A visit to Inazusa.

Now part of the city of Shimoda, Inazusa is a peaceful countryside village on the Izu Peninsula, the easternmost part of Shizuoka prefecture. It actually occupies almost half of the city area, but its population is just over 10% of the city's, standing at 2,855 as of 2008. 35% of them are over 65 years old, which is a little above the average rate for a Japanese countryside village. Many of them are farmers, but nowadays they run other businesses alongside to make both ends meet. In April, I had the opportunity to visit Inazusa Clinic, a relatively new clinic that was set up just five years ago by JADECOM (acronym for Japan Association for the DEvelopment of COmunity Medicine), one of few health care organizations putting effort in bringing health care to rural, isolated areas in Japan.

Inazusa had a clinic that was funded by the city of Shimoda until 2002, when the sole physician of the clinic neared the age of 90, and without a doctor to take over the job, was forced to close down. So the village went without a doctor for three years. People who could drive traveled 20 minutes south to central Shimoda, where they could find some privately-run clinics. Accompanied by two nurses and two clerks, Dr. Hajime Kawasaki is the head of Inazusa Clinic, and he kindly accepted my one-week visit. Because I didn't have too much time, I wanted to spend the time to know the village and its people, and at the end of the week be able to 'draw a picture' of how the community looks like.

The first place I went to to meet the villagers was Ryusouin. This little local temple has been holding what it calls 'Temple Wellness Renko' (traditional exercise) sessions, where locals come to do exercise with the the monk, who interestingly has a bachelor's degree in physical education. In a rural area like Inazusa, during the 'obon' (Japanese Buddhist custom to honor the ancestor's spirits) season or whenever a funeral takes place, the family of the deceased along with the monk walk through the town visiting each and every home so the deceased can bid farewell. And the monk here found out that there were many who complained about back pain or joint pains, and together with the awareness that he himself was lacking exercise, came up with the idea. About 10 people come to each session, which takes place four times a week, and pay 500 yen per session that runs for about one hour followed by chit-chat time with tea and sweets. Asking the participants, not all of whom are locals, they say they come to talk with the charming monk, more than for the exercise. The monk says that he hasn't been able to attract the people who he really feels he needs to do exercise with, especially more locals, and that certainly is an issue to be solved. Also, citing the temple's proximity to the clinic, he says he has many ideas he might want to try together. Monks could play an important role in bringing a community together, like in Buddhist countries such as Thailand.

Another place I visited was the local nursing home called Azusa-No-Sato, which literally means 'the village of Azusa'. Like many other similar facilities in Japan, it also operates so-called 'day care' activities where the elderly who live with their families at home come to spend a day to play, take a bath, and socialize with the fellow elderly, not only to have them enjoy time, but to spare some break for the care-giving families. The national elder-care insurance is where the money for the service comes from, and the families would usually pay about 2,000 yen (JPY) per day, though funding for the insurance comes partly from the insured's past monthly payments. Because the nursing home's service includes picking up as well as dropping them off, I had a chance to get a glimpse of the actual homes and the areas the people live in. For the staff, it's not an easy job. It requires lots of energy, both physically and mentally, and considering their often below-average salaries, I had the impression that many workers in this field were not enjoying their work. However, it was different, at least here. Yes, the staff were always thinking and doing what they have to, but still, they were enjoying joking and playing around with the elderly as well, in a genuine sense. A staff said, "This is not the kind of job you can continue if you don't enjoy it. I really like my job."

In Inazusa, or like in many other places, farmers have always naturally formed informal groups with fellow farmers nearby, like a neighbors' small gathering. Many of them would have lunch together, chit-chat, or even do some leisure traveling when they can spare the time. One of those groups, which calls itself Chalette, has interestingly founded a small 'manju' (Japanese traditional pastry with sweet red soy bean paste filling) shop. They say they wanted to do something different, something they enjoy doing, and something they can continue doing, and that's when they realized members in the group were good at making Japanese traditional pastries. So they collected 100,000 yen and started this shop. Conveniently located along a road that connects Shimoda and towns on the other side of the peninsula, the now well-known shop earns enough to fill the members' piggie banks. When they sell out, they sell out, but they don't increase their job because they want to enjoy it and don't want it to become a burden on them. "Family comes first. Job comes second."

