It is not what I had expected. Fukushima prefecture has some of the most stunning and beautiful countryside I have seen. Rolling, heavily wooded steep hills, dense vegetation and dark rich fertile soil in the valleys below. I tried in my mind’s eye to visualise the invisible radioactive particles permeating and polluting the natural beauty; it didn’t take much effort as the regular clicking of the Geiger counter beside me began to sound like old late-night television static as we travelled into the mandatory evacuation zone, where the only sign of life was the occasional police car prowling to deter looters. Radiation levels are too high to allow human habitation.

More than a year on from the Japanese tsunami, which claimed an estimated 19,000 lives and caused the Fukushima nuclear disaster, I visited the nuclear zone as a medical practitioner to hear the testimony of the local people whose lives had been irrevocably changed.

The Kawauchi Village area, home to 3000 people, is largely a farming community, with a third of the area falling in the 20-kilometre mandatory exclusion zone to the east and the remainder in the voluntary exclusion zone. As we drove into the mandatory exclusion zone, it was a ghost town. Vegetation had overgrown many of the dwellings, some of the houses were beginning to appear dilapidated and the paddy fields were occupied by thousands of large bright blue plastic bags containing contaminated soil that had been shipped here from areas attempting decontamination. A playground once filled with happy playful children stood silent. What had happened to these children and where were the once-proud, hardy farmers whose ancestors had farmed this land for generations?

We stopped at an emergency housing site established in an asphalted clearing and composed of many small, cramped demountable-style dwellings. Once proud farmers were now welfare recipients with a poky existence and very little to do. Most were elderly. Younger people, particularly those with younger children, had move to where they were more likely to find work. There were some young couples remaining, but very few children. The children had been sent to live elsewhere in Japan with relatives away from the risk posed by the radioactive contamination, thereby separating families at a time when the support of an intact family was most needed. As a parent, I thought of the gut-wrenching decision the parents were compelled to make and the likely trauma the children were enduring.

We spoke to an elderly farmer who had lost his farm. He spoke with hope, but despair was written on his face. It was as clear to him as it was to us that he would never return to his farm, however his greater fear was that he would spend his final years in this makeshift camp. Farmers in the evacuated zones were required to slaughter their livestock. One farmer in another village was forced to kill 1000 of his cows — and then killed himself. Suicide is unfortunately not uncommon given the degree of psychological trauma engendered by the disaster. Surveys in some of the most affected regions reveal the majority suffering some degree of emotional distress or specific psychological disease.

The modern primary school that originally taught 300 pupils now had 25 children. The gleaming school stood there as a testament to future hopes dashed. A community that is predominantly comprised of older citizens is not viable.

But it would be wrong to assume that despair pervaded. Some learn to thrive amidst the adversity. We visited an elderly organic farming couple who beamed with pride that their farm had been chosen to show foreign experts how the locals were responding to the disaster. He and his wife were “salt of the earth”, kindly, gracious simple folk who knew nothing else but how to organically farm. They spent much time in explaining the intricacies of gamma dose rates and radioactivity levels in the soil and their crops, yet they had no scientific background. As we stood beside a pond with dozens of ducks he told us of his scheme using ducks to decontaminate his property of radiocesium. How this was meant to work didn’t quite add up for us, but it didn’t matter: they were on their ancestral farm doing what they loved, and were feeling empowered by regaining some control over their lives.

As it was, the radioactivity on their farm had decreased since last year; I suspect this had much more to do with rain washing it away and with the soil being turned rather than their ducks, but I wasn’t going to rain on this wonderful couple’s parade. They had hope vital for any recovery from a major trauma. Hope that they would overcome adversity through sheer dint of their resolve and hard work. They had to destroy last November’s entire contaminated potato crop, but hoped this November the crop would be suitable for sale.

Transparency and openness are essential to regaining the trust of citizens, and vital to encouraging them to return. Part of achieving this was being frank about radiation levels. We drove by numerous radiation meters in public areas which gave a real-time measure of ambient gamma dose rate (groundshine). It is a confronting experience to see a gamma dose rate meter where one would normally expect to see a statue or fountain, or to see radioactivity levels on fresh produce sold at the market (confirming that it is below the regulated threshold) where prices are normally posted.Decontamination of public spaces and monitoring of radiation levels is also vital to confidence. Usually this involves removing the topsoil and replacing it. By necessity however, this can only be of limited success. Living in a valley entails recurrent contamination from cesium being washed down from the more highly contaminated forest (and incidentally polluting the streams and fish stocks within them). At best we can only consider this as control rather than elimination of the hazard. And no one is contemplating decontaminating the forest, which would involve razing all vegetation and removing the topsoil. This is the reality of living in a nuclear fallout zone.

For other, more heavily contaminated communities, decontamination has failed. The mayor of nearby Iitate village recently declared decontamination efforts a failure and reluctantly concluded that this spelled the end of the village community.

Progressively, we came to appreciate the importance of continuity of a community in the recovery from a nuclear disaster. The psychological impacts are immediate, extensive and prolonged. Decisions to relocate come with trade-offs that need to be considered in the decision to return. What level of cancer risk (the only recognised health risk at these radiation levels) is one prepared to live with to regain one’s previous life?

At an excess of 10mSv per annum (roughly three times standard background radiation levels in Australia) the approximate risk is one extra cancer per 1000 people. Science can provide an estimate of the risks which can assist people make the final decisions, but ultimately these decisions are beyond the realm of science and only able to be made by an informed populace. For some, relocation and rebuilding may be the outcome they choose, for other communities, remediation and return is the answer.

Citizens need the resources (health, financial, administrative and political) to implement their decisions rather than be coerced or deceived into predetermined politically convenient outcomes. Prescriptive values of cut-off radiation thresholds as “safe” are simplistic, and undermine confidence.

Ultimately, the earthquake and tsunami not only caused physical destruction, but also, through the associated nuclear disaster, ruptured the delicate threads of trust that bind citizens and their elected leaders responsible for their welfare. The government was revealed to be part of the corrupt “nuclear village”, which promoted the nuclear industry’s interest at the expense of the public’s safety. Trust will only be regained slowly, if at all, and recovery will be commensurately compromised.

The consequences of the nuclear disaster pervade every level of Japanese society and will continue to echo for decades.