sport Center in the Town Hall. Tomorrow, we are going to visit the Local Government Exchange Center and to plan a schedule to realize the actual circumstances.
The following four points are our future tasks in the evacuation shelter:
1.There is a sufficient amount of relief provided by the Japan Self-Defense Force, the Japanese Red Cross Society, etc. Therefore, we don't need to send relief supplies one-sidedly to the affected area, but to confirm and deliver necessary and timely goods since the communication network is gradually restored.
2.Under the status quo, despite of its necessity, it is difficult to set up welfare evacuation shelters. However, we are expecting the following illnesses (pressure sore, disuse syndrome, pneumonia, constipation, dementia, etc.) brought about disadvantages by bed-ridden elderly people. It is necessary to send support nurses to care for evacuees.
3.There are still about 13,000 people missing in the entire damaged area, so evacuees may discover remains of their loved one in near future. Also, it is necessary to dispatch the specialists for the following issues: anxiety about their unforeseen future, a sense of stagnation in the present situation, and early detection and care for other mental illnesses.
4.It is necessary for the replacement of local health nurses and volunteer nurses who were working at refugee centers. They were suffered from the disaster, so they should need to take time to care for themselves and their family. Moreover, it seems that it is necessary to provide back-up support of nursing profession from outside in order to support refugee centers when they return to their workplaces where they used to work before the disaster.
Mariko Ohara, Takako Ito
The second advance members, Tomoe Watanabe and Yuko Tategaki, started their missions mainly in Miyagi Prefecture from March 17th, and ended them on March 21st. We would like to express our deepest gratitude for your cooperation to our activities.
Since the communication network has been restored, we are able to grasp the more detailed situation than before. Thus, we will update the homepage as quickly as we can. For your further information, we updated the following report on the activity from the first advance party for Fukushima and Miyagi in our website, "bulletin board on information and knowledge about the 2011 off the Pacific coast of Tohoku Earthquake"
Report from the first dispatching party for Fukushima and Miyagi (March 12th to 17th)
http://www.jsdn.gr.jp/doc/report2011.03.12to17fukushima.pdf
Tuesday, March 22nd
We visited Kami-toyomane Community Center where the elderly people who are in need of care are evacuated, according to the information yesterday from Yamada Town Hall. After that, we moved to Miyako City and visited Iwate Prefectural Miyako Hospital, Public Health and Welfare Division of Miyako City Hall, Public Health and Welfare Environment Center of Branch Office, and General Welfare Center. On the way to Miyako, we dropped by Jodogahama Beach, but the coast was devastated as well as Yamada-machi.
There are one public health nurse, one social welfare worker, and two staffs working at the center located in the district away from the coast of Yamada-machi. In total, four public officials of Yamada Town Hall have managed this center by staying with evacuees. A volunteer care worker is working during the daytime until March 23rd. 41 evacuees who lost their home by tsunami and fire live in the Center, and it includes two paraplegia and three bed-ridden elderly people. Other sufferers also need care and support to some degree. There is a bed-ridden elderly person who was transported to the hospital once due to the treatment for the pressure sore of the waist, but he returned to this center in the next day. This patient is suffering from acrocontracture and dementia, and the family members have provided tube feeding to the patient from stomach before. Moreover, we were consulted by them about there has been no bowel movement for 10 days when we visited there. For that reason, we extracted stools with fingers and did enema. This patient is suffering from bedsore, so two regular staff members take care of the patient by changing the body positions for 24 hours a day with taking a nap each other. A person with paraplegia had done self-catheterization, but changed bladder catheterization in the aftermath of the disaster. A person who has a major depression aggravated the symptom by suffering from the disaster, thus wandering around the shelter and shouting out loud at night. Therefore, the doctor prescribed some antidepressants for the mental disorder.
An office has started "the mobile bath service" since yesterday, but only one care worker helps take a bath, so one of our members supports it. Those who can walk by themselves could go to the hot springs in the neighborhood. There are many elderly people with adult diapers, so home care volunteers come twice a day and change their diapers. There are plenty of food supplies and local volunteers prepare for cooking. Furthermore, evacuees can have three meals in a day such as rice porridge, rice ball and some side dishes. Water supply is still available at the beginning in this area, and electricity had restored about one week after the earthquake. They have already prepared for cold weather, so right after the disaster they operated the dynamo to produce electricity and used paraffin heaters by the distribution of oil.
The community's future concerns are that they may not accept the volunteer service and the bath service due to the shortage of oil. The relief party of the Japanese Red Cross Society is planning to visit here until March 28th, but the schedule after that is undecided. Evacuees longed for nurses who are able to support and care for the pressure sore, excretion, and good sanitary conditions. They have requested air mattresses and are waiting for the shipping of them. However, they realize that also need some water proof sheets for those who are incontinent.
