Looking back at 2007.

Time flies.

Oh boy, I wonder how many times I've said this phrase on this blog. But well, it's true. But it's also true that this year was full of meeting new friends and discovering my interests... and myself.

In spring, I participated in VIA's (a non-profit based in San Francisco and on the Stanford University campus) Exploring Health Care program to learn about health care in the USA and in the Bay Area in general. Along with medical students and undergraduates thinking of going that way, we hopped around the area to see hospitals, clinics (both private and free), homeless shelters, shadow doctors' rounds, participate in class to get a taste of what medical education is like there, and much much more over a period of 2 weeks.

The gay clinic called the Magnet, located in the heart of Castro, the gay mecca of the country, is what sparked me into community-based health care, or in other words health care that involves the entire community. What's amazing is that it's not merely a clinic but has the potential to act as a catalyst to bring a people together and empower them as a whole. I'll talk about this much more in detail another time...

And this summer, I found myself in a 11-day primary health care (PHC) training program at Mahidol University's ASEAN Institute for Health Development (AIHD) in Thailand. Along with nursing school students from that country, we followed a highly-concentrated course to see health care in the urban areas of Bangkok (including the slums), go up 4 hours by bus to the rural areas in Uthai Thani Province and stay in a village to do some epidemiology field work 'for beginners', and do a presentation at the end with our groups.

The rural area home-stay and the interviews and other interactions with the villagers totally changed how I think, and this is where PHC and community-based health care got on me. Again, I have to save another time to tell this in detail...

And last but not least, DOCS (acronym for Development of Clinical Skills), which we formed with the former participants of the Exploring Health Care program in our university to get a head start and practice clinical skills, played an important role in my life this year. We found energetic, passionate, student-caring doctors who were willing to teach us, in a university where we once felt finding those kind of mentors was devastating. Moreover, the activities led me to knowing general medicine, family medicine, and primary medical care, which then led me to Ukima Clinic, a community-based clinic up in northern Tokyo. (See post 2007/11/20.)

The more I look back at this year, the more the activities I was involved in get connected in one straight line. Compared to a year ago, I couldn't have imagined myself where I am now. This year helped me discover what my true interests are in (at least for now), and now I can much better describe the bigger picture of the doctor I have in mind for my future.

Wishing everyone a happy holiday season and another great year! :-)

Autumn leaves and climate change.

Autumn... trees are starting to change color, like a rendering of warm colors on a canvas. Temperatures have gone down, and I notice it's almost the end of November. Time flies.

Last Monday, I paid a visit to Kita-no-maru Park near the Imperial Palace in Tokyo. Spent maybe about an hour or two sitting on the bench, gazing at the picturesque scenery adorned with beautifully colored trees, while some little nursery children played with parents and other people sat on the lawn reading books or just taking a nap. Calm, quiet, and peaceful. Birds flew from a tree to another from time to time.

An oasis in bustling central Tokyo.

When you talk of autumn leaves in Japan, Kyoto is the first place that comes to mind. The former capital of Japan is just purely beautiful during this season. The scenery of numerous history-rich artistic temples with a balanced mix of red, orange, yellow, green, and sometimes pink and purple leaves is just simply magnificent.

However, peculiar things are starting to happen in Kyoto. The autumn period is becoming shorter and shorter year after year. Compared to half a century ago, leaves now start to change color two weeks late, and leaves fall off the trees a week late, shortening the "autumn leaves season". Why? It doesn't take a rocket scientist to guess... the temperatures at Kyoto have risen, widely thought to be the result of global warming. According to records, the average temperature of Kyoto is three to four degrees (Celsius) higher today than in the Meiji period, about a century ago.

Kyoto is where the international community agreed on a protocol to reduce greenhouse gases, and the host country promised to cut 6% by 2012 from the 1990 level. However, the reality is emission has increased by more than 8%. Experts note that the Japanese industries had already gone through a series of rigorous cost cutting measures in the 1980s through developing new technologies, thus cutting carbon emissions, so much of the current plans focus on taking advantage of the Kyoto Mechanism, such as emissions trading (ET) and joint implementation (JI), and also promoting and persuading offices and homes to save more energy.

We, as individuals, need to act now. For our future, not only to help our environment but also in order not to lose trust from the rest of the world. There are lots we can get done if we all do it. :-)

A visit to Ukima Clinic.