Another group of farmers founded a community farmers' market called 'Kimagure Shop', which literally means 'the range of products and price is up to the mood of the day'. When crops are harvested, it normally goes through a number of wholesale dealers before it reaches the consumer, and along the way the cost adds up and is represented in the price. So, what this community market does is farmers directly come from the fields to drop off their products, specify a price, and the market sells them off here, and 88% of the income goes back to the producer. This way, the farmers get bigger margins but the consumer gets them for less than what they would pay in an ordinary supermarket. Plus, the products are consumed relatively locally. So the products sold depend on the season, and now over 90 producers, not only farmers but local bakeries and flower shops, drop the market. It's becoming a place where not only the people of the community gather, but chit-chatting between the locals and travelers as well, being located alongside a main road.

Inazusa is certainly a typical rural village, but does have many encouraging activities run by the locals that are helping to sustain happiness in the community. :)

A visit to Lao-China Friendship Hospital.

When we visited Laos in August, I went without any prior contact, since I knew nobody in the country, but still, I wanted to get a glimpse of what health care looks like, and listen to the actual health care workers in the country. So, one afternoon, we negotiated with a 'songthaew' driver to take us to Luang Prabang Provincial Hospital, more commonly known by locals as the 'Lao-China Friendship Hospital', or simply the 'Chinese' hospital.

Located off the main road four kilometers south of the city on a seven-hectare land, the hospital was completed in 2004 with assistance from China, as its name implies. It was already during the late hours of the afternoon, so the outpatient department had already closed and many staff gone home. Although without any contact beforehand, the staff at the counter in the deserted main hall kindly allowed us to walk around the hospital. Upon starting our 'tour', we noticed that all of the emergency exit signs and fire hydrant labels were written in Chinese and English only, and without Lao, no wonder the locals call it the 'Chinese' hospital.

While we were walking, we came into a nurse, who was apparently about to go home, and she was kind enough to let us hear about the hospital and her job. The hospital is divided into four major departments: inpatient, outpatient, labor room, and pediatrics. The outpatient clinic includes internal medicine, surgery, pediatrics, obstetrics and gynecology, family planning, otorhinolaryngology (ear-nose-throat), dentistry, and emergency. Depending on the day, the hospital sees about 25 to 100 patients per day, with Monday getting the highest number. Its medical staff comprises 97 nurses, 27 physicians, plus 10 volunteering nurses from South Korea. Some common medical problems include common cold, respiratory infections, cardiovascular disorders, gastroenteritis, and accidents. She said that an increasing number of people do not take enough exercise, something I am used to hearing in other parts of the globe as well.

After going through the examination rooms, we visited the ANC, or the antenatal care department, which they say is the busiest part of the facility. At least three staff must constantly be present here, so they are currently working on a 24-hour-work-and-24-hour-rest rotation. For vacation, they get 10 days off per year. According to them, the busiest months are February, March, May, and June, before the rainy season starts. Here we met some nursing students, who told us that they have a 2.5-year program. There were no medical students, but we found out that is because the sole faculty of medicine in Laos is in Vientiane, the capital.

For the patient, there are two often-encountered problems in the medical scene, although they do represent larger underlying issues. One is the lack of medicine matching that of international standards. In recent years, foreign aid, especially from China and Japan, has helped hospitals to update their out-dated facilities and equipment, and bring up more health care professionals, however, there still are often cases where the patient is asked to travel down to the capital of Vientiane, almost 500 kilometers away on a recently-paved mountainous road. And even at there too, the patient is often asked to cross the 'Friendship Bridge' to receive further treatment at a Thai hospital. In emergency cases, such as major traffic accidents, this clearly does not work. And, obviously the patient would have to pay for all of the transportation costs, and the fees skyrocket if you need to be transported across the border.