We brought the following items from the relief supplies of the Japanese Red Cross College of Nursing: disposable protective gowns, masks, diapers, incontinent pad, etc.
We talked to the person from the Nursing Department: "This hospital hasfunctioned as the center of cooperation hospitals right after the disaster. We cooperated with DMAT (Disaster Medical Assistance Team) and transported serious patients to the hospital of Morioka City or Akita Prefecture. Until today we have provided extra office hours due to the disaster, but will resume regular medical treatment by tomorrow. Most of the current patients lost their medicines by tsunami. There are about three nurses who were unable to work because of suffering from the earthquake and tsunami. Now, there is enough number of nurses who are dispatched from Iwate Prefecture although the number of patients in the hospital increased because of the disaster and it caused the nurse shortage at the beginning. Therefore, we don't need any additional support nurses."
We thought Miyako City Hall lost its function even though the building did not collapse because it located in the coastal area so suffered extensive damage. We talked to the staff member: "Two days ago I worked here under the light of candle. Also, there is no access to the outside world till yesterday, so all information was concentrated on Iwate prefectural office, and their branch offices monopolized it. It was difficult to increase in the number of comings and goings of people and goods due to the lack of information and gasoline. Therefore, by human-wave tactics the staff members visit each shelter on foot or by car. The patrol party consists of two or three people and there are from seventy to eighty groups working independently. It seems effective to help evacuees if nurses, public health nurses, and public officers cooperate with each other. Although it is necessary for the staff members to recover from their fatigue, their morale is still high. For that reason, it should not depend entirely on the support from outside, but cooperate in case of being offered the support."
Miyako Public Health Center takes charge of accepting public health nurses, but they did not know about the activities offered by Miyako City and the Support Nurse Program sponsored by the Japanese Nursing Association. This is also the same situation that they could not keep in touch with other organizations until yesterday, and therefore there is no information about the support nurse even though Public Health and Welfare Environment Center takes charge of admitting medical related team.
We talked to the staff members of the Miyako City General Welfare Center: "We receive instructions from Miyako City not to recruit volunteers for health care providers. However, four nurses working in Miyako City have already been registered as volunteers, but they have been already dispatched not as nursing profession but as staff members for the reply to the request of the management of evacuation shelters."
There are some areas that they cannot obtain the information, so do not grasp the situation of shelters. We thought they need to consider the necessity of nursing care and to gather information of the shelter as soon as possible. Moreover, if they make the check list on dispatching nurse and relief supplies, they can decide the priority. Although public health nurses from Iwate Prefecture have been already sent to the shelters, they need to plan an important role as the home care providers as soon as the situation is settled down. The nursing profession ought to be dispatched to the refugees, and it is predicted that the necessity of home care provider will increase rather than that of nursing care. It is also predicted to transport those who are in need of social aid or care because of the setting up welfare evacuation shelters in future. We brought the following items from the relief supplies of the Japanese Red Cross College of Nursing: diapers, masks, and disposable protective gowns, etc.
We asked a question about the support nurse, but both City Hall and its branch offices do not have any information. We thought they need to communicate with the public health nurses of the city. It seems effective to make use of the support nurse that the nurses who work at the hospital can have a rest or replace the local nurses who stay in the evacuation shelters while lifelines are completely restored. We felt the nurses who live in the all evacuation shelters are necessary.
Mariko Ohara, Takako Ito
There are some evacuation shelters where we do not know the current conditions even though eleven days have passed since the disaster. Moreover, "disaster support nurses" have been sent by the Japanese Nursing Association since March 22nd. Some organizations do not know the information itself, and others realize the system of "disaster support nurses" and then they decided that it is unnecessary. There is huge digital divide and thus it creates inequality of the supporting system. However, at least nurses are necessary in the shelters. It is necessary to dispatch the local nurses and "disaster support nurses", etc. from outside of the affected areas. Therefore, the Nursing Associations in each prefecture need to administer the survey to the local nursing profession regularly despite the communication breakdown.
Wednesday, March 23rd
We visited the Iwate Nursing Association (INA), prepared the material of our activity of "Outline of the report on the activities of the advance team for Iwate by the Japan Society of Disaster Nursing to the Tohoku-Pacific Ocean Earthquake."
On behalf of the Japan Society of Disaster Nursing, we, the advance team for Iwate, made the following five proposals:
Not only two damaged hospitals which were already decided now, in case other hospitals need the support of the affected nurses, the supporting system is not well publicized how the Iwate Prefectural Government draws on nurses' opinions and she informs the INA of them.
