Awareness: Japanese palliative care

A difficult topic to talk or write about but: an overview of palliative care in Japan

This is a difficult topic. This is a guide which should able to give you some guidance if you need it. This guide does NOT offer mental or spiritual advice, just an overview on palliative care.

You may be wondering why the warning- simple: dealing with either life shortening illnesses or end of life care is hard to experience. I have seen family members go through this and it is never easy. This guide should be helpful and it will include my opinions, and where to find help in Japan. If you do comment, please remember this is an extremely difficult topic- everyone has their own opinions and needs.

What is palliative care?

Palliative care helps individuals and families that are dealing with life-shortening illness and end of life care. Life shortening illnesses could be ALS, cancer, motor-neuron disease etc. End of life care is usually helping with pain management, emotional, physical, and spiritual support to those whose time is limited.

What you must remember is that everyone has different needs and wishes. Some end of life treatment plans may include hospice care, home care or hospital care. Additionally, palliative care seeks to neither hasten nor post-pone death. It simple seeks to improve the quality of life.

In developing countries at time of diagnosis 80% of cancer is incurable and the only thing left is palliative care- which is still a ‘new’ concept in may countries but millions of people are seeing the benefits of it.

The best resource I have found to show the benefits of this is a YouTube video. Please check out the ‘further resources’ page for the link.

Hospice care

Going to a hospice does not mean a place to die, for many it is a place to live before death. If you are in a position where palliative care is necessary- remember you are still alive and there are still bills to pay, things to do- life does not stop.

Hospice care takes these worries away from a person at a time when they’re usually extremely tired and don’t have much energy. For cancer patients, they can (and usually do) outlive their prognosis and are discharged from hospice care and in extremely rare circumstances return to a normal life (this is from a terminal prognosis).

For others, it is a place to help prepare one’s self and the family for the end.

Japanese hospice care

There are an estimated 300 hospice programs in Japan since the start of the program in the 1970’s.

Hospice care works with one basic principle: quantity rather than quality. For end-of-life treatment, emotional support and pain relief is at the heart of care. However, the hospice movement was a late movement in Japan. Many other countries had programs and support systems in place before Japan and in some respects Japan is catching up.

Therefore, end-of-life treatment in Japan primordially takes place in hospitals, and at home.

The Japanese hospice palliative care foundation looks to improve the image of palliative care in Japan as it is only seen as a place to die not as a place to live.

Home hospice care starts with a care plan with one member becoming the leader of a persons care. Doctors, nurses, people who supply medical equipment etc come together with the patient and family to talk about their goals of care, what they would like and what their family would like.

Home hospice treatment is supported by doctors and nurses trained in palliative care to ensure that (especially in Japan) terminal cancer patients have all the support they need. Home hospice care is becoming even more important in Japan due to 2 factors: an aging population and a short-fall of hospital beds.

Another reason for the rise of home hospice care is cost. For people under 70, a hospice can cost 469,000 JPY a month with a 70% reduction- this could be as little as 93,000 JPY a month- which is still, in my opinion, an unreasonable amount of money. For those over 70, hospice care costs 57,600 JPY a month- which is still expensive. Home care is cheaper- just a consultation fee, medical equipment fees and care support costs are needed.

However, home hospice care is not what most Japanese want. Many Japanese do not wish to be a burden on their families and would prefer to experience hospice care in a hospital setting. This is one of the things that the Japan Home Hospice Association is trying to combat.

There are brilliant resources in Japanese and English- the English resources are more limited. The key focus of this article was awareness and to give you a better understanding of what palliative care in and what your options are if you are researching it.

Thank you for reading and enjoy exploring.

Cardiac issues in Japan

I have spoken to many people about food in Japan, whether is about breakfast, lunch, special food, shabu shabu (almost a winter broth) or even snacks and everyone I have spoke to said the same thing: watch the salt.

As this is the month of awareness, let’s take a look at the problems salt, along with other causes, may bring. Welcome to cardiac problems in Japan.

Firstly a definition. Cardiac problems will consider heart disease, heart attacks and cardiovascular disease as well. If this were to be published anywhere else I would have to think about each problem separately but not too many people would be interested in that, do let me know if I’m wrong on that front.

