 Over to you, Elena. Hello, good afternoon to your audience. We are very happy to have you with us in this incredible session. And it is my pleasure to present to you our first speaker. His name is Ryuki Kasai. He is a founding professor and chair of the Department of Community and Family Medicine at Fukushima Medicine University, Japan. He is a member of the Board of Directors of the Japan Primary Care Association and acts as senior advisor of its international community. Dr. Kasai graduated from Hokkaido University School of Medicine, Sapporo and completed a residency training in family medicine at the University of British Columbia, Vancouver, in British Columbia, in Canada. In 1996, he founded the Hokkaido Center for Family Medicine and started the first formal family medicine training program in Japan. After having made this center a successful model of Japanese residency program, Dr. Kasai moved to Fukushima to find the first medical school department of community-based family medicine in Japan and Fukushima Medical University in 2006. So it's our great pleasure to present to you Professor Ryuki Kasai, the Fukushima Medical University professor and chair of the Department of Community and Family Medicine. You are welcome, Dr. Thank you very much for your kind introduction. It is a great honor to be speaking to you at the Wonka World Conference 2021. I wish I could be in Abu Dhabi today and sincerely hope there will be an opportunity to meet in person at future Wonka conferences. It was March 11, 2011, when a magnitude 9.0 earthquake and tsunami struck East Japan, primarily affecting Iwate, Miyagi and Fukushima prefectures on the Pacific side of northern Honshu, the main island of Japan. More than 22,000 people died or are still missing and 347,000 were evacuated, with 40,000 people still displaced and during the difficulties of life as a neighbor QE. Infirmary, the tsunami hit the Pacific coastal areas and destroyed the Daiichi nuclear power plant in Fukushima. The reactor lost all the power, including to the cooling mechanisms, bringing it to the verge of meltdown. Eventually, hydrogen explosions caused the meltdown, releasing radioactive materials into atmosphere. After the disaster, on the advice of my colleagues on the International Advisory Board of the BMJ, I started writing blogs. Initially, I wondered how they would turn out. As I'm no Reiner Maria Rilke, perhaps the greatest lyric poet of the 20th century, but I spelled out what came to mind as I lived through the unfolding events. Fortunately, I physically and mentally survived the experience and can now reflect on my thoughts of the day. I'd like to thank my colleagues for suggesting this blogging endeavor and would humbly like to share some of my accounts and subsequent reflections. The first thing that came to my mind was this quote from Hiroshima Note by Nobel Prize-winning Japanese novelist Kenzaburo Oe, who reported on the tragedy of the people of Hiroshima after the atomic bombing. I felt like we lost the light and were falling into the darkness. With the infrastructure of daily living suddenly lost, I could neither confirm the safety of my colleagues and trainees dispersed across the region, nor see the whole picture to comprehend the scale of the damage. The next problem was hospital dysfunction. This was especially pronounced as Japan to this date has been slow to implement primary healthcare policies, meaning the function of medical institutions is poorly differentiated. In the following two to three days, hundreds of patients came to Fukushima Medical University Hospital, either by themselves or in chartered buses from community hospitals and nursing homes in the devastated areas. Many patients were framed, demented, bed ridden elderly, often without documentation of their clinical history or circumstances. The supply demand mismatch was tragedy for both sides. The elderly re-evacuation to a place of safety became a burden, with the mental well-being of carers was a constant issue. Sometimes it became difficult to keep to our strong Fukushima tradition of endurance and non-blaming culture. At this time, a video clip on YouTube entitled, Before Japan to be strong, be strong, moved us to tears. It reminded us how music and sharing narratives can help us to heal. Sadly, for those in evacuation shelters, it wasn't possible to listen to music without bothering others. Instead, they watched TV that repetitiously reported the disaster with tsunami images day and night, further eroding their mental well-being. Fukushima has many farmers and fishermen, so our thoughts turned to the risk of contaminated produce, including meat, fish, vegetables, and rice. We wanted to know how to inform local people and support them emotionally in this acute phase of beyond, in this acute phase and beyond. I still remember the beauty of the snowy white mountains I saw while shivering in the cold. There were 50 people, later respectfully called the Fukushima 50, made up of the plant director and workers, most of whom were local Fukushima people. They stayed in the disaster and destroyed nuclear plant, working hard to cool the reactors to minimize nuclear contamination in the surrounding area. We needed to understand and bridge the knowledge gap between radiation medicine experts and lay people, but it was too big. Rumors were rife, spread maliciously or through lack of knowledge, aggravating fears of future hardship. Cherry