Returning to good old Philly.

Philadelphia. It's like my second home, or the first. It's where I spent my young days, my middle school years, and where I made many friends. I don't remember too much of the days when my family lived down near Washington D.C. before we moved up to the Keystone State, and though I spent no more than four years up there out of a total of ten I spent in the U.S., Philly means more to me than any other place in the country.

Looking back at the days, it's where I grew up most while living overseas. It is where environmental studies caught on me, while simultaneously being drawn into participating in activities that do social good for the communities, locally or globally. I still clearly remember the days when I did volunteer work every other week with the Whosoever Gospel Mission, a homeless shelter in Germantown, helping the homeless to empower themselves and become independent, or helping fundraisers for the UNICEF and the Kobe earthquake. Come to think of it, how many middle schools in other parts of the country or in Japan have volunteering with the homeless as part of the curriculum? Maybe some in the U.S., but I've never seen nor heard of in Japan. Looking back now, it helps to make you feel that they're not too different from us, but maybe just born in socially handicapped families, and together with unfortunate circumstances and some mistakes, have become 'homeless'. Well, this leads to a different topic so I'll stop here...

I revisited Philly in March, as part of our 'graduation trip' I went along with five other friends at my university. In my words, Philly is like a countryside city of charm sleeping or rather 'hidden' between the economic powerhouse of New York and the capital Washington D.C. However, it's not any other mega city nor just a countryside city. Having been the first capital of the nation, the historic Old City area or the many cobblestone streets accompanied by well-preserved homes, churches, and various other monuments help to keep the rich history alive, while Center City has blossomed into a world-class downtown with towering skyscrapers, five-star restaurants, theaters, and galleries.

Philly is a city that has also given birth to a handful of favorite local foods that are now known throughout the country: cheesesteak, soft pretzel, and water ice. So I definitely made sure we didn't miss out on having a taste of those, especially the cheesesteak. Some say that "a proper cheesesteak consists of provolone or Cheez Whiz slathered on an Amoroso roll (definitely a must!) and stuffed with thinly shaved grilled meat", however, it's pretty much up to personal preference. Some like the rolls toasted and crispy (that's me), while others like them soft and chewy. Some would dip it in grease, while others would complain that too much grease makes the roll soggy (me). Some prefer the meat to be diced as thinly as possible (yup, me), while others prefer larger chunks. Some love the artificial Cheez Whiz (me too), while others prefer American or provolone cheese. Where to get the best? Again, up to you, but my favorite is Jim's Steaks. Although Pat's and Geno's both claim to be the first cheesesteak, Jim's produces better. Jim's has four shops, with the original one still located in West Philly, but the one that attracts most is the one down on South Street. It was 15 years ago when I went there the first time.

South Street is one of many shopping districts in the city. Offering an eclectic mix of over 300 mostly independently-owned shops, including diners to ice cream parlors, head shops to tattoo parlors, hip-hop clothing stores to jewelry shops, records stores to home and gift shops, and add to that lingerie and sex goods shops, South Street offers a unique selection of shopping opportunities; no wonder Jim's at South Streets gets a waiting line every weekend. Another shopping district I like, despite with a totally different atmosphere, is Chestnut Hill in Northwest Philly. The only business district in a largely residential area (big homes too), Germantown Avenue, with cobblestone and trolley tracks, is like the Main Street in a small old town with quaint storefronts, Victorian lampposts, and shoppers who stop to chat with one another. It has a modest selection of antique shops, upscale home goods shops and clothing shops, and several independent art galleries. It's a nice place to stroll on a weekend afternoon.

Oh boy, am I missing Philly. :)

Savoring Polish cuisine and Żywiec.

When my Polish friend's family took me around the country, I had the opportunity to savor a variety of Polish cuisine, both at their home in Żywiec and at restaurants around the country. Polish cuisine contains much that is distinctive, but little that is truly unique to the country, with most of it representing a blend of culinary styles that run across countries in east-central Europe, such as Belarus, Lithuania, and Ukraine. Meat and potatoes are the mainstay of the national diet, while north European vegetables including carrots, cabbage, and beetroot provide good accompaniment.

