HICARE has contributed to healthcare of radiation-exposed for 30 years

by Kyosuke Mizukawa, Staff Writer

Providing training to medical personnel in 37 countries and regions

The Hiroshima International Council for Health Care of the Radiation-exposed (HICARE) marks its 30th anniversary in April. The organization, consisting of local governments and medical and research institutions, has worked actively to make use of the knowledge and experience gained in the A-bombed city of Hiroshima to treat the “hibakusha of the world.” Participating organizations collaborate with each other to regularly invite physicians from other countries for training. HICARE has contributed to the improvement of medical care for A-bomb survivors living overseas as well as for victims of nuclear tests and accidents. Herein, we look at the current status of the organization and the challenges it faces.

“I’m so happy I can use the knowledge acquired from the training when I see patients.” Lidia Mine Miyoshi, 61, is a physician in Brazil who examines local A-bomb survivors at Santa Cruz Hospital in São Paulo. In 2012, she received one month of HICARE training in Hiroshima from which she learned about the health effects caused by radiation.

As of the end of March last year, the number of Atomic Bomb Survivor’s Certificate holders in Brazil was 87, the largest number after South Korea and the United States. Thus far, HICARE has accepted 67 physicians from Brazil for training. In 2007, the organization dispatched doctors to the country to hold training sessions for those who treat A-bomb survivors in the country.

As a result of the organization’s efforts, since April 2019, local A-bomb survivors do not have to first pay medical costs at the Santa Cruz Hospital or two other hospitals in São Paulo and request reimbursement later, the same situation for the survivors in Japan. The hospitals now send the applications directly to Japan on behalf of the survivors.

Even in the case of later reimbursement, survivors of limited means might have hesitated to see a physician. The application process was complicated and a great burden for patients. Although the clerical work load has increased, the three hospitals willingly agreed to handle communication with the Hiroshima Prefectural government, given the situation of the local survivors.

Takeshi Yahata, 60, was head of Hiroshima Prefecture’s Atomic Bomb Survivors Support Division until March last year and had coordinated with the contact person in Brazil. “Many of the physicians in these medical institutions have participated in HICARE’s training program. Their understanding of the survivors’ situation led to the realization of a change in the system.” Junko Watanabe, 78, a resident of São Paulo who recently visited the Santa Cruz Hospital for a medical examination, expressed relief. “I can just come to the hospital with no worries.”

The impetus for HICARE’s establishment was the Chernobyl nuclear accident in the Ukraine of the former Soviet Union in 1986 and a serious medical radiation accident in Brazil in 1987. As a backdrop, each time an accident occurred in the past many issues had to be overcome, such as difficulties in securing the necessary budget and personnel and in forming a support team. Over the years, HICARE has made great efforts to strengthen the development of personnel that can provide medical support to A-bomb survivors through the acceptance of medical workers from numerous countries around the world for its training programs.

By fiscal 2019, a total of 768 people from 37 countries and regions—including Kazakhstan, the location of the former Soviet Union’s nuclear test sites, and Belarus, a country near the site of the Chernobyl disaster—underwent HICARE training. In 2014, HICARE was designated a collaborating center of the International Atomic Energy Agency (IAEA) for the training of such personnel. Since then, the numbers of participants from countries in Southeast Asia and the Middle East are on the rise.

As for collaboration with IAEA, HICARE became involved by providing technical guidance to Mongolia, for example, when the country’s first high-precision radiotherapy equipment was installed at that country’s national cancer center. HICARE has been expanding the range of its support, but the organization’s activities were hit hard by the coronavirus pandemic and it was forced to stop accepting trainees.

Timing for the restart of training will be determined on the basis of actual circumstances. Miyuri Fukuhara, a HICARE official, said, “Participants not only acquire specialized knowledge, but they also are deeply impressed when they meet A-bomb survivors and learn about the actual devastation caused by the atomic bombings. I hope the pandemic situation improves soon so we can resume our program.”

Example of three-week training program
・Visiting Hiroshima Peace Memorial Museum and A-bomb Dome
・Listening to A-bomb survivor testimonies
・Support measures for A-bomb survivors
・Medical treatment for radiation accidents
・Epidemiological research into radiation exposure
・Visiting nursing home for A-bomb survivors
・Medical examinations of A-bomb survivors and analysis of results
・Contribution to medical treatment of A-bomb survivors since after the atomic bombings

Support for victims is common activity shared by HICARE and TPNW

In January there appeared a worldwide movement that might help garner attention for HICARE’s activities from countries around the world. That change was the effectuation of the Treaty on the Prohibition of Nuclear Weapons (TPNW). The treaty stipulates that international society should cooperate to support victims of the use or the testing of nuclear weapons.

