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 The doctors were prepared to treat a large number of
eye infections due to contaminated water in the aftermath of the
earthquake and tsunami. But in fact, what people needed most were
replacements for lost eyeglasses, contact lenses or eye drops.
The Great East Japan Earthquake hit off the coast of Tohoku, Japan,
in March of 2011. The magnitude 9.0 earthquake was the largest to
ever hit the country. It caused a massive tsunami, which traveled up
to six miles inland, according to the BBC.
The earthquake resulted in more than 15,000 confirmed deaths, most
due to drowning, according to the National Police Agency of Japan,
in addition to radioactive leakages at Fukushima Daiichi and Daini
nuclear power plants.
Most eye care clinics in the Miyagi prefecture were damaged so badly
that they could not be used. With infrastructure severely damaged,
doctors from outside the disaster area had to travel to the region
in their own cars bringing equipment they were able to carry
themselves, said Dr. Hiroshi Kunikata, one of the authors of the new
report in JAMA Ophthalmology.
Kunikata is an ophthalmologist at the Graduate School of Medicine at
Tohoku University in Sendai, Japan.
After a month of this inefficient system, doctors from Tohoku
University and the Miyagi Ophthalmologists Association and trained
volunteers were able to travel around the area of devastation in the
customized Mission Vision Van, a large bus outfitted with all the
key equipment required to perform general ophthalmologic
examinations.
In the new paper, doctors report on the treatment they administered
between April 15 and May 29, 2011.
Over 15 clinic days, the van visited 11 emergency districts and
delivered treatment to 731 patients.
Only eight percent of their diagnoses were infectious diseases, like
conjunctivitis. Most commonly, doctors diagnosed refractive
disorders - like nearsightedness, farsightedness or astigmatism - as
well as cataracts and dry eye. These would not have been caused by
the earthquake or tsunami.
Doctors and volunteers handed out emergency prescriptions for more
than 800 bottles of eye drops for conditions like dry eye, cataracts
or glaucoma.
“One of the key effects of the 2011 disaster in Tohoku was to
deprive survivors of eyeglasses, contact lenses and medications for
chronic eye diseases,” Kunikata told Reuters Health by email.
“In some cases, this placed a severe burden on these survivors, in
addition to the burdens already faced by all those who lived through
the disaster, not only in the immediate aftermath of the disaster,
but during the days, weeks and months that followed, while they
waited for outside assistance,” he said.
The authors recommend that in the future, mobile emergency eye
clinics have an auto lens edger and a large supply of medication on
board.
“We found that a properly equipped mobile clinic was an
indispensable way of ensuring that survivors of this disaster did
not face additional hardships due to the simple loss of glasses or
medicine,” Kunikata said. “Thus, we believe that mobile eye care
vans will be of the greatest importance in future natural
disasters.”
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The Mission Vision Van used in the study, one of at least three such
vans in the U.S. and which was assembled to aid in recovery after
Hurricane Katrina in 2005, was airlifted from the Bascom Palmer Eye
Institute of the University of Miami Miller School of Medicine to
Sendai. It made the trip thanks to the friendship between Dr. Kazuo
Tsubota of Keio University in Tokyo and Dr. Eduardo C. Alfonso,
director of the Bascom Palmer Eye Institute.
“Eddie is my good friend; we did a fellowship together 25 years ago
at Harvard,” Tsubota told Reuters Health. “I called him because we
had an emergency, and he had seen already the tragedy of the tsunami
on TV.”
It would have cost $1.6 million to transport the van to Japan, but
Russia’s Volga Shipping Company agreed to make the trip free of
charge.
The relief efforts in Japan went so well that the Japanese
government presented the Miyagi Ophthalmologists Association with
its own Japanese Vision Van in 2013.
The Japanese version is smaller and, unlike the American version,
conforms to Japan’s lower emissions standards, Tsubota said.
The Japanese Vision Van has been used in Japan and in the
Philippines following a typhoon in November of 2013, Kunikata said,
and would also be of great use in many other kinds of large-scale
disasters.
“I think the medical van in general is an excellent idea for
disaster relief, particularly if the team has to cover a large area,
like the (Great East Japan Earthquake) and Tsunami,” said Dr. Shun
Kohsaka of the cardiology department at Keio University in Tokyo.
Kohsaka was part of a primary care relief team in Japan after the
earthquake in 2011 and also published on the subject in Archives of
Internal Medicine (now JAMA Internal Medicine) in 2012, but was not
part of the new research team.
“We also had an ophthalmologist in our team and were surprised that
so many patients needed his care, both for their refill of their
usual medications and urgent trauma care,” Kohsaka told Reuters
Health by email. “Our team was assigned to a station at one of the
satellite clinics but having a mobile van would have probably helped
us more.”
The Vision Vans are highly specialized to provide eye care and
cannot be converted for other uses, but the idea of converting vans
for other types of emergency care has great potential, Kunikata
said.
SOURCE: http://bit.ly/1mVghEy
JAMA Ophthalmology, online May 8, 2014.
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