Healthcare Delivery to a Repopulated Village after the Fukushima Nuclear Disaster: A Case of Kawauchi Village, Fukushima, Japan.

Sustaining access to healthcare in a resourcepoor setting is a key challenge in achieving global health.1 While there exist huge differences in healthcare systems between developing and developed countries, shortages of doctors and other health professionals in rural and remote areas are universal issues.2 In rural areas, both patient-specific and extrinsic factors affect access to healthcare.3 Among these factors affecting access to healthcare, disasters represent one of the most complex conditions that aggravate healthcare access over the long term. While disasters cause tremendous damages every year around the world, little information is available on which approach is effective in sustaining long-term healthcare access in disaster-stricken remote areas. Here, we describe the healthcare delivery in Kawauchi Village, Fukushima, which is located in a mountainous area 12 to 30 km southwest of the Fukushima Daiichi nuclear power plant (Fig. 1). While the Japanese government issued an evacuation order to nine municipalities including Kawauchi Village immediately after the Fukushima nuclear disaster, the local government declared that it is safe to start returning to the village in January 2012 considering the relatively low radiation level in the area,4 and all areas of Kawauchi Village were ready for repopulation in June 2016. Among the total 2746 residents, 1820 people have returned to the village (as of July 1, 2016). However, the areas that regional foundation hospitals exist are still under the evacuation order; therefore, access to healthcare services continues to be difficult. The examination of healthcare delivery in Kawauchi Village will hopefully contribute to understanding the essential needs and responses to sustain healthcare access in disaster-stricken remote areas. There is a national insurance clinic in Kawa uchi Village, which is the only medical institution in the village. One full-time physician provided by the Fukushima prefectural government works in the clinic. The number of patients and their reasons for visiting the clinic are shown in Figure 2. Hypertension, dyslipidemia, diabetes, chronic gastritis, gastroesophageal reflux disease, back pain, shoulder pain, arthritis, and sleep disorder are the major causes of visits. Needs to establish outpatient services for metabolic diseases, gastrointestinal diseases, orthopedics, ophthalmology, and psychosomatic medicine are present. In response to these demands, specialized doctors in these fields are provided by private sectors (Hirata Central Hospital, Asaka Hospital, and Maeda Ophthalmic Clinic) that are in collaboration with local governments, thereby contributing to the delivery of healthcare services in Kawauchi Village. This system is significantly different from the one that was in place before the disaster, in which one physician handled all the patients who visited the clinic and