45
I witnessed heartbreaking destruction
and loss of life. It’s also daunting,
but admittedly exciting, to tackle a
language I do not speak well. It’s
also fatiguing to navigate the nu-
ances of one of the most sophisticated
cultures on the planet. Coming from
Western culture that prides itself on
individuality, I remember the cultural
contrasts that became apparent from
the very first idiom I ever learned in
Japanese: “The nail that sticks out
gets pounded down.” I wondered
if such a culture would be willing to
disclose its problems. There are many
claims by Western scientists that
things are far worse than the Japa-
nese authorities claim, but I assumed
that asking pointed questions would
not get frank answers from my Japa-
nese hosts. How then would I get the
information I wanted?
This time I crossed the country,
studying the nuances of the health
care structure. I started by observing
the care of people on outer islands
where it is cost-prohibitive to keep
stroke centers, stock a tPA (tissue
plasminogen activator), or main-
tain cath labs where there are few
specialists, but where a growing
elderly population needs both acute
and chronic care in all specialties.
Japan’s solution was an interesting
combination of aggressive geriatric
preventative medicine that included
a well-coordinated system of com-
munication with health care on the
mainland as well as well-maintained
fast-care helicopters.
Next, I worked at a health screen-
ing outpost for farming villages. This
was an impressive and uniquely
Japanese thing. They literally outfit-
ted tour buses with EKGs, X-rays,
CTs, complete medical labs, commu-
nication satellites, and every modern
piece of medical and dental screening
equipment one could imagine—but
NO doctors. The buses are staffed by
nurses, PAs, phlebotomists, lab techs,
etc. Each village then makes a yearly
appointment with the buses, sends
out notices to the community, and ev-
eryone appears with medical records
in hand at a prearranged field where
the buses are parked for an annual
health screening. It’s a brilliant way
to get health screenings to everyone
on the larger islands of Japan.
On the other hand, some Japanese
argue that not everyone needs such
extensive screening and that the
country is wasting a lot of money. In-
deed, the Japanese system is by and
large free to the individual citizens,
paid for by a substantial tax burden.
There is a sliding-fee scale based on
income, which means the wealthi-
est people pay at most 30 percent of
their modestly and governmentally
priced fixed medical care, while
those at the lower end of the eco-
nomic spectrum pay nothing out of
pocket. Interestingly, the Japanese
see their doctors on average four
times more often than most of the
developed world does.
A Focus on Geriatrics
My next stop was a chronic care
hospital for geriatric patients—a
huge and growing percentage of the
Japanese population. The Japanese
take a very different approach to
geriatrics than Americans do. On one
hand, there is a tremendous respect
for the elderly in Japan. The result
is astonishing and wonderful as pa-
tients, and not insurance companies
or doctors, are at the center of their
health care model. I often saw nurses
and various therapists literally run-
ning to get something for a patient.
In fact, there was a tea ceremony
room in the hospital, where staff
Somber—and Amusing—Images from Japan
Geiger counter (right) tracks radiation levels A grammatically challenged English translation Piles of bagged radioactive dirt dot the landscape
COM Outlook . Winter 2015