Starting off in a happy place, cardiac issues is one of if not the main causes of death in Japan, like many other highly developed nations. There are many causes for this, not just McDonald’s and fast food. The WHO have ranked 3 heart related conditions as the main causes of death in Japan which were: Ischaemic heart disease (aka Coronary Artery Disease), Aortic aneurysm, and other cardiovascular disease.

However, there have been 42,300 fewer CHD deaths because of medical and surgical treatments from 1980- 2012.

Major health trends

To start with let’s take a look at some general health trends which have contribute towards higher levels of heart disease in Japan. Firstly, Japan has become increasingly Westernized and has been since the 1960’s. While this has had many advantages culturally, economically, socially etc, there has been a negative impact on health.

The major trends that have been seen in Japan are a rise in the number of smokers within Japan, a noticeable difference in BMI- levels are much higher (in 1980, the average BMI for men was 22.5 kg/m^2 and by 2000 this has risen to 23.4kg/m^2); a rise in the number of diagnosed diabetics; an increase in blood pressure.

Side note: blood pressure. Blood pressure has 2 values: a systolic value (the top number) and a diastolic value (the bottom number). The WHO recommends that one’s BP should be 120/80 mm Hg- which is the ‘perfect’ value. High blood pressure is any reading that at rest is over 130/80 mm Hg.

Japan’s blood pressure is worrying- the average systolic blood pressure is 135 mm Hg (which is high) and the mean diastolic reading is 85 mm Hg. This average 135/85 mm Hg puts you into the Hypertension stage 1 category or High blood pressure stage 1 group.

Major factor: salt

One resource I used during my research was the Cardiovascular Risk Assessment Chart by Dietary Factors in Japan (which is a brilliant resource- linked in further information) and the major risk assessment was salt.

Salt is essential to life as we cannot naturally product it but we need it in moderation only. In the UK, it is recommended to have no more than 6 grams of salt a day- the recommended daily limit in Japan is 1.5 grams of salt (which explains why Japan has a lower level of CDV (cardiovascular disease). However, daily recommended limits are not always possible.

Average daily salt intake (from a sample size of 9115 people) was 14.0±5.2 g. This means that the lowest average daily intake was 8.2g. The risk assessment categorizes people into 2 groups based on salt intake high (men and women that consumed more than and including 8g and 7g of salt respectively) and low (those who consumed less than this).

This risk assessment showed that after 29 years, there had been 1070 deaths attributed to CVD. From the 2 salt intake groups, there were 57 deaths from the low salt intake group and 1,013 deaths from the high salt intake group (while there were other factors which contributed to their deaths- numbers are telling).

What factors have contributed towards Japan’s low CVD death rate?

Strangely enough, the Japanese diet has helped (and hindered) CVD in Japan. The main things which can reduce risk is consuming omega 3 (eating fish or rarely via supplements), avoiding sugar (hard to do in Japan), avoid trans fats (again difficult to do), ensure adequate vitamin D intake (either dietary, by being in sunlight or supplements) and controlling iron.

Fish

Not surprisingly, the Japanese consume a lot of fish- but the amount the Japanese consume has dropped. In 2016, the Japan Times reported that the average fish consumption as a mean 27.3 Kg a year- which is still a massive amount.

Additionally, the Japanese diet of high levels of fish, fruit, vegetables and (ideally) low salt consumption are the perfect heart diet. However with higher salt consumption and what can only be described as a fast food diet (low vegetables, fruit and fish), CVD is extremely likely and possible.

Soy based products (tofu) are also extremely helpful in reducing CVD risk and its’ benefits have been noted in men and women but especially in post-menopausal women.

CVD is regional in Japan and it has mostly been reduced except in major urban areas (Tokyo and Osaka). In major urban areas, there are higher levels of stress, less time to cook (so more processed food), less time for exercise etc so there are higher levels of CVD.

Further reading- The Japanese heart foundation (JHF)

There is certainly more information on this topic- in English (more research papers than advice) and in Japanese. The best resource I have found was the JHF or Japanese heart foundation (BHF or AHF anyone?).

The JHF have information on diet, research, AED and first aid training and so much more. Please do check it out- there are enough info-graphics that if you have a good scientific mind, you should be okay.

