Background Within the vague system of primary care and COVID‐19 infection control in Japan, we explored how primary care (PC) physicians exhibited adaptive performance in their institutions and communities to cope with the COVID‐19 pandemic from January to May 2020. Methods Narrative analysis conducted by a team of medical professionals and anthropologists. We purposefully selected 10 PC physicians in community‐based hospitals and clinics and conducted a total of 17 individual and group interviews. The verbatim transcript data were analyzed using the conceptual framework of adaptive performance. Results We identified three “phases” of the time period (January–May 2020). In Phase 1, PC physicians initially perceived the disease as a problem unrelated to them. In Phase 2, the Diamond Princess outbreak triggered adaptive performance of the physicians, who began to deal with medical issues related to COVID‐19 by using social networking services and applying the collected information to their organization and/or communities. Following this, in Phase 3, the PC physicians’ adaptive performance in their own communities and institutions emerged in the face of the pandemic. Reflecting their sensitivity to local context, the PC physicians were seen to exhibit adaptive performance through dealing with context‐dependent problems and relationships. Conclusions PC physicians exhibited adaptive performance in the course of coping with the realities of COVID‐19 in shifting phases and in differing localities in the early stages of the pandemic. The trajectories of adaptive performance in later stages of the pandemic remain to be seen.

The triple disaster of March 11, 2011 posed a formidable challenge for Japanese society in general, and for affected coastal communities in particular. In the immediate aftermath of the catastrophe, there was widespread support for the construction of high seawalls to protect communities. However, many communities began questioning this approach. In Maehama, the question of land-reconstruction and protection gave rise to a set of complex responses. The government aimed to put in place even higher seawalls; however, the local community proposed instead to mark the boundary of high water with trees and stakes. These solutions instantiate different ways of infrastructuring the post-tsunami environment for safety, and they carry different assumptions about infrastructure itself. Whereas the seawall solution was technical and quantitative, centering on the question of height, the boundary markers embedded a qualitatively different set of assumptions about what makes a workable infrastructure. In particular this difference centered on issue of visibility. On the one hand, the seawall was meant to slowly become unremarkable, whereas the boundary markers were specifically intended to maintain community memory. On the other hand, the seawall would make the sea itself invisible, whereas keeping the sea in sight is very important to villagers. However, the opposition between these forms of infrastructuring the environment was not total. Slowly, a solution was negotiated in which the sea wall and the boundary markers could complement one another. This situation highlights the intricate and transformable relation between visible and invisible forms of infrastructure. KeywordsDisaster, Infrastructure, Invisibility, Japan, Visibility Biographical note on the author Shuhei Kimura is assistant professor of cultural anthropology at the University of Tsukuba, Japan. Since 2011 he has conducted field research in tsunami-stricken communities in northeastern Japan and published several research articles on disaster and public anthropology. 2 When a seawall is visible:Infrastructure and obstruction in post-tsunami reconstruction in Japan Acknowledgements I would like to thanks the anonymous reviewers, Casper Bruun Jansen and Atsuro Morita as well as the guest editors, Anders Blok, Brit Ross Winthereik and Moe Nakazora, for their very helpful comments on previous drafts.

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Vaccine rollouts have been underway to combat the COVID-19 pandemic globally. Based on ongoing interviews with ten primary care physicians ‘in the field’, this paper elucidates how in practice the vaccinations were carried out in Japan in 2021. We examine what the primary care physicians did to prepare for the rollouts, what problems they faced, and how they responded to these problems. Large-scale vaccination projects are supposed to proceed smoothly and quickly, or to have what Anna Tsing calls ‘scalability’. In practice, however, they required a variety of tasks for coordination, information sharing, and promotion. Despite feeling stressed by the lack of information and exhausted by the work overload, the primary care physicians carried out the vaccinations as an important service to their patients and communities. The findings of this paper will provide valuable materials for improving future vaccine rollouts.

BackgroundGeneral practitioners (GPs) commonly deal with complexities, such as patients with socio-economic-medical problems. However, the methods they use to approach these complexities are still not understood. We speculated that elucidating these methods in terms of complex adaptive systems (CAS) to comprehensively assess GPs’ daily activities would contribute to improving the professional development of GPs. This study aimed to clarify the approaches adopted by GPs in Japan to handle complexities in their daily activities and examine them in terms of CAS extracted from GPs and other healthcare professionals.MethodsWe adopted interdisciplinary team-ethnographic research. Five hospitals and four clinics in Japan, selected by purposive sampling based on the presence of expert GPs. 62 individuals of various backgrounds working in five hospitals and four clinics were interviewed. Using field notes and interview data, the researchers iteratively discussed the adequacy of our interpretations. The first author (JH) prepared a draft report, which was reviewed by the GPs at the participating facilities. Through critical and iterative consideration of the different insights obtained, the final findings emerged together with representative data.ResultsWe identified four approaches used by GPs to deal with complexities. First, GPs treat patients with complex problems as a whole being and address their problems multi-directionally. Second, GPs build horizontal, trusting relationships with other healthcare professionals and stakeholders, and thereby reduce the degree of complexity of problems. Third, GPs change the learning climate while committing to their own growth based on societal needs and by acting as role models for other professionals through daily interpersonal facilitation. Fourth, GPs share community values with multi-professionals and thereby act as a driving force for organizational change. These various interactions among GPs, healthcare professionals, organizations and communities resulted in systematization of the healthcare and welfare network in their community. ConclusionsExpert GPs developed interconnected multidimensional systems in their community health and welfare networks to adapt to fluctuating social realities using four approaches. GPs’ work environment may be considered as a complex adaptive system (CAS) and the approach of GPs to complexities is CAS-based. Our findings are expected to have practical applications for GPs.