Wrapping Things Up...

Now don't get excited, Mom, I'll be in Japan for a bit longer. What I mean is I'm wrapping up my rotations at Kameda. I have spent my first month here shadowing different departments, viewing surgeries, spending time with nurses, physicians, department heads, support staff, and of course, my preceptor John Wocher.

I had the most meaningful encounter yet yesterday while researching for one of my projects and shadowing a palliative care physician, Sekine-sensei. Palliative care is in it's infancy in Japan. Sekine-sensei was trained in the US and brought what he learned back to Japan. He believes patient suffering can come in a variety of forms and needs to be treated in the same form any other wound would be treated. While many Japanese hospitals are beginning to assign physicians to take charge of palliative care, they are not specialists in the field. Kameda is one of the only hospitals (if not the only) in Japan that has a designated palliative care department. 

When we went to see the second patient of the day, I recognized her as the woman who always says 'Good Morning' to me on my walk to the office in K-Tower. What you need to understand is I consider it a treat to have someone unexpectedly speak English, specifically when I'm ready to hear and respond with 'Ohayo Goseimuss'. I sat down and spoke with her for about an hour while Sekine-sensei continued on his rounds. She is a cancer inpatient and about seventy years old. She decided to start learning English about six years ago when she felt she needed more stimulation (to that my response was 'I tried Japanese and it was much too stimulating...'). For the six months before she learned about her illness she was teaching English to students and providing home stays for Americans, Canadians, and Australians. On 11 March, 2011 she lost her home, many of her friends and family, and all of her posiessions in the tsunami in Myagi Prefecture. Onozawa-sensei, a home healthcare physician, was providing relief in her prefecture and, as she put it, rescued her and brought her to Kameda. She is here with the clothes on her back, homeless, but smiled brightly through our entire conversation. 

Sekine-sensei was glad I came along that day and planned to take me to see her, knowing that she would want to talk with me. He said it is so rare to see a smile like that on a patient in her situation. His specialty would be very difficult to deal with but can ease patients' pain in so many different ways. I'm glad he took me along and I plan on returning to see her more often.

FTK!!

I know I mentioned the title of this site was partially about training for the Chicago Marathon which I will be running in October with the Dance Marathon the Marathon team. For those of you that might not know, Dance Marathon supports children with cancer and their families treated at University of Iowa Children's Hospital. In order to run with the team, I need to raise a certain amount of money, all of which is donated to Dance Marathon to help these families get through this difficult time. By donating to the organization you are helping countless patients treated at UI Children’s Hospital. Here is a link to my online giving page, please help me reach my goal FTK!!

Giving Link: http://osl.iowa.uiowa.edu/dancemarathon/donate/3/5049

Nokogiri-yama

You know that scene in Ace Ventura, When Nature Calls with the the Slinky? There's a very long staircase and he almost makes it to the bottom? Well, I'm here to tell you those places do exist. While my pictures don't do it justice, I definitely got my workout in for the day. And sadly the Slinky trick would not have worked, these stairs were curvy and through the mountains and trees, not yet above tree-line.

Nokogiri-yama or Mount Nokogiri (sawtooth) is an area in southern Chiba Prefecture with a vest amount of cultural significance but is not well-traveled by foreign tourists, I still got the usual stares and dumbfounded looks when I encountered people. This was my first experience taking the train alone, but for the most part it was a successful one. The local trains in Japan aren't really any different than an El in Chicago, many stops and relatively slow (but pretty inexpensive as well). From the station at Hamaka-naya, it was only about a 10 minute walk to Nokogiri, and up I went. To reach the 'top' I took a cable car jammed with Japanese tourists. The picture at the top was the view from the top of the cable car. I started winding my was through the mountain from there and found there were many treasures hiding within.

There were ancient stone carvings throughout the mountain, though this one, Hundred-shaku Kannon, was significantly larger than  many others. Additionally, there were thousands of small statues built into the mountainsides. Nokogiri is also home to the world's largest stone Buddha.

You can notice it has seen better days, but based on its age I'd say it is holding up quite well. I continued to wind through, up and down thousands of stairs (no exaggeration, I thought that cable car meant I only had to go down stairs...). I came across a few people who were curious about where I was from and what brought me to Japan and Nokogiri so we would talk for a few minutes at a time. Even though there are very few Western visitors to the site, they do have directions in English which was very helpful. Belive me, it's not easy following a cartoon Japanese map if you don't even have a few signs along the way. After the stone Buddha, I came across the Nihon-ji Temple, the first temple I've seen the inside of. I was surprised how well maintained they are.

