In the wake of the Great East Japan Earthquake on March 11,2011,we interviewed three ostomates from cities hit by the tsunami(Miyako,Kamaishi,and Rikuzentakata)in lwate Prefecture who took refuge at home,a shelter,and a distant place. We also interviewed health and welfare staff members across the nation who worked in the areas during the acute stage of the disaster, and analyzed the problems faced by ostomates in the various timeframes after the disaster. Five problems were revealed: a difficulty to obtain ostomy appliances, poor sanitary facilities for stoma exchange and skin care, ostomate inaccessibility to their supporters and vice versa, insufficient information for ostomates regarding the support they needed during the disaster, and delayed awareness of ostomate support requirements in the acute stage by health and welfare staff members. The following countermeasures are suggested to address the above issues:
(1)Disaster-base hospitals should store generalized ostomy appliances, as ostomates cannot collect their stomal records and ostomy appliances in emergent situations.
(2)Shelters should secure ostomy toilets for stoma care (private, flush toilets with an anti-odor remedy) and store ostomy aids from the early stages.
(3)Means of communication such as mobile phones and emergency telephone numbers should be established exclusively for ostomates in case transportation or communication becomes problematic.

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The Great East Japan Earthquake caused devastating damage, and for many ostomates, their ostomy care was affected by infrastructure failure. ln order to assess the current state of ostomates following the disaster, we conducted a hearing survey according to an interview guide. Serious infrastructure damage was caused by the tsunami, and progress for lifeline restoration varied widely by area. Ostomy care was greatly influenced by the suspended water supply. Most ostomates expressed anxiety about losing means of communication, which highlighted the need to secure such a means and establish assistance services in the event of infrastructure failure. ln addition, continuous maintenance of detailed care guidance, as well as reserve and decentralized storage of ostomy appliances are essential to prepare for future disasters.

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The present study assessed the status of ostomates who had obtained ostomy appliances at disaster base hospitals after the Great East Japan Earthquake. ln addition, we examined the supply process for these appliances and considered measures to help ostomates to prepare for future disasters. Eighty percent (n＝38) of the ostomates supplied with the appliances had not attended regular consultation at stoma outpatient clinics, which made them ill-prepared for the disaster. Seventeen percent (n＝8) visited disaster base hospitals before relief supplies arrived, and received sufficient appliances from those stored at the hospital. To prepare for future disasters, ostomates should be strongly encouraged to make regular and continuous visits to stoma outpatient clinics, attend classes on maintaining a normal social life, and join a patient association. Support systems would be greatly enhanced by greater storage of appliances to be used in emergency situations, especially at disaster base hospitals. Supply routes for appliances and methods for information dissemination to ostomates should also be reconsidered, with the cooperation of local governments.

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We conducted a questionnaire survey among Wound, Ostomy and Continence Certified Nurses (WOCN) to examine the use of ostomy supplies donated after the Great East Japan Earthquake. During the 4 days prior to the arrival of donated ostomy supplies, they used products stored at hospitals. However, these supplies were limited and ostomy patient requests could not be addressed sufficiently. For example, several patients did not know the exact names of the products they required, and some had to use different products due to an insufficient stock. Nurses provided guidance on the proper product use, and WOCN felt that they were able to do this adequately.
Other issues that arose involved patients such as those who could not use scissors or those who insisted on using their own appliances. For these cases, the nurses commented on the necessity to be flexible while providing guidance. Effective stock control could be improved through the negotiation and disclosure of donated supplies among patient groups, medical societies and appliance associations.

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As an enterostomal therapist in practice, as well as the Director of our Society, I became involved in support activities for ostomates following the Great East Japan Earthquake. Specifically, I established a consultation service counter, and mapped out locations in the Tohoku region for ostomy supply shops as well as areas where ostomy appliances were supplied by the Japan Association of Ostomy Appliance lndustries. Our Society also drafted a list of hospitals nationwide which would serve as “facilities accepting ostomates designated by the Japanese Society of Stoma and Continence Rehabilitation (JSSCR), ” such that o stomates affected by the earthquake could receive treatment. Nine months after the earthquake, we conducted a postal questionnaire survey among certified nurses in all six prefectures in the Tohoku region to investigate the actual damage suffered by ostomates due to the earthquake. ln this report, we present the survey results and propose ways to prepare for future disasters.

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Immediately after the Great East Japan Earthquake, the Japan Association of Ostomy Appliance lndustries, in accordance with its “Disaster Countermeasure Manual”, took a cooperative stance with the “Japan Ostomy Liaison Council”, and sent free ostomy appliances as emergency relief supplies to people in the disaster area. Unfortunately, issues arose regarding insufficient stomas, a lack of manuals, and problems related to the use of information. We report details of the activities conducted as well as related issues, so that knowledge gained through this experience can be applied effectively in the future.

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The Public Relations Committee of the Japanese Society of Stoma and Continence Rehabilitation (JSSCR) launched a disaster emergency link on the society website following the Great East Japan Earthquake. The importance and utility of a website as a way to collect and transmit information in times of disaster was revealed， as was the need for high efficiency to operate such a site. We therefore propose to communally utilize the disaster emergency website in cooperation with other societies in the same field. Operation of this website should aim to address other matters related to disaster management of JSSCR, and thus require the establishment of a committee to manage emergencies in times of disaster. Cooperation among societies is indispensable not only for the website operation, but also for providing relief supplies, creating disaster manuals and dispatching medical staff．

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We recorded the outcomes and problems associated with stoma site marking which was utilized for the 106 ostomy surgeries performed at our institution's Department of Gastrointestinal Surgery from January 2009 until October 2009.

1. Stoma site marking yielded positive outcomes, particularly with regard to sta bilizing the ostomy appliance and reducing skin irritation.
2. Eighty percent of patients for whom stoma site marking was performed devel oped difficulties in stoma management due to surgical complications. Stoma location was problematic in 75％ of patients for whom stoma site marking was performed before surgery.
3. Even if stoma site marking is performed prior to surgery, ostomy control may still be difficult for patients with risk factors, other operations, or changes in the shape of their abdominal wall.

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Patients with ileostomies often develop skin problems due to the digestive enzymes and the alkalinity of the stool. We administered a thickener to control stool consistency in two patients with ileostomies and measured the effects. The thickener slightly increased the stool consistency, which helped alleviate the skin problems. This also helped to relieve patients of their psychological pain and lower QOL. This showed that administration of a thickener may help improve the rehabilitation process in patients with ileostomies.

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An ostomate who had only used toilet paper for stoma management for 66 years received instruction regarding the attachment of an adhesive appliance. While she hesitated to change her long-term practice, she agreed to attach the appliance after receiving the instruction that catered to her perspective. Ostomates who have performed stoma management for many years without attaching appliances exhibit high psychological resistance towards changing their management methods. As such, it is critical that their needs with regard to excretion are carefully considered. Specifically, one must 1) focus on their actual problems, 2) attempt to make as few changes as possible in their management methods, and 3) prioritize and address their concerns about excretion.Health care professionals must provide ostomates in any situation with management instructions that conform as consistently as possible to the principles of hygiene as understood and practiced in modern society.

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