Post 3/11: Interview with Dr. Kiyomoto (Part 3 of 4)

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Part 3- Moving Forward: The Establishment of New Programs for Medical Progress

Nicole Gunawansa | February 3rd, 2015
This interview was held on December 2nd, 2014 in Tohoku Medical Megabank Building

Question 7: The ToMMo Clinical Fellowship Program was initiated in response to the urgent need for more physicians in affected areas. Did you feel that this system was/is effective in administering aid?

Immediately after the disaster Tohoku University sent out rescue medical teams to help with the injured in the coastal areas. We also used telemedicine in order to help local doctors manage patients that needed treatment. However, both of these relief efforts did not provide a long term benefit to the local medical system. In fact, those local areas even started to refuse volunteer medical staff about fifteen months after the disaster because they claimed they had enough doctors. Initially, my department was confused about this strange situation, but we then realized that the problem was the vast presence of temporary 'hero' doctors. These physicians are not from the local areas, but they come to the coast to gain recognition for helping in the disaster relief and leave afterwards. There was a shortage of local doctors long before the disaster. This issue would not be alleviated if relief medical staff kept flooding into the area only to stay for a short period of time. Also, free distribution of medication by these doctors did not help improve the local economy. We needed to devise a more sustainable plan to promote human resource in the local area.
In addition to increasing disaster relief education of local doctors, ToMMo began the Clinical Fellowship Program with Tohoku University Hospital and School of Medicine. This program rotates medical staff to devastated location so that physicians spend only a part of their training on disaster medicine, while the local areas are ensured of the accountability of the visiting doctors. Physicians who participate in the Clinical Fellowship Program receive specialized medical training and spend four months in an affected area. This time period is short enough to keep up motivation and morale for the visiting doctors, but also long enough and consecutive to certify that the medical staff truly learns about various aspects of disaster medicine. As of now, the program seems to be effective for the communities, patients, and participating physicians.

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Question 8: What are the current contingency plans for various types of future disasters? How have these plans been altered by 3/11?

As I have mentioned, after Kobe, Japanese DMAT came about. This time an integrated medical record system came about: MMWINTM(Miyagi Medical Welfare Information Network). MMWINTM is a secure electronic health record database in which hospitals in different areas can (if necessary) communicate patient medical information. A database of patient information would be helpful in the case of a future disaster because patient records would be saved from physical damage (i.e. being washed away by a tsunami). However, there has been reluctance to participate in this system due to fear of a lack of privacy. Only some hospitals have implemented this system, and they often only feel comfortable to share their information with other local hospitals (within the same prefecture). In the words of René Sand M.D. (1877-1953), "Health cannot simply be given to the people. It demands their participation." We hope to overcome the fear that the Japanese people have of MMWINTM and genomic medicine with education. In Kesennuma, after educating the public, agreement rates for blood samples (for cohort studies) is higher than it is in Sendai, so education is the key to unlocking this change of mindset.

 

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Cohort Survey conducted in Kesennuma (May 26th, 2014)

Question 9: Can you explain the immediate response system for people whose cohort study results show abnormalities?
As of December 2014, more than 48,000 people have been surveyed (including physiological sampling) in Miyagi Prefecture. The number of patients whose results have indicated serious diseases is 312. All of these patients were informed of these abnormal results so that subsequent appropriate medical testing could occur. There is a grading system which categorizes how serious the results are, and how the news is to be transferred. In less severe cases, patients receive a notification letter which provides information about referral to medical specialists. In more severe cases, patients are contacted via phone immediately and asked to come in for a meeting to discuss the next step in their diagnosis or treatment.
This system is effective at communicating survey analysis abnormalities to the affected patients, and has been well received by the patients who have been helped. I believe that the immediate response system could be improved if a system like MMWINTM was more available within Japan. If more people consent to having their information put in the database and more hospitals utilize shared electric medical records, then incidental findings could be better communicated and more collaboration could occur to help treat patients.

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