When I contacted Dr. Fujinuma to ask whether I could see Ukima Clinic, a community-based clinic operated by the Tokyo Hokuto Health Co-operative, he happily nodded. So, on November 6th, I had the chance to visit the clinic I had been wanting to visit since spring.

I invited three friends who also participated in the Exploring Health Care program this March at Stanford University and University of California San Francisco (UCSF) and now belonging to a clinical skills practice group called DOCS (acronym for Development of Clinical Skills), which we formed after knowing how much clinical experience the medical students on the other side of the 'big pond' are exposed to.

So that morning, the day there started out in the outpatient clinic. Of course, it was our first ever time shadowing a doctor, so there was so much to learn, both in terms of knowledge and the way the doctor interacts with the patient. However, what I felt here most strongly is that health care is truly patient-oriented, in other words, even if patient A and patient B have the same health issues, the medical treatment or the approach taken by the physician may not necessarily be identical.

For example, there's not much hope in persuading an alcoholic or a heavy smoker to quit or reduce the amount if he insists he earns money to drink or smoke, respectively, and if that is the ultimate joy for his life. However, a different approach may be taken towards a person who is more willing to care more for his own health. A woman who smokes five cigarettes a day to refresh herself during break at her work says she is aware that it's not good and she's thinking of cutting the amount, but just couldn't make the move. So, then the physician would actually show her some other ways of refreshing, for example drinking tea or coffee or having a light snack, and chatting with her fellow workers. Naturally, there are exceptions, but in general, the doctor does what makes the patient most happy.

In the afternoon, we participated in what is called an 'Oushin', which is a house call where a doctor goes and sees the patient at his or her home. This is a very interesting form of health care, since you really have the chance to see the environment the patient is in, including the lifestyle and the socio-economic background. There are households with various status, from seriously poor ones to rather wealthy ones. In this afternoon we visited seven.

There was a family where the only person in the house was a 90-year-old lady lying all day in the bed, having only one grandson living with her to look after her when he doesn't have work. Other members of the once big family have either died or are literally 'missing'. The house looked as if it's going to crumble with a couple more earthquakes (yes, common in Japan), and the physician, now used to visiting this home, told us the places in the room where the floor had become too weak to support us. There was also a relatively wealthy-looking family, living in a mansion. Nicely dressed ladies (apparently sisters) had gathered to look after their mother who had become ill. This was a first-time visit for this patient, so the doctor goes through the explaining and all the communication with the patient's family thoroughly and carefully with detail. After the visit, she added that it's essential to build a favorable first impression, since that leads to trust and will ultimately have a substantial effect on the future relationship with the family.

So the day ended roughly eight hours after we arrived at the clinic in the morning, though the physicians still had some paperwork left including reviewing the patients' medical records. It was a day where I had the chance to truly understand that there actually are various kinds of people with various backgrounds. I mean, I knew that by words, but this experience enabled me to put those words in my own context. It is often said that the socio-economic disparities have widened in Japan, but still not to the extent of those seen in the U.S., Europe, or developing nations, however, disparities do exist and those are not minute. It is all the more important to understand the true needs of the patient, considering the background and the environment of the patient, and think about what happiness means for each of the patients, and tailor health care to help them become happier.

At the end, Dr. Fujinuma summarized the day by giving us a small lecture about what primary health care (PHC) is, and what strategies the clinic is taking to make the community more happy as a whole. Through this talk, three key words got connected in one straight line in my mind: primary health care (PHC), public health, and community building and empowerment. There's a whole another story to this, so I'll stop here for now. :-)

Reshuffling the political industry.

When the leader of the main opposition party in Japan said he would resign, I first thought it was the beginning of a much-needed radical reshuffling of the "political industry" in Japan, contrary to what many critics and most media are saying.

He cited a couple of reasons for his decision to step down, but some notable points are him admitting that the Democratic Party (DPJ) still does not have enough strength to run a government, followed by presenting an idea of entering into positive talks with the ruling Liberal Democratic Party (LDP) about lawmaking, even hinting the possibility of a team-up. While DPJ's victory in the upper house (House of Councillors) elections that took place this summer represented a significant boost for the young party, effectively blocking the LDP from passing laws, ironically, the same could be said the other way around, as the LDP still controls the majority of seats in the lower house (House of Representatives), thus creating a political stalemate. Of course, the law says the lower house can pass laws even if the upper house vetoes it, but the LDP will not dare to do that, knowing how much criticism they would be receiving immediately afterwards.

