Allergies in Japan

Although this is not applicable to me, for many people coming to another country can cause anxiety because they have allergies. Sometimes allergy some minor things like hay fever for example however some people can have major anaphylactic reactions to certain products.

This post is to fold the first post this post will be a guide on how to navigate Japanese food labels and restaurants. The second part of this post will be an awareness post on allergies in Japan.

Food labels

Under Japanese law there are 7 foods or ingredients that must be labelled on food packaging and these are: shrimp (えび), crab (かに), wheat (小麦), buckwheat (そば or 蕎麦), eggs(卵), milk (乳), and peanuts (落花生).

There are more foods that may cause a deathly reaction and an epipen to be used and that is the first problem: what are you allergic to? Because there are so many other allergens, you must look up in Japanese, ideally before you travel, what you are allergic to. A handy phrase would be:

______アレルギーがあります。I’m allergic to_____.

A person I know who moved to Japan is allergic to bananas and must be careful with any confectionery product because it’s an ingredient that is used everywhere.

In restaurants, the 7 allergens will be listed in Japanese on the menu if not apparent e.g. “egg salad” contains egg. If you are allergic to anything else, research before you arrive. Most menus are available online and even if you only have the ingredient that you are allergic to, you can usually see if they have it.

Additionally you can ask! If you don’t speak Japanese, use the phrase above and the waiter/waitress will help you out.

Voluntary ingredients

In addition to the 7, there are an additional 20 ingredients that can voluntary be put on packaging. These 20 can roughly be separated into 4 groups: nuts (walnuts, cashews etc), fruits (oranges, bananas etc.), meat (pork, fish roe etc.), and other (gelatine). This is down to the manufacturer of each product and you need to be aware of this fact when buying food.

Furthermore, there is always a risk of cross-contamination because even though there are extremely high standards of food manufacturing in Japan, allergies seem to be the exception rather than the rule.

The reaction to allegies

Japan is becoming more aware of allergens and allergies as the number of sufferers increases globally. One brilliant example of this is Mos Burger. This fast food chain has released a range of low allergen products in an effort to allow people with severe allergies to still enjoy their food.

According to the ministry for health, it is estimated that around half of the Japanese population have some sort of reaction to some foods.

Medication

Japan is known for having a hey fever problem and there are many medications for this and others. There are 5 types of medicines for allergies in Japan:

• General allergy medicines (the best I would say is Claritin EX [loratadine 10mg] which is a pharmacy only product, or contac Z [cetirizine HCl 10mg]- if you can take these. There are many other ones but the list of contras(contra indications e.g. Don’t take if you have X or not for people who are Y) does get quite long.
• Eye drops. Many people use medicated eye drops to stop an inflammatory reaction occurring.
• Eye washes. None medicated option to clean the eye of irritants
• Nadal sprays. To stop the airways reacting to allergens or to prevent this reaction
• Epi pen.

I hope this guide is helpful if your travelling to Japan.

Thank you for reading and happy exploring.

Awareness: vaccine

This week I along with one of my colleagues went to a clinic and got the winter flu vaccine. The winter flu is said to be exceptionally terrible this year and it requires, in some cases, an entire week off work- no thank you.

As part of the visit I had a chat with the doctors and I need further tests. The ironic thing is that one of my awareness topics (diabetes) is something I am now being tested for along with hypertension (high blood pressure).

The vaccine costs ¥3300 (regardless of insurance) and an extremely common side effect is a localised rash and fatigue, both of which I had.

I would recommend getting the vaccine if you haven’t already had it. Additionally, if your at a clinic, spend an extra ¥1000 and get a diabetes test.

Thank you for reading and happy exploring

Quick note, my laptop has broken (thank you window’s update) and is stuck in a boot loop, and my recovery disk broke, so posts may be slower or shorter for a time.

Awareness: Japanese palliative care

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.

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).

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.

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!

How2: Japanese addresses

Japan, unlike many other countries seems to enjoy inductive rather than deductive reasoning, that is to say they look at life from big to small, rather than small to big.

Such examples of this in Japan is their group culture, being either in (内) or (外) out of a group and thus accepted. It is an invisible barrier that every foreigner needs to cross to be accepted in the community or city that they live in. In addition to this, Japanese addresses follow a similar trend- they look at the wider community before the local and then the individual property- with a slight exception of the post code (ZIP code).