Thank you for reading and happy exploring.

Organ donation in Japan

Organ donation is a complicated topic in Japan. Here’s a quick guide.

A needed practice but the Japanese usually don’t follow it

One thing I have found during my research on all things Japanese is the need for tradition. Traditions almost govern modern Japanese society and can be observed at every level. However, tradition costs lives.

What I specifically mean by that is traditional practices takes precedence over life in some circumstances. For example, it is culturally expected that a body is to be cremated whole without anything missing. The problem with this is simple, that body is to be disposed via cremation- it is to be burnt and all organic material with it. Why should I be concerned with this- you may wonder. Simple- statistically there are only 0.7 transplants per million or 64 took place in 2016 (for all organs) and in 2019 there have been 102 donors and 372 recipients ( https://www.jotnw.or.jp/ ).

The bright side, the numbers have increased by 38 over a two year period. Alas, the number of people waiting for an organ is 13,948 as of Halloween 2019. This looks especially terrible when you consider that over 1,000,000 Japanese people due annually and many bodies are ‘put on ice’ until there is room at crematoria. I do realize that not all bodies are suitable for transplants- but which ones are?

Under Japanese law, anatomical gifts (organ donations) can be given under 2 conditions: brain death and cardiac death. But the rules governing organ transplantation are possible the strictest in the world. Organ transplantation may only be considered under the following circumstances:

  • Organ donation or 臓器提供 is based upon explicit permission where people have to opt in. The individual has stated (in writing) that they wish for their organs to be donated.
  • The family is in agreement
  • The only causes of death accepted are brain or cardiac death (cases involve suicide to try and help another will NOT be accepted)

In fact, donations from brain-dead donors (脳死)still makes headline news especially donors under 18. In February, the parents of a boy under 6 (his exact age was not given) made the difficult decision to donate the organs of their son- who was always looking to help others. Recipients were almost immediately chosen- highlighting the need further.

There are still problems with this system and again it is cultural. Many doctors still do NOT recgonise brain death as a cause for human death in Japan and if the cause of death is declared as anything else, organ donation is not possible.

Brain death under Japanese law is cited as the following:

Brain death will only be declared if organic injury is observed in the brain with attributable cause and if the following criteria are met:

Deep coma

Dilated and fixed pupils

Loss of brain stem reflex

Flat brain waves

Loss of spontaneous respiration

Two or more doctors with requisite expertise and experience confirm no changes after a second test conducted six or more hours later.

Japanese organ transplantation network

There are ongoing campaigns to either change the law in Japan to allow donations from a wider pool of donors and campaigns to raise awareness. The green ribbon campaign works with one core principle:

Yes is okay. No is okay. It is your intention [choice].

Green ribbon campaign

This campaign shows the difference organ donation has on many lives and has a section on the website to share the stories of recipients so you can see what a difference it has made.

Families that have not been able to receive a new organ have only a few options.

Firstly, do nothing. For patients who need a major organ (heart, liver, lungs etc) they can choose to do nothing. This would result in their death.

Secondly, secondary care options e.g. dialysis for kidney issues. The problem with this option is the expense. Dialysis costs 6 Million yen a year- for the rest of their lives- whereas transplantation costs 6 Million yen and only requires blood tests and doctors appointments instead. This is a cheaper option which takes us to option 3.

Travelling abroad in hopes of paying for a transplant. This method is expensive as in remortgage your house expensive. The problem is that no country has a stockpile of spare organs- but these organs need to be sources from somewhere. This may be the black market or taking organs from others in that country that also need them.

This is an extremely complicated issue in Japan where tradition and human life fight against each other. Japanese law was changed in 2010 and even though may younger Japanese are filling out organ donation forms and, as an outsider, I feel more still needs to be done in order to help more people survive.

What do you think about organ donation in Japan?

Thank you for reading and happy exploring.

Christmas: special drinks, for children

Japan and Christmas are a wonderful match, especially when Japanese culture is added to the mix. Partying, even having a dinner party, is an expected part of any festive celebration but why should the adults get the special drinks- won’t anyone think of the children?

Okay this sounds weird but don’t worry children, the soda industry has your back. Firstly, these drinks are not cheap but they are covered in colorful plastic packaging with Doraimon and other characters. There is also Appletiser, which I do like but is still full of sugar.

