Missing doctors

march 10, 2012

ONE YEAR AFTER THE DISASTER / Doctor shortage raises concerns in Tohoku / Patients in desperate need of diverse medical treatment

The Yomiuri Shimbun

http://www.yomiuri.co.jp/dy/national/T120309006422.htm

"Your neutral fat level is a bit high. You should start walking when spring arrives," Dr. Minoru Kawashima recently advised a woman in her 60s. He also asked her if she was suffering from hay fever when he examined her at a hospital in Kesennuma, Miyagi Prefecture, which is still recovering from the March 11 earthquake and tsunami.

Kawashima, 37, is the director of the municipal Motoyoshi Hospital. The facility is located in the Motoyoshi area, which has a population of about 10,000 people.

After the disaster, the hospital was on the verge of closing as two full-time doctors left the institution. However, it was able to survive thanks to doctors like Kawashima who came to help from all over the nation.

Kawashima became the director in October at the hospital's request. He moved to the city, leaving his family behind in Yamagata Prefecture.

Kawashima treats many different kinds of ailments, ranging from infectious diseases such as influenza to stitching up cuts. He visits patients during the afternoon at their homes.

He also started a pediatric practice as the hospital did not provide such care before the March 11 disaster.

In 2010, there were only 14 doctors per 10,000 people in coastal regions of the three hard-hit prefectures, excluding Sendai. The figure is two-thirds of the national average, and only half that of Kyoto Prefecture, which has the nation's highest doctor-to-population ratio.

Put simply, there is only one doctor for every 700 people in the coastal areas.

According to a Yomiuri Shimbun survey conducted last month, 30 out of 106 participating hospitals in the coastal regions of the three prefectures said they had fewer doctors than before the March 11 disaster.

Since medical needs are expected to increase further if evacuees return to their hometowns, securing doctors will become an immense challenge.

Miyagi Prefecture started hiring doctors as prefectural government officials and sent them to local government-run hospitals in need of doctors.

"Home doctors" like Kawashima who can satisfy various medical needs will be needed in areas with a considerably low number of doctors.

Hiroki Ohashi, director of the Japan Primary Care Association, said: "Doctors practicing in such areas are required to deal with a wide variety of problems, ranging from diseases and symptoms particular to the elderly, such as high blood pressure, diabetes and joint pain, to cancer. The ones who are able to do that are family doctors."

The Health, Labor and Welfare Ministry also is studying how to train home doctors.

It is also necessary to build a system that enables local communities to support patients by sharing functions between medical institutions and nursing-care facilities to improve efficiency.

In June, the health center in Ofunato, Iwate Prefecture, set up a panel to study measures to restructure the medical system.

A major discussion point was how to ease the burden on the prefectural Ofunato Hospital, which has only 489 beds. The hospital was the only designated emergency hospital in the area after the prefectural Takada Hospital was damaged in the disaster.

People in these areas are concerned that medical care, including surgery, will deteriorate unless a system to share responsibility among medical institutions and nursing-care facilities is established.

Ofunato Hospital accepted 1,760 emergency patients in January, up 20 percent from a year ago. Additionally, the number of outpatients and inpatients at the hospital each rose 6 percent from a year ago.

Following the panel's discussions, an Ofunato clinic was reportedly willing to accept patients from Rikuzen-Takata, Iwate Prefecture.

Jichi Medical University Prof. Eiji Kajii stressed the need to fully utilize facilities and manpower in the disaster-struck areas.

"Since there are limited medical and nursing-care resources in the region, it is necessary to utilize related facilities and human resources beyond the boundaries of local governments," he said.