A collection of Correspondence in this week's Lancet provides first-hand accounts of various aspects of the earthquake/tsunami disaster in Japan.

In one letter, Drs Yuichi Tamura and Keiichi Fukuda, Department of Cardiology, Keio University School of Medicine, Japan, talk about how Twitter was vital in getting people appropriate medical assistance. They say that, despite the disruption to the telephone networks, internet access remained relatively stable. This meant that a particular group of patients that were of extreme concern could be reached: those on continuous-infusion prostacyclin for pulmonary hypertension.

The authors say: "Forming a supply chain for such drugs in the earliest stages of the disaster was difficult; however, we found that social networking services could have a useful role...We were able to notify displaced patients via Twitter on where to acquire medications. These 'tweets' immediately spread through patients' networks, and consequently most could attend to their essential treatments."

In tandem with the efforts of Japan's health-care professionals, Twitter ensured that all patients on prostacyclin treatment received their required medication. The authors conclude: "Our experience has shown that social networking services, run concurrently with physical support, were significant in triumphing over many difficulties in the recent catastrophe."

In a second letter, Drs Junichiro James Kazama and Ichiei Narita, Niigata University Medical and Dental Hospital, Niigata, Japan, discuss what they believe to be the unprecedented rapid transfer of 600 dialysis patients to a new setting and provide them with vital life-sustaining care in a very short timeframe. The patients were transferred from Iwaki, a city located only 40 km south of Fukushima's stricken power plant, to the Niigata hospital.

Two previous earthquakes, and the resultant transfer of some haemodialysis patients, had meant that the authors and their colleagues had a system in place ready to deal with large numbers of patients new to their hospital. They say: "The patients were unable to bring their own medical records with them. Therefore, on their arrival, they underwent short physical examinations, and inquiries were made into their recent history to establish their immediate needs. Those identified as requiring haemodialysis therapy as soon as possible were immediately sent to the dialysis facilities...The transfer of 600 haemodialysis patients is an unprecedented event."

And in a third letter, authors criticise the weakness of Japan's primary care system, which was already inadequate to deal with current problems even before the tsunami struck. Authors Dr Jay Starkey, University of Iowa, USA, and Dr Shoichi Maeda, Keio University, Minato, Tokyo, Japan, say: "Patients have no other option but to go to the hospital for all types of ailments irrespective of severity; normally this just results in long waiting times at the hospital. In the aftermath of the earthquake, tsunami, and nuclear accidents, hospitals were unable to tend to patients with non-urgent but important needs such as treatment of hypertension, diabetes, gastroenteritis, and so forth. Japan needs to strengthen its primary-care system."

The Lancet