In order not to either 1. give my address away or 2. help commit identity theft, I will use Nabari City hall’s address as it is a public body.

• 〒518-0492 – The first line is the post code. When sending a letter to Japan, the 〒 or Japanese postal symbol is not needed.
• 三重県- Mie Prefecture. Once established that you are sending a letter to Japan, you need to narrow it down to the prefecture (都道府県）
• 名張市- next is the city which in this case is Nabari. Cities are also districts. Nabari is a massive area and if you speak to someone else who lives there, you make the distinction of either a slightly smaller area (美旗- Mihata or 名張市街- Nabari city (as in the intercity)
• 鴻之台１番町- smaller area within a city. This specific area is Konodai number 1 block/ neighborhood/ district etc
• １ – which is the building number. For the city hall, being number 1 makes logical sense.

If you are sending a package to Japan, you will need to write “JAPAN” in big letters on the package. Additionally, it does not matter is you write the address in Kanji or romaji (romanised Japanese i.e. using letters instead of symbols).

Occasionally, you do end up with a double name being used, for example Nara Prefecture, Nara city; Osaka Prefecture, Osaka city; Tokyo Prefecture, Tokyo City etc.

I hope this HOW2 was helpful. Thank you for reading and happy exploring.

How2: prefectures in Japan

When speaking English, prefectures are vastly simplified. Nara is simply Nara Prefecture, Kyoto is Kyoto prefecture, Hokkaido is Hokkaido prefecture etc. However life for the Japanese is not so simple.

In regards to prefectures, there is a lovely phrase 都道府県 (と・どう・ふ・けん or to/dou/fu/ken) which are the administrative divisions of Japan. To break it down further:

• only 1 都 :　東京都 Tokyo
• only 1 道 : 北海道 Hokkaido
• only 2 府 ：大阪府と京都府 Osaka and Kyoto
• 43 県 i.e. every other prefecture in Japan.

For non-Japanese speakers the difference is almost unimportant. The difference in suffix represents the power each area had prior to WW2. Each kanji actually has quite an interesting history as to why they were chosen.

Modern use can simple be summarized:

• 道 was initially used to represent a territory which Japan had conquered. The use of 道 is technically redundant as it simply means prefecture in modern use. One difference is that 北海道 is also a Chiho (地方) one of 8 regions of Japan and the Hokkaido prefecture government refer to themselves as the “Hokkaido Government”.
• 都 which is used to represent the capital city- or the place where the imperial palace is. This use is quite modern. It was changed from 府 to 都 in 1943 to represent the power changes in the region.
• 府 are metropolitan areas that previously held more power than they do today. Today’s meaning simply means prefecture, but the history of the kanji is important to residents in Osaka and Kyoto
• 県 meaning prefecture technically comes from the classification of land areas which was started by the Portuguese when they arrived in Japan. Japan adapted this practice and the prefecture system was born.

I hope you found this interesting. Thank you for reading and happy exploring.

The small thanks

Convenience store raffle

A win is a win

Occasionally while buying extreamly unhealthy food and coffee, it was treat day (come one next Tuesday), you’ll be told by the attendant to take a ticket.

At first you are likely to be confused. But as the attendant holds this card box, you see that there are ticket inside. You take one, after struggling to open it while holding your lovely bento, and see a Barcode, you have won.

What a Nice dramatic story for winning a pack of sugar free chewing-gum but the spend X to get a free Y is extreamly common in Japan. The change of winning has enticed me in the past, even with winning being highly unlikely.

With this post, today’s Japanese phrase is はずれ which is simply better luck next time.

Thank you for reading and happy exploring.

Post in Japan

Where to post a letter

So you have a stamp and a letter, now what?

Postbox outside Nabari train station

Like many things in Japan, they are designed to be as simple as possible, but this does not work.

In brief, you have local and non-local mail in red and blue respectively, simple right? Now look closer at the picture.

The red section is for local letters and postcards, yes they are still a thing. The pager has only just become obsolete here. Anyways, if you wanted to send a local non-standard sized letter, firstly it wouldn’t fit in this specific box and secondly it’ll be in the blue section along with international mail.

Post boxes are handy things but just go to a post office, it’ll make life much simpler.

I hope you enjoyed reading and are well (unlike myself this past week),and as always happy exploring!