Is there a doctor in the country?

Patients dying in ambulances, not getting treated, being misdiagnosed ... Japan is a wealthy, technologically advanced country so what are all the horror stories about its hospitals and doctors? And what do you do when you find yourself in a health fix? KS holds its own stethoscope to the Japanese medical system.

Get me to the hospital on time

It was a beautiful, cloudless evening in May when the shortness of breath started. Having lost a co-worker earlier in the year to asthma, I took no chances and called the Japanese looking glass version of 911, otherwise known as 119. As soon as the operator picked up, the choice was made between a medical emergency and fire. Both the ambulance and fire department share the same emergency system, so I was greeted with the question "Kaji desu ka? Kyukyu desu ka?" (Is this a fire or ambulance emergency?) Next came the details - name, address, and description of the symptoms. A few minutes later, the pinpon cacophony of the siren came into earshot, growing louder by the passing second. Finally, the life-saving crew knock- ed on the door and whisked me away to the nearest hospital for instant treatment. Oh, if it were only that simple. Everything up to the last step is completely logical, but once you enter the ambulance, bureau- cracy rears its ugly head. "Which hospital would you like to go to?" the paramedic asked. "Um, the closest one?" I quickly replied. Having no "membership cards" to any hospitals, it was difficult for me to produce the name of a preferred medical facility. The ambulance sat in front of my apartment building while the medical personnel called hospitals in Osaka city until they found one that would accept me. Luckily they gave me some oxygen and checked my vital signs while checking around. I ended up, about 20 minutes later, en route to Otemae Hospital near Osaka castle. They ran some tests and determined it was a slight asthma attack, brought on by an allergic reaction to cat hair.

While I was lucky to have found a medical institution so quickly, others haven't been so fortunate. (See page 8 for a description of the current state of affairs.) The aging population, as well as the acute shortage of emergency room physicians, means that this problem will become more and more acute in the years to come. What can we, as foreigners, do to protect our- selves? The best advice is to avoid the emergency room at all costs. In order to do this, you should find a primary care physician who can take care of your medi- cal concerns. Local clinics are the easiest to find, but are of dubious quality. It's really a case of hit and miss. On your first visit, simply say "Hajimete desu kedo." (It's my first visit.) You'll be asked to fill out some paperwork and the staff will inquire about your medical coverage: "Hokensho o mochi desu ka?" (Do you have a health insurance card?). Clinics are best utilized for smaller, non-life threatening conditions such as a lingering cold, bronchitis, or the flu. More than likely you'll be hooked up to an IV drip (tenteki) to help rid your body of any dehydration. While questionable in its necessity, these drips are likely the major source of income for these smaller clinics.

More serious medical conditions, on the other hand, should be handled by a major hospital. The first visit, no matter what the condition, will always be with a general practitioner, who will then refer you to a specialist. Some hospitals have a one-time fee for patients who were not referred by another hospital or clinic. These fees run anywhere from ¥2,000 to ¥5,000.

During your first visit, a shinsatsu ken (patient card) will be issued and must be shown on every subsequent visit to the hospital (or in the ambulance in an emer- gency). Bigger hospitals tend to have the most experienced doctors and the most up-to-date technology. Perhaps the best way to find one is to ask co-workers or other expatriates for advice.

Another option would be to get advice from the AMDA International Medical Information Center. AMDA is the Association of Medical Doctors of Asia, a non- profit organization created to not only provide foreigners with medical information, but also to provide Japanese doctors with information on how to treat people from other countries. Call them (in English) to find English-speaking doctors in your neighborhood, a listing of hospitals where English is spoken, or for any other medical questions. The website is also filled with helpful information about what procedures to follow in the hospital and examples of medical forms that need to be filled out. In addition, the Kansai center is looking for volunteers to help with interpreting and telephone consultation.

Regardless of how fluent your doctor may be in your native language, if you're faced with any kind of surgical procedure, it's imperative that you speak Japanese (or have a friend with you most of the time to help with interpreting). Unlike medical facilities in other countries, in Japan you've got to bring a fair amount of stuff with you before being admitted. Each hospital has different requirements, and the bigger ones will have some kind of convenience store or shop where you can buy most of the necessities. Things to bring include toiletries, eating utensils, towels, bottled water, and the like.

Consider being hospitalized a bit like staying in a hotel, except much more regi- mented. Up by 6am and in bed by 9pm, with an endless array of nurse visits, blood samples, tests, paperwork, and other inconveniences. Peace and quiet? Only during the operation when you're under anesthesia! But then again, an operation is never supposed to be a holiday, and if you overcome the hurdles and the hassles and come through safely you can put up with a few early mornings and bland food.

Text: Wes Lang • Photos: KS