When I visited, it was in February, still the winter season, though at the end of it, so there was plenty of snow that had yet to melt. During this time of year, vegetables become harder to come by, excluding those imported, and together with the long cold season, the people consume more meat and cheese. Every morning, together with the family I had bread with many kinds of cheese and ham. It was simple, but the bread bought at a nearby bakery was certainly not something I find everywhere, and it was the first time I felt I could eat cheese without eating it with something else. Simple, but depending on the combination of bread, ham, and cheese, you could enjoy a variety of tastes. A good choice of sweet pastries goes along well too.

What I also enjoyed much was the soup. It plays an important role in any Polish menu, serving as an introduction to a multi-course meal or just a mid-day stomach-filler. The most famous of them, and what I found to be my favorite as well, is barszcz (borscht), a reddish beetroot-flavored broth with a mild yet perfect balance of sweet and sour tastes. If you visit in the summer, you would find a refreshing variation on these theme called chłodnik, which is cold borscht served with lashings of sour cream and a side order of boiled potatoes. Another soup I remember is the fasolka, a solid, almost stew-like combination of beans and smoked sausage.

As I previously mentioned, meat is often the main part of Polish cooking, but it is pork that takes up top billing. You can reveal for yourself how important the pig is to the Polish society if you look over the delicatessen counter and see the sheer size of the repertoire of sausages and smoked cuts of pork. Although the generic name for sausage is kiełbasa, there are plenty of varieties to choose from: the thin, smoked kabanos, the garlic-rich wiejska, and the pink, mildly-spicy krakowska. A pork dish that I remember well is golonka, a deliciously tender roasted pork knuckle, traditionally served with chrzan, which is horseradish sauce. Dairy products, especially the cheese, is also central to the Polish diet. The oscypek, which is a bun-shaped sheep milk cheese sold everywhere in the town of Zakopane (though available in other places as well), was delicious, especially the smoked ones.

Something not to miss, and what has become more or less an icon of Polish cuisine is the pierogi. They are boiled dumplings of scallop shell shape and size, and are stuffed with a variety of savory or sweet ingredients, from minced meat, cabbage, potatoes, mushrooms, and cheese, to strawberries, cherries, or other fruit. The food is consumed well in this part of Europe, where the people speak language of the Slav origin. Belarus, Russia, Ukraine, Slovakia, Estonia, Latvia, Lithuania, Germany, Czech are all among them, although sometimes they are under different names such as kalduny in Belarus, and koldūnai in Lithuania. There is a similarity to the Italian ravioli and tortellini, or the manti, khinkali, or chuchvara in the trans-Caucasus region, including Turkey, while not too similar but still sharing some aspects are the Afghani mantu, Mongolian buuz, Nepalese-Tibetan momo, Chinese wonton, Japanese gyoza, and the Korean mandu.

Oh, yes, and I didn't leave out beer! Situated in the southeastern corner of Silesia province in Poland, Żywiec is a peaceful countryside town with a population of just over 30,000, and it is known for the beer that is named after the town. Although now under the Dutch Heineken empire, the Żywiec Brewery was originally founded by the Habsburg family in 1852 and has been producing ever since. Competing brewers include Tyskie and Lech, and though I could not recognize too much of a difference between the three, it was certainly nice to visit the history-rich bar located adjacent to the brewery and sip on a glass of Żywiec, naturally the most popular of the three in this part of Poland, enjoying the atmosphere of a Polish countryside bar.

A visit to Auschwitz, Oświęcim.

70 kilometers west of Kraków lies the town of Oświęcim. Although a quiet, countryside town with a population of just over 40,000, this place is recognized widely as, and is still indissolubly linked with the name the Nazis gave it when they occupied Poland: Auschwitz.