The treaty also states that “rehabilitation and psychological support” must be provided to victims in addition to medical care, which is the same challenge that HICARE has faced. Visiting nursing homes for A-bomb survivors and listening to A-bomb survivor testimony are activities incorporated into the HICARE training program to ensure that participants learn how to handle the physical and mental health of aging victims.

Akira Kawasaki, 52, a member of the international steering committee of the NGO International Campaign to Abolish Nuclear Weapons (ICAN), points out, “Hiroshima and Nagasaki actually have venues of support for the survivors. If we were to hold an experts meeting on such assistance in these cities and report the outcome to the Conference of the Parties, it would be very helpful for countries to implement the treaty.”

In Nagasaki, the Nagasaki Association for Hibakushas’ Medical Care (NASHIM) continues to offer training for medical care of the radiation-exposed. Mr. Kawasaki is calling for the Japanese government to contribute support for the victims of radiation exposure, as stipulated in the treaty, by utilizing such citizen activities.

Exploring ways to foster next-generation personnel

One of the challenges that HICARE has faced in recent years is how to foster next-generation personnel in the field of radiation healthcare. Three years ago, the organization started a school visit lecture program for high schools in Hiroshima Prefecture to cultivate young people’s interest in radiation research. It also dispatches Hiroshima University medical students to IAEA to provide the students with the opportunity to access cutting-edge research.

Although preservation is essential for future research, related materials have deteriorated over time. Last year, the Radiation Effects Research Foundation and Hiroshima University’s Research Institute for Radiation Biology and Medicine, both institutional HICARE members located in Hiroshima’s Minami Ward, agreed to collaborate with each other to preserve historical materials. The two organizations also plan to jointly create digital archives that would be later made available to the public.

The Hiroshima Atomic Bomb Casualty Council, a HICARE member located in the city’s Naka Ward, also works to preserve A-bomb survivors’ medical and other records. HICARE was established with the aim of enhancing international contributions as well as collaborations among medical and research institutions that have over time gathered research results and materials. It is important that this “All-Hiroshima” team, which Hiroshima City and Prefecture are part of, focus its knowledge on the preservation and utilization of such materials.

Interview with Kenji Kamiya, HICARE president: There is an urgent need to foster specialists in Asia

The Chugoku Shimbun interviewed Kenji Kamiya, HICARE president and Hiroshima University vice president who specializes in reconstruction assistance and medical treatment for the radiation-exposed. We talked to him about what HICARE has achieved and the challenges it needs to address.

What is your assessment of HICARE’s 30 years of activities?
HICARE has been working to improve medical care for the worldwide radiation-exposed by making use of the experience and knowledge accumulated in Hiroshima based on cooperation from A-bomb survivors. One of our pillars is to provide medical assistance to areas suffering from devastation caused by radiation throughout the world. A physician involved in the treatment of the victims of the Chernobyl nuclear accident told us that our training was very helpful when conducting medical examinations and treating patients in that country. At the time of the Fukushima Daiichi nuclear power plant accident, we sent experts and offered health consultations.

Another of the organization’s pillars is support for A-bomb survivors living overseas. Physicians in Hiroshima have built a relationship of trust with local doctors through the training program. Also, the manual “Effects of A-bomb Radiation on the Human Body,” which we published in 1992, has been widely read and is considered the “bible” in this field. In addition to the English version, a Russian version has also been widely utilized.

What are some challenges to be addressed?
One urgent issue is that we need to foster specialists in China and other Asian countries. As that region’s economy grows, use of radiation in medicine, industry, agriculture, and other sectors has increased. While a radiation accident could happen at all levels, in such countries there are few specialists who have the knowledge about radiation’s health effects and radiation protection. We want to invite trainees from countries with which we had no connection previously through collaboration with IAEA and its global network.

Another challenge is how to nurture the next generation of researchers in this field. As more than 75 years have passed since the atomic bombings, we are concerned that young people’s interest in the study of radiation has waned. We therefore initiated a school visitation program that provides lectures to high schools, which has been received enthusiastically by the students. I hope that, in the future, some students become researchers that contribute to the world regarding medical care for A-bomb survivors and conduct research into the effects of radiation.

Some expect Japan to contribute to “assistance to victims” as stipulated in the TPNW
All the institutions that form HICARE are in favor of abolishing nuclear weapons. It is natural for us to engage in peacebuilding activities while taking advantage of each institution’s characteristics. We would be honored if our expertise could be used in this way.

(Originally published on February 8, 2021)