People usually buy these drinks for either the Christmas party of for New Year’s eve/day celebrations at an extremely cheep 1000 JPY a drink (or 10 USD).

This section is also brilliant for the non-drinkers (me) wanting a social life- just a little one though.

Thank you for reading and happy exploring.

Disposition in Japan

Definition: disposal of human remains in Japan

Time for another jolly post but this time about disposition. But why talk about such a topic during awareness month? Simply put, it is a problem that no-one talks about.

Global disposition options

The reason to address this first, it to highlight the differences between Japan and the rest of the world.

When considering disposition, 2 options usually come to mind: burial or cremation.

Burial

There are 2 main types of burial: natural burial and traditional burial. Natural burial is the type of burial that has been practiced for generations within the Jewish and Islamic communities and is slowly become more accepted in the western World- even though it has only been about 100 years since it was commonly practiced in the West.

A natural burial is simply burying a body, without any sort of preservation (embalming) in a grave to allow it to decompose and return to nature. In Islamic tradition, a body is washed, shrouded and buried within 24 hours.

Traditional burial (usually but not always) involves emblaming the body to help preserve it, placed into either a coffin or casket (yes there is a difference) and placed into a traditional cemetery with a burial vault (mostly in the US) or into the soil.

Side note: embalming fluid is highly carcinogenic and this fluid enters the water table…how nice.

Cremation

The other main option is cremation. Cremation is the process in which all organic material (the body) and only non-organic calcium oxide and phosphorous pent-oxide remain. This process takes approximately 1-2 hours and in most countries, the bone fragments are, by law, ground up into the ash that we all know.

While there are different cremation services on offer, the simplist is known as direct cremation and just involves an organisation picking up the body, cremating it and returning the ashes.

The cost does differ on country but you are looking at approximately 1000 USD, 500 GBP plus, or 50,000 JPY (in Yokohama).

Other global options
  • Alkaline hydrolysis: dissolving the body in an alkaline solution. Any organic material is not released into the air and breathed in by others, but instead go into the water system.
  • Burial at sea: weighing down the body and allowing it to decompose in the ocean.
  • Sky burial: breaking up the body and allowing it to be scavenged by animals- another way to “give back to nature”
  • Human composting: allowing the body to be turned into compost and being reused
  • Immurement: being placed into a mausoleum or tomb
  • Mummification: a body is prepared and preserved to make it last a long time
  • Plasternisation: think of the body works exhibit. It replaces body fats and fluid with plastic and it preserves the body.
  • Donation: to either help future doctors (medical school use), help scientific research (including body farms and biomedical research, and military use (weapons testing – including biological)
  • Cryonics: AKA cryogenics the art of freezing the body for possible future revival
  • cannibalism*

*There are cultures that do practice cannibalism- sometimes for positives reasons (to keep them within the community) or negative reasons (because they could).

Disposition in Japan

Even though, legally, there are 2 options that are considered, in practice there is only 1: cremation.

While the UK’s cremation rate is about 70%, France’s at 20%, the cremation rate in Japan is above 99.5%- which is a fantastic number. Burrial is legal but is forbidden in most prefectures or as per local by-laws. Exceptions can be made for religious reasons but new graveyards are forbidden from burying bodies.

Problems with cremation in Japan

Japan has a severe aging population and over 1,000,000 people die each year in Japan. The problem is that even at the largest crematorium, there is still a “waiting list” for corpses.

There are more bodies than crematoria (the plural of crematorium) available and during the traditional Japanese funeral, the family waits in the “lobby” (actually is the funeral hall) while the body is being cremated. Then then pick out the bone fragments from the warm remains and place it in an urn.

Fun fact: this is the only time in Japan when it is acceptable for more than 1 chopstick to move an item at once. 2 people may need to work together to move a large bone fragment into the urn. So, if you do this in public, it may remind someone of this situation and cause flashbacks, so just don’t.

Alternatively, there is a growing trend: 直送 lit. direct delivery or direct cremation- as this is a much cheaper option. It is also the option for those that are from low income backgrounds, live or die alone or the homeless (their funerals are organised by a civil servant).

