JAPAN TSUNAMI UPDATE By Mikihiro Sunayama Japan was not prepared to help survivors traumatized by the Great Eastern Japan Disaster, and Lions are supporting counseling for post-traumatic stress. Typhoons, torrential rain, flooding, landslides, tornados, volcanic eruptions, earthquakes, and, perhaps most frightening of all, tsunamis: the fragile islands of Japan suffer devastating natural events on a yearly basis. Since time immemorial the Japanese have said that “no sooner do we forget of the last disaster that the next one will strike.” The magnitude 9 earthquake that shook northeastern Japan and unleashed a savage tsunami on March 11, 2011, killed more than 18,000 people. Most died by drowning. It was fourth most powerful earthquake since modern recordkeeping began in 1900 and the most powerful one to hit Japan. Survivors still live in temporary housing units, and lives remain in shambles. Psychiatric care for victims is still woefully inadequate. Bodily injuries have healed but mental trauma persists, among many families not even addressed yet in any way. Lions in Japan have offered many kinds of aid. They’ve made a difference particularly through counseling. Helped by Lions worldwide, who made donations to LCIF, Lions in Japan are enabling traumatized people to regain their mental bearings and put their lives back together. When the earthquake and tsunami struck, there were hardly more than a handful of post-traumatic stress disorder experts in Japan. One of the few PTSD specialists, Hidefumi Kotani, a professor of clinical psychology at International Christian University (ICU), traveled to the disaster-stricken area in May 2011. While lodged in a childcare center owned by a friend, he visited disaster areas along the coast including Sendai. The downtown of Sendai had been largely spared, but the damage to its outlying areas was a different story. Vast swaths of land along the coast had been inundated. Debris from thousands of homes lay everywhere. Journalists dispatched to report on Sendai struggled to describe the devastation but often resorted to “apocalyptic.” Convinced of the necessity for adequate mental health care, Kotani met with Tomoaki Adachi, a researcher at Miyagi Women’s College in Sendai. In September 2011, ICU and Miyagi Women’s College started the Disaster Relief Clinical Psychology Center (EJ Center) in Sendai to provide clinical counseling to disaster victims. The Japanese are well aware of PSTD. Media reported on case after case following the Kobe Earthquake in 1995 and the Sarin gas attack in the Tokyo subway that same year. Untreated PTSD was blamed for attention-deficit related traffic accidents, truancy, isolationism, domestic violence and even suicide. Psychiatric care in Japan is much less developed compared to that in other advanced nations. Cultural awareness for mental health issues is discouragingly low in Japan, and few patients know who or where to go to receive counseling or treatment. Mental disease is also largely brushed under the rug by the education and social welfare system. PTSD is insidious. Immediately after a tragic disaster, most people quickly try to bounce back and find a new rhythm. Yet psychological distress can remain deep in the person’s mind, and initial symptoms often arise many months and years after the actual trauma. Symptoms include dizziness, nightmares, insomnia, emotional detachment and respiratory distress. The disaster’s impact is reflected in the rise of social maladies in the Miyagi Prefecture where Sendai is located. The reported incidence of domestic violence has increased by 33 percent since the disaster. Child abuse has risen by 34 percent. Truancy, delinquency and traffic accidents all have increased as well. The Sendai EJ Center has served 1,770 patients through December 2014. Many of the patients are professionals working in the disaster-stricken areas: students, medical professionals, caregivers and teachers. The founding premise of the EJ Center is that taking better care of the caregivers will have a trickle-down effect to the disaster survivors. Healthcare professionals often downplay their own misfortune and stress. “My experience during the crisis was not so bad. I have no right to complain compared to people who lost children, spouses and parents. I got off easy” is a frequent reflection. Many of the professionals insist that they simply don’t have the time to take care of their own health. They repeatedly internalize their stress, which eventually manifests as physical ailments. One psychiatrist reported that after hearing countless stories of personal loss and suffering from disaster victims, he subconsciously formed memories of being directly affected in the disaster, even though he had not been. His own health became compromised. In some cases the internalized trauma became tragic: incidents of healthcare workers committing suicide at the workplace. The EJ Center duly provides individual counseling. But