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The Japan Disaster: Reflections of a Wits emergency medicine doctor

7 June 2011 - By Deborah Minors

An earthquake so powerful that it shifted the Earth on its axis by 10cm and stopped the clocks in Japan at 14:46 on 11 March 2011 followed by a 10m-high tsunami travelling at the speed of a jumbo jet, the impact of which set off a nuclear accident, encompassed ‘the Great East Japan Earthquake’ that claimed a reported 15,057 lives.

As medical director of the Rescue South Africa Disaster Response Team (RSA), Wits Professor of Emergency Medicine, Efraim Kramer (MBBCh 1978) recounted the experience to some 80 Health Sciences students and staff at Wits Medical School on 20 May 2011.

The 50-member strong RSA team left South Africa on a chartered flight for the city of Ishinomaki, Miyagi Prefecture, on 16 March. “It was a 767; cost a couple of million and that’s where the bulk of the funds went – but we flew economy class for those that are interested,” Kramer jokingly assured the audience.

“You go there and learn how to manage a disaster (as) the Japanese are an absolute text-book example of how it should be done”, says Kramer.

The Japanese are equipped for earthquakes. “Japan is built earthquake-proof,” he explains. Homes are built of wood to minimise the impact of collapse and every household has a haversack containing families’ travel documents and essential supplies, easily accessible when the country’s siren alerts its people to prepare to evacuate. A second siren signals that they move. Quickly. But thousands of Japanese, patiently and obediently awaiting the second siren, never heard one, as aftershocks had destroyed the power supply to the signal. The image of a 10ft black wave “like a plague of biblical proportions”, was their first indication that a tsunami was upon them, Kramer observes.

As powerful as the earthquake was (8 000 times stronger than the Christchurch quake in New Zealand earlier this year) it claimed only 100 lives. The massive loss of life was due to the devastating tsunami that followed the earthquake.

Vivid and shocking images of the impact of the disaster flashes on the screen as Kramer describes the “tsunami wave that comes out of the sea [like] a black death” at an estimated 800km/h and engulfed an area equivalent to the distance between Durban and Amanzimtoti in KwaZulu-Natal.

The RSA team’s priority on arrival was to identify evacuation points to ensure their own safety once they began the grim task of searching and recovering the deceased (“this is very important to the Japanese – ‘just bring me back a fingernail!’” implored Kramer of his team).

A priority of the medical team in particular was to look after the crew’s psychological and physical well-being. “You see horrible things and have to make sure everyone manages,” Kramer said in an interview before the mission. “You can search for 16 hours and find a dead baby and then you have to deal with it. I came back from [the earthquake in] Haiti and it took me four weeks to recover. It’s a risky mission. The guys push themselves. They’re full of adrenaline and will go for 24 hours for seven days a week if you let them. You have to make sure they eat properly and rest.”

Half of the RSA team were new recruits who had never left South Africa before, providing a unique learning experience in line with the vision of Kramer’s emergency medicine department to go out, assist, learn, and then come back and teach.

“The guys that have done this before know when to take a step back. With the young guys you have to be careful,” he says. “If there’s a change in a member’s temperament or a guy moves away from the crowd, you sit down and have a chat.”

“Unseasonable” spring weather in Japan further challenged the team’s psychological and physical endurance. With temperatures averaging –2°C (the coldest recorded was –17°C), hyperthermia, trench foot and frostbite were constant threats. “We wore every item of clothing we brought,” recalls Kramer. “Then we reversed the order and wore everything again, and then turned everything inside out and wore it again.” He tells us, chillingly, that the frigid temperatures preserved the expressions on the faces of the deceased as they died.

An image of the team nursing Nestlé hot chocolates and ‘Ouma’ rusks flashes on the screen, providing momentary light-hearted relief. Regarding the dietary requirements of urban rescue workers Kramer emphasises, “It’s not about the taste; it’s the heat.” One of the four squads of the team remained at the camp each day to cook and clean while the others searched and recovered. “We had some pretty creative meals – soup, pap [maize meal porridge], veg, and pilchard fried cakes – and chocolate mousse! “We introduced the Japanese to pap – I think they want to import it – and we’ve brought home some great recipes.”

The mood darkens and the audience turns sombre as Kramer shows images of cars like toys incongruously piled atop each other, planted into the side of a mountain. He indicates the outline of a body he says is an old woman, wedged between a vehicle and the mountain. “We found a CAT-scan machine 2kms away from a hospital – and a car in the hospital ward,” he says solemnly.

He tells of a psychiatric ward in Ogatso Bay, where Japanese medical officers had no choice but to pile dangerous, aggressive and panicking psychiatric patients into an ambulance – and then run for their lives; how the team had to secure and safeguard blood banks and “rescue” critical documents, such as last wills and testaments, for legal firms.

Kramer’s presentation suggests that, amidst the annihilation, the most resounding impact of the rescue mission was the camaraderie and the bonds that were forged. Indeed, ‘solidarity’ is one of the key motivators. “Imagine you had a major disaster and no one came?” exclaims Kramer!

The RSA team was one of 21 selected by the Japanese and has a reputation for undertaking the less savoury and more sensitive missions that other teams can’t or won’t. “When we get there, we don’t say ‘we’ll do this or we’ll do that’. We ask, ‘what do you need us to do?’”, says Kramer. “Only the South ��һ�Թ��� team was equipped with inflatable boats to go onto the islands of toxic water left behind after the tsunami receded,” he adds. “We’ve earned our stripes and are a more mature team. We’re a tough bunch.”

Japanese Prime Minister, Naoto Kan later wrote: “…the ‘Rescue South Africa’ team…swiftly flew to Japan, being the first ever rescue and relief operation by an ��һ�Թ��� nation in Japan. Their courageous and effective work under severe conditions represented the clear testimony of friendship and solidarity that the government and the people of South Africa have shown us.”

Kramer concludes his presentation to the emotionally exhausted audience. He shares how the RSA team, killing time at international departures, spontaneously launched into Nkosi Sikelel’ iAfrika; the strident harmonious melody of South Africa’s national anthem effectively bringing Narita International Airport to a standstill.

All images courtesy Rescue South Africa