blossom, or sakura, has always been a spiritual flower for Japanese people, and continues to occupy a special position in modern consciousness. Since the petals begin to fall only a week after the tree is in full bloom, it was once regarded as a metaphor for some rivalries who valued a beautiful, honorable death. At the beginning of April 2011, I was sent by the anti-disaster headquarters of Fukushima's prefectural government to command the operation to find and take care of those people left behind in the zone between 20 and 30 kilometers from the damaged nuclear plant. Without sufficient information or health records, we had to visit each house in abandoned communities to see if anyone was left, assess and connect them to medical care as needed. By the end of the two-week operation, we had found and taken care of about 400 left behind people, most of whom were frail, heldery and were disabled. Most of them needed support from basic community services to resume such as home helpers, balanced meals, bathing, rehabilitation, and oral hygiene. Four were admitted to hospital. Even after a year, there was little noticeable reconstruction or reform in Fukushima, and we were keenly aware of our lack of effort. I wanted to rebuild a more sustainable community-based primary health care system along the affected coast of Fukushima through programs of capacity building and social networking. However, it has been difficult for long-term human resources projects like this to attract the support of policymakers, bureaucrats, and the wider Japanese medical community. Many serious things were happening in front of us, and we grew less sensitive to each of them. The Japanese novelist Haruki Murakami wrote about a similar experience after he encountered the great earthquake in Kobe in 1995. Every day looked like a silent slide show of disaster images. As I could not break the chain, the numbness I had experienced in the acute phase of the disaster returned. I had focused only on what was in front of me and had a little sensitivity to the misery of the outside world. I thought this was very bad. Looking back, I think I was a little depressed at the time. Writing my feelings as blogs and trying to maintain interest in the outside world helped me to overcome this over time. I will never forget the kindness and encouragement from my friends, especially Wonka colleagues around the world. I am deeply grateful to two past Wonka presidents, Professor Chris Van Will and his wife, Everyn, and Professor Michael Kidd, who came in person to Fukushima. Also to Professor Neil Paraphoks of the University of Hawaii, who gave us his 30 years of hands-on experience in helping people of the Republic of Marshall Islands after U.S. nuclear weapons testing. He even created the opportunity for me to visit the Republic of Marshall Islands to interview the local people and learn from their experiences. The national and Fukushima prefecture governments together launched a thyroid cancer screening program in October 2011, where thyroid ultrasound examinations were provided to children younger than 18 years old who lived in Fukushima at the time of the accident. The program united the needs of scientists to understand the impact of this type of radiation exposure and the public interest in alleviating anxiety by identifying and treating cancers early. More than 80% of the target population of 380,000 children participated in the survey. Unfortunately, a significant number of abnormal findings arose with more than 100 children found to have a possible or confirmed malignancy. This led to enormous anxiety and confusion among people in Fukushima, causing many to live day-to-day with an added psychological burden and pessimism about their future. This became an infodemic, resonating with the similar challenges we see today from COVID-19. However, most of these victims were the people of Fukushima. Most thyroid cancers are slow to progress, with good prognosis and considerable latency. However, a small proportion of cases can lead to life-threatening cancer. Clinically distinguishing between these groups, deciding whom to treat with the added burdens and side effects is challenging. It is also uncertain whether the cancers identified were in fact caused by the radiation exposure, as some may well have developed regardless. It is a big controversy politically as well as scientifically as to whether this program has resulted in overdiagnosis and potentially unnecessary harmful treatments. Reflecting on this situation, I think that to successfully address the anxieties of people in Fukushima, it was necessary to listen to their concerns in a patient-centered manner. Utilizing a shared decision-making approach coupled with an informed discussion on the nature of thyroid cancer, preferably by a primary healthcare team. Every year, as March 11th approaches in Japan, media coverage related to the Great East Japan earthquake increases. As this year marked the 10th anniversary of the disaster, and many more programs and news articles were produced, I found myself getting uncomfortable with the narrative reported. It seems that many media outlets expect the victims to have overcome the difficulties and be living with positivity 10 years later. They expect the disaster-stricken area to be restored and are reporting according to their expected storylines. However, I don't think their expectations reflect the lived experience and the