This blog is the second of a series of blogs linked to the Evidence & Policy special issue (Volume 16, Issue 2) on Opening up evidence-based policy: exploring citizen and service user expertise. Guest Edited by Ellen Stewart, Jennifer Smith-Merry, and Marc Geddes.
How are you doing? You told me how you could not stop binging on COVID-19 news. So, I am sending you something different: “Risk, uncertainty and medical practice: changes in the medical professions following disaster” by Sudeepa Abeysinghe et al. I can see you wince, complaining that a paper written about a nuclear disaster that happened 9 years earlier has nothing to do with what we are undergoing now (note: this piece was written in March-April 2020). Well, I would argue that the paper is quite relevant today because it gives us perspective on how the medical professionals stretched their roles/responsibilities in times of crisis. You told me of your deep respect for these professionals, and I believe this paper will increase your understanding of their challenges and even deepen your appreciation.
The focus of the paper is the professionals in Minamisoma city, Fukushima. You remember I visited the city in September 2014 for the eighth International Commission on Radiological Protection (ICRP) Dialogue meeting. Minamisoma is located approximately 25km from the defunct nuclear power plant, and at one time, it was placed under three restrictive zones, including a shelter-at-home order. You can vividly imagine the confusion and the anxiety felt by the residents. Through the Dialogue, I learned of the challenges faced by the medical professionals including the material disruption and the acute supply shortage immediately after the accident (the authors wrote an excellent analysis) as well as the development of Babyscan, a device to measure the internal exposure of infants and young children.
The authors’ claim that key medical professionals in Minamisoma city went beyond the expertise they were trained for to meet the demands from the public for radiation-related information (especially measurement), etc. This resulted in an adjustment of boundaries among doctors, technicians, nurses, and pharmacologist, etc. The authors suggest using the concept of post-normal expertise in mode-2 science to understand the work of the medical professionals.
I can relate to the reason why the citizens of Minamisoma relied on the medical professionals and not the other experts or the authorities. After the accident, in addition to the strong and widespread distrust of the authorities, there was intense disagreement among the experts on the radiation from the accident and the effect on health. Just like we are hearing about R0 and Epi curve, terms like sievert and becquerel suddenly became part of our daily decisions on what to eat or where to visit. How can we make an informed decision on something even the experts could not agree on? Amid such confusion, one thing was certain: the medical professionals in local hospitals shared the experience of post-accident Fukushima. Also, the doctor-patient confidentiality meant one could discuss fears and concerns without peer pressure. Mothers of young children could speak the fear of children’s radiation exposure without being scolded that they were being oversensitive. I am grateful for the extra efforts put in by the interviewees to aid the residents.
The paper also sheds light on the strain caused by such change. It was often physicians and hospital managers who took the initiative to take on new work/role such as Whole Body Counters, giving lectures to the public and liaising with the stakeholders. And, their stories tend to be focused in the media. In times of crisis, we instinctively seek for feel-good stories, and there is a temptation/risk to idolize certain actors (you can now order a stuffed Dr. Fauci doll). In reality, medical service is a team effort where all professionals/workers matter. The paper includes comments from a technician and a pharmacologist who felt challenged by the change in boundaries. As the shortage of PPEs became Achilles’ heel in the current crisis, the overall quality/effectiveness of a medical service depends on its weakest link. The strength of this paper is pointing out the importance of listening to voices that are often neglected, those who signal that all is not rosy.
I hope I have convinced you that this paper is worth reading. Today, the authors and the interviewees must be tackling COVID-19 instead of radiation―I am deeply grateful for the work they do for the community, and pray for their safety.
With best wishes,
 Abeysinghe, S., Leoppold, C., ozaki, A., Morita, M. and Tsubokura, M. (2017) Disappearing everyday materials: the displacement of medical resources following disaster in Fukushima, Japan. Social Science & Medicine, 191:117-24.
 Aoki, M. (2015, October 9). Extensive radiation study finds no internal cesium exposure in Fukushima children. The Japan Times. Retrieved from https://www.japantimes.co.jp/news/2015/10/09/national/science-health/extensive-radiation-study-finds-no-internal-cesium-exposure-fukushima-children/ on April 20, 2020.
Tazuko Arai is a freelance translator/interpreter and a full-time cat caretaker based in Tokyo. These days she wears a face covering almost all the time and is crocheting one for warmer weather.
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