I had the opportunity to visit this notorious camp in February, right after I had my license examination. I actually hopped over to Europe the very next day. My trip to Poland, and the first one to a country in eastern Europe, was made possible by Krzysztof Sanetra, a Polish friend I got to know well through a program at the University of Edinburgh, and his family. Although it was not his best time, as he was busy writing reports and preparing for exams, we were finally able to meet up once again, and he and his family were kind enough to plan out a sightseeing trip for me. I truly don't know how to thank them for driving me around the southern half of the country, sometimes on five-hour legs, arranging English-speaking guides for me everywhere, letting me stay at theirs, and taking care of me.

Following the Nazi invasion of Poland in September 1939, Oświęcim and its surrounding region were incorporated into the domains of the Third Reich, and the town's name was changed to Auschwitz. Establishing new concentration camps in this newly conquered territory was a German priority from the beginning, as camps in their homeland were already getting overcrowded, and the occupation of Poland dramatically increased the number of potential 'undesirables' who would need to be interned. The site of Oświęcim was perfect for many reasons. It already had a Polish-built camp for migrant workers (which could easily be converted to prisons), it was remotely located between the Soła and Vistula rivers, and it was strategically situated at the 'center of Europe'.

Designed by Rudolf Höss, the camp was opened on June 14, 1940, initially with 728 Polish prisoners. The camp originally comprised 20 buildings, of which six had a second floor. However as the number of inmates grew, an extra story was added to all one-floor buildings and another eight buildings were built by 1942, using the prisoners as workforce. As time passed, the Nazis started to deport to the camp people from all over Europe, including Soviet prisoners-of-war (POWs), Gypsies, Czechs, Yugoslavs, French, Austrians, and Germans as well, though many of them were Jews. The number of prisoners kept on increasing, and a second camp, which is much larger than the original, was opened in 1941 three kilometers away in Brzezinka. It became known as Auschwitz II - Birkenau. A third site was constructed in Monowice near Oświęcim and became Auschwitz III. At peak, the camps accommodated no less than 20,000 people

When you enter the Auschwitz Museum, which is located at the original Auschwitz I site, you will see above what the prisoners passed under each day: a gate with the cynical inscription 'ARBEIT MACHT FREI', which translates to 'work brings freedom'. It was a bitter cold day when I visited, with temperatures only reaching a high of five degrees below zero Celsius and snow still frozen, but back when the monstrous facility was still in operation, prisoners being forced to hard labor (sometimes exceeding 12 hours) in this harsh environment was the norm. Prison cellars now display various objects, including numerous photos, empty cans of Zyklon B (the substance thrown into the 'shower room' and could kill 2,000 in 30 minutes), the actual belongings of the people such as shoes and suitcases with the name of the deportees, and cloth and carpets made from human hair.

We also walked to the 'Death Block', which was a prison within a prison, completely isolated from the rest of the camp. The ground floor and the basement 'torture' cellars are still preserved in their original form. The courtyard between Blocks 10 and 11 is enclosed on two sides by a high wall. The wooden blinds on the windows of Block 10 were installed to prevent the inmates from observing the executions taking place here, though they could still hear the bullets being fired. At this 'wall of death', the Nazis shot thousands of prisoners, mostly Poles. In the yard in front of Block 11, the Nazis carried out punishments in the form of hanging prisoners to a special stake by their arms, which were bent behind their backs. An endless number of visitors leave behind flowers and candles at this place.

The more I walked though the Auschwitz facilities, the more it gave me an eerie feel. It is so-to-speak a 'factory of death'. When prisoners arrived, children, the elderly, the handicapped, the pregnant, were immediately sent to the 'shower rooms' and mass-executed in a mere 30 minutes with Zyklon B (Cyclon B). Their belongings would be collected and reused or sold, their hair would be 'reused' to weave cloth, and there were experiments to collect fat from the corpses and produce soap. And, not surprisingly, all of this was carried out by the prisoners as well. Those who were young and of the working generation were kept alive longer, though forced to hard labor in temperatures of sometimes -20 degrees Celsius, given only one meal per day, allowed to visit the toilet only twice, and lived in bunks with poor hygiene. Cleaning the toilets was said to be the 'best tasks' among the prisoners, as they were always working inside, and could visit the toilet anytime they wanted to. There were tortures all the time, however, the harsh environment was often enough to take the toll. Whenever someone died, it was the norm for the inmates to keep it a secret, so that they can receive one more meal.

