Bringing Healthcare into the Community — Twenty Years of the Kashima Model
Episode 70 — Kuma-rgency.
On the evening of September 4, 2026, I attended a seminar on bear-related trauma jointly organized by the Iwaki Medical Association and the City of Iwaki.
The speaker was Professor Manabu Takahashi of the Department of Critical Care, Emergency and Disaster Medicine at Iwate Medical University.
His lecture was titled:
“The Current State of Bear-Related Trauma in Iwate.”
I will admit something.
I have never treated a patient injured by a bear.
Living and practicing medicine in Iwaki, I had rarely given serious thought to the possibility that one day someone might be brought to us after a bear attack.
But recently, bears have begun to be sighted in Iwaki as well.
And that is precisely why we gathered.
To learn from the cases before we have cases of our own.
So This Is What a Bear Can Do to a Human Being
During the lecture, Professor Takahashi showed us actual cases of bear-related trauma.
Out of respect for patient privacy, I will not describe the details here.
But the impact of seeing those injuries is difficult to put into words.
Until then, “bears” had somehow belonged to television documentaries.
To the mountains.
To somewhere beyond our everyday lives.
But a chance encounter lasting only seconds can cause injuries that change the course of a person’s life.
Suddenly, the issue became very real.
Simply saying,
“Be careful. There are bears around,”
did not seem nearly enough.
“We Can’t Show These Photographs to the Public, Can We?”
During the discussion, the Mayor of Iwaki raised an important question.
He, too, had been deeply shocked by the clinical photographs.
But obviously, photographs like these cannot simply be used as they are for public education.
Could illustrations or graphic design be used instead, he asked, to convey what can actually happen when someone casually goes hiking or gathering wild plants in an area where bears have been sighted?
Professor Takahashi’s answer was surprisingly simple.
Keep telling people: “A bear was here.”
In Akita and Iwate, warnings are placed where people encounter them in everyday life—even around town and in places such as convenience stores.
A map may be useful.
But usually, only people already interested in the issue will go looking for one.
Seeing a notice that says,
“A bear was seen near here yesterday,”
is different.
The bear in the news suddenly becomes
the bear in your neighborhood.
Before the Bear Bell
Of course, there are bear bells and bear-deterrent sprays.
They have their place.
But most people are not going to carry bear spray every time they leave home.
Children are unlikely to take it with them every time they go out to play.
One message came up repeatedly throughout the lecture:
Prevent the encounter in the first place.
When a bear is sighted, spread the information quickly.
Share it throughout the community.
If people know a bear is nearby, they can choose not to go there.
They can look carefully around them before stepping out of a house or a car.
And if they do encounter one, they should avoid unnecessarily provoking or approaching it and create distance.
In other words,
before learning how to fight a bear,
build a community in which people are less likely to meet one.
That may be far more important.
Bears Don’t Know Prefectural Borders
The mayor raised another question.
Bears do not live their lives within the boundaries of a single municipality.
They cross city borders.
They cross prefectural borders.
So can population management and prevention really be addressed separately within each administrative jurisdiction?
Professor Takahashi discussed the different approaches being taken in Akita and Iwate, as well as ongoing ecological surveys.
As I listened, I realized something very obvious.
Humans draw lines on maps. Bears do not know those lines exist.
This is not a problem that can necessarily be solved by one city or even one prefecture alone.
If Someone Is Attacked, Where Should They Be Treated?
Then came another practical question.
What should actually happen when a person injured by a bear arrives at a medical facility?
There are things that community hospitals and clinics can do in the initial phase.
Some very minor wounds may be managed locally.
Severe injuries, however, need to be transferred to an emergency and critical care center.
And depending on the location and extent of the injuries, highly specialized care—including plastic surgery, ophthalmology, and other specialties—may be required.
So the answer is neither:
“Manage everything locally.”
nor:
“Send everyone immediately to a tertiary center.”
The important question is:
“Where should this particular patient be treated?”
Then we make sure the patient gets there.