Price

A traditional Japanese funeral service, not including cremation or the burial plot, ranges from 500,000 JPY to 2,000,000. Cremation usually ranges from 70,000 to 170,000 JPY and if a grave is wanted, prices usually range from 350,000 to 2,000,000 JPY. The final gaijin price range for everything is 920,000 JPY to 4,170,00 JPY (plus tax). This is a massive price: 8,400 USD to 38,000 JPY- considering the average price for a ‘massive’ funeral in Japan in $5,000- Japan is extraordinarily more expensive.

While it is cheaper if you do not require a plot or take the cremation price from Yokohama (12,000 JPY for residents and 50,000 for non-residents), or choose a small family orientated wake, you are sill looking at 3000+ USD.

Please note, I have NOT talked about the annual fees for grave maintenance, the headstone and other fees e.g. food and drink at funerals etc.

Other options for cremains (cremated remains)

  • Internment in a home shrine (extremely traditional)
  • Internment in a sky scraper grave
  • Interment in another mass memorial
  • Interment is a communal grave (extremely cheap option)
  • Interment in a company grave
  • spread on the winds (not really practiced in Japan)
  • Shot into space (a small part of you only)
  • up-cycled into jewelry, pictures etc

The Japanese problem

With the amount of dead bodies, and with the limited space available, there is no-where for the dead to go. The tradition of the family plot is unfeasible for those who live in major cities- even those within the industry, do not wish for a traditional Japanese funeral as it would put “too much pressure on their families”.

Cremation is the norm within Japan and will continue to be so- it was the way the Buddha was given back to nature after all. It is just strange that a funeral is so much more expensive than a wedding.

The one positive to Japanese death culture is simple: there is active death awareness. Unlike in the West, death is a taboo topic but with Japan’s death culture and festival (お盆- Obon which takes place in August) is is an active part of life.

Thank you for reading and happy exploring.

Christmas: Pepsi?

December the month of xmas

Have a grape Christmas

Eve though it’s now December I still protest Christmas due mostly to the fact I’m in Japan. That does not mean I’m going to stop trying strange things.

Enter stage left: grape flavoured Pepsi. I know what your thinking, like OMG I can’t believe you bought that. But believe it or not it was really nice.

Imagine a mix of Pepsi and grape, it’s the ronseal of combinations. It’s refreshing and goes brilliant with ice. I don’t quite know how it’s a Christmas product but it gets my thumb up.

If you can do try it but if you can’t, you already know what it is like.

Thank you for reading and happy exploring.

Cancer in Japan

Photo by Pixabay on Pexels.com

Cancer is a non-commutable disease (NCD) which is a developed rather than infectious disease. Like many other high-income countries, there is seemingly an epidemic of NCDs. To highlight this fact, in the 1900’s one of the leading causes of death in Japan was TB- a highly infectious disease and according to the latest data (well 2015 is recent…) only 1 of the top 20 causes of death in Japan is due to infectious diseases, 1 due to external factors and the other 18 are due to NCDs.

Side note, the number 12 spot is classed as “self harm” which should be read as suicide.

Cancer takes up 8 of the top 20 spots from the 5th leading cause of death (lung cancer) down to the 18th leading cause of death (oesophageal cancer) and while other cancers have appeared and disappeared from the table at times, cancer is always present. Additionally it is always present of DALYs reports- Disability adjusted life years.

Japan has active cancer screening programs and cancer awareness events (the most recent that I was aware about was in Nabari at the ADS hall which I remembered 2 days after the fact) and this occurs all across Japan- especially in Fukushima Prefecture where the WHO has rules that there is little chance of cancer development throughout the region with the exception of children and infants who may have been exposed to higher doses of radiation after the 2011 earthquake.

CAM treatment options

While researching cancer in Japan I came across complementary and alternative medicine (Kanpo in Japanese- 漢方) cancer treatments. The research suggests that of respondents in 16 cancer treatment centers and 40 palliative care treatment centers and 44.6% of cancer patients used CAM and 25.6% of patients with benign tumors use a form of CAM.

While there is sparse research of CAM treatment options in a Japanese context, current research does suggest that CAM treatment options have been used without consultation with a doctor.