officials also developed a unique workshop therapy. Most people in Japan simply will not open up and talk about what they went through. Group workshops have been effective in giving people the freedom to speak out. In the workshops, participants with similar experiences are divided into groups of about 10 people. Depending on the situation, various therapeutic approaches are used. In one method a participant reads a children’s picture book in a loud voice. That’s a first step in creating a comfortable environment before transitioning into actual therapy. Another method borrows from a strategy that works with children, who often have difficulty verbally expressing their emotional troubles. Adults in the therapy session recall deeply hidden memories from the disaster by using building blocks as a visual aid. They build pieces of furniture or houses only to later knock them over as if they were recreating the earthquake. Though seemingly simplistic, the building block strategy has proven effective. One survivor had participated in many sessions but not spoken about what had happened to him for two years. Then, in tears, he related his story: “On 3/11, I was in my apartment. The furniture and everything else fell over. I was unable to get out of the apartment for two days. I was so scared.” The EJ Center has become a much needed lifeline for medical professionals. EJ Center Director Adachi says, “Disaster victims’ experience is varied. It is difficult to quantify the therapeutic time and effort needed to help each individual patient. However, after a two-year treatment course of bimonthly workshops [6 hours per session], most patients report remission.” Lions have played a crucial role in supporting the workshops. In 2013, the Sendai Aoba Lions Club, the Shizuoka Aoba Lions Club and District 332-C provided aid. In 2014, the same two clubs were able to supplement the operation of the EJ Center with funds from LCIF. The Kyoto North Lions Club began contributing in 2015. Appropriately, the EJ Center is known as the “Lions Clubs Mental Health Reconstruction Project.” Recently, other institutions have begun to request workshops. The center has started providing monthly dispatch therapy sessions off-site as well. Lions help cover staff transportation costs. In the nearby city of Rikuzen Takata in the Iwate Prefecture, all clinics and pharmacies were demolished on March 11. Just five months later, a new consolidated clinic with internal and surgical medical treatment was opened. Lions clubs used the LCIF 3/11 Disaster Fund to purchase medical equipment and to erect temporary clinic buildings including one set aside for mental health care for middle school-aged children and younger. Therapy also is provided for high school ages and above. The middle school and younger patients are seen by psychiatrists; older patients are seen by psychosomatic specialist physicians. The psychosomatic consultations for patients in high school and older have been provided every week without fail thanks to the Japan Society of Psychosomatic Medicine, the subspecialty’s regulating body. Dr. Keiko Yoshida, the chief of child psychiatry at Kyushu University Hospital, has visited Iwate often since 2011 to treat children. Until recently patients seeking psychiatric care in Rikuzen Takata have been few, she says. However, people are finally beginning to open up and talk about the 3/11 disaster and aftermath. Yoshida expects the number of patients to seek care will increase but many “shadow patients” exist. Disaster survivors often hide their traumatic past in an effort to forget the painful memories. Others convince themselves that “I couldn’t possibly be sick.” Shadow patients’ mental injury becomes deeper and more internalized. The more deeply they hide these injuries, the greater the potential for violent outbursts later on. Lions of Japan will continue to support counseling and offer other aid. Disasters in Japan are a way of life, and Lions know their service will remain crucial for years to come. A version of this story appeared in the Japanese LION. Digital LION Japan recovers from the tsunami with the help of Lions and LCIF. (May 2013 LION). LCIF Provided $21 Million in Aid Counseling for survivors was one of many ways LCIF partnered with Lions in Japan after the tsunami. LCIF’s relief efforts focused on replacing healthcare equipment that was damaged or destroyed and on supporting economic revitalization projects. LCIF mobilized and disbursed $21 million for Japanese Lions after the disaster. LCIF provided $1 million in Major Catastrophe Disaster funds, and Lions worldwide contributed $20 million to LCIF for relief in Japan. DESPAIR AND HOPE Some adult survivors are unable to find closure yet children are showing signs of recovery. BY HIDEAKI SUZUKI The waves unleashed by the tsunami easily topped the seawall protecting Otsuchi, a small beach town of 1,300. Nearly one in ten residents perished within moments. Dainen-Ji is the