reality of the victims and affected areas well. Another TV program featured a young victim who lost her family in the tsunami. She said, quote, for five years after the disaster, I was a cheerful and innocent girl despite my vague knowledge about what had happened to my family. I laughed normally, played joyfully with friends. However, as an evacuee, when I behaved that way, the students at my new school and the TV people who came to interview me looked embarrassed. They said, you are not like a victim. You are too cheerful. As I experienced that over and over again, I became the sad-looking girl without laughter that they expected, unquote. The victims should look sad, the disaster areas should look chaotic, but after a catastrophe, the victims lived to the best of their ability. So much suffering compounded by painful, depressing experiences made them forget how to smile. But after 10 years, those victims have regained their smile and can positively talk about reconstruction. Many people have this shared illusion about the victims and the disaster areas upon the 10th anniversary. Many people in Fukushima have been confused and sometimes frustrated by the gap between that illusion and the reality we face. One Fukushima man said, quote, it's been 10 years, but nothing has changed since the disaster time has stopped, unquote. For Japanese, the experience of the atomic bombs in Hiroshima and Nagasaki is familiar. We can refer to the reports of the US nuclear weapons testing over the atolls in Marshall Islands and the nuclear accidents at the Chernobyl and Three Mile Island. But the situation in Fukushima was very different. The amount of radiation emitted into the air was orders of magnitude lower. Nevertheless, the social and psychological damage has been enormous. The trouble is that there is little scientific evidence about the long term effects of very low dose radiation on the human body and mind. Looking back over the last 10 years, there are still gaps everywhere existing between those who help and those who are helped, between those who report and who are reported about, and between those who criticize and who are criticized. It is important for us to better navigate these gaps in order to understand each other better. Our background, intention and the illusions are all different. It is difficult to completely close the gap and which side of the gap you find yourself on may change in an instant. Nevertheless, my experiences have taught me that we can still communicate to bridge the gaps between us. I'd like to build a future grounded in context, not buying into the illusion, but one that shares the reality of the others. The world has been, is and will be full of disasters, earthquakes and tsunami, conflicts and wars, bushfires and floods, and of course the ongoing COVID-19 pandemic. As I conclude my reflections on the 10 years since the Great East Japan earthquake, tsunami and nuclear disaster, I want to review one with one last message, translated from Japanese phrase, mochitsumo tarits, the person who was helped yesterday may be helping someone in another context tomorrow. Finally, let us not forget the importance of music and narratives in healing, as noted by Wilke. I wish good health to you all and hope you stay safe. Thank you very much for your kind attention. Thank you, Professor Kasai, for this moving presentation. I would like to remind the audience that we will have the possibility of questions and discussions after the second lecture, nevertheless, Professor Kasai, this was a very moving and I compliment you again on your marvelous work in leading in Japan through primary care, this response to this terrible catastrophe. And catastrophes, as you said, are with us everywhere, also in terms of wars, also in terms of refugees. And that brings us to the next presentation on the plight of refugees and their health problems and what better country to turn to because of their experience than Jordan. And when turning to Jordan, whom better to turn to than Dr. Mohammed Razou Tarana. Dr. Tarana has a fast experience in primary care, bridging more than 25 years in the field of the Royal Medical Services in Jordan. As a tutor, a master trainer and examiner for family medicine, the residency program of the Royal Medical Services. He served on the Royal Medical Council and he was also a member of the Scientific Committee of the Faculty of Medicine of Muta University. Currently, he is in private practice as a consultant. But for me, Dr. Mohammed Razou Tarana is also the tireless working past president of the Wonka EMR region. I admire his work very much and therefore, without much ado, I would like to turn over to Dr. Mohammed Razou Tarana and invite him to give his presentation. Good evening everybody, it's great pleasure to be with you here at Wonka conference and I'd like to thank the organizer for inviting me and for the effort they did from this conference. My talk will be about the impact of Syrian refugees on Jordan health sector, the role of family positions in Jordan. Let me start from the definition who is a refugee. A refugee is a person who owned to a well-founded fear of being persecuted for reasons of race, religion, generality, membership of particular social group or political opinion or either some other reason. Who is outside the country of his nationality and is unable to or owned to such fear, is unwilling to aware himself of the production. Jordan