That principle has nothing specifically to do with bears.
It is simply good community medicine.
An All-Hospital Effort
Professor Takahashi coauthored a book with Professor Hajime Nakae of Akita University and colleagues:
Bear-Related Trauma 2: Kuma-rgency Medicine.
Its cover features the face of a bear and a striking phrase:
“The reality of an all-hospital battle against bear trauma!”
Kuma-rgency.
A play on the Japanese word kuma, meaning bear, and emergency.
The first time you hear it, the word may sound almost humorous.
After seeing the cases presented that evening, however, it did not sound funny at all.
This really is an emergency.
And I understood why the book describes it as an “all-hospital” effort.
Emergency medicine alone cannot finish the job.
Depending on the injuries, plastic surgeons, ophthalmologists, and other specialists may be needed.
Nurses are involved.
Emergency medical services are involved.
Community healthcare facilities are involved.
This is not the kind of trauma that one physician or one specialty can manage alone.
Wild Boars First, Bears Next?
Near the end of the seminar, someone asked another question.
“Last month, I was out for an early-morning walk and came across a wild boar.”
Now that sounded uncomfortably close to home（笑）.
The question concerned injuries caused by animals other than bears, such as wild boars and deer.
Professor Takahashi explained that wild boars, once uncommon in Iwate and Akita, have been increasing in recent years.
Deer have been increasing as well.
Then he mentioned something that is apparently said—perhaps more as local lore than scientific prediction:
“When the wild boars and deer arrive, the bears are next.”
And then he added:
“If you’ve already encountered a wild boar, bears may not be far behind.”
The room laughed.
But—
perhaps this was not entirely a laughing matter（笑）.
Why Learn About Something We Have Hardly Seen Yet?
The seminar itself had been prompted by recent bear sightings in Iwaki.
The question was raised:
“Is there someone who really knows about bear-related trauma?”
That search eventually led to Professor Takahashi, who came to Iwaki to share the experience accumulated in Iwate.
In the closing remarks, one phrase stayed with me:
Bears do not recognize prefectural borders.
Exactly.
But I found myself thinking of something else as well.
Neither should learning.
Someone in Iwate or Akita has already experienced what we may face in the future.
They have learned what worked.
What did not.
What saved lives.
We do not have to wait for the same thing to happen here before we begin learning.
Experience can travel from a region that already has it
to a region that does not.
Before It Becomes an All-Hospital Battle
The cover of Bear-Related Trauma 2 describes
“the reality of an all-hospital battle against bear trauma.”
But by the end of the seminar, I found myself thinking about what needs to happen one step before that battle begins.
Residents learn where bears have been seen.
Local government gets the information out.
People stay away.
Encounters are prevented.
The medical association prepares.
Community clinics and hospitals provide initial care.
Patients who need more are transferred to an emergency and critical care center.
And when necessary, they are connected to specialized care.
It becomes one continuous line:
Sightings
→ Public warning
→ Behavior change
→ Injury prevention
→ Initial care
→ Life-saving treatment
→ Specialized care
Before it becomes an all-hospital effort,
perhaps we need
an all-community effort.
Bear Trauma Does Not Begin in the Emergency Department
Saving someone who has been attacked by a bear is, of course, the work of medicine.
But so is something else:
reducing the number of people who are attacked in the first place.
Healthcare can have a role there, too.
That, I think, was the real meaning of learning from Iwate here in Iwaki.
We do not learn only after we have experienced something.
We can learn so that we may never have to experience it.
Kuma-rgency.
I sincerely hope that Iwaki never accumulates expertise through a growing number of bear-trauma cases.
That is precisely why we should learn now,
while we still have few cases of our own.
Bringing healthcare into the community means more than providing medical care after a patient arrives at the hospital.
It also means preparing together with the community,
so that fewer people ever need to come to the hospital in the first place.
That is our challenge.
And I certainly never imagined that, by Episode 70, even bears would find their way into our “catchment area”（笑）.
Atsushi Ishii
