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. :)

Flying into the sunset.

On October 29, 2008, Northwest Airlines became a wholly-owned subsidiary of Delta Air Lines, after the U.S. Department of Justice (DOJ) approved their merger on that date. The name of the Atlanta, Georgia-based mega carrier, which takes its name from the Mississippi River delta, will be the surviving brand. Although it will still take some time for them to merge completely, including combining operations, frequent flyer programs, seniority lists, Northwest's aircraft have already started to be repainted into Delta's livery, signaling the beginning of the end of a long history that has continued since its founding on September 1, 1926.

The year 2008, along with many other recent years, saw a number of carriers going into the history books, with some going out of business while others being bought out by others. From record high fuel prices to extreme competition and now a global recession, the aviation environment is becoming more harsh and unforeseeable than ever before. For the mighty incumbent flag carriers too, there is no safe haven. In Europe, former major airlines, some of which are now but a shadow of its glorious past, are being amalgamated into the big three: Air France, British Airways, and Lufthansa (Germany). KLM is now part of Air France; Austrian Airlines, bmi (British Midland), Swiss International Air Lines are now owned by Lufthansa; Iberia (Spain) is discussing a merger with British Airways; others that are so far 'left out' such as SAS (Scandinavian Airlines) face an uncertain future and Alitalia (Italy) ran out of cash. Established low-fare carriers easyJet and Ryanair continue to thrive with their rigorous cost-saving measures, but have felt pinches with strong competitors and other low-cost newcomers.

The same is happening in the U.S., despite at a slower pace. Once a trademark for air travel, Trans World Airlines (TWA) is now part of American Airlines, Phoenix-based America West Airlines acquired troubled U.S. Airways (retaining the latter carrier's name) in 2005, and after the announcement of the Delta/Northwest merger, Continental Airlines decided to switch loyalty from Air France/Delta-led Skyteam Alliance to Star Alliance, agreeing to cooperate comprehensively with United Airlines. The low-fare market is dominated by AirTran Airways, jetBlue Airways, and the mother of all low-cost carriers Southwest Airlines, and many new entrants who have dared to challenge have failed, though tiny Allegiant Air seems to have found its own niche, for the time being. And Alaska Airlines? Where are they heading for?

From March 30, 2009, Northwest's crew will start wearing Delta's uniforms, and rumors have it that they will start standardizing the interiors of the aircraft then, including replacing Northwest's WorldTraveler in-flight magazine with Delta's Sky. Frequent flyer programs WorldPerks and SkyMiles are planned to be combined by the end of next year. On the last day of TWA's operations at San Diego on December 1, 2001, a Northwest crew joined them on the radio frequency saying "we sure are going to miss hearing your call-sign"... probably little or never had they imagined that the same day would come for them just a couple of years later. I find Northwest's product on international routes superior among U.S. airlines that I have flown on before, including their acceptable meal service, warm and charming flight attendants, enjoyable in-flight entertainment (IFE), affordable fares, and a good mileage program. I will surely miss those red tails lined up at Narita Airport.

So long, NWA. :-)

Banning fast-food in low-income communities.

On July 29th, the Los Angeles City Council voted unanimously to place a moratorium on new fast-food restaurants in South Los Angeles, an impoverished swath of the city with a proliferation of such eateries and above-average rates of obesity and diabetes. The action, which is yet to be signed by the mayor, is believed to be the first of its kind by a major city to protect the health of a people in a community, in this case, a low-income neighborhood.

An area with a population of 500,000 people, most of whom are African Americans and Hispanics, 28% of families here live on a budget of under 20,000 U.S. dollars a year. According to a report by the Community Health Councils, 73% of restaurants in this district are fast-food eateries, compared with 42% in West Los Angeles. These eateries alike are popular choices especially among the economically-handicapped. And not surprisingly, 30% of adults in this area are obese, compared with 19.1% for the metropolitan area and 14.1% for the affluent Westside, the Los Angeles County Department of Public Health found out.

The year-long ban of new fast-food restaurants is intended to give the city time to attract restaurants that serve healthier food. Often referred to the 'Food Apartheid' by the health-conscious, the number of stores selling fresh foods is less than a quarter of that in other areas of the big Californian city. Research has shown people will change eating habits when different foods are offered but cost is a key factor in low-income communities. If you are running on a low income, or don't even have a job, and you don't have a car or other means of easy transportation, fast-food restaurants in the neighborhood serve as a cost-saving and convenient option. Although depending on what products you choose, it is not difficult to eat three meals a day for under five U.S. dollars total. Cheap, unhealthy food and lack of access to healthy food is a recipe for obesity.

However, some people in the community believe this is not enough to solve the issue. Many people are aware that fast-food is unhealthy and it is not that they don't have any supermarkets selling fresh foods. Formerly called South Central Los Angeles, this is a part of town whose name was replaced by the current one in 2003, as 'South Central' had become almost synonymous with urban decay and street crime. One pointed out that local gangs dominate some areas near the supermarkets, and people wouldn't dare to take the risk of getting robbed, beaten, or shot. The same could be said for the supermarkets, as their numbers are actually dwindling, because they don't want to risk being attacked and robbed by the gangs. To add to that, even if the crime rate is lowered, many people in the area don't know how to cook, as they have never learned how to.

The ordinance comes at a time when governments of all levels are increasingly viewing menus as a matter of public health. By the year 2030, it is estimated that 86.3% of Americans would be obese. L.A.'s ban, which can be extended by up to a year, only affects stand-alone restaurants, not eateries located in malls or shopping centers. It defines fast-food restaurants as those that do not offer table service and provide a limited menu of pre-prepared or quickly heated food in disposable wrapping. It exempts so-called 'fast-food casual' restaurants, which do not have drive-through windows or heat lamps and prepare fresh food to order, such as El Pollo Loco, Subway, and Pastagina.

Meanwhile, representatives of fast-food chains said they support the goal of better diets but believe they are being unfairly targeted, claiming they already offer healthier food items on their menus. Not surprisingly, the California Restaurant Association and its members are considering taking a legal challenge to the action.

A former gangster in the area has said the ordinance would bring minimal change, and for fundamental change, it has to be done by the people in the community... and this is an idea that lies at the roots of 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! :-)

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... :-)