is not a signatory of the 1951 Convention relating to the status of the refugees. However, the protection space for refugees in Jordan and asylum seekers is considered the other way. Also, Jordan is one of the countries most affected by the Syrian crisis, hosting the second highest share of refugees. At the slide here shows us that what's the global migration crisis out of 59.5 million. We have 19.5 million refugees all over the world and 3 million are refugees. Where our refugees fleeing from 53% refugees are worldwide are coming from three countries. Syria, Afghanistan, Somalia, so three countries from our region. The population of concern as for 30 February 2021 and the countries of region for the origin of the refugees in Jordan is Syria, Iraq, Yemen, Sudan, Somalia, others. We have 57 nationalities that are the refugees. 83% of them living in urban areas, 17% of refugees living in three major camps in Jordan. Zaab Dari has recognized that. 51% of refugees under the age of 15. The majority of refugees are women and children. Again, Jordan is the major migrant receiving country. And it's also now the top refugee hosting country in absolute numbers. Where refugees constitute one third of the total population. Despite the fact that only 655,000 are registered in UNHCR. And Jordan has been become a home for several waves of Arab migration since the establishment of Jordan. From the Palestinian refugees to refugees and other refugees, other way for refugees. Looking at the population of Jordan, the total population for them since 2015 is about 9.5 million. And the number of refugees around the three million. The total number of Syrian refugees in Jordan is 1.3 million. And as I said, those who are registered are less than half of that population. The others are still inside the camp. 90% of Syrian refugees in Jordan are outside camps. We are shown here the three major camps that the Syrian refugees reside in. One of the biggest camps all over the world is at Zaab Dari. Where 79,000 Syrian refugees are living there. And two other major camps. And the slide showed us the increase in the population. And Jordan from 2004 up to 2015 has been almost a triple. And the number of the non-Jordanians who are living in Jordan is also about 20 times have been increased over the years. What is the refugees accessibility to service? There are some accessibility for those who are living outside the camps. And from the beginning of the crisis to 2014, all refugees have free access to all Ministry of Health facilities. But from the middle of 2014, they are being put as if all refugees are treated similar to Jordanians who are not insured. But for those who are living inside the camp, the Ministry of Health and the family facilities here, supervise and provide all the public health services. They supervise vaccination, control of infectious disease, drinking water, medical waste, and many other public health issues that are supervised by primary healthcare physicians and family physicians. The United Nations Agency and some NGOs provide some basic needs. These are referred to Ministry of Health facilities and some to private hospitals according to the agencies responsible for healthcare. The Syrian crisis affected Jordan on different, but the mostly affected domain is the health sector, in addition to education, social, economic, and security. One third of refugees have been vaccinated in Jordan refugee camp of the 47,000 refugees who are eligible for the COVID vaccine. The success of the vaccination campaign that have been led by family physician is very much connected to the government's decision to include all persons in Jordan territory, national and refugees. The impact of the refugees in Jordan health sector, many of the indicators had been decreased. Looking at the workforce indicator had been decreased by 30% physician, dentist, nurses, pharmacist pair population had been decreased. The hospital beds were 10,000, but this also had been decreased. The primary healthcare centers and the family physician clinic also had been decreased according to the huge number and the influx of the Syrian refugees since the war crisis. Here I'll show some of the health impacts of this year. The major one is the infectious disease, the commonest infectious disease among the refugees that many family physicians and primary healthcare physicians deal with are diarrhea, chicken box, scabies, blood diarrhea, hepatitis A, cutaneous leash manuals. And there are some serious infectious disease that had been reported among the Syrian refugees. To be close is one of them looking at the number of cases among Jordanian people, 100,000 populations, around five years, compared to 13 cases among the Syrian. HIV cases, nine cases had been reported and diagnosed, followed up by family physician who were reported to stay. The health impact also on the vaccination and the national immunization program, all your maleites. Since 1992, no reported cases of all your maleites in Jordan. 