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AB1417-PC Rheumatic patients in japan after earthquake, tsunami and nuclear disaster. -Reportage from rural areas, including fukushima-

Background The March 11 disaster, including 2011 Tōhoku earthquake, tsunami and Fukushima Daiichi nuclear disaster affected the rural districts, where many doctors migrated away to the cities. In these areas, the health care system had been collapsing gradually and many hospitals collapsed actually at that time. Emergency medical services after these disasters were provided and reported in various parts of Tōhoku. Although many rheumatic patients resided in these areas, they were scarcely reported. Objectives To elucidate the status quo of both the rheumatic patients and rheumatologists in rural areas in Japan. Methods In the year of 2011, the author visited the rural districts in Japan: for example Kushiro, Imabari, Fukushima and so on. Several pieces of information about patients, rheumatologists and the medical system in each distinct are collected and compared each other to elucidate how the circumstances surrounding rheumatic patients are changing. Results The Japanese National Police Agency confirmed 15,844 deaths due to these disasters in Tōhoku. The number of the evacuees has once passed 300,000. Many elderly people and many rheumatic patients are estimated in these people but the number of these patients is unclear. Many doctors were killed by these disasters and more moved to other areas except Tōhoku; therefore a lot of rheumatic patients may have lost their home doctors in these stricken areas. Fortunately or unfortunately, a considerable number of doctors assumed their new posts in some other rural districts where rheumatologists had been insufficient. Discussions The collapse of the health care system had affected more seriously the patients with chronic rheumatic diseases than the patients with fatal diseases, because the former group did not seem to require urgent medical care. Almost everyone with severe headache or acute chest pain calls an ambulance without question, but few people with knee pain visit the hospital immediately. Many patients with rheumatic disorder had become medical refugees in the countryside. Some patients had travelled 2 hours to get to the hospital for the treatment of rheumatoid arthritis, and other patients with osteoarthritis had have to wait several years for total knee replacement surgery. Medical tourism, which involved travelling to foreign countries to obtain health care, had not been so popular and realistic in the rural districts. After the March 11 disaster, the circumstances surrounding rheumatic patients became worse and worse. Lonely death or “kodokushi” in Japanese is feared among these rheumatic patients who are not mobile sufficiently, as was occurred after Kobe earthquake in 1995. Conclusions On behalf of many rheumatologists who are working in Tōhoku, the author makes a reportage on the patients with chronic rheumatic diseases. These patients are suffering from the insufficiencies of medical services and must be protected from “kodokushi”. References Nukada I.: “Kodokushi” in Japanese. Iwanami-shoten. 1999. “Kodokushi” in http://en.wikipedia.org/wiki/Kodokushi Disclosure of Interest None Declared