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As a result of the economic slump that followed Japan's economic growth in the 1990s, the number of Japanese homeless has increased dramatically in large cities. The city of Osaka has the largest homeless community in the country, officially estimated at 8,000. There is only one hospital that responds to the medical needs of this group, and the problem has grown beyond its capacity.
In August 2004, MSF attempted to open an outpatient dispensary in the Miyakojima ward of the city. This location was easily accessible to the homeless population living in Osaka's northern parks, riversides and transportation terminals. However, strong opposition from a part of the local community forced MSF to halt plans for the clinic. Instead, the team decided to start the project using mobile clinics that regularly visit various parts of the city.
A mobile-clinic team composed of a medical doctor, nurse, social worker and logistician- administrator, now visits four city parks, providing care to the approximately 1,000 homeless people who live nearby. The MSF team monitors some 130 regular visitors a month, providing basic medical consultations, prescribing medicines and referring those who need more help to other medical facilities or social agencies.
The majority of MSF's patients have chronic diseases such as hypertension, asthma, chronic back pain or gastritis, due to their older age, their limited diet or their harsh living environment. Only 20 to 30 percent of the patients have acute health problems related to exposure to the cold, wounds or severe pain.
While MSF waits to establish a fixed dispensary, consultations are carried out in a large van. The team also refers patients needing more sophisticated tests or longer- term care.
MSF has worked in Japan since October 2004.