You are asleep when the volcano's stirrings begin, sprawled out on your futon beside an open window, hoping the slight breeze will keep you cool in the intense Kyushu heat. It doesn't.

Keep in mind that you are no stranger to calamity. You are used to earthquakes, and your children still walk to school amidst typhoons. The suggestion of natural disaster is an ever-present element of your life, a reminder to tread lightly. Living on the narrow space where the rim of an active volcano meets the ocean means that, even if only on some instinctive level, you understand the fragility of your everyday routine. You understand that there is a chance, however remote, that you will lose everything to nature. You have understood this since the first time you felt the earth shake beneath your feet as a child.

Fugendake, the tallest of Mount Unzen's overlapping stratovolcanoes, is always there, stealing half of your sunsets. It's too high, and the houses are pushed up against its base too tightly, like fans pressed in against the stage at a concert; for several months out of the year the sun dissapears behind its peak long before night actually falls. You quite literally live in its shadow. Occasionally, as if to remind you of all of this, it spews smoke into the evening sky.

In November, it finally happens. Part of you always knew it would.

From 1990 to 1995, residents in the area of Nagasaki's Shimabara lived side-by-side with a continuously threatening stratovolcano. It wasn't all fire and brimstone, you know. Fugen didn't simply explode. It didn't blow its top and then sink back into dormancy. It oozed, all the while belching gas into an increasingly polluted sky, twisting the environment of the area. It all felt less like a massive surprise attack and more like a slow war of attrition. Though this meant that the number of casualities was significantly smaller than one might have expected from a sudden explosion (a few dozen deaths as opposed to possible thousands), it also meant that nobody could move on. It's impossible to rebuild buildings when a new pyroclastic flow or uncontrollable mudslide is likely to knock them over again in weeks to come. If you've never felt it, imagine the sinking feeling that comes with the realization that something catastrophic isn't going away any time soon.

The area in question is not a particularly wealthy one. The residents of the towns endangered by the eruption are not people who can simply pack up and relocate. Try selling your home when 10% of the other homes in your town have been reduced to rubble, as was the case in Fukae, a town of 8,000 partially leveled by a lava flow that tore through neighborhoods at 60 MPH without warning. It would be fair to say that property values at this time were under extreme duress.

Nonetheless, as humans are often wont to do, people carried on. They adapted. Despite periodic bouts of calamity, they loved and lost and generally lived.

The Case of Takagi's Wing Hospital

The goal of this writeup is not to investigate the larger socio-economic ramifications of a particularly violent Act of God, nor is it to delve into the geological elements of the eruption phenomenon. Rather, the goal of this write-up is to pose the following question: what do you do with 170 displaced mental patients when the institution they call home is wrecked?

Throughout the ordeal, Takagi Hospital's patient-base fluctuated, but it hovered around 170. (Around 63% suffered from schizophrenia, 20% mental retardation, and the remaining from other issues.) The city government of Shimabara was gracious enough to provide a shelter of sorts for the displaced hospital residents, but the accomodations were far from first class: between 200 people, they shared 1 toilet, 1 laundry room, and 2 telephones. They were unable to bathe.

Because of the minimalist living conditions, the hospital's residents continued using the hospital building whenever possible. Pyroclastic flows were less of a concern than flooding was, and as the building deteriorated it was evacuated time and time again when rainfall was heavy enough to cause the nearby Nakao River to overflow. Eight buses were borrowed from town businesses and before nightfall the residents were stuffed into them and transferred to the shelter until it was deemed safe to return. Returning to the hospital was necessitated primarily by two things: the need to bathe and the need to cook. The shelter had no kitchen. During the periods in which everyone stayed in the shelter, hospital staff struggled to use the hospital's half-flooded facilities and make boxed lunches to truck to the shelter, though at times the building was too dangerous to enter and catering companies had to be called in.

The families of the patients understood fully the evacuation methods being used as well as the fact that their relatives were spending extended periods of time in a poorly-outfitted shelter, but none volunteered to help. In fact, the Takagi Hospital staff received no aid from volunteers, the police, the fire department, city or prefectural officials, or the Self Defense Forces.

Understand that the employees had problems of their own. Several had lost their homes to fire, flooding, or mudflows. Many were living in evacuation sites themselves. When heavy flooding necessitated an emergency presence, they simply showed up at the hospital or the shelter and got to work. Despite the extreme circumstances, only one of Takagi's 100 employees quit.

The logistics of it all may sound challenging enough, but let's not forget that there was a reason these patients were permanent residents in a mental hospital -- they needed round-the-clock supervision. At the evacuation site, there were several incidents:

  • One patient suffered from severe hepatitis and was eventually transferred to Nagasaki University for intensive treatment.
  • One patient had asthma problems.
  • One cerebral hemorrhage.
  • One patient attempted to escape through a bathroom window.
In addition to these isolated incidents, many of the patients had persistent trouble sleeping. Things were tense. They were nervous. They were displaced and under-supported and held together by the loyal determination of the hospital staff. It's never easy for a handful of people at a time to care for 170 individuals who are too debilitated mentally to interact with the rest of society. Here, for three years, these problems were multiplied exponentially.

You probably didn't see this in the news. You may have caught the eruption in passing, but the body count wasn't quite high enough to earn it consistent front page coverage.

This was one case in a city of tens of thousands of people. It's one case, chosen only to illustrate the point that every day people slip through the cracks.

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