30 cases of acute flaccid paralysis were detected by family physician among Syrian refugees during 2013-2012. MISILs during 2008-2012, no confirmed MISIL case among the children, but due to the Syrian influx and the Syrian refugees, 51 cases among the refugees had been reported. So there should be a response for this. The emergency response led by family physician is to conduct vaccination campaign. Mine vaccination campaigns had been conducted to cover the MISILs, polio, and to one campaign, huge national campaign, that covered thin vaccine according to national immunization program. There are some impacts due to the crisis itself, while related trauma, amputations, medical injuries, all of these had been built and referred to the secondary care when due to family physician. The major aspects of health service that affected the Syrian refugees is the mental health disorder, like post-traumatic stress disorders, depression, anxiety, schizophrenia. The other aspect is the non-communicable disease, like diabetes, hypertension, renal failure, 100 cases had been registered and followed up post-care by family physician. Cancer cases, talassemia, 20-207 cases had been. Seven cases of phenylketymorium had been diagnosed and followed up by primary health care and family physician in the U.C. At the maternity and child health services, which almost in Jordan run by family physician, female family physician, there is an increased demand on antenatal care, post-natal care, childcare, family planning, keeping in mind that all MCX services in Jordan are provided by family physician to refugees for free. The slide showing the utilization of minister of health facilities by the Syrian refugees, how the number is increased, the number of refugees attended the hospitals, those who attended the primary health care centers had been increased during the period of the influence. And this is showing how they are just the mostly affected governorates in Jordan by at least 10% of the Syrian patient had been visited as some kind of healthcare facilities, either primary health care center or family medicine clinic or even hospitals. And this is the affected by the hospitals, some hospitals have been, 20% of their attendance are Syrian. Those hospitals would know far from the border with Syria, mostly affected by the Syrian at this institution. The impact on the quality of health service and the index went down by 12 points. And this is shown as the longer waiting list and is primary health care center adverse affected on the quality of service that heavily affected. And there are more complaints and disrespects by the patient due to the number of refugees. The health care utilization by person amongst Syrian refugees twice as the Jordanian. So Syrian refugees utilize health services more than Jordanian according to the study done in the minister of health for the cost and financial impact of spending insurance coverage. So Jordan developed Jordan response plan where the major player in this plan are primary care and family business with three major objectives, increased access, update and quality of primary, secondary and tertiary health care for Jordanians and Syrian refugees in impacted areas, strengthening access uptake and quality of integrated community interventions for Jordanian and Syrian and strengthen adaptive capacity of the national health system to add this current and future stress. There are some of the project that we developed in the primary health care setting that strengthening and expanding the program of immunization, sustained the quality of environmental health and medical waste and capacity building is one of the major issues that family business played a big role and this by training and increasing the efforts of health assistant and health staff. So the major two roles in the family business that played is the access, update and quality of primary care provided to the Syrian refugees and strengthening the access and update of the integrated community intervention that the most team in the community team is hit by family business in Jordan. So the approach that used and followed up by the family physician Jordan is smart approach, smart approach that had been a little bit modified by the Jordan society family physician and the primary health care administration is for screening in the primary care setting and the family physician clinic and the refugees are screened for physical health, social and other issue and mental health and other needs. The second step is the management. They are managed all the conditions and the situation for these and had been managed some additional training of the clinician and staff or on some side resources for this. A, for assist they primary care physician assist refugees and patients in effectively navigating resources in the community and understanding local policies and penalties. They repair refugees and patient to external agencies of need that may provide more comprehensive physical, mental and social support. A team, the primary care setting coordinated team of partners that can collectively offer comprehensive service to refugees, patients and their families and meet a wide spectrum of their... In summary, the occurrence of certain communicable diseases among the refugees which obliged emerge to conduct frequent vaccination had been increasing. The prevention control, monitoring activities of some specific community and monitoring control of MCH services, antenatal care, postnatal care and obstetric service. There was a demand and pressure on the school health services that provided to refugee students because this kind of service almost run by family physician. The continuous provision and monitoring of specific public health services related to safe living water, medical waste and other issues of other public health issues. As I said, there is increasing of the