WAJIMA, Ishikawa Prefecture—The ground was still shaking from aftershocks when Makoto Shinagawa heard the first report about conditions at Wajima Municipal Hospital.

“We’ve got a huge number of patients coming in,” a staff member told him on the evening of Jan. 1. “The hospital is in a panic.”

Since then, Shinagawa, the 65-year-old director of the hospital, has been desperately trying to treat a steady stream of disaster victims, from those with bone-crushing injuries to people suffering from contagious diseases.

Although Wajima Municipal Hospital is designated as a disaster base hospital, its many struggles since the Jan. 1 quake underscore the difficulties of preparing for calamities in this earthquake-prone nation.

TRIAGE AT HOSPITAL ENTRANCE

Shinagawa was returning to his home in Shika, about 40 kilometers away from the hospital, for the New Year’s holiday when the Noto Peninsula earthquake hit.

He had evacuated to an elementary school on higher ground in the town after a tsunami warning was issued.

It was there where he heard from the hospital staff member. “Medical equipment is broken and we can’t operate,” Shinagawa was told.

But the director could not move because of the tsunami threat.

“I’m sorry. You’ll just have to hold on with the members who are there now,” he said.

The commute from his home in Shika to Wajima Municipal Hospital, the only general hospital in the city, normally takes about an hour.

On the morning of Jan. 2, the drive took four hours because a national highway was cut off by a landslide.

When he finally arrived at the hospital, he saw fluorescent lights hanging by wires in the entrance, which was filled with injured people.

Doctors were performing triage to determine treatment priorities. Several people were black-tagged, meaning there was no hope of saving their lives.

In the evening, Shinagawa took charge of a woman in her 90s who was red-tagged as severely injured.

She had been trapped under a collapsed house for 24 hours. Although she was pulled out of the rubble, her legs were necrotic and she was in a state of shock.

Her legs had to be amputated, but the medical equipment for such a procedure was damaged by the earthquake.

Shinagawa wanted to airlift her to a hospital in Kanazawa, but a helicopter was unavailable because it was too late in the evening. Driving her to the prefectural capital would have taken eight hours.

The woman was nearing the black-tag category.

When Shinagawa consulted with the woman’s family, they told him, “We would rather have her die in our care where we are rather than have her die alone on the way to (Kanazawa).”

She passed away at Wajima Municipal Hospital.

Shinagawa said the mortuary at the hospital was a painful sight.

The bodies of two children, 10 and 12, who were visiting their grandparents’ home on New Year’s Day, were lying on the mortuary floor.

“They were all supposed to be having a good time on New Year’s Day,” he said.

The earthquake also seriously affected hospital employees.

Full-time doctors have a dormitory near the hospital, and more than 10 of the 16 doctors there rushed to the hospital immediately after the quake.

But the hospital’s approximately 120 nurses live throughout the Noto Peninsula. Only 30 percent of them could reach the hospital after the quake.

One staff member climbed over cliffs from an isolated village to get to the hospital.

But many others were unable to come because of roadblocks and infrastructure damage. Some of the workers’ homes were destroyed in the quake, and they were evacuating the carnage with their children and elderly parents.

Other staff members could not be contacted.

SUPPLY SHORTAGE

The hospitalized patients were given priority for the hospital’s stockpile of retort rice and canned food. At times, the workers could only eat jelly or pudding.

“If this continues, we will die,” Shinagawa heard one staff member say during an overnight shift.

Doctors on the Disaster Medical Assistance Team (DMAT), which began providing support on Jan. 2, told Shinagawa that the hospital would be unable to sustain itself unless it transferred patients to other facilities.

In addition to easing the workload on staff members, available beds were needed for patients brought in from evacuation centers.

The severed water supply and equipment damage also made it impossible for the hospital to provide proper medical care to critically ill patients.

At the beginning of the disaster, the hospital already had about 110 inpatients, mostly local senior citizens.

The hospital obtained the consent of their families to transfer these patients to other hospitals.

Shinagawa said he was at a loss for words when asked by the families when the patients could return to Wajima Municipal Hospital.

Some of them were elderly singles. Others were elderly couples who had been taking care of each other.

“Community health care only makes sense if (patients) stay in their hometowns,” Shinagawa said. “I am sorry that we had to force them out halfway.”

Since Jan. 3, about 85 patients at the hospital have been transported by Self-Defense Forces’ helicopters and ambulances to medical facilities in and out of the prefecture.

NEW THREAT: INFECTIOUS DISEASES

Shinagawa and his colleagues at the hospital are now dealing with a new phase in the disaster: treating a growing number of infected patients from evacuation centers.

About 15 feverish patients arrived on Jan. 10. The daily number jumped to between 40 and 70 from Jan. 11 to 13, and the hospital was treating about 40 on Jan. 14.

Most of the cases were caused by the novel coronavirus, influenza or infectious gastroenteritis, Shinagawa said. Many of the patients were dehydrated.

He said he fears the number of hypothermia patients could rise.

PREPARATIONS FALL SHORT

This is the second major earthquake disaster that Shinagawa has experienced.

In March 2007, just after he assumed the post of director, the area was struck by an earthquake with an intensity of 6 on the Japanese seismic scale of 7.

The hospital was swamped with trauma patients. Water was cut off, and it took several days to bus about 80 dialysis patients to other hospitals.

Learning lessons from the 2007 quake, Wajima Municipal Hospital had been preparing itself as a base hospital for disasters.

In addition to stockpiling its own water and food, it signed an agreement to share supplies with nearby welfare facilities.

Two weeks before the New Year’s Day earthquake, which registered an intensity of 7, the hospital conducted a triage simulation.

As a result of these efforts, Shinagawa said, the hospital could prepare to transport dialysis patients from the first day.

However, Shinagawa said he was not prepared for a situation in which so many employees would be unable to work.

The nearby welfare facilities were also damaged, making it impossible to take advantage of the supply-sharing agreement.

The chronic shortage of physicians forced the hospital to shut down its neurosurgery department. Catheterization procedures that were previously performed have been discontinued.

Shinagawa said there is little hope of soon restoring the water supply, and repairs and inspections of medical equipment will require more time.

Each morning’s meeting at the hospital begins with the report, “We have only three days’ worth of water and four days’ worth of food left,” Shinagawa said.

“If a patient’s condition worsens during the evacuation and they become seriously ill, they won’t be able to receive advanced medical care at our hospital,” Shinagawa said. “It is realistic for the victims to evacuate to a secondary evacuation center in a well-prepared area as soon as possible.”

Working under such stressful conditions has also taken a physical and emotional toll on staff members.

Some of them have expressed their intention to retire from the field because of the disaster. It is difficult to foresee how many will remain at the hospital.

“As it stands now, I can hardly picture the reopening of a ‘normal outpatient clinic’ where any illness can be treated,” Shinagawa said.

He believes this disaster will likely accelerate discussions on consolidating hospitals on the Noto Peninsula.

Shinagawa has been the director of Wajima Municipal Hospital for 17 years.

He often visited the Wajima “asa-ichi” morning market that burned down in a huge fire triggered by the earthquake. Many of his patients are acquaintances.

Shinagawa said he will continue to provide disaster medical care for as long as possible while remembering the faces of each and every patient.