This leads to the second issue: money. Universal health care is still non-existent, so even in public hospitals the patient needs to pay. The same goes with ambulance, where patients pay by the kilometer, like a taxi. If she or he gets admitted, the average fee per night for a normal room is 40,000 kip (about US$4.80), but that is not easy for a country where people live on an average 10,000 kip (about US$1.20) per day, though the economic disparities are great. People who live in Vientiane, the nation's capital, are the richest, where over 50% of households have cars and 40% have air-conditioners, while next comes those living in the capitals of the provinces, like Luang Prabang, and the poorest are the farmers who live in the mountains and the countryside. According to the staff, patients who have financial difficulties paying fees may submit a request to receive aid from the government, but again, one needs to travel down to the capital to do so. It is not surprising that the 150 beds at Luang Prabang hospital are never near full.

The government seems to have started working on these issues over these few years, and is in the process of not only setting up a clinic in every village, but a primary school, and encouraging more villagers to have their children enrolled. Of course, the families would have to give up on earnings that would be made through having the child work instead and understand the long-term significance of education, so it's not easy, but at least they wouldn't have to walk hours to go to school anymore. They are also working to put more emphasis on preventive medicine, and moreover, health-building through community participation. Things have only started to change, and it will certainly take a long time, however, the interesting point about Laos is that they are going through the process at the same time their economy is developing, something other economically-developed nations went through at separate times, with economic development coming first.

A visit to Sanyukai.

Poverty. What does it mean?

Many say it's about not having enough money to make a living, while some others put it in a different way: they are people who have not only lost their money, but also their families and all their trustworthy social relationships, as well as self-esteem and pride. While a good portion of the general public in other countries still see Japan as the darling of economic prosperity, and even the typical Japanese are not too aware, the poor population has been slowly increasing over the years, and at a quicker pace more recently. Poverty does exist in Japan, and it does in Tokyo.

In April, I paid a visit to Sanyukai again, a non-profit organization (NPO) that runs a free clinic, provides temporary housing, clothes, and food for the homeless. Located in the heart of Sanya district, an area that has become synonymous with poverty and homelessness, the group has been carrying out outreaches to hand out clothes and food, and so-called 'clinic tickets' for those who seek medical consultation for over a decade. The clinic is totally free (one of only two free clinics in Japan for the homeless), but naturally, it's sometimes not easy for a person to come and drop by, but reaching out to them and giving them these 'invitations' not only encourages them to come but also "makes them feel easier" to do so, says one staff. Situated in the northeastern part of the huge bustling city, Sanya has been a home for many who work on a daily wage basis, taking advantage of its proximity with factories in the area and the abundance of rediculously-cheap hostels.

So what did I do? I participated in one of the outreaches they carry out on Wednesdays and Thursdays. Why? Because I like it. And this phrase means much more than it's said. I go to Shinjuku every day, and it's not too difficult to find a homeless there since nearby Shinjuku Central Park is home to a good number of them, so I have always felt that they are part of the picture I am in in some way. But what is there that I could do by myself? If I do have some leftover food I am not going to eat it, could I give it to them? But what would that do to their self-esteem? Do they really want that? After all, unlike in the U.S., begging is not common here. We belong to the same world, the same society, but there is something that is separating us. But through the outreach, I can be of some help and talk to the homeless without hesitating, and it really gives you the feeling that as if it not only opened the door for them but for yourself too. It's like this: they are near you but not as near as it seems, but you've finally found a way to step closer to them. Surprisingly, many seem to be happy even when we just say "hello, how's it going?". They've got lots of things they want to talk with you. That smile on their faces I don't forget.

