Reporting from ICN: Japanese Nurses Take on Disaster; Swaziland Saves its Nurses

By Maureen Shawn Kennedy, AJN editor-in-chief

In a special press briefing held at the International Council of Nurses (ICN) meeting in Valetta, Malta (see my recent blog posts), on Wednesday, May 4, I had the opportunity to listen to two incredible stories of instances where nurses—or, in one case, a nurse—stepped up to deliver despite extremely trying circumstances. 

Japanese Nurses Association president Setsuko Hisatsune

Nurses do this all the time, and it’s important to recognize and highlight these situations because they make visible the value nurses bring to delivering health care and developing innovative health models.

After the tsunami. Japanese Nurses Association (JNA) president Setsuko Hisatsune (in photo) spoke of the rapid mobilization of nurses following the earthquake and tsunami that struck northern Japan on March 11. She explained that while the JNA had had a disaster system in place since the 1995 Kobe earthquake, this disaster, followed by the widespread destruction from the tsunami, was unprecedented.

“We could not imagine this,” she said.

The JNA worked with the disaster coordinators of the local nursing associations in the affected areas. They immediately dispatched public health nurses with drivers to go into areas to assess the situation. But they needed to bring nurses from the south, as many nurses in the tsunami and earthquake areas were dead or  injured. She noted that in one town, five of the seven public health nurses died, while another was severely injured.

At the same time, volunteer disaster nurses (nurses working in other areas who are registered volunteers and have had disaster training) were called to gather in Tokyo; they carried their own food and water, enough for a three-to-four day deployment. Transported north to the damaged areas to staff evacuation centers, they triaged patients, sending those with severe injuries or illnesses to hospitals that were still operating. The evacuation centers were established in damaged but stable schools and halls; they lacked privacy and basic facilities. Swimming pool water and tsunami-contaminated water were used to flush toilets.

The JNA deployed 914 nurses between March 11 and the end of April. Once the areas became affected by the nuclear power plant leakages of radioactive materials, it could no longer send volunteers to the area. Much of the direct care in evacuation centers is being managed by government-employed public health nurses. The JNA is now in a supportive role, working with government to plan health care clinics in the temporary housing that’s being established for those displaced by the disasters. The JNA estimates it has spent $1.5 million dollars on disaster relief. Amazingly (or not so amazingly?), most if was donated by nurses and nursing organizations from around the world.

Masitsela Mhlanga

The endangered nurses of Swaziland. Masitsela Mhlanga was the president of the Swaziland Nurses Association in 2004 when—after seeing the entire graduating class of 40 nurses from the University of Swaziland take jobs in other countries—he realized that his country, and with it his profession, was in crisis. (I had the opportunity to speak with Masitsela in Malta—you can listen to the podcast of our full conversation.)

Masitsela found that the nurses were not leaving because of salary but because they felt “undervalued and not cared for”; many of them were dealing with HIV infection themselves or had family members who were.

He said, “Not a weekend went by without us burying one of our valuable colleagues who had died of AIDs.” To get care, nurses became patients at the clinics where they also worked, creating problems of confidence and trust in their relationships with patients. He reached out to the ICN for assistance, and then with their help in securing funding from the Danish Nurses Organization, the Stephen Lewis Foundation, BD Corporation, and the Swaziland Ministry of Health, he opened the Swaziland Wellness Centre for Health Care Workers. (See this Lancet article for more on this remarkable project.) 

The nurse-managed center provides primary care for all health care workers. According to ICN figures, 77% of Swaziland’s 6,225 health care workers have accessed care there. More importantly, since 2006 there has been little nurse migration—and last year, there was none. The Centre has been hailed as a model for caring for and retaining health care workers, and similar centers are now operating in Lesthoto, Zambia, and Malawi, and—according to Linda Carrier-Walker, ICN’s director of development and external relations—building is under way in Uganda and another center is planned for Ethiopia. 

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2016-11-21T13:13:18+00:00 May 6th, 2011|Nursing|6 Comments
Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. Loudie Valme April 15, 2013 at 6:36 pm

    The tsunami situation in Japan was unprecedented. Despite their disaster preparation system they were overwhelmed by the incomparable widespread destruction of the tsunami. They required a lot of aids to face the situation. Therefore, two questions or scenarios needed to be asked. First, are all nurses in the United States, particularly the American Nurses Association, ready to face any disaster at the same level like the Japan tsunami?
    Japan is a well developed country and they were exceeded by events. Imagine a third world country like Haiti with the devastated earthquake without any real disaster preparation system. What will be the outcome? How to provide real and adequate response to this adversity?

    These types of catastrophic events when happened must must shed light on the necessity to evaluate ourselves about the importance of nursing and how the nurses manage to operate in extremely hard conditions.

  2. Rafael Borroto April 12, 2013 at 3:59 pm

    I wonder if we would have a similar response from our medical personnel in the U.S. if a truly large scale disaster occurred here. I cannot fathom having an ongoing group of volunteers bringing their own food and such, deploying to a radioactive area. I believe that we should foster this idea of selfless service when the conditions warrant it. Historically, the Japanese have held service to the public as a national standard that is above all other considerations. It has carried the Japanese people from a defeated nation to an economic superpower. In the U.S., we should learn this lesson before its too late.

  3. Monica Montoya November 26, 2012 at 9:34 pm

    WOW! It’s incredible that an estimate of $1.5 million dollars were donated for Japanese tsunami disaster relief by nursing organizations and nurses themselves. I could not begin to imagine how overwhelming, unprecedented and simply horrible it would’ve been to deliver care after the disaster, but I can see myself donating whatever I have in efforts of helping those who were terribly affected by the tsunami. I kind of see it here, in Miami, where I work ,in me and the nurses around me. Us nurses, donate so much of ourselves while nursing. Being a nurse is everything but cut and dry. So much risk, emotion, and “going the extra mile” is put into our jobs, and we do it on a daily basis just to get the job done. I believe nurses give a lot more than what they get paid for, but then again, we get a smiling, thank full, and healthy patient in return. I love nursing!!

  4. Francine November 21, 2011 at 9:48 pm

    As a nurse, it can be really discouraging when your effort and hard work goes unnoticed. If an entire class of 40 students chose to work anywhere but there native land, something must be wrong. In addition, where is the privacy for those health care workers with HIV? Sadly, they have to receive health care in the same place that they work. As the article mentioned, this is a problem when it comes to trust and patient confidence in health care workers. The stigma that goes along with having the virus presents a problem for the nurse receiving care at his or her place of employment.

  5. FIU Nursing Student November 21, 2011 at 8:38 pm

    I think that the United States can really learn a lot from the JNA. In a time where disasters such as these are commonly taking place, it is imperative to develop a fool-proof disaster plan for these situations. Nurses are vital to the health of the population and should be utilized. We need to formulate plans for how we would get out to our citizens and provide the amount of emergency care that will be needed. The idea of volunteer nurses is also great. The truth is that we never know what can happen, and therefore we should do our very best to be prepared

  6. […] that have made a difference in the lives of nurses or patients. (I wrote about two of these moving stories.) The conference also served as a reminder of how much I regret not being fluent in another […]

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