After leaving the Nihon-ji temple, I saw a sign for a Japanese Tea House. Thinking this was just another attraction, I started to walk back and take a look at the gardens. Then, a man walked out and asked if I would like tea (in very respectable English). Caught off guard, I agreed and sat in the garden. I've got to say, the view was incredible, he had the best maintained garden and koi pond I've ever seen (sorry Uncle Dick), and he brought multiple courses of tea and snacks.

I headed back to Kamogawa after a long day of sightseeing at Nokogiri. The Japanese are very meticulous about their landscaping. I believe it is this trait that translates into their everyday lifestyles. They are very clean, enjoy high-end, luxury items (Gucci, Burberry, Louis Vuitton, etc. are completely normal here, even in Kamogawa), but take great care of everything and in everything that they do. Exiting the park only confirmed these thoughts.

Nuances

It was to be expected, but things in Japan are very different than they are in the US. For example, did you know they speak an entirely different language here? While that may be true (and I hope everyone knew that...), the Japanese are required to take about six years of English while they are in primary and high school. Still, many are reluctant to speak English. In asking some individuals about this I'm told there was little emphasis on speaking and listening and more emphasis on reading and writing. So for future reference, when any of you are in Japan if you ever really need to communicate with someone just write it down.

They drive on the opposite side of the road as we do. Again, not that strange. This is common in many countries. There are actually many other things that amuse me about their driving system and automobiles. They have many of the same makes of cars as the US (Toyota, Nissan, Honda), but while the vehicles look the same all the models are different. Also, even though their roads are extremely narrow, they still have huge SUVs (some people even import Hummers!). I have noticed that very few American cars will put the steering wheel on the right side of the car for the driver (that is to say the steering wheel is still on the left side even though they are driving on the left side of the road). I do hope this is making sense. Additionally, there are many places where their roads simply go down to one lane and the drivers need to figure out. These aren't always straight, simple, untravelled roads either. They can be very windy, relatively busy (at least neighborhood-level) roads. Drivers will utilize mirrors placed on the sides of the road to see if there is traffic around a bend and just go for it! I can only imagine how many accidents there would be in the US...

The last major difference I have noticed (by all means this is not an exhaustive list) are the bathrooms. For starters, my shower is an entire room with a tub, a sink, a mirror, and a shower head. This whole area is used for bathing. Modern toilets are very complex. They typically include a keypad on the wall with various heat settings (for the seat), the options for flushing, the options for the bidet, and other buttons that I can't read because I'm not well versed in Kanji. I have included a picture of a relatively simple toilet, enjoy.

Recent Developments

The last couple of days I've been trying to expand my horizons a little bit (I know that's what Dad would tell me to do). In fact, I've been so apt to do this I even ran north instead of south the other day, and this is where it took me:

I ran through a series of tunnels, probably 6 or 7 before I decided to turnaround. The tunnels went along the ocean and through the mountains with a running path along the side. I typically run with Ipod but there's really no point because it gets so loud in there (sorry Posner). I think I'm scoring points with MapMyRun; they think I'm running up and down all these mountains when really I'm just running through them... that's fine, as I understand it the Chicago Marathon course is pretty flat anyway.

Today, I ventured out with Isobe-san and Yoshida-sensei to visit home healthcare patients. This was definitely a unique experience. These patients live out in very rural areas and are unable to easily access the hospital. Some of the scenery along the way includes the terraced rice paddies of Oyama Senmaida:

Not only is it rare to be invited over to a Japanese home (let's be honest, I wasn't really invited), but I also got to see how the physician interacted with the patient in another element, outside of the hospital. Yoshida-sensei was an excellent individual to learn from. He was patient with me when I asked questions and he was thorough in his explanations. All of the patients we visited were courteous and were prime examples of Japanese hospitality. The last house we visited served us coffee, watermelon, cookies, and cake! I think I surprised them; I was the first foreigner this 90 year old woman had ever seen. With their permission I took this photo (I know I look funny, I'm tall):

Before we headed back, Yoshida-sensei and Isobe-san introduced me to real Japanese sake (not that fake stuff they have in the US). No, I didn't go on a bender in the middle of the day... although it was about FAC time. We stopped in at a local sake shop (ironically named Kameda) and I may have bought a few gifts.

The Rainy Season

Here are some pictures of the rainy season in Kamogawa. Japan actually has five seasons. Much like our April, they set aside a couple of months for rain. I'm fortunate enough to be here during that time. It hasn't been bad so far.

