PROBLEM: In the Taro District (population: 4434), the great tsunami of 11 March 2011 destroyed the central region including the clinic, the sole medical facility (one physician, 13 nurses and other staff) in the district, and many citizens were forced to live in evacuation centres.

CONTEXT: The Taro District experienced massive damage during the tsunamis of 1896 and 1933. Since then countermeasures to tsunamis have been implemented. The great tsunami on 11 March 2011 caused catastrophic damage to the lowlying areas where approximately 2500 people lived; 1609 buildings were completely destroyed, and approximately 200 people died or were missing across the district.

ACTION: The Taro National Health Insurance Clinic, the sole medical facility in the Taro District, was required to play a central role in a variety of activities to care for residents in severely affected areas. First of all, evacuees needed to move to neighbouring hospitals or safer evacuation centres because lifeline services were cut off to the first evacuation centre. Then, the clinic staff worked in a temporary clinic; they visited the evacuation centres to assess the public health and medical situation, cared for wounded residents, managed infection control and encouraged a normal lifestyle where possible. Additional medical, pharmaceutical and logistical support was received from outside the district.

OUTCOME: There was no noticeably severe damage to health, although there was manifestation of and deterioration in lifestyle-related diseases (e.g. diabetes, hypertension, obesity). Health care activities gradually returned to their pre-disaster levels. At the end of July 2011, the evacuation centres closed, and all evacuees moved to temporary accommodations.

Discussion: Isolated rural health practitioners were required to be involved in a wide variety of activities related to the disaster in addition to their routine work: e.g. preventive health (public health and safety activities), routine medical care, acute medical care, psychological care, post-mortems and recovery of medical facilities. Although the whole health care system returned to near-normal six months after the disaster, it is important to plan how to develop more resilient medical systems to respond to disasters, especially in rural areas. This article describes my experience and lessons learnt in responding to this disaster.

Influenza is one of most common acute viral infections in humans. It is estimated that seasonal epidemics affect 10–20% of the population, resulting in 250 000 to 500 000 deaths every year. In addition to seasonal influenza epidemics, antigenically distinct viruses originated from animal species tend to emerge in the human population every 10 to 40 years. Since most the human population does not have immunity to such viruses, global epidemics with significant impact, i.e. influenza pandemics, have occurred in the past.

The Japanese Society of Hospital Pharmacists (JSHP) started to collect the pharmaceutical care reports from the hospital pharmacists by a name of “PreAVOID” from 1999. The report number of PreAVOID increased year by year and reached about 50,000 totals in 2006. PreAVOID reports are classified in 2. One is the prevention of the adverse reaction and the drug interaction, the other is the avoidance of progress to the adverse reaction. In the latter, the role of the adverse reaction monitoring is included. Therefore PreAVOID is able to apply in Pharmacovigilance. PreAVOID is reported to JSHP by Fax or E-mail or the homepage of JSHP and it is evaluated and classified and then are accumulated in the database. The accumulated PreAVOID reports are utilized for creation of the pharmaceutical care information, study promotion about the medical economy. Therefore PreAVOID takes an important role as a nucleus of the pharmaceutical care management system by the pharmacists.
We are convinced that PreAVOID will be able to contribute to achievement of real purpose of Pharmacovigilance that is the effective and safety drug therapy.

　　The “Akita Heart-full Net” started operation as a cooperative community medical network in April 2014. It was established jointly by Akita Prefecture and Akita Medical Association and is run by the latter. Problems experienced in its operation have been addressed, and a duplex system was introduced so that many medical institutions can now easily join the system. Functions in relation to participating clinics especially have been enhanced. The new functions, “unloader” and “portal window”, were included so that clinics can used the system whether or not they the use electronic health records or standardized data. A seamless system that does not distinguish between flagship hospitals and clinics enables information exchange and sharing. This will further enable a cooperative system for clinical practice to be established based on free access to information about referred patients and the use of the community medical care cooperation pass. To contribute further to medical care in Akita Prefecture, we plan to extend the system further so that it functions as a collaborative network, covering a wide area and involving different professionals, with a focus on home medical care within the context of integrated community care.