occupancy rate in hospital by 20 percent, a pressure on the provision of therapeutic service by 20 percent, a pressure on medical equipment high cost of infestigation for some specific diseases by laboratory, high consumption rate of medical and non-medical consumables by 30 percent, high consumption rate of medication by 20 percent, the effect of the psychological, physical, social and emotional burden on medical care is all in this article. I will finish my talk by some key message that Jordan remains committed to provide humanitarian aid to Syrian refugees. Jordan can no longer be alone, the financial impact of crisis. Jordan public health system is dangerously over strict, especially that Jordan no more eligible for Gavin crisis means for the vaccination to cope with its national vaccination program. Jordan needs a significant contribution from the international community to sustain its health services for the Indians and Syrian refugees alive. Jordan needs to build the capacity of health workforce in terms of training and scholarship so that it can cope with the refugees impact. By this end of my talk, thank you for listening. Thank you very much for this moving experience from a country so long caring for huge groups of refugees. We are now coming to the possibility of questions and discussion. I hope I get a message of how much time we still have with us here. Not seeing any questions yet on the Q&A, I probably would like to ask you a question, both of you. My question would be both of you have experienced the situation of crisis and crisis is something you are not prepared for, you have to step in. Both of you have lived through it and we are here in an international conference with many other countries trying to benefit from your experience. Can you enlighten us first on is there anything? How primary care can see as a message from your presentations? How as a profession, how as a discipline, we can be prepared to cope with crisis? Or which elements that we have regularly in primary care are particularly relevant to make available in communities hit by crisis, hit by a catastrophe? May I ask Professor Kasai to start with his thoughts and then come to Dr. Tharavanay. Yes, thank you very much for this question. I think the advantage or privilege of primary healthcare team and family doctors is to take care not only of the acute phase of the care, but also of the continuing the long-term care after the acute phase. So we can address the issues in both groups of the problems. But the problem is we have the regular work without disaster and then all of a sudden the disaster happened and we ourselves become victims as well. So all of a sudden we had to do two things. One is to overcome the difficulties in my life or in the very proximal context issues. But also we need to address the other, address the problems happened by the disasters. So this is very difficult. And so the basic wisdom will be to be prepared always and what would happen. But sometimes it's quite difficult. And probably you're saying as well that to be effective as primary care, we as primary care professionals should be supported and happy and healthy and protected for the impact such experiences have directly on us. Dr. Tarana, maybe you can share your views on this and you have virtually an ongoing crisis with refugees that over time change and still have their impact. What do you think the world can learn from what primary care has gone through in the past decades in Jordan? Well, thank you, Sam. Really the Jordan Health System and the primary healthcare particularly had been tested by the influx of refugees and the byway continues under testing where family physicians are the leader and they can utilize many of their attributes in dealing with the huge influx of patients within a short time. They are the one who can easily engage the community and facilitate community participation. They are, I mean, primary care sitting are the place where all patients can get an easy access at any time. The most important thing that is the one who are familiar with the cultural background of refugees, it could be not that so difficult with the Syrian refugees but I mentioned in my 75 nationalities with different culture, different background from different countries. So, focusing on the culture of refugees is very important to look, particularly when it comes to mental effect of the crisis. So, to summarize that, I think we can build on the experience that primary care physicians gain from this unfortunate crisis is to be a good leader when they lead the team and the one who can use time and limited the resources efficiently are, I think that's things that we can build on. But in general, I think primary care in peaceful time is very far different from primary care in emergency. I think that we have to work on in our residency program training curriculum to put them, what is the best way and how to deal with some diseases that have been neglected. Example is Ateneus leshmanians, leshmanians haven't been diagnosed in Jordan for many years. The same with polio which is eradicated but they have to know it again when the crisis starts. So, a lot of lessons that can be learned from our undergraduate to our junior family physician from this crisis. Thank you. Okay, thank you very much. I'm still looking at the and inviting those who are on the audience to pose questions through the Q&A and not seeing that and wanting to