Above is the trail I have been running on. Though I wasn't running here... I did run 7 miles that day then walked another 6 or so to take some pictures (in the rain...). 

Along the same running path from the south/southwest looking across towards Kameda.

 From the north looking to the south towards downtown Kamogawa.

Along the beach close to downtown Kamogawa. I took this with my phone while I was running. There are a lot of surfers here on the weekends (I think the less experienced surfers as it is a more protected area).

Also along the running trail, this is Kameda's helipad. It's right across the street from the ER but it's a busy enough street and a long enough distance that they drive an ambulance over to pick up the patients. I caught this while I was running. There are about 10 flights in a week.

 The pier in Kamogawa. Lots of fisherman down along here.

Biggest hornet I've ever seen. I don't know how it got into my apartment it was so huge. I think it must have grown from (an egg?) in there. This picture doesn't do it justice due to the depth of the Advil bottle. It was about 2 inches long... I beat it with a towel...

I don't have a dryer. It rained all weekend so I dried my clothes inside. If you look closely you can get a peek at my under garments...

A view of the fringe of downtown Kamogawa from a bridge crossing over a stream that spills into the Pacific.

These Are My People

So I had a few requests to showcase some of the more important people in my life over here. Without further adieu from left to right: Michael Burke, Isobe-san, and John Wocher.

Isobe-san is John's assistant and also translates for me when necessary (which is pretty often). There is no way I would be able to function without her helping me. She has scheduled meetings for me throughout my time here in all the departments throughout the hospital and attends them with me so I am able to (1) understand what they are telling me and (2) ask questions. Additionally, she looks for opportunities for me to see things that I wouldn't normally be able to see and tries to schedule those in as well (hopefully I'll be able to see a c-section at the end of the month, twins!). Isobe-san lives over an hour from Kameda and makes the drive everyday to work. She has a three and a half year old daughter and is expecting her second.

John Wocher is the EVP of Administration at Kameda. He wears many different hats, one of which is being my preceptor this summer. So far it has been a great learning experience and I have had basically unlimited access to ask all the questions I need. He has taken me to a variety of area healthcare facilities and shared more about Japanese healthcare than I ever thought I would know (until I accepted this internship, that is). He and his wife, Midori, have been very helpful in getting me settled for my short stay in Kamogawa; they helped with everything from bug spray (necessary) to furniture.

A Day in the Life

You may be wondering why I haven't written anything intelligent about Japanese healthcare yet (or you all know I'm not intelligent and just accept everything I write is drivel). Either way, I'm waiting to get a good grasp on what exactly it is I'm seeing here to sum things up about Japan's healthcare system and how things are different (and maybe how things are similar).

As it is, I have spent the better part of the last week shadowing and interviewing personnel throughout different departments. Most of this week was spent in nursing which was very beneficial as a large part of Kameda's (and most HCO's) workforce is in the nursing department. I rotated through several units and spoke with the chief nurses (via translator) about what they do, the patients they treat, and any process improvements they are making, some of which can be attributed to JCI (Joint Commission International).

After nursing, I moved on to Patient Relations (which they call Customer Relations; I'm not sure if something is lost in translation or if there is a larger audience they are trying to serve in this department).

Most days I come in a little before 8 and prepare for meetings and interviews that are scheduled from 10-12 and 2-4. In between these times I do write-ups about the interviews and research JCI. The people I am meeting along the way mostly have a limited grasp of the English language but are always excited to get a chance to use it. Some have asked me to practice further with them outside of our meetings. I tell them I'll do what I can...

Getting Back Into It....

Just like I said I would, I took my first (Japanese) run Monday after work. TJ, Japanese runs are very similar to regular runs but they are in Japan. I decided to run north along the beach as its really the only way I knew to go. At first I passed a parking lot full of surfers that was emptying out for the day. Kamogawa is a surfing destination in Japan. Once I passed the surfers the trail became somewhat smaller and what was the beach turned into more of a fishing village. Unfortunately, with the fishing village came the sights and smells of the fishing village and I was forced to turn around rather quickly. Still, I got in about 3.5 miles. Not bad for my first run in over a week (and commensurate with what was recommended by the DMM running coach!).

The next two days I decided to go the opposite direction down the same beachside trail. Much better. I passed Sea World Kamogawa and went through downtown Kamogawa. The downtown here has a pedmall! I can't really tell what anything is, but it is an area that only pedestrians can go, so that's exciting. The last two days I went 4 and 5 miles (also recommended by the DMM running coach).