In Japan, many speak of the advance the DPJ has made as the dawn of an era of a two-party system in Japan. However, if you look at the DPJ, it's just a cluster of former smaller opposition parties that joined together just because they weren't big enough to beat the dominant LDP in elections. So still, if you look at the members, some really have different views and ideas. Mr. Ozawa probably had this reality in mind that they at least aren't ready now to run a country. But then again, a similar comment could also be said with the LDP, since they are made up of nine factions that often compete against each other, though an increasing number of politicians do not belong to any. This said, I personally strongly believe that a radical reshuffling, or a reorganization in politics should be made. The resignation had the potential to spark this.

Many speak of DPJ's leader Ichiro Ozawa as a backroom dealer, but he has clear views and knows what he wants to do and what needs to get done. Politicians who have a clear picture should have their own parties with their own ideas with fellow politicians who share very similar views. However, the reality is, they just continue to cling to the LDP or DPJ, just for the sake of the support (including the financial part) they're eligible to receive when it comes to elections. But, we all have to remember that politics is for the benefit of the citizens and not the politicians themselves. Right?

Had Mr. Ozawa resigned and formed his own party with his colleagues who share similar views with him, independent from both the DPJ and LDP, it could have started a major reshuffling. After all, there are politicians in both parties who are likely to agree with him on a lot of terms. But well, he has somehow gone back to the chair. Now, he must be prepared for all the criticism he will be receiving especially through the media, in a country where the media has so much influence on the people. He might have changed his opportunity to instead be the beginning of an end of his career, at least in politics. But, I had hopes, yes, hopes... :-)

An evening in Shinjuku's good old backstreet.

A block still retaining post-war Showa era style, near bustling Shinjuku Station, houses over 30 "nomiya", or Japanese-style counter bars. It's called Omoide-Yokocho, which translates to something like "the backstreet of the good old days". The small community truly lives up to its name.

On October 28th, after we had the patient assessment workshop, I decided to go for a glass of beer and a light snack in Omoide-Yokocho with two of my friends who also participated in the activity. It's Sunday night, so not all of the nomiyas are open, and if you want to see how it is when it's busiest, Friday night would be best. So we walked down the small but lively alley and hopped into one named Asadachi. Many nomiyas call people walking by to come in, but this place didn't, so we just said why not.

This place had a very interesting, or to some maybe peculiar menu. They had raw pig and cow liver, testicles, penis, and uterus, while also boasting frogs, whale meat, fish, and many kinds of shellfish. Most of these could also be served cooked. A wide choice of rare alcohol was also offered, like "sake" made from aloe, snakes, lizards, etc... but with all of this, the two-hour talk with the owner of this place was so interesting that it made the menu irrelevant.

When he talked, he talked as though if he had met everyone from everywhere. And he closely looked into the other's eye when talking, and continued to look into it even after the other had shifted his eye somewhere else. Very observant he was... he really reads people's expressions. He's met all kinds of people, from TV superstars to politicians and company executives to front-line employees. They all come here to babble about what's up in the world they belong to, and that's why he knows a lot about them... And maybe because he has seen the eyes of so many that, he says he can read one's personality just by looking into the eye.

A 68-year-old actor came in while we were there, and says he has been a regular visitor for over a decade. The owner knows a lot about his life... that he was a playboy when he was young though having a wife, did ordinary desk work in his 40s and 50s at an insurance company, but decided to become an actor after he retired at 65.

The owner told us many things... but the one that seems to have been carved in my mind is "What's most important is your heart, but just that won't get you anywhere... you have to be clever, maybe sometimes even cunning or sly..." Hmm, maybe so. :-)

Patient assessment workshop by young doctors.

What would I do if a person walking in front of me suddenly collapses? He's holding his stomach and seems to be suffering from some kind of severe pain...

Much has been talked about basic life support (BLS), but that algorithm basically only applies to cases where the patient's heart has stopped. Well, then what do we do if a person's heart still seems to be working but he's unconscious and seems to be hurt in some way, is the question here. This is called advanced medical life support (AMLS) or international trauma life support (ITLS), and it's about assessing the condition of the patient in an emergency.