Cancer screening

Cancer screening in Japan is purely voluntary, like any other country. However, the screening rate in Japan is lower than other HDC (highly developed countries) which but organisations like the Japan cancer society (the name could use some work) screening more than 10 million people annually working to ideally reduce the prevalence of cancer to 0.

To put some numbers behind this, in 2017 the JCS screened over 11.2 million people and 13,712 people were diagnosed with cancer so their actions are saving lives.

There is also a free cancer consultation hotline 03-3541-7830 which is a Japanese only hotline which provides expert advice on treatment options, advise on being employed with cancer.

If you would like to help the JCS out, there are many fundraising events throughout the year and donations can be made directly to the society.

More information can be found on: https://www.jcancer.jp/ and there is information in English and Japanese.

The main cancers prevalent in Japan are:

  • lung cancer
  • stomach cancer
  • intestinal cancers
  • breast cancer
  • cervical cancer

More interestingly, according to the JCS (who grouped all cancers together), cancer was the leading cause of death in Japan in 2017 with a total 373,334 people dying of cancer out of a total of 1,340,397 in 2017. Obviously the JSC have a bias ; but should that distract from it’s importance?

There is plenty of research on cancer in Japan, but it is either never translated into English or it exists as research papers which most people avoid.

Japanese note

Cancer in Japanese is simply がん and it mostly appears in this form. While there is kanji for cancer 癌 it is rarely used- even though it is interesting. The kanji is made up of 3 parts: 疒 Cancer in Japanese is simply がん and it mostly appears in this form. While there is kanji for cancer 癌 it is rarely used. The kanji is made up of 3 parts: 疒 meaning sickness, 品 meaning goods (in this context) and 山 meaning mountain. Collectively it means sick goods as high as a mountain.

I will leave this article here but there is so much more available and there is so much more I can talk about including types of cancer, death rates, treatment options including palliative care options etc.

If you have the resources, please do consider either spreading the word of cancer in Japan or donating.

Thank you for reading and happy exploring.


If you would like a list of the resources used in my articles please do message me. I do not include my resources on blog posts but I usually, and if applicable, include links to major organisations and communities that may help.

The Japanese healthcare system: an explanation

Photo by Pixabay on Pexels.com

The 101 for the Japanese healthcare system

Japan has had a universal health care system in place since the 1960’s and has enjoyed the benefits of such a system. Coming from another country with a health care system it is something I can appreciate and understand, not just the positives but also the negatives about it.

The problem with Japan’s health care system is 3 fold:

  1. an aging population
  2. low economic growth with high rates of unemployment
  3. a negative population growth i.e. low birth rate

There are plans to change the system into something more sustainable and allows more collective responsibility to ensure it remains stable and sustainable. But what about how the system stands currently?

A post-code lottery

There is an uneven distribution of health care providers in Japan as most clinics are private and it is down to the business to where it should open. As a general trend clinics are only found within built up areas and clinics that specialise in something are extremely rare outside cities. While researching this article, I came across a singular diabetes specialist in Nabari and Iga but there are many clinics that specialise in diabetes in Osaka.

Another example is palliative care which is expected to be the responsibility of the household. An advertisement on the train (of all places) gave commuters information about a palliative care clinic in Osaka and people were reading this and taking that information in.

Cost of healthcare for foreign nationals living in Japan

If you live in Japan, you are required to join the health care system and I will always say one thing: do it. The current system will cover 70% of the costs of any necessary treatment plan e.g. dentistry, internal and external medicine etc. A recent trip to the dentist should have cost me just offer 10,000 JPY but under this system I paid around 3000 JPY instead.

This has a few positives especially for Americans living in Japan. This is a form of insurance that everyone is required to have and if you’re filling US taxes, this does count in the eyes of the IRS.

My monthly cost is just under 2000 JPY and just one visit to the dentist or doctor would be the equivalent to 4 or 5 months work of insurance. It is brilliant for the end user but not for the system. The amount of money that the government spends under this system is astronomical. This is a better system than the UK as everyone has a more direct input into the running costs of health care in Japan, but there is still money being pumped into the system.