What is poverty? What is homelessness? I've been thinking about this for a while, and ironically, Mr. Hiroshi Goto, one of the staff there, pointed out something that I had heard before two years ago from a staff working in a homeless shelter in San Francisco: we shouldn't really 'categorize' them as homeless, but as people who have had various difficulties in the past that led them to how they are now. And that's true. They have come different ways. The 'issue' for each of them is different from person to person. And in the U.S., add to that those who have willingly chosen to become homeless. But there are things they have in common too. They have no money, no shelter, nobody to rely on, and have been deprived of dignity and self-respect.

The number of people living under government aid, called the Temporary Assistance for Needy Families, has been increasing, and at a faster pace now with the slowing global economy. Back in 1992, that number was 585,972, but it reached 998,887 in 2004 and surpassed 1,000,000 in 2005, and as of March 2009, it stood at 1,168,306. Now, especially in these unsure times, it is not so difficult for a person to take a moment or two to think about poverty and take that as an issue that is not unrelated. With just a combination of some accidents, wrong-doings, or unfortunate consequences, anyone could find him/herself without a home. However, we must also keep in mind that the real homeless, the 'true' poor, have been deprived of all they could be, including friendships, families, and even their self-esteem. Whether that is the responsibility of the individual, or another, or the society, or more than one of those, varies from person to person. But we have to understand. And I think there is something we can do.

Sanyukai is not merely a group that gives out a hand to the homeless, but one that is helping the absolute poor and using several creative ways at different levels to help the homeless empower themselves and become self-dependent. The true poor are deprived of their family and friends, and it starts from re-building relationships or making new ones. Every day, Sanyukai puts seats and some tables in front of their compact three-story building, and it acts as a place of gathering for the homeless. Sipping a cup of green tea that Sanyukai serves, they come and tell about the meal they had the evening before or joke about the noisy neighbor cat that wouldn't let him go to sleep. It's a place for socializing and relaxing, and up to around 15 people can be seen on some days. Some stay for lunch and eat with the staff. Whether it's a staff or a visiting homeless, everyone eats the same food here. And many of them visit on a routine basis, some even every day, so it is also an effective way for the staff to see who didn't appear on a day and try to find out what happened.

Last month, Sanyukai was ordered by the metropolitan government to stop handing out its weekly free meals in one of the areas, after local residents filed a number of complaints saying the outreaches attracted more homeless and that "children are afraid" of them. One of the continuing challenges is how to have the local community understand their activities. There is a quote from a book by French writer and aviator Antoine de Saint-Exupéry. "Men travel side by side for years, each locked in his own silence or exchanging words which carry little or no fright, until danger comes. Then they stand shoulder to shoulder. They discover that they belong to the same family."

A glimpse of a university hospital.

Time flies.

Hmm... I think I've been using this word too much lately. But it's true, times really does fly. So here I am, finished with all the clinical rotations, something which I had so much expectations of just a year ago. Did it meet my original expectations? Well, that's another question. But nonetheless, I did learn quite a few things, was able to see and talk with many patients, and was able to get a glimpse of what a physician's everyday life here is like, working in a 1,000-bed university hospital located in the heart of one of the most important business districts in Tokyo: Shinjuku.

I have believed and still do, that working in a university hospital means you have to take part in educating and nurturing the next generation of physicians, and that is not an option but a responsibility. And until I started my clinical rotations, I had believed that those who don't do too much or refuse to carry out that part don't have enough passion and enthusiasm, and therefore are working in the wrong place. But... that view has changed. Most physicians here, especially those in the upper 20s to 40s, whether an internist or a surgeon, or a pediatrician or a obstetrician/gynecologist, are super busy.