The algorithm consists of three major steps, and the first is called "Scene Size-Up", where the checklist assesses five points: body substance isolation (BSI), scene safety, number of patients, nature of the illness or the mechanism of the injury, and the resources that you have at that moment. The main purposes of this step is to provide safety not only for the patient but also for yourself, and collect information that can be gathered in a glance.

"Initial Assessment" is the second step, which is also the most important of the three. We assess five things here too: general impression of the patient, mental status, airway, breathing, and circulation. Does the patient seem severe? What's the level of consciousness? (AVPU - Alert, reacting to Verbal stimulation, reacting to Pain stimulation, or Unconscious?) Is there anything obstructing the airway? Is the patient breathing? What's the heart rate and condition of the peripheral circulation? Is the patient bleeding? Appropriate assessment in this step is vital, as the third step depends on the condition of the patient.

If the heart is not moving, we move on to BLS or advanced cardiac life support (ACLS). But if that's not the case, we first evaluate whether it's a trauma case or not. If it is, then we see if it's a single trauma or multiple. If it's single, we do a focused rapid examination of the injured area and ask the patient SAMPLE (Sign/symptom, Allergy, Medication, Past medical history, Event prior to the symptom) questions, while if it's multiple, we need to do a rapid thorough trauma survey of the entire body before asking the same set of questions. All of this is done before handing the patient over to the hospital.

Now, if the case is not a trauma, then we first see whether the patient is responsive or unresponsive. In the latter case, we must go through a rapid medical assessment of the entire body and check the vital signs (circulation and blood data). Gathering the medical history of the patient comes last, since one cannot speak at this moment. If the patient can respond to you, you gather this information first and then move on to rapid medical assessment and checking vital signs. Again, this is done outside or in the ambulance, before it reaches a hospital.

Of course, there's more detail and thinking to this, but the important thing about this type of learning right now is for us to do simulations with our fellow peers over and over to memorize the algorithm with your body, instead of the just the brain. Then we can move on to the details and the thinking of case-by-case scenarios. What's amazing about this workshop was that it was planned and carried out by a group of only first and second-year doctors and students. It really motivates you. :-)

AIHD 2007 reunites in October.

I really like these people.

And I think these people truly like each other. Almost three months have passed since the Primary Health Care (PHC) program at the ASEAN Institute for Health Development (AIHD) at Mahidol University, Thailand in August, but we're still close together. We're holding dinners and parties at least once a month, and the members just keep on coming. The October dinner was held on the 23rd, and one came from Nagoya by shinkansen, another came from Fukuoka, 900 km from Tokyo, just for the event. Two others dropped by at 10PM after finishing work and training, respectively, just to have a few moments to see who's here and what's up with them.

Just amazing. I wonder what got us so hooked up with each other... and no doubt I'm one of them. We had 37 Japanese in the flock in Thailand, and of course, not all of us come to join these events, but every time we get together, there's at least a dozen members, and what's both surprising and amazing, is that that number keeps on going up time after time.

And, we're all with different backgrounds. Not only are we comprised of medical or nursing students, but also people who already work, either in the medical field or somewhere else, or students from totally different areas of study (at one glance different, but actually connected). But there's some kind of intrinsic common factor that's keeping us together... :-)

International Health Co-operative Forum.

The International Health Co-operative Forum was held today in Shinjuku, Japan. It's the 3rd forum after Tokyo 1992 and Manchester 1995, and the theme of this occasion was to decide on the global objectives of the co-operatives' approach to health care, especially after the birth of regional health co-op organizations such as the International Health Co-operative Organisation (IHCO) and the Asia-Pacific Health Co-operative Health Organization (APHCO).

We first had a general assembly featuring some very interesting speeches, one of which I will discuss later, and then we divided into five sectional meetings: world's health co-ops, primary health care, poverty and international cooperation, coping with aging societies, and international exchange of people. I decided to participate in, you've guessed it, the primary health care meeting.