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Patient enpowerment

A patients choice is at the heart of the Japanese healthcare system and people are encouraged to give suggestions to policy makers in Tokyo. People have the right to chose which clinic, which hospitals they would like to go to regardless of insurance status, disease or background. There may be a fee incurred but people have that right.

Please note there is also voluntary private health insurance available which helps cover things that national health insurance dies not including: loss of income insurance, transportation, food etc.

Care

There is no difference between primary and secondary care in Japan, even historically. This means that you can go to a clinic or a hospital without a referral, a small clinic may be extremely specialized in an obscure disease but they are located in the smallest town imaginable or have no specialist available within a city.

In Japan there are over 8,400 hospitals and over 100,000 clinics and 80% are privately owned. The system is split into several major sectors: internal medicine, external medicine, dentistry, gynecology, emergency medicine, pediatric medicine and pharmaceutical.

Emergency care

Even emergency care is split into primary care (on call doctors and prefecture run care), secondary care (hospitalization is required) and tertiary care (advanced or more grievous care).

The general pathway for this system is 119 (ambulance) assistance, then hospitalization, the removal to a specialist facility e.g. ICU.

Where to go?

As a general rule of thumb, the guidelines about where to go are:

  • External medicine: injuries and problems of the limbs
  • Internal medicine: anything else e.g. vaccines, non-commutable diseases (cancer, COPD, cancer etc)
  • Dentistry: teeth….
  • Gynecology: females
  • Pediatric medicine: Children
  • pharmaceutical : drugs
  • Emergency medicine: ambulance

There is a lot more information about the Japanese health care system and I can, and really want to, go into so much more detail but this is an overview and a general guide.

Thank you for reading and happy exploring.

Advanced directives in Japan

Not an easy topic but a necessary one.

Please look at this beautiful picture, its nice and pretty and if you are squeamish please try to read this article- its important.

Anything that is in relation to end of life care or dying is NOT popular at all. To be perfectly honest, I do not expect this article to be read but this is (I hope) the start of a conversation, the start of an understanding that will be covered.

Please note, I have not studied Japanese law extensively and as this concerns Japanese law please do consult a lawyer or solicitor to ensure that the information you need is legal and correct. Additionally, at the end of this article and on the further information page of this blog is a like to Advanced directives and the actual form in English and Japanese from the university of Michigan. Let us begin.

What is an advanced directive?

Firstly you will die, one day. That is at the core of an advanced directive- one’s mortality but more importantly one’s choice. You have a choice to make to either have an input into your last days and your funeral or to see what life throws your way.

An advanced directive or living will is a written document that states your wishes regarding end-of-life care (from live extension to removal of support), pain management, organ donation, and postmortem options. The link to the document I have provided includes mental health options, life ending decisions, end of life plans and giving someone the durable power of Attorney of health care.

Why choose an advanced directive?

An example for this is extension of life or allowing one to die in cases of incurable diseases such as cancer, ALS, dementia etc. At this stage, do you want your life to continue regardless of the chance (or lack therefore of) of recovery or allow yourself to die.

What are your personal beliefs? Under what circumstances (or none perhaps) do you believe life is not worth living. What about your religious beliefs? What are your options regarding end of life care or postmortem options?

What about a DNR or DNACPR?

You may be wish to have a DNACPR or commonly called a DNR- do not resuscitate. To add a personal note to this, my mother had a DNR- it was a decision I did not agree with but I accepted her decision. When her time came, the wishes were respected. Additionally, my mother had planned her entire funeral and it progressed exactly as she wanted. Even if no-one were to be at her funeral, it would have progressed exactly the same.

What this comes down to is personal choice. In Japan 58% of Japanese nursing homes have advanced directives (but that is not to say they are filled out) and this allows a person a choice.

The choice is simple: do you want a say in what happens to you if you cannot?

The final note on this article will be a piece of advice from my company. If you die in Japan, all expenses will be your (or your families) problem not the companies. The words used were more of the idea that you don’t have a choice nor a say- live with it. But what happens if you want a say in it? Or want/need a choice.

This is a needed topic to cover in the month of awareness and while leading a health life is one of my core principles, dealing with difficult topics will help either mentally, spiritually, or emotionally. This topic cannot be ignored death is the end of the journey of life.

Thank you for reading and enjoy exploring.