Arriving at work before 8AM, their day often starts with a conference in the morning, followed by a visit to the in-patient ward, and then on to run the morning portion of the out-patient department (OPD), or head to the operation rooms instead if that's a surgeon. The lines of patients in the waiting room are seemingly endless, while some operations can easily take five or six hours, naturally. When do they have lunch? Well, they're lucky if they can get a meal at noon. The schedule for the afternoon doesn't look too much different, except for some more case conferences and lectures by older doctors or advertisement sessions by pharmaceutical companies. When do they finish all that? Maybe 6PM. Okay, can the doctor go home? Not so fast... because all the paperwork and some medical records are waiting to be processed by nobody but the physician. After that is 'free time' for the doctor, where he/she can work on research papers or make a PowerPoint for the next day's lecture for students, etc. It's not rare to see a doctor working well over 12 hours. Or, is he/she on-call for the night? Well, that adds another 10 hours or so, and on to another day. You don't get rests here after on-calls.

And yes, to add to that, the pyramid of hierarchy in Japanese university hospitals is still present. You have to do as your boss (professor) says, and that is often a must. Some would even be too concerned about writing research papers or simply trying to make their daily work appeal to the chief professor of your department, since he/she would be the only person who can help you get promoted to a higher academic status. If the professor doesn't like you, tough luck. Yes, it's all about faculty politics. And then, on the other hand, you also have to help young doctors who have this long list of questions for you to answer. A physician in the upper 20s to 40s are kind of stuck in between the old and the young.

Hmm... yes, a physician working in a university hospital has three major responsibilities; providing medical care, research (often for academic status), and education. But does the doctor really have enough time for all of that? And especially when considering the fact that doctors working in university hospitals in urbanized areas get one of the lowest salaries among doctors in the country, how much would that do to the enthusiasm of the physician? What's the incentive? Now that I have seen some of the reality in a university hospital, I even feel sympathy for some of them.

When doctors start quiting, that is probably a tipping point, a beginning of a vicious cycle; quitting means more tasks for those who are left.

A visit to Nagi Family Clinic.

During the final week of August 2008, I had an opportunity to stay with Dr. Akira Matsushita, the family medicine physician at Nagi Family Clinic, one of Nagi town's only two medical facilities. A larger hospital in nearby Tsuyama, which is a 40-minute drive, is the only in the region offering tertiary medical care.

Nagi is a small town in Okayama, situated in the partly mountainous region of this rural prefecture in the southwestern part of Honshu, Japan. A 15-minute drive will take you to the border with Tottori prefecture. Sarcastically nicknamed 'the Ginza of Nagi' by some, the central part of the town is not bustling at all, with only two supermarkets (closing at 7PM), one convenient store, a tiny locally-owned bookshop, an elementary school, one pharmacy, the town office, and the clinic. Home to 6,690, Nagi's population has been decreasing year after year, just like many other rural towns and villages where younger generations have decided to move to not-too-distant urbanized areas such as Okayama city, Kobe, or Osaka, in search for better jobs, a wider choice in academics for their children, or simply a more convenient lifestyle.

So, why did I visit the clinic? Well, after seeing various types of community-based health care in the U.S., Thailand, Scotland, and Tokyo, I wanted to have a glimpse of what rural health care is like in a place far from the country's capital or any other big city. The closest to Nagi is Okayama city, which is more than a two-hour drive. Dr. Matsushita, well-known among general practitioners in Japan for family-oriented primary medical care and medical education in family medicine, happened to be the former attending of a doctor at my university's general medicine department who I am very fond of, Dr. Hiroyuki Saito.

Now what's so special about this clinic? Well, to put it in a single sentence, Nagi Family Clinic knows its patients very well, and that is very, very well. The doctors take a considerable amount of time in listening to the patients, some of whom make visiting the clinic part of their weekly schedule just to have someone to talk with. You may think that is wasting time, but if that is helping the patient stay happy and actually healthy by means of making the patient think and recall what happened in the past week, that is not necessarily correct. All the medical records have been digitalized and are online on the clinic's server, and that has enabled them to create the 'electronic family tree', where when you look at a patient's medical records, you can also see the family members and their medical records at the same time, which is a handy tool that helps to make medical care more family-oriented. The doctor can interact with the patient with all that background of the patient in mind. Another special feature I noticed is that, every single staff, including the paramedical workers, know so much about the patients. Their medical issues, their character, their habits, and so forth.

