Lessons on disaster medicine learned from the Great Hanshin-Awaji Earthquake

Dr. Imura was the president of Kyoto University when the Great Hanshin-Awaji Earthquake struck Kobe. He felt the large earthquake even at his home in Kyoto, and was very shocked to watch the TV showing the terrible situation in Kobe. He soon contacted the governments of Hyogo Prefecture and Kobe City, and arranged to send necessary medicine and medical aid teams.

As I had once worked as a professor at Kobe University and had lived in Kobe City, I was extremely worried about Kobe. Considering that many people must have been injured, I set up and dispatched medical aid teams mainly made up of surgeons. At evacuation centers, however, they needed more physicians. Medical care at times of disaster requires doctors who have the extra capability to make quick judgments and carry out medical treatment with limited equipment. Since then, we have deeply reflected on our medical system, learning many lessons from our experiences on disaster medicine.

In spite of his strong desire to get to Kobe immediately, Dr. Imura was unable to leave his work as the university president. It was four to five months after the disaster that he finally visited Kobe. The city he saw at the time was completely different from what he had used to see.

I was always thinking about Kobe since many of my former students when I was a professor at Kobe University were still in Kobe. I heard that one of them, a doctor, had died of overwork after the disaster. He had to work extremely hard, walking between the hospital in Kobe and his home in Nishinomiya every day. I felt so sorry about that.

Photo: Dr. Imura explaining the technical subjects of medicine in layman’s terms


If I can be of any assistance…

Three years later in 1998, Dr. Imura became the director of Kobe City Medical Center General Hospital.

Immediately after assuming the hospital director, I was asked by the Mayor of Kobe at the time, Mr. Kazutoshi Sasayama, to help rebuild Kobe. His hope was to develop a biomedical cluster in Kobe to revitalize its economy as well as to create a new industry. I thought it was a great idea because there would be increasing demand for the medical industry in Japan with its aging population.

After the disaster, infrastructure of the city was recovered relatively quickly, but there was a sense of impending crisis looming over the city with industries that had once flourished in Kobe like heavy industry in a difficult economic situation. We thus reconsidered a new industry that would be necessary in the future to create more employment opportunities, through taking advantage of advanced techniques of manufacturing companies in Kobe.

There are two major advantages to the medical industry. One is constant demand for a new industry, which can increase employment and business opportunities locally. Some say that such an industry in advanced countries like Japan would be able to contribute to global economy as well. The other advantage of medical industry is social significance. Recovering from illness positively affects not only patients themselves but their families and society.

At that time, Dr. Imura also served as chairman of the “Council for Medical Studies and Health Care in the 21st Century” promoted by the Ministry of Education, Culture, Sports, Science and Technology, and thought that translational research, which connects results from basic research to clinical practice and industrialization, should be developed further.

Japan was lagging behind the world in translational research. Just as I was thinking there would be a need for establishing a clinical research center to catch up in the field, Kobe Mayor Sasayama proposed the idea of developing a biomedical cluster. I hesitated to accept his proposal first, considering the fact that Kobe had rarely been involved in the medical industry thus far.

The former Kobe Mayor Sasayama, however, never gave up his idea, and, following Dr. Imura’s advice, visited several cities in the US to inspect precedent initiatives of such biomedical clusters. Dr. Imura was moved by the mayor’s strong will and enthusiasm to realize it, and decided to accept the mayor’s proposal, hoping that he could be of any assistance to Kobe.




Building up of enthusiasm and knowledge for supporting Kobe at any cost

Thus, a project of creating a biomedical cluster, which we call now the Kobe Biomedical Innovation Cluster (KBIC), has started. To map out a fundamental plan for the project, a meeting was held with the attendance of deans of the Faculties of Medicine of Kyoto University, Osaka University and Kobe University, the President of the National Cerebral and Cardiovascular Center in Osaka, and the Chairperson of Kobe Medical Association.

It was really unusual for people in such positions to gather so often. The study group spent one year working out a plan, which became a core concept of the KBIC and is still ongoing. Without their enthusiasm and knowledge to support Kobe, the project today could not have been realized. I would like to express my deepest gratitude for their devoted efforts.

Then, based on the fundamental plan, building up of a major medical foothold started moving forward, in which all kinds of medical-related fields were located including research institutions, hospitals providing sophisticated cutting-edge treatment, and private companies related to medical industry. All these medical-related facilities have gathered in and around the area of Kobe Port Island’s second construction phase.