We can predict that the number of diseases (bedsore, disuse syndrome, pneumonia, constipation, dementia, etc.) caused by the disadvantages of the bedridden elderly will increase. However, it is difficult to set up welfare evacuation shelters even though they are necessary. Therefore, we need to dispatch the support nurses to do nursing care.
About specific shelters which are the object to dispatch in Yamada-machi and Miyako City
In both Taro-cho and Omoe areas, many refugees have been still isolated since the disaster due to the communication breakdown and there are many evacuees who are advanced in years there. We believe that sending the support nurses makes them possible not only to care the victims, but also to inform the local administration of the crucial information.
About 13,000 people are still missing in the entire damaged area, so those who are suffering from the disaster may discover the remains of their family members. Also, it is necessary to take countermeasures against the following issues: anxiety about their unforeseen future, a sense of stagnation in the present situation, and early detection and care for other mental illnesses. Therefore, we need to cooperate with expert counselors.
It should be necessary for the affected local nurses to take time to care for themselves or their family. Moreover, it may be necessary to support nursing profession from outside for the backup of the evacuation shelters in case they return to the places where they used to work before the disaster.
A sufficient amount of relief supplies are provided by the Japan Self-Defense Force and the Japanese Red Cross Society. However, there is the gap between haves and have-nots in each area. Therefore, we do not need to send relief supplies one-sidedly to the affected area, but to confirm and deliver necessary and timely goods (such as water proof sheets, protective gowns, toiletries, sox, carpet slippers, rubber gloves for cleaning the toilet, rubber boots, sandals, etc.) since the communication network is restored.
Many disaster relief nurses are dispatched to the devastated area through the Japanese Nursing Association (JNA) for this earthquake and tsunami disaster, and about half are in Sendai, and the other half are in Morioka. In Iwate Prefecture, they are dispatched to the hospitals in Kitakami and Kamaishi City. The affected nurses are working around the clock, so it is the purpose to support them.
Although we need to support welfare evacuation shelters, now is a particularly difficult time to establish these shelters. The reasons are that a) evacuees are unable to move due to the gasoline shortage, and b) they have to live separate from their family. It also depends on how long the JNA sends disaster relief nurses to the damaged area. If there is a request from the prefectural government, the JNA would send them.
In terms of doctors and public health nurses, it is the system that the Japanese government sends them to the prefectural governments. However, in terms of nurses, the prefectural governments do not know the system of disaster support nurse by the JNA, so they cannot use it. Therefore, the Iwate Nursing Association (INA) explained it to the prefectural governments after the disaster, and INA was tied up with the prefectural government in a hurry. Furthermore, it is the current situation that public health nurses who were dispatched to the shelters by the local government do not request any support to the government, since they do not know the disaster support nurse system. It is against this backdrop that the number of public health nurses who are registered with the Japanese Nursing Association is small and decreasing year by year.
Mariko Ohara, Takako Ito
First and foremost, we would like to express our deepest gratitude for your cooperation with our activities. Our fellow members, Mariko Ohara and Takako Ito, the advance team to Iwate Prefecture, have finished their activities on Wednesday, March 23rd.
The Japan Society of Disaster Nursing provides the purpose to dispatch the advance team as follows: "We, as a disaster nursing expert, enter the devastated area and play a part (advice and mediation for making nursing care plans) in adjusting the supporting structures and to offer nursing care in the local area, in case the large scale of disaster occurred. More specifically, we gather and assess the information on health problems of victims and on the request from nurses, etc. and define the necessary support. Our activities focus on the domestic disaster as a general rule, and we establish a systematic knowledge base for disaster nursing through these activities."
Each advance team, which is dispatched this time, provided nursing care for the victims in the shelters, made an assessment on evacuees' health problems and living conditions from the nurse's point of view with, and reported the administration which takes charge of the shelters in the same day if possible. We could only receive the summary of their daily activities right after the disaster due to the poor communication network, but the amount of information on the activities increased as gradually as the network is recovered. Now, each advance team is organizing the first phase of their activity report. The report from the first advance team for Fukushima and Miyagi has already updated at the front page of our website, "The bulletin board on information and knowledge of Tohoku-Pacific Ocean Earthquake" (http://www.jsdn.gr.jp/index.html), and we will update other team's reports as soon as they are completed. Moreover, after we provide further analysis on the reports, we will contribute to the journal of Japanese Society of Disaster Nursing (JSDN), or will give a presentation at the JSDN 13th Annual Convention held on September, 2011. Although the activities of the advance teams have been completed, we will continue to present a progress report on the activities of Tohoku-Pacific Ocean Earthquake as the responsibility of JSDN.