So, my week at the clinic and town enabled me to get a glimpse of who and what kind of people live here, the social issues that underlie, and how health care is done in this small rural town, from different perspectives, as Dr. Matsushita kindly made it possible for me to spend time not only with the clinic staff but also with the social worker at the nearby town office and staff at the local non-profit organization (NPO) called Kazamakura, which offers services for the elderly including home-visiting nursing care and driving them to health care facilities. A low-fare local town loop bus was introduced recently, but for the elderly, bus-stops are often still too far from the home to walk to, and you don't have the option of a taxi in this rural part of the prefecture. Like in many other rural areas of the country, the over-65-years-old population is growing there too, now exceeding 25%.

The Japanese Self Defense Force (JSDF) base and training grounds play a large role in supporting the local economy (the JSDF even pays a certain amount to the town for each and every single bullet fired) in a town where apart from one construction company's factory are only small local businesses and agriculture. And that factory is currently amid a dispute with the people living nearby, who are complaining of the exhaust that comes from the factory chimneys causing respiratory problems, though company officials claim they are meeting all environmental standards. It is a bittersweet situation for the local government, which finally succeeded in inviting this first company to make a factory in town but that is now having conflicts with the locals.

Every week, a 'community care meeting' is organized at the family clinic, which is a gathering attended by staff from the homes for the aged in the town, the local town office, Kazamakura, the local pharmacy, and the clinic, to discuss the latest health matters and try to solve them through cooperation and close coordination. For example, they would talk about s 90-year-old lady living in the southern part of town who's dementia has recently deteriorated and needs more frequent home-helper visits, or how to make efficient and sustainable safety nets for the elderly living alone and far from the center of the town. This town, being small, means human resources are limited, but on the other hand it could also be an advantage, as it makes it easier for them to communicate with each other, coordinate closely, and make decisions fast. And including the aforementioned clinic staff, everyone knows the town people very well. Truly a form of community-based holistic care.

People of Nagi are bright. I don't know, but every time I visit countrysides, I can't help myself from getting the impression that people in rural areas generally seem to be happier than those living in the busy mega cities. And the elderly in Nagi, yes, some are surely vulnerable to illnesses, but there are still many 80-year-olds and even 90-year-olds working in the fields from sunrise to sunset. One old man told me, "yes, I'm way past 65 (retirement age), but working in the fields is what I enjoy and that is my living".

Good communication and cooperation is there with the health care staff and happiness and livelihood are not yet lost with the people. Yes, many small villages and towns have chosen to merge with their neighbors due to financial uncertainties, and no doubt there will be challenges ahead for Nagi as well, but with all the strengths plus a touch of creative thinking, I believe they could well be poised to become a good example of rural community holistic care. :-)

Goodbye to a flying sports car.

Fleet rationalization is happening everywhere in the commercial aviation industry. With fuel prices sky-rocketing, airlines are doing whatever they can to cut costs, and fleet simplification is one of them.

That is no exception with the airlines of Japan too. When Japan Airlines (more commonly referred to by its ICAO three-letter code JAL) and Japan Air System (JAS) merged in 2002 to take on All Nippon Airways (ANA), which had and still has the biggest share of the domestic market in terms of passenger numbers, it not only created an initial series of coordination problems but also a diverse fleet as well, as the two only had one aircraft type in common. Operating more aircraft means more maintenance work, a larger spare parts inventory, more training of its employees, etc, which adds to costs.

For example, the competitors in the short-haul market are the Airbus A320 family, Boeing's 737 family, and the McDonnell Douglas (merged into Boeing in 1997) MD-80/90 series. Production of the latter was terminated not long after its takeover by its former arch-rival, so essentially the A320 and 737 have the market all to themselves now.