The RIKEN, Japan's largest comprehensive research institution for natural science, chose Kobe to locate one of its centers, Center for Developmental Biology (CDB), which became a driving force for promoting the KBIC. In addition, when it is rebuild due to decrepitude of the building, the former Kobe City Medical Center General Hospital was closely located to the RIKEN CDB and the Institute of Biomedical Research and Innovation to make these 3 facilities a core center for the cluster.

At present, 286 medical-related companies and organizations (at the time of interview, Dec. 2014) are located on Port Island, with further participation of facilities including Child Chemo House, a facility for pediatric cancer patients and their families; Kobe Minimally Invasive Cancer Center, a cancer center equipped with high precision radiotherapy systems; Hyogo Prefectural Kobe Children’s Hospital; as well as a research institution operating the “K computer.” Kobe has grown to become one of the largest-scale biomedical clusters in the world.

Kobe City has tradition of accepting new things and casting them into shape, and strong power to change structures. It is still difficult to conduct clinical research in Japan, but we can treat more patients through gathering more medical facilities in the cluster, which will lead to establishing the environment of conducting translational research. On the other hand, state-of-the-art simulation enabled using the K computer made it possible to improve the accuracy and the quality of basic research.

There is a large barrier between industry and academia, with little interaction between them. For instance, research efforts by private companies are handled as confidential information until they have progressed to a certain stage, while public research institutions including universities usually keep information open. As such, I thought it would be great if we could create a biomedical cluster in Kobe where people can exchange information openly without such barriers.

Photo: Port Island in 1998

Photo: Port Island in 2014, medical-related facilities being built one after another with the number continuously growing


Creating an open environment where people can freely walk between facilities

Dr. Imura emphasized on the importance of understanding other cultures regardless of affiliations such as private companies and universities. He added his idea to the construction design of the Institute of Biomedical Research and Innovation.

A corridor connecting the RIKEN CDB and the Institute of Biomedical Research and Innovation was built as a symbol of translational research linking basic research and clinic research, which has enabled active information exchanges necessary to advance medical technology.

In 2014, the Institute of Biomedical Research and Innovation succeeded to carry out an operation using iPS cells, one kind of stem cells which can grow into various tissues and organs.

A retinal sheet derived from iPS cells was transplanted for the first time in the world. The success of the operation owed not only to the patient but also to a large extent to the cluster development. Some areas are still lacking in the cluster, but the ideas we worked out at the beginning were pretty much realized. However, medical research including drug discovery takes considerable time. While having a long-term view, we would like to continue creating an innovation in medical technology in Kobe.

Photo: The RIKEN (back left) and the Institute of Biomedical Research and Innovation (right). The connecting corridor, a symbol of a biomedical city without any barriers


Hoping more and more people can live a healthy life

At the end of March 2015, MIRAI EXPO ’15, a participatory event hosted by the General Assembly of the Japan Medical Congress where anyone could experience the progress of medical technology and medicine, is going to be held on Kobe Port Island. (The event was finished in a great success.) Dr. Imura has wanted Kobe to be a medical city open to the public in every respect. We asked him about his thoughts on that.

I hope the project will develop further to the extent that medicine in Asia is associated with Kobe. Much can be done, including the development of new medicine and medical technology that have their origin in Kobe. Fortunately, we can closely work with many excellent universities of medicine located in the Kansai region as well.

I also think that not only Kobe but also Japan as a whole has to become more international in its mindset, although Japan, an island country, has geographical barriers and great differences in language and culture compared to other countries. Research institutions now have more staff members from overseas, and hospitals should be ready to accept non-Japanese patients. Internalization in the medical field is one of the major issues Japan has been facing now.

Photo: Dr. Imura at the corridor connecting the Institute of Biomedical Research and Innovation and the RIKEN CDB

Facing the aging society, there is an increasing importance on preemptive medicine, preventing disease before the onset of symptoms based on genomics and biomarkers. In order to realize preemptive medicine, we all have to work closely together including local governments and private companies, and build a new social system.

I hope new medical technologies created in the cluster contribute to the society where people can live a healthy life for 80 years or more. Any people can spend healthy and happy time as long as possible…this is really the only hope that all of us as healthcare professionals share in common.

(Photographed by Kyoko Kataoka, interviewed and written by Aya Yamamori)