There I met Dr. Yasuki Fujinuma, one of four guest speakers for this sectional meeting. Actually, I've met him before, at a primary health care workshop which was held at the end of September. He's currently the director of Center for Family Medicine Development (CFMD), and also works at the Ukima Clinic, a community-based primary health care clinic located near Akabane in northern Tokyo, and is actively involved in both improving medical education and developing primary health care in Japan. Ukima Clinic is one of the clinics I have an eye on, as it is doing very interesting health care activities at a community-based level. I hope to visit the place sometime next month. Anyway, the part of his speech that caught my attention was when he talked about the near-term plans of primary health care in health co-ops. He talked about three.

One, he stated the need for clinical training in primary health care clinics. He showed us some numbers, and it was something we could nod at. If there were 1000 patients, 88 of them would be going to local clinics while only 0.3 would be paying visits to university hospitals, but the reality is, most of the young doctors train in university hospitals and others alike, the ones that provide specialized, so-called tertiary health care. Clearly, there is a definite need to do at least some training at the community-based, primary health care level.

Secondly, he mentioned that the health co-op should take part in more international activities, taking advantage of the fact that there are co-ops around the globe. In primary health care, you look at the patient as a whole, not just the disease, so it's all the more important to know and understand the socio-economic and cultural backgrounds of the patient. International staff exchanges and training sessions would surely provide an opportunity to see patients with various backgrounds and also have a look at what cross-cultural health care is like. The infrastructure already exists and works around the globe, so networking those is the key here, and I believe the recently-formed IHCO and APHCO can play a pivotal role in this.

And thirdly, he urged that more research be done on primary health care, and also stated that the quality of co-op's primary health care activities must be improved. After all, medicine is still a world where the more specialized skills you have, the higher your authority. In other words, areas like primary health care where you need more of a broad knowledge than specialized knowledge in a certain limited area are not so highly regarded, at least in Japan, so the people need to show with undeniable evidence that primary health care is something that plays an essential role in health care. The co-op's primary health care activities need to be improved too, since obviously you need trust from the people and the community, and quality is what builds it.

When I heard Dr. Fujinuma's talk, I just purely felt moved, and encouraged, as those were exactly what I had in mind. Primary health care, community-based health care, cross-cultural and international health care, education, networking of people and organizations... all of these words I've been thinking about suddenly got connected in one straight line. It's really exciting and encouraging when you meet these energetic people who share similar ideas with you, and especially if that person is already starting to get some things done.

Can't wait to visit Ukima Clinic... :-)

Thanks for reminding me.

The other day I was talking about doctor-patient relationships with one of my friends who goes to nursing school, and it helped me remind myself of the image of the doctor I want to become.

Clinical rotations and training have started for her, and right now she's rotating through general hospitals to local clinics and health centers, while also shadowing nurses who are involved in various kinds of health care. And that day, she was complaining that some doctors really only look at the disorders the patients have and not the patients. In other words, these doctors are more focused on diagnosing and treating the disease, not the patient.

Then I thought... do I want to be that kind of doctor?
Well, I don't think so, but not to mean any offense to those doctors.

After all, I believe the doctors who immerse themselves in facing the diseases rather than the patients are the ones who bring new breakthrough technologies and advances in medicine. I also feel that many surgeons belong to that category too, as they're more like artisans or craftsmen, spending a significant portion of their life just to build up skills, sometimes just to treat only a couple of diseases. But that's still necessary, no question.

But the picture of the doctor I have in mind is more like a general practitioner, and probably more general and broader than the term actually means. I'm not attracted to craftsman-type doctors, and this just comes from my tastes, you either like it or not. I want to be able to serve people with various backgrounds. Not sure why, but I guess it has something to do with the fascinating discoveries and thoughts I've had in the past through meeting many people, many of which have helped me shape what I am now. Through examining the medical problem of the patient, I want to interact and understand more about the patient, including one's socio-economic background. If this is done at a certain community-based level, I have a feeling it would enable you to see the strengths of the community, as well as the social issues that are underlying.

Well, in conclusion, whether the doctor focuses on the disease or the patient, I don't think it matters much as long as it makes the patient happier than before. And as long as the patient is happy, what form or type of approach the doctor follows is up to the doctor's personal preference. The doctor should be happy and comfortable too, about not only what he does, but also how he does it. Anyway, there will always be a need for both types of doctors.