continue this interesting discussion. Both of you have mentioned the interaction with the victims, not just as patients but also as individuals, as communities. How effective is it in a situation of crisis to liaise to and work with the actual population of what we then call the victims, the ones who are at the receiving end of the crisis to involve them at that moment during crisis? Has that been possible? Is that because it's such a powerful mechanism in community-based primary care in general is that under crisis and catastrophe? Also a possibility? Can both of you give a short reflection on that and maybe we start with Dr. Tarewane? Yeah, thank you. It's a very good question that Sean from experience when family physician do work, they look at the whole aspect of health and non-health issue, not only the physical aspects of their health also at the social aspects and even at the financial aspects of their conditions. So this is encouraged and post-family physician to look for cooperation with other NGOs or civil societies that they can arrange some kinds of health in terms of housing, in terms of other things related to their health and directly. So this again encourages the family physician to be completely familiar with the communities with whom they work and even among the group of victims or inside the camps, they have to be familiar with respected or well-known victims who can help them in terms of the background of the victims and what things that are concerned with more than others. Okay, thank you very much. Professor Kasai, your comments as well, but you also have a question directly to you on the Q&A asking you about what you've learned of being prepared and what specific preparations have you started working to prepare doctors for the next disaster. Of course, in the situation you faced, it was a sudden-on catastrophe, no one had seen coming and how do you prepare future doctors for it and particularly given in the situation you were facing where probably the health problems were only a minor part of the problems people were facing. They lost their house, they lost their jobs, they lost their income. Here we see primary healthcare at its full breadth and acting outside the borders of strict borders of healthcare and medicine. It's a long and complex question, but I'm certain you have something valuable to see and particularly address the question that is on the Q&A. Thank you. I think the Japanese situation is very complex, but most of all, the primary healthcare implementation is quite underdeveloped in Japan. Ten years ago, we didn't have good systems of primary healthcare in any affected areas, and then the Japan Primary Care Association, which is the member organization of Ubonka, have addressed several projects and now we have the teaching modules for the future family doctors in Japan. This is an off-the-job training modules for the trainees, as well as we have a team to be sent if something happened to the disaster-stricken areas. Those activities organized by the Japanese Association is the one example of preparedness, but the fundamental issues, one of the issues is how to pass away the government to take primary healthcare as the strong weapon or tool or solution to address the disaster. There is a question from Dr. Sonja Wicklum in the Q&A for both of you. I think it's more or less covered what you, for example, said we're just referring to, but if you can have a look, and then probably I can also ask, because I suspect we're running a bit towards the end of the session, also Dr. Tarana to comment on that, a response team as a matter of, as a way of keeping the experience alive and making it available for the future. Well, thank you. Thank you and very short. I will reflect on the previous question, because one of the lessons learned is to integrate mental health in primary healthcare. This is what we started, and we are building on and expanding in the family price scheme. The second, as you mentioned, is the team response. We are working on building the capacities of family physicians to build and to lead the team and keeping the team in primary healthcare in a way, a manner that, to check for anything that has been defaulted or not working on as a weakness point. So team building is now an area that we are working on and building the capacities of all the primary healthcare centers as one of the things that have tackled some weakness. Thank you. Okay. Professor Kasai, do you have anything to add to the question of Dr. Sonja Wicklund? Yeah, the speaking of cultural knowledge and cultural understandings. So I used the word, the context, and we needed to understand the context of each people who have had unique experiences over the acute phase of disaster. So we needed to listen carefully to that context issues. Okay. I'm sorry to interrupt you because I'm signaled that I have to round up this session and I don't want to let it slip away. I want to thank both of you for your presentations. I think these were moving examples of the value of primary care operating under unpredictable circumstances and not fully supported by governments in a way primary care should be supported. Thank you very much for this. I thank the audience for their listening and for the questions. And I think I should now round off this session. Thank you very much. Thank you. Thank you very much. Thank you very much. Thank you, both of you. Thank you. Thank you. Bye-bye. Bye.