Visiting Scholar Dr. Nobuaki Matsuo Provides Tsunami Relief in Thailand

When Nobuaki Matsuo, MD, learned that a massive tsunami had ravaged south Asia on December 26, 2004, his first desire was to join in the emergency medical relief effort. He knew that a relief team would be mobilized and sent from Japan.

At his home in Japan, Dr. Matsuo is on the faculty of the Kansai Medical University Department of Family and Community Medicine. He has extensive experience in Emergency and Critical Care Medicine and is experienced in disaster relief. Right after the most recent Gulf war, he spent one month with Doctors without Borders in Jordan and on the Iraqi border to provide medical care to refugees.

He also is a member of the Japan Disaster Relief Medical Team (JDR), a Japanese government organization. When Thailand, Sri Lanka, and Indonesia asked Japan to send medical supplies, the cabinet decided to send a medical team, a rescue team, and a helicopter team to those countries. His colleagues on the disaster teams were prepared to travel to the tsunami region immediately.

But this year Dr. Matsuo is a visiting scholar with the Michigan State University Department of Family Practice, exploring how family medicine is practiced in the United States. It was a 14-hour plane ride to his home in Narita, Japan, and he expected that the relief teams would be leaving Japan within 24 hours.

In Dr. Matsuo’s words:

At first I thought I could not have a chance to go, because I was here in the United States. It’s very far away, and we have to go within 24 hours, or at the most 48 hours.

JDR has both a rescue team and a medical team. The rescue team has to leave Japan within 24 hours. The medical team should leave Japan within 48 hours after the government decides to send them. I heard that the team assigned to Thailand planned to start on December 30, so I thought I could have a chance. I made a phone call.

The JDR asked me to return to Japan as soon as possible. They said the government will decide if they will send me to Thailand or Indonesia. I bought a ticket on a direct flight from Detroit to Narita. On the 28 th, early in the morning, I left East Lansing for Japan. At that point, on Dec. 28, I did not know to which country I would be sent.

The medical team is made up of registered doctors, nurses, and coordinators. We have training exercises three times a year--how to pitch a tent, how to make clean water. When we are sent to a disaster, our first job is to treat patients, and second, to prevent infectious disease such as water borne disease. We also advise the government. Our assignment usually lasts two weeks, because it is very hard. If we need a longer period of activity, we call a second team or a third team to replace the original team.

Soon after I landed in Narita, the medical relief team embarked on the six hour trip to Bangkok. During the flight, I slept.

We took another one-hour flight to Phuket, in the most damaged area. From Phuket, we then drove to a site on the coast.

We set up a tent as a clinic in the refugee camp. There were 3,500 homeless people there in small tents. People had fled to the mountains because they were scared of the seashore. That is where we visited the survivors. They are relatively poor people, so they had lost everything. The Thai government sent them our clinic. There were 1,600 households. There are many orphans.

Our team consisted of 22 people, including four doctors, seven nurses, one officer from the Japanese Foreign Ministry, and coordinators. We later hired 10 translators in Thailand. We brought everything we need with us, even the tent where we would establish our clinic.

Many robbers come across the border from the country of Myanmar. Our team was robbed two times while we were out treating patients. They knew that were a medical team and they robbed supplies. Also, there is kidnapping and the selling of children to other countries, especially in rural areas.

We treated approximately 600 patients. About 16 percent had infected wounds. Patients had been hit by broken wood, dragged under the water. If they had severe wounds, they were transported to Bangkok. Survivors had many small wounds, but most of them were infected. We treated them, cleaned them, and sutured them.

Most of the wounds were on the lower legs. They had been searching for missing people in the mud, through the wood and stones. The lower legs were in bad water. The wound is very small, but becomes infected. So it is swollen, and some people have high temperatures.

They are living in very small tents. Some children and elderly were suffering from dehydration. They are staying in a small tent under high temperature. It was about 90 degrees, very hot. In Thailand, the dry season had started. So we had to take care of dehydration of children and elderly.

Another significant problem was acute stress disorder (ASD). Symptoms are headache, insomnia, suffering from mental illness. Most of the patients came to our clinic tent and complained of headache. The doctors asked why they had a headache, when the headache started. Then the patients started talking…and talking. And then many patients were crying. I think in such a case talking is very important.

One month after the disaster, if the symptoms continue, we call it post-traumatic stress disorder. ASD is defined as up to one month. After one month, if the symptom continues, it we call it PTSD.

In Japan, there are many, many natural disasters. In 1995, we had a huge earthquake in Kobe, my home town. It was strongly damaged. Around 6,400 people died. After that experience, we learned that early interference with patients was very important. So after we arrived in Thailand, we tried to talk with patients, visit many tents.

In Thailand, most of the people are Buddhists, so there are many monks. The monks got together from around Thailand to visit the camps. It’s very important for monks to speak to the people, to prevent ASD or PTSD.

Sanitation to prevent infectious disease is important after such a disaster, such as cholera, typhoid fever, dengue fever, malaria. In Thailand, fortunately, the infrastructure is very good. Compared to Sri Lanka or Indonesia, where they are still fighting each other in the country. Soon after the tsunami disaster, clean water was supplied (by the government). It’s important to prevent water borne disease. We didn’t see so many diarrheal diseases.

We educated the people, especially children, to wash their hands after the latrine or before eating. We drew some pictures and put them in front of our tents. Once a week we put on a play for the children. Some doctors played the bacteria. After the play, we heard that children were washing their hands.

They knew the importance of washing hands, but this is not daily life. They live in a refugee camp, so they sometimes forget. Once we have a huge natural disaster, it will take more than three years for things to be normal again.

After the Kobe earthquake we received many supplies from overseas, such as blankets, food, water. Thailand, for example, sent a medical team, blankets, and rice. Sri Lanka sent three tons of tea.

Once I knew about the huge tsunami disaster in Asian countries, I knew that I would like to join the mission. I wanted to; I really wanted to. I’m Japanese, and the Japanese should play a role in helping Asian peoples. We remembered that after the Kobe earthquake many Asian peoples, from developing, not-so-rich countries, they gave us help. So I was really happy to go.

Dr. Matsuo has now returned to his studies of family medicine as a visiting scholar with the Department of Family Practice.