I've always been interested in combining the characteristics of general medicine and public health in a clinical manner. You know how you want to face your profession, but there are times when that picture gets blurred, and this recent talk with my friend helped me see it clearly again. Many thanks to her. :-)

Get some exercise and make a difference to your day?

I don't know why, but there are times when I can't concentrate in anything. I know what I want to do, and what I need to get done, but at those times, I either just don't have a will strong enough to do them or simply have no energy. It's nothing like agony, but something like chronic exhaust. Don't know why...

I had also been having sleeping problems until recently. Of course, living a rigorous and irregular schedule probably wasn't helping that at all, but still, I just couldn't get to sleep. I would go to bed, yawn, hoping to fall asleep... but then I would start thinking about all these things from what to do tomorrow to things I want to do in the future. Hours would pass away, and the next time I see the clock it's like four in the morning. No wonder I heard some birds starting to sing.

So today, I decided to go jogging with some of my friends who make it a routine to do it twice a week. We went to Yoyogi Park, one of the three or four big chunks of nature in cramped and bustling Tokyo. A nice day, 20 degrees celsius, beautiful blue sky, a weather not so common in the middle of October. It really helped me get refreshed, after all, I realized I hadn't really taken any exercise for a month or two. Boy, how just putting a pair of sneakers and going jogging with a couple of friends made the day so much different. After that I went to Jimbocho (an area in Tokyo with 150 bookstores) to search for a Japanese-Thai-English dictionary, and went on to Akihabara (an area in Tokyo with as many electric appliance stores) to do my part-time job.

I guess it's important to take some exercise from time to time, for reasons some of which I'm not sure of. Well, don't know how much difference it's going to make to tonight's sleep, but I think I'll go to bed now, hoping I have more concentration tomorrow. I've got to study dermatology... :-)

Social entrepreneurship.

I'm seeing this word more and more often these days...

A glimpse of the word may give you a weird feeling, as the words "social" and "enterprise" aren't often seen in the same sentence... well, at least until now they weren't. But today, an increasing number of people in Japan are showing interest in doing something for the society. Hence the popularity of jobs in the fields such as international cooperation. However, up until maybe a couple of years ago, these activities were thought to be exclusive to the non-profits and the government. Well, times have changed.

We have many global issues. Some of them are small, while others are bigger. Many people notice them, and some of them stand up and say "I've gotta do something about this." However, for them to really get down in the mud and get some things done takes more preparedness than just saying it, because (1) you need a lot of time, (2) you need manpower, and (3) you need to make your own living. But one who is willing to do all of this while simultaneously staying true to the passion to work for these global, social issues, I call a "social entrepreneur".

Whether it's a private business or a non-profit organization, it must be a sustainable one for it to continue pursuing what it has to do. You need time, manpower, finance, and those resources also have to be managed effectively and put into use in the best way possible. So, I believe a business-like approach is essential for the non-profits too, the only difference between a business being whether its ultimate mission is to make money or to make positive changes to the society.

But then again, existing businesses are also changing. Long term survival in the industry has become more challenging than ever before. They need to thoroughly understand who their customers are and what they truly want. They all need to find their niche. And, catering to the specific needs of those people can sometimes also be considered doing something for the society. Ah... heading towards becoming "social enterprises"?

Of course, all of this depends on how one defines the word "society". And though many organizations will still remain like an ordinary NPO or an ordinary business, I believe the differences and the disconnects between those two will continue to erode, in a very positive sense. :-)

Two months since Thailand's experience.

Time flies.

Already almost 2 months are about to pass since I participated in a primary health care program at the ASEAN Institute for Health Development (AIHD) in Thailand. The facility is on Mahidol University's Nakhon-Pathom campus.

When the program was over, my heart was filled with something... a strong passion, a strong will to do something. Of course, the program had a big impact on me, and that impact will probably be as big as making changes in my life in a very positive sense... but I'm not sure whether this was the direct reason for me feeling that strong something. It also kind of felt as if I were rushing.

Maybe I was too excited during the program that I wasn't able to "switch" that mode back to reality even after being pulled back into my everyday world? I came up with new ideas that I may want to try, and maybe I got too excited about them? Or, maybe I felt frustrated that I still didn't have the capability to start turning those into reality? After all, I'm still a university student, without profession nor money. Maybe all of these reasons?

