March 23, 3011, 2011 -- The massive destruction left in the aftermath of the tsunami and earthquake that rocked Japan nearly two weeks ago also left disaster-hit areas with a major medical crisis.
ABC News reached out to physicians near the front lines of the relief efforts and asked them for their perspectives on the health situation. They said that while things are starting to improve, there's still a long way to go to recover fully.
Dr. Takashi Shiga, an emergency medicine physician at Massachusetts General Hospital in Boston, has just returned from Miyagi Prefecture, where much of the severe damage was done. During the week he was there, Dr. Shiga spent time in Sendai, the hardest hit city, and Kesennuma, a city to the north.
He tended to patients at shelters as well as at the municipal hospital in Kesennuma. Most of those who were initially injured critically have since died, casualties of the tsunami. Hundreds of disaster medical assistance teams evacuated many survivors.
"The hospital was intact, but the infrastructure was damaged. There was no Internet, no electricity, no water and no cell service," he said.
Patients who were severely ill or injured were taken to other cities within 72 hours. The remaining patients, Shiga said, suffered from stress-related insomnia or worsening of chronic conditions, high blood pressure, colds and constipation. Medical supplies and medication have also been scarce.
Shiga also said the municipal hospital didn't get overcrowded because the clinic was shut down and only patients in dire need of treatment were admitted. Other hospitals throughout the disaster haven't been as fortunate. They are still overcrowded and dealing with shortages of medication and supplies, preventing critically ill and chronically ill people from getting the help they need.
"Hospitals in the disaster area are still crowded now," said Dr. Fuminobu Yoshimachi, director of the department of cardiology at Aomori Prefectural Central Hospital in Aomori City. Yoshimachi has numerous colleagues in the areas most affected by the earthquake and tsunami.
He said he and other physicians have been trying to make their way to the disaster areas, but are in limbo because of bureaucratic challenges. Local governments, the Red Cross and medical groups who have gathered to help have been unable to organize relief efforts.
"There is no chain of command," he said. "If we want to go to help some area, it is rather difficult to determine when and where we should go, how we can go, what kind of drugs and support we should bring."
But Shiga says the response by the government and other agencies has been great.
"I think they did quite a good job handling it," he said.
In the days immediately following the quake and tsunami, Dr. Tsuboya Toru gathered information from a number of other doctors in the hardest hit regions. In a report he distributed to colleagues, he noted a severe shortage of food, medication, milk and minimal electric power and water in the quake-hit Miyagi Prefecture.
"Medicine and medical equipment are short and we are trying to minimize IV [intravenous] drips and prescribe only limited amounts of pills to outpatients," Toru wrote.
Yoshimachi said there are patients with chronic diseases that are getting worse, and many of those patients can't get the medication they need.
Dialysis patients, he said, must head to Tokyo or other parts of Japan because there are more hospitals with the necessary equipment and supplies as well as an adequate supply of clean water.
One doctor from another hospital in Miyagi Prefecture reported that several patients who needed intracranial surgery couldn't get it and instead, were treated mainly by observation. Other hospitals reported performing limited surgeries.
One of the biggest problems, doctors say, is a shortage of fuel.
"It is difficult to go to some areas because of no gas for cars," said Yoshimachi.
Even those who recover from their illnesses or injuries may not be able to go home, because their home was lost. Hospitals for many have become temporary homes.
Radiation Still a Concern
Shiga said he didn't see any patients with illnesses related to radiation exposure because very little radiation leaked in the area where he treated patients.
"Even now, except in Fukushima, I don't think there's been any radiation leakage," he said.
Dr. Yoshito Yamamoto works at Iwaki Kyoritsu General Hospital in Fukushima, about 27 miles from the power plant.
"Both our medical activity and the lives of citizens were seriously limited by the nuclear disaster. We could not walk outside freely, and suddenly the supply of everything including gas, food, water and medications stopped completely," Yamamoto said. Drivers refused to deliver to the hospital.
There are still a lot of medical needs in Fukushima, but many medical personnel are afraid of radiation exposure and are reluctant to assist in the area.
Recovery Slow, But Communities Optimistic
Physicians have expressed their gratitude to their colleagues from other nations who have traveled to Japan to assist in relief efforts. Recovery is slow, but the communities hit by the disaster remain optimistic.
"I saw daily changes of recovery," said Shiga. "We got more medical supplies, and communities are intent on recovering as well."
It will take years of effort and an estimated $309 billion to rebuild, but doctors say the Japanese people are committed to it.
"We Japanese have spirits of cooperation and we will be able to overcome this," said Yoshimachi.