PAMF's Dr. Enoch Choi
Technology has its limits.
At least one American aid team has dispatched to Japan, iPhones and iPads with mobile EMR software and medical reference tools in hand. But they haven’t been able to unleash the power of their handheld computers to help the estimated 261,000 people still living in shelters as of Wednesday—12 days after the devastating earthquake and tsunami.
“They’re desperate for basic food, water, fuel,” says Dr. Enoch Choi, an urgent care physician at Palo Alto (Calif.) Medical Foundation and medical director of Jordan International Aid, a California-based Christian aid organization. “They’re out of medicine.”
There is a particular shortage of potassium iodide pills to counter the effects of radiation from crippled nuclear power plants, Choi says.
Jordan International Aid has sent a team of nine disaster-response veterans, including a physician and a nurse, to help in the coastal city of Ishinomaki, which was all but washed away by the tsunami that followed the 9.0-magnitude quake on March 11. But most couldn’t get transportation from Sendai, the capital of Miyagi Prefecture and the largest city in Japan’s Tohugu region, where the disaster is centered.
“The sad thing is, medical volunteers are all jammed up in Sendai,” Choi reports. While he remains in California, he is in regular contact with the aid team in Japan and is preparing for future relief missions once the situation is more under control.
“This time, it’s almost far too early,” says Choi, who notes that the conditions are very different in Japan than they were in Haiti last year. Choi helped put together nine relief missions to Haiti in 2010, where he and other clinicians charted patients with iChart mobile EMR software on iPhone 4s, obtained through a grant from Epocrates.
For the Japan relief efforts, the team has six iPhone 4s and three iPads, plus mobile Internet access via a MiFi hot spot donated by XCom Global.
So far, only a couple of Jordan International Aid representatives have made it to Ishinomaki. (Jesse Mendoza, president of the organization, has posted a series of videos, shot on an iPhone, of his journey to Ishinomaki and his observations there.)
The physician, Dr. Tim Riesenberger, and nurse, Vanessa Remhof, have registered with local authorities so they are able to practice in Japan and have been doing what they can to help displaced people in shelters around Sendai. They participated in a web chat Tuesday night that is archived on interactive health site MedHelp.org.
Major issues there include transportation to the hardest-hit areas, as well as a tragic bit of irony. The Japanese people are among the best-prepared in the world for a disaster situation, and, according to Choi, elderly citizens with chronic diseases often keep a couple months’ worth of medications on hand. “The problem is, all of their homes are washed away,” Choi says.
When such people show up at shelters seeking help, they often can’t remember the names of the medications they were on, Choi notes—exactly what happened to those forced out of New Orleans by Hurricane Katrina. But because Japanese physicians often dispense their own medications, there aren’t good pharmacy records available like there was in Louisiana in 2005, so volunteers at relief clinics to guess.
“They know what problem [patients] have. They just don’t know which meds to prescribe.” Choi explains. “Some elderly may die because of adverse reactions.”
This, according to Choi, “underscores the need for health information exchange.”
Choi’s team also reports not being aware of any medevac operations from the disaster area to Tokyo, even though many local hospitals were destroyed. “This suggests that many people were swept away by the tsunami and died,” he says.
He also believes that the self-sufficient nature of Japanese culture has prevented many people from seeking help. “I’m worried that a lot of people are sheltering in their homes without food and water,” Choi says. Based on United Nations reports, Choi says that more than 170,000 people in Japan were not in shelters but also not in their homes, either, as of Tuesday.
“This speaks to the need for telemedicine,” he says.