It's like this... I had this liter of fuel in me, and I continued to burn it through the program, but the more I burned it, the more I was refueled. But after the program was over, all of a sudden, I was left with all this fuel but nothing to burn it for. It's like you all of a sudden have a big empty space.

I made really good friends during the program too. Maybe I just simply felt sad that itwas time to say good bye for now? The program itself ran for only 11 days, but by the time it was over, I felt as if I had known these participants for months, or even years. I had the opportunity to do some really deep, interesting, and stimulating talks with some of them. Those friends might turn out to be really close partners in the future, maybe some of them even closer than now.

Well, am I still excited? Yeah... of course. Why not? But, I have to be cool-headed, think ahead, and plan out things carefully. While there are things I can do for the society now, now's a time for me to put building my profession at the top of my to-do list. I need to and want to invest time in the future now. Meanwhile, I'd like to look back and share how the program had such a big impact on me, and may have on my future... maybe on another day.

Ah... how I enjoyed talking over those bottles of Singha... "Chai-yo" :-)

What the news on Burma tells us about the Japanese media.

How many times has the word "Myanmar" made it to the headlines of newspapers in Japan?

Not sure... but I'm pretty sure it's one digit.
And, I don't think it has happened for over a decade.

So it was amazing and fascinating to see news about the recent movements in Burma (Myanmar) on the very front pages of newspapers on September 28th, and some also on the 29th. All news programs covered the news on those days, and even the LCDs on the Yamanote Line trains were broadcasting it. But, this all came at the expense of a life of a Japanese humanitarian journalist, named Kenji Nagai, who had become a victim of one of the clashes in Burma a few days earlier.

Without his death, how many people would have even known the name of the country?

Dozens of crises still exist around the globe, and the Japanese media has so far done little to tell those stories. There are still many crises that have yet to be reported. If you look at the international sections of the newspapers, it's pretty obvious that they focus so much on North Korea, Iraq, and Iran. Of course, that's natural, but we have to always keep in mind that the world is much larger than that.

Japanese news is so domestically-directed, so to speak. A lot of the news is very local. Most of them cover things that occur inside Japan. There are couple of reasons I can think of, but the biggest reason is probably because Japan is not a multi-racial nation. It's also an island, geographically isolated from the Asian continent, and has a history of having closed its doors to the rest of the world in the Edo era with just a few exceptions... this might also represent the character of this race. Not sure how much this is related to the topic, but anyway, the majority of the people do not feel the need to know what's going on in places like Darfur or Burma, at least not until it involves a life of a person who is Japanese.

To add further to that, most of the programs on TV are those viewers want to see. The latest "trends" of the people have so much influence on TV programs here. Of course, the private TV stations always have to keep the sponsors happy, so it is often difficult, but how about NHK, the biggest public broadcaster and by far also the largest Japanese broadcaster overall? Why do they have to care about viewing rates? There is no need to worry about pressure from sponsors, so in my opinion, they should concentrate on telling people what we really need to know, from an ethical and moral point of view. I feel they are the only organization that has the capability to truly pursue that job, both financially and technologically, and I believe that is their niche, and their social responsibility. :-)

Comparing the non-profit sector.

With organizations such as Peace Corps and Teach For America getting a lot of attention nationwide, I don't think it's an overstatement to say that the non-profit sector has grown to become one big industry in the United States. Over 1.6 million non-profit organizations (NPOs)... now that's an amazing number.

How about in Japan? Um, not so close. Well... not close at all.

Of course, comparing the numbers directly is unfair and incorrect, since the term "non-profit organization" varies between countries. For example, in the US, hospitals, universities, and religious groups are also categorized as NPOs by the laws over there. But even considering that, there's a vast difference.

Why? Well, I've come up with 3 major reasons.

One, there's no Bill Gates in Japan. Many people in Japan have been complaining of economic disparity in recent years, and though it is true that the gap between the rich and the poor is widening, the difference is still minute compared to other so-called developed countries. After all, Japan has a tendency of giving equality priority over fairness, but this leads to another story so I'll stop with this here... Anyway, when I say there's no Bill Gates, I mean by there are no billionaires in Japan. So compared to the US, there is much less money people can give away.