JAL had been operating a substantial fleet of 737s, while JAS had been loyal to the Long Beach-based manufacturer, operating the MD-80 and also acquiring the advanced MD-90s in the mid-1990s. So the merged airline operating two (or three) major types for the short-haul sector was naturally deemed uneconomical, and the decision was made to acquire newer 737s to eventually replace the Douglas twin-jets. JAS operated the MD-81, MD-87, and MD-90, and the first to say farewell became the MD-87.

First delivered to JAS on June 3, 1988, the fleet eventually built up to eight aircraft. The MD-87 is basically a MD-82 (a MD-81 with more powerful engines) with a shortened fuselage, compromising capacity for longer range and better take-off and landing performance. JAS acquired these 117-seat jets, sometimes nicknamed the "flying sports car" for its superior climbing performance, to bring jet age to the local regional airports in Japan with limited runway length. These markets had long been served by the Japanese-built NAMC YS-11 turboprop airliner.

After the merger, all eight were repainted in JAL's new "Arc of the Sun" corporate livery which was developed by Landor Associates, however, as the merged airline took delivery of more newer 737s, it was only a matter of time before retirement. So the first of eight was withdrawn from service in October 2007, and the ultimate aircraft is now planned to operate its last revenue flight on March 31, 2008, flight JL1386 from Nanki-Shirahama to Tokyo's Haneda airport. All were already withdrawn from scheduled service by the end of February, and have since been operating mainly as back-up equipment.

The MD-87 was never the most popular jetliner like Boeing's venerable 747, but it did have its own niche, and brought jet age to the regional airports in Japan, boosting tourism. It surely will be missed by its crews, employees, and those local airplane spotters. Fortunately, many are now finding a new lease of life in Thailand with low-fare airline One-Two-Go (a subsidiary of Orient Thai Airlines), instead of being reduced to piles of metal somewhere in the southwestern USA where many older jetliners end their life.

Farewell, sports car in the sky. :-)

Farewell to an old local friend.

January 22nd marked the last day of regular revenue operations by Tokyu's 8000 series train.

I've lived most of my life in Japan near the Toyoko, Denentoshi, Oimachi Lines, and grew up watching the train's stainless side look and hearing the unique thundering sounds. Whether it's a train you use every day or a local shop or restaurant you visit regularly, these are things that are usually taken for granted, things that you don't really stop to think about. But once you know they're going to be gone soon, you suddenly realize that times are changing. You miss these things you've never missed or even cared to think much about before.

The 8000 series started service in 1969 and for almost four decades served the people of Tokyo and Yokohama on the Toyoko Line, which connects the two big cities, hence its name. These series of trains were the most technologically-advanced of its time, being the first to be controlled digitally, enabling trains to run on tighter schedules, and has claims to being the first in the world to incorporate a field system chopper circuit which made regenerative brakes possible. With its length being 20 meters, it was also much longer than the commuter trains of its time, helping to make way for Japan's economic growth of the 1970s.

On January 13th, the gradual replacement of the series by newer, more advanced types was completed for the Toyoko Line with much fanfare, where amazingly over a thousand people from local residents of all ages to train afficionados gathered to bid farewell to the grand old workhorse. Truly a sign that it was loved by everyone. The last remaining example (ironically the first to roll off the production line), which served the Oimachi Line, a 10.4-km local route in southwestern Tokyo, was retired on February 22nd.

Tokyu Corporation has transferred many of these trains to Izukyu, a wholly-owned (but financially-troubled) subsidiary in Shizuoka Prefecture carrying holiday-makers to resorts on the Izu Peninsula. A handful have also been donated to Indonesia as part of Japan's official development assistance (ODA) to help set up Jakarta's railway infrastructure.

Adios. :-)

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... :-)

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. :-)

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... :-)

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... :-)