I found myself at a loss of words. With the even more massive Auschwitz II facility, the complex gives you the impression that it is truly a 'human-processing' factory, and one that is carefully planned and cleverly laid out. Yes, it was politics. But, how can humans become so inhumane? Was it not possible to direct all that intelligence and effort towards something else? We learn history so that we do not make the same mistakes and we can build on top of the past. However, though in different situations, genocides have been repeated, and more than once. Oświęcim will remain a place everyone should visit at least once in their lives...

JAIH-S International Health Training Camp 2008.

I was given an opportunity to participate in a four-day global health training program that was carried out by the Students' Division of the Japan Association for International Health (JAIH-S) from March 13th to the 16th. The main aim of this annual program is for the participants to be able to (1) create an image of what working in the global health field is like, and (2) know what you can do and how to start it.

We had lectures done by people currently working at the front lines in this field, including staff from the International Health Center Japan, a tropical medicine researcher, an epidemiologist, officers from the Ministry of Health, Labor, and Welfare (MHLW), and health specialists from NGOs, JICA (Japan International Cooperation Agency), and UNICEF. The lectures were followed by many group activities including discussions, debates, and a PCM (project cycle management) workshop which we had to work on through a night to complete.

My impression? Well... frankly speaking, I felt a little weird throughout the program. Of course, all the participants were highly-motivated, deep-thinking, yet thoughtful people who had gathered from around the country, and without question, the chats with them were really stimulating and one of those memorable times. However, most, if not all of them, were drawn by the terms 'global health' or 'international health', while on the other hand, my interest doesn't necessarily have to go beyond the border, as my 'theme' is community-based health care or primary health care (PHC). Yes, often times, these words have been talked about more in the developing communities rather than the industrialized ones so no doubt it does have a 'global health' taste to it, however, when you take a close look at the developed communities, you actually do see many forms of community health, and plus, there are many things these communities around the globe can learn from each other.

And, another reason for my feeling not right is probably due to the fact that many of the speakers have already literally abandoned the clinical part of being a physician. In other words, many of the doctors in this field do not see patients anymore at a hospital or clinic. Yes, it is true that so-called logistic-type jobs are more needed than specialized people like doctors or nurses. For example, when you take infectious diseases, the main underlying issues in the developing communities are more basic, such as sanitation or health education, and tackling these issues is the most radical solution. Treating patients and prescribing drugs is also a job that can not be cut, but it does little in terms of remedying the bigger picture. So what's needed in the field of international cooperation? Leadership, management, communication skills, and creative thinking. It's what one of the lecturers said, and I agree.

However, at this point, I have no thought of abandoning the clinician's work. Well, that's what I am studying medicine for right now! To obtain specialized skills. Yes, I am interested in public health, community health, and doing positive things for the bigger public, but I want to do that through interacting with the patients. So the image of my future I have right now could be called 'clinical epidemiology-based community health'. In other words, through interacting with the people, know the community, know its strengths, weaknesses, and hidden potentials, and do something creative to bring out their strengths to make the community happier as a whole, with the people in the community. This training program helped me reaffirm my interest.

By the way, I had a chance to talk with Dr. Honda, the founder and current chair of SHARE, the biggest non-profit organization in Japan specializing in international health cooperation, and I was deeply moved by his talks, as he and I had so many common interests... his 'theme' also sounded like community-based health care and primary health care (PHC). :-)

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! :-)

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... :-)

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. :-)

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" :-)