only Buddhist temple in Otsuchi that survived the disaster. It serves as a final resting place for the cremated remains of the disaster victims. Since all of the other temples were destroyed, Dainen-Ji accepts remains of all religious denominations. Today, four years after the disaster, there are still 80 reliquary boxes resting in the main worship hall of the temple alongside the spirit tablets of the temple’s parishioners. “Regardless of whether they were parishioners or not, many of the deceased persons’ graves were swept away in the tsunami,” says temple abbot Shuichi Ogayu, a member of the Otsuchi Lions Club since 1989. “We are responding to the wishes of surviving family members, and we offer a final resting place where the town can be viewed. There are still more than 40 boxes that are yet unidentified.” Ogayu says he will never forget the looks of distress and abandonment of the surviving family members who came to the temple to find their loved one’s remains but left empty-handed. “It was so hard to watch,” he says. Determined to help them find a sense of closure, he made rounds to the parishioners living in temporary housing. “For the families with children, they have to keep on chugging along for the sake of the kids. But for those individuals who lost their entire families and now live alone. … Some of them are just living every day in destitution,” says Ogayu. In Otsuchi, interviews for those wanting public housing have begun. The reality in the community is that not everyone in need is stepping forward. As the construction has not even started, people are pessimistic about how long they will have to wait and when they will actually be able to move in. In the immediate aftermath of the disaster nearly everyone shared the same predicament, forging a strong sense of camaraderie and mutual support. But four years have passed, and the survivors’ emotions have diverged. Some are coping well and others are struggling terribly. The burden on those who are helping is growing. Their challenges seem insurmountable. “The longer people stay in temporary housing units, the further they sink into despair. This is the moment of truth. The deciding factor is going to be how well we can help heal hearts and minds,” says Ogayu. Youth’s Resiliency The elementary school building in Otsuchi remains in shambles. Truancy after summer vacation at the middle school was rampant again this year. The disaster has weighed heavily on children. The feelings they hold inside come spilling out in anger on occasion. Yet rays of sunshine burst through the dark times, says Ogayu. Before the disaster, the Dainen-Ji temple held storybook readings at the request of the elementary school, adjacent to the temple. The readings have restarted. The student choir once again is practicing at the temple. Normalcy has made a comeback. The schoolchildren are benefiting from a variety of programs and projects. A nonprofit in Tokyo has sent university students to tutor the children affected by the disaster. Counselors are available at schools for one-on-one sessions. Hiroshi Sado, a world-famous conductor, and other world-class musicians have performed for the community and held hands-on musical workshops. “Since the disaster, the kids have been exposed to so many rare experiences. They have been able to meet famous people from Japan and abroad,” says Ogayu’s wife, Lion Miyako, who helps run the storybook reading and chorus practice. “The exposure to these kinds of once-in-alifetime experiences has increased dramatically post-disaster. Their perspective has broadened. They have more ambition. Many lost parents and are suffering greatly psychologically. But it hasn’t been all doom and gloom for these kids.” Adds her husband, “I think that it’s safe to say that there is a lot of hope for the children right now. Hope that they can and will turn out to be strong adults. Personally I really feel that the children and the youth in general have a renewed sense of love and pride for the community.” Looming ahead, however, is the cutoff date for government recovery funds. The clock strikes midnight in April 2016 for many of the most beneficial programs. The Lions clubs of Japan have a longstanding reputation for supporting children in need, and communities will count on the continued support of Lions. In Otsuchi there is a small island off the coast called Horai-Jima, which served as the inspiration for “Hyokkori Hyotan-Jima,” a famous children’s puppet theater TV show from the mid-1960s. The loudspeakers in Otsuchi play the Hyokkori Hyotan- Jima theme song at noon each day. (Every town in Japan plays a midday chime and a 5 p.m. melody on massive PA systems.) Serendipitously, the song’s lyrics seem to capture the feeling of hope and recovery: Sometimes it’s gonna be rough Sometimes it’s gonna be sad That’s why we gotta keep hangin’ on tough We don’t like to cry, we just laugh it off.
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