When a powerful earthquake struck Kumamoto last week, Tomoko Sato found herself torn between two urgent demands: caring for a surge of incoming patients and protecting her own children.

As chief of emergency medicine at Saiseikai Kumamoto Hospital, a 400-bed regional trauma center in the city’s southern Minami Ward, Sato, 55, was thrust into the center of the disaster response.

The quake hit at around 4:30 p.m. on July 28, registering a strong 6 on the shindo seismic intensity scale at the ward — just one notch below the maximum of 7. By Sunday, 38 people had been confirmed killed and communities across Kumamoto were still struggling to recover.