Two, there's a big difference in law. While I've already pointed out that the definition of NPO covers a more extensive area in the US, there's another big difference: tax. In the US, if you donate to an NPO, you're exempt from paying tax for the amount that you donated. In Japan you're not. Actually, a similar law exists, but has only been applied to about 30 NPOs so far. Simple, but big difference. No wonder big companies and billionaires in the US give off a lot of money to foundations and other NPOs if they don't have any big business plans for the near term.

Three, the culture and values of the people are different. I can list many examples here... One example is, in Japan, though many people are often angered by the way the government handles its responsibilities, the people still put a lot of trust on them. For instance, in the US, the majority of people would prefer to cooperate with NPOs than a government-affiliated organization such as USAID, but in Japan, many would prefer to work with JICA (the Japanese counterpart of USAID) than NPOs. Same with the regular private, business sector. For example for cellphones, the majority of people still prefer to use NTT, the successor to the communications arm of the government.

The religion is different. Donations and charities play a key role in religious activities in the US such as in Christianity, and religion also remains a big part in one's life, or at least bigger than in Japan. Here, the majority of people don't care too much, which can obviously be seen from the fact that there are as many Buddhist temples as Shinto ones and many people don't have preferences about which to go to. Of course, this is more complicated than I've said, but I won't get off track for now. People donate to temples, but the money flow stops there. The temples don't do charity kind of work. I also feel something like a natural "charity culture" in Christians.

Then there are differences in values. I think more people care about being socially responsible in the US than in Japan. Again, this is just a comparison and I don't mean everyone in the US does and everyone in Japan doesn't. But, here in Japan, more people are concerned about how to make their own lives better. However, this is starting to change though... which is the good news. An increasing number of companies are teaming up with NPOs and publishing corporate social responsibility (CSR) reports. Of course, some do this for the sake of building a better corporate image, but nonetheless, when few companies start, others will have to follow... :-)

Am I interested in international cooperation?

Am I interested in the field of "international cooperation" or "international health"?

The answer is yes, and also no.

Nowadays, an increasing number of young people talk of wanting to become involved in international cooperation. Of course, it sounds interesting, and I'm sure it is. You can definitely use your English skills for those who are good at it, or it'll still give you opportunities to train it if you aren't as good. You'll probably get to travel overseas and get to know many people from other cultures and backgrounds too.

But, there always has to be an objective, I think. At certain points in our lives, we find things that we want to do. Things we want to devote our time, energy, and the resources that we have in. And I think these are the things that we truly yet naturally feel that we should do. If that's something that involves a country other than your home country, that's something "international", right? If that's a not-for-profit kind of work you do with people from other countries, that can be called "international cooperation", right? If that has something to do with health care, that's "international health", right?

The point I want to make clear is that when I talk of "international cooperation", it's just a character of the picture I want to be a part of. We're doing things that we want to do and as a result, that could be seen, or classified in other words, as "international cooperation", but I think there's nothing more to that term. It's just one way of categorizing.

To make a long story short, my interest is in using health care as a tool or a catalyst to bring a people together and bring more happiness. This I'll probably talk about another time... but anyway, if this thing I'm thinking about is outside Japan, then I guess it can be called "international health", but it's not because it can be called that way that I'm interested in this. :-)

Lunch time in Japanese med schools.

Lunch time in Japanese medical schools is interesting.

Our university is in a highly-developed area, a very urban area, so most of the students go out and buy their lunch. We have an extensive selection to choose from... many kinds of food, meaning a wide range in prices too. Students with relatively more cash don't hesitate to and tend to hop into relatively high-class restaurants, while the ordinary (like me) are always trying to find the cheapest food around. Sometimes is fine, but sticking with with those affluent people for lunch everyday would easily put me into bankruptcy in a matter of days.

So what happens is, rich students tend to hang around with rich students, and ordinary students tend to hang around with those of its kind. And they become good friends... not that it is causing any problems (so far), but I just thought it's an interesting phenomenon... :-)

About myself.

Global social issues, especially environmental issues and peace-building, were of my greatest interest when I was young. Choosing health care came only after graduation from high school when I started to feel a strong desire to interact more with people and be at the forefront of social issues.

Since then, I have seen health care in various socio-economic settings, and I am strongly moved when a people becomes able to address the issues in the community they belong to and tackle together with their strength and resources, an idea which I believe is what empowerment is and leads to social development.