My New Diggs

So after returning from Tokyo Friday night I crashed at my new place for the first time. We got back late but I still managed to arrange a few things and get somewhat settled even though I had to be up early for work on Saturday (yes, we work on Saturday, short days though). After hitting my head multiple times on the doorways (I don't think last years intern had the same problem...), I quit and went to bed.

The next day after work John took me out to get some more provisions for the apartment and I spent most of the day unpacking and getting settled. I found that it is rather functional. The Japanese have a unique way of going about things. Instead of a shower, there is a shower room. This room is used for all activities so there is a sink, a mirror, and a tub. I've found it difficult to brush my teeth after showering without getting my socks wet...

After unpacking, I went for a stroll along the beach to determine the best running routes. I probably could have run... But that would have taken energy.

Sunday was the Kameda golf outing. Those who know me and know how well I golf can make their own assumptions about how well that went. Enough said. Though I'd feel reluctant if I didn't mention how well maintained Japanese courses are and how excellent the service is at their courses.

Today I am starting my first full week of work. My schedule will be the same most days which, for the first month or so, will include shadowing different departments. Part of this week is nursing.

After work today I'm bound and determined to resume my training...

First Week

So I titled the blog 'Training in Japan'. It's kind of a double entendre as I'm training with John Wocher but also training for a marathon. Unfortunately, little marathon training (no marathon training) has taken place thus far. I'll keep you posted.

I worked Thursday and Friday of my first week as I arrived late on Wednesday night. Both days started off similarly, work at 7:45 am with an administrative team meeting at 8:00 am. This can be confusing as it is, obviously, conducted in Japanese. Good thing I've mastered the language. It's amazing how quickly you can pick things up once you're immersed in it (just kidding, I know at least someone fell for that). Typically they go slowly so someone can translate and I can get an idea of how the meeting goes.

I thought these two days were particularly important because I spent them mostly with my preceptor touring many of the Kameda facilities in addition to some city facilities that Kameda works with. On the first day we toured the clinics which are located to the right of the K-Tower (the largest building that can be noted in almost any picture of Kameda). Their clinics operate very efficiently but one thing I took away is how little time the patients spend with their physicians. Many are in and out in about 15 minutes. However, the average Japanese patient sees their physician 16 times per year! Much more than the average American.

I had lunch with Isobe-san, John's assistant. She has been very helpful getting me setup and showing me around Kameda as well. I learned a little about her family and she probably learned more than necessary about me.

After lunch John and I toured a couple more facilities, intermediate care and long term care. Kameda provides the doctors for these facilities when necessary but they are city owned.

On Friday, John and I went to Tokyo for a wine tasting dinner with the Tokyo Wine Society. It was my first time to Tokyo and it was impressive. The city expands for what seems like forever. We tasted 9 wines (none of which I could tell you anything about, but I did still rank them). We met a variety of people, everyone seemed to be from a different country and my first pick-up attempt in Japan was thwarted by John. She was a doctor and was shocked that I worked for Kameda, but once she found out I was with John Wocher, well then she only wanted to ask him more about Kameda and tell him he's famous. Thanks. I think I'll give her a call anyweay, I need a Tokyo tour guide...

Arrival

Upon arrival at Narita International the first thing I noticed was how trusting Japanese people are. When going through customs in most countries, I would typically open my bag and allow the agent to sift through my belongings (destroying my neat packing) to assure them I had nothing dangerous inside. However, after lifting my suitcase onto the stand, the agent looked confused and just told me to continue on toward the exit. Not that I'm promoting it, but sneaking things into Japan would be pretty easy (Jessica, don't forget those cookies).

A Kameda driver was waiting for me at the exit and we struggled to even say hello to each other. It was a long car ride with very little spoken. We managed to establish that we both wanted the radio on and that we were going to the same place (the sign definitely helped with that one).

When we pulled into Kamogawa, the driver pointed out Kameda Medical Center, where I would be spending the next two or so months which is also the largest employer in Kamogawa. There are 11 companies associated with Kameda from property services to healthcare to IT. Just Kameda Medical center employs about 2,500 people.

Another five minutes past Kameda we pulled into a neighborhood and drove up a steep, narrow street to my preceptor, John Wocher's house. He built his house about four years ago and it is a mix of eastern and western styles with a great view of the Pacific Ocean. Midori, John's wife, greeted me at the door. They both gave me a very warm welcome and we sat down to dinner. We stayed up for a couple more hours talking about John's career and family and my background and interests. Since it had been a long day of traveling I went to bed somewhat early.