Advanced directive resource https://medicine.umich.edu/sites/default/files/content/downloads/99-10048_AdvanceDirectives_Booklet%28Japanese%29.pdf – advanced directive document in English and Japanese

Final note.

If you are part of the LGBTQ* community an advanced directive allows you to, for example, keep your gender identity after death. There have been cases where trans women have been changed to show them as males rather than females.

Additionally, some countries do not recognize same-sex partnerships and thus, legally, have to follow the directive of the next of kin rather than their partner. An advanced directive and giving someone the durable power of attorney for health care allows their partners to be involved in the entire process and even if your partner does recover, it is a safety net that is necessary even in LGBTQ countries (the US, the UK etc). Please consider an advanced directive no matter where you live!

COPD in Japan

Idamichi

COPD is finally getting the awareness that it needs in Japan. It a problem that the rest of the world is aware of but Japan liked to bury its head. Quick note, why the pretty picture? You’ll need something nice to look at.

The lack of foresight about COPD within Japan was made apparent by the “COPD awareness campaign” advertisements that have appeared in my newspaper recently. What is strange about this is the Victorian impression Japan gives to “curing” diseases but nothing (much) on treatment or prevention.

When I say a Victorian impression- I do mean this literally. In all Japanese newspapers, there is at least 5 companies offering a special product that will help cure X, or help alleviate Y or further improve the quality of life regarding Z. A lot of this comes from the mix of eastern (or Chinese) medicine and western medicine.

I am aware that communities and tribes in Africa, in Asia and south America use traditional medicine. However, Japanese law requires companies to list the ingredients used in the ‘miracle cure’ and most ingredients are either common plant extracts or vitamins and minerals so are mostly useless.

COPD, however, seems to be an unknown concept as the newspaper gives not only the kanji (with the entire reading), not only the international name (COPD), not only some causes behind the disease but the effects it has and where to find additional information- highly unusual for Japan. Kanji reading, for example, are expected to be known by the reader as you are an educated, respected person of culture (again Victorian in attitude). Moving on.

COPD is 慢性閉塞性肺疾患 「mann/sei/hei/soku/sei/hai/shik/kann」. The kanji used (as a quick side note) is fantastic. The Kanji is literally:chronic (first 2 kanji), closed, obstruct, lungs, rapid, disease. But is this a good translation?

COPD 101

COPD is Chronic obstructive pulmonary disease- so the kanji use is quite good. I imagine it comes from either a translation of a western term either recently or just after the collapse of the Tokugawa shogunate. The term is used to describe multiple similar conditions that cause limitation in lung airflow- which is an extremely basic definition of COPD (but this is a blog about cultures not medicine) and even though I am studying medical science I’ll keep it there (which is extremely painful).

COPD is caused (primarily) by smoking, indoor pollutants (the main cause in low-economically developed countries around the world, and cleaning products. Japan has seemingly discovered that smoking is harmful and with the ease of getting cigarettes, there are waking up to a wider problem.

The current campaign is focused on awareness. The advertisements I have seen are the COPD awareness strategies which are ideas like: increasing the warning label on cigarettes, letting people know smoking causes COPD.

But why has Japan been forced to acknowledge this? According to a national survey on the http://www.copd-jp.com, there are over 5.3 million people aged 40 and over that have a COPD and 2.1 million of those are over 70.

People with COPD need to be aware of every activity they would like to do that day (especially in later stages) and elderly people that have advanced COPD may require more help and in a country that has a rapidly aging population, there is immense strain (already) on the health care system.

What can you do about it? Firstly be aware of what COPD is and how to reduce your change of contracting it. COPD is a progressive disease Daily management of the disease is ensuring that you lead a healthy lifestyle.

What does Japan need to do? Simply put, change its’ attitude. Japan is changing and some old culturally accepted practices (smoking for example) are no longer as acceptable as they once where. I just hope that Japan is able to change sooner and avoid a major future problem rather than face additional millions of suffers and try to find a care solution.

On the first day of December I talk about COPD morbidity. Merry Christmas?

Thank you for reading and happy exploring.


Final note, there are still adverts for cigarettes in Newspapers as well as the COPD awareness campaign. This is case and point why awareness in English as well as Japanese is needed and warranted.