Monday, November 21, 2011

Photos

I just heard the my photo post a few weeks ago may have been buried. My most recent photos, including newborn photos of Masato are now in the most recent album.



Monday, October 17, 2011

First few months of San Diego

My intern year of residency is very busy. It leaves me little time to blog. So here is a quick summary:

Pics

Masato was born on August 11th.

We have had visits from all the grandparents. Father-in-law will be here the longest. We also were visited from the Milonas's. Trips include many pool trips (there is one in our community), the beach, the Safari Park, the zoo, pumpkin patch, and others.

I have been rotating on inpatient and outpatient pediatrics here in San Diego. It has been a lot of fun and very busy. I like all the other residents that I work with, especially the ones that are the same year as me.

San Diego really has close to perfect weather. I bought an electric bike to help me get to the extra far places on huge hills without sweating too much because it is bikeable weather every day here. We miss family of course but the are itself is just beautiful.

Sunday, August 7, 2011

We lost this gamble

Keiko's mom has been visiting for the past 10 days. Se said she could get a max of 10 days off work. Keiko thought the most important thing was for somebody to be around when Baby M is born. I have 2 weeks of vacation (started last Fri) to help once we get back to the house. So we had to guess which 10 days are most likely that Baby would be born...

...
...

Unfortunately, tomorrow, Keiko's mom goes home and no baby has arrived. Since Keiko wanted her to be here for labor more than anything, we just had to guess. That's the way these things go.

Monday, August 1, 2011

The absent minded pediatrics resident

Finally, school is over. I have finally finished medical school (and grad school) and become Jefferson Jones, MD/MPH (masters in public health).

We have moved to San Diego to start residency at UCSD. We are having a great time. The weather is perfect every single day.

Pictures and movies have been updated. Since I am a resident, I have little extra time for blogs but will try.

There are some super cute videos of Taisei on Keiko's youtube page. He enjoys singing and dancing these days:
http://www.youtube.com/user/jklohana#p/u

Pictures:

Saturday, June 4, 2011

Uyuni, Salt Flats





I am going to try and update my blog to include some of the travelling I did. I lost most of my pictures so I had to wait until some of my friends posted their pictures online so that I could use them.


They had sections where houses, hostels, chairs, tables, and nearly everything was made of salt blocks. I am not sure how it works or what it is mixed up with so that it doesn't melt in the rain. But it looked pretty neat.


This is the largest salt flat in the world. I believe a salt flat is a salt lake that dries up in the dry season and may be a lake during times of rain. Depending on the time of year you go, it is either all lake, all dry white land, or a mix as in the time I went. It looks like you are on another planet, with nothing as far as the eye can see except mountains in the distance and either water or a white snowy looking flat land.

This is our car in the distance. You definitely need a guide. There have been people that have died when they got lost and couldn't find their way back. It's quite cold.



It's quite beautiful, but there is honestly not a ton to do so my group filled out time taking random pictures of jump shots, perspective shots, shadow pictures, etc.

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Tuesday, May 10, 2011

Sum of Bolivia trip

I am back in the US. This is more for my records. I had to write this as an evaluation of the course. It is probably boring to read, but this is my best place for recording information like this.

Depending on the rotation, I arrive at the clinic or hospital between 8 and 9 am. Until noon or 2 pm I worked with an attending physician. There were days where it was outpatient and days inpatient. On outpatient days, I would often conduct the entire physical exam and report my findings. The attending would sometimes confirm my findings and sometimes just take my word. I only took limited histories from the patients. At times I would assist with the patient records. On inpatient days, I would participate in rounds. I would play the same role as Bolivian medical students. I would usually just participate in discussions and answer questions that the attending asked. I would receive topics to research and present the following day. Only rarely did I receive patients to do history and physicals on who were inpatients.

All physicians ended their day from about 12-2pm and went home for lunch. I would always do the same. I then had 2 hours of Spanish class in the evenings, which would sometimes focus purely on medical spanish, practicing doing histories in Spanish, etc.

The main hospital, Hospital del Nino, was about a 30 minute walk away from my homestay. There were optional other clinics and hospitals which were further. I spent one week at an adolescent clinic service which was a 1 hour combined walking and public transportation commute.

The dress code was very casual. I usually wore khakis and a short-sleeved collared shirt with my white coat as did most other foreign medical students. Bolivian medical students were casual with jeans and sweatshirts with white coats. Attendings were more formal with shirt and ties, slacks.

The attendings were quite attentive. They were always quite busy but all of mine would take the time to answer questions whenever I had them and were very kind. Most would try to find teaching points, give out handouts, and were overall excellent teachers.

The biggest challenge for me was the language. This was the reason I went but my participation was limited by my lack of language ability. My language skills did improve over the month, but I never was able to the point that I could understand all of what was said by the patients or inpatient medical teams.

My first 2 weeks I worked with Dr. Velasco in the depat of pediatriac infectious disease at Hospital del Nino. It was a combination of inpatient and outpatient. The majority of patients were pneumonias, RSV, and other diseases simlar to the US. I did see some disease less common in the US including leishmania, pulmonary and mengineal TB, and ITP.

The 3rd week I worked at the adolescent services clinic. It was mainly a prenatal care for poor, single females aged 16-25. It was primary care on the ground. She spent a lot of time working on prevention of future pregnancies, STD, etc.

The last week I returned to Hospital del Nino working in the pulmonology unit. The attending was a leader in South America for taking care of kids with down syndrome. On our outpatient days, we mainly did normal well child and sick visits for kids with down syndrome rather than a pulmonology clinic. The inpatients were nearly all various types of pneumonias.

I believe this experience will help me in 2 main areas. The first is with my Spanish. I think it has made a huge difference in getting me to a level that I will begin to be able to improve my Spanish by talking and working with patients during my residence and afterwards rather than just no understanding anything and making no improvement. Knowing Spanish may be quite important in my future career goals, as I wish to work with the underserved. My residence is in San Diego, where Spanish is very important and in the future, Spanish will continue to be important to work with underserved Spanish-speaking populations in the US.

The other main area was being able to experience a health care system with limited resources. I can have numerous examples where the care differed than that in the US because of constraints on resources. Some of them were unfortunate, such as the lack of care for most kids with cancer due to the lack of insurance for cancers. Others were good examples of using less expensive but effective drugs, diagnostic techniques, and other choices that would be good examples to physicians in the US.

Friday, April 22, 2011

Adolescent Services

My 3rd week was spent at the adolescent services. It is a primary care clinic for 15 to 25 year olds. It ended up being a good review of obstretrics. 90% of the patients we saw were pregnant. It was really great primary care in the trenches. The Spanish was better for me than at the hospital because it was less technical and will likely be more useful in the future. By the 3rd day, I was largely doing the physical exam, vitals, doppler, etc. while the doctor wrote the notes and interviewed the patient. I didnt see any crazy diseases not in the US but quite enjoyed my time seeing a clinic in Spanish.

There were a few differences I saw from the US. They were much more quick to diagnose a disease and give medicine. Nearly all pregnant women with vomiting were diagnosed with hyperemesis gravidarum, a disease of vomiting too much during pregnancy. I rarely saw it diagnosed in the US and have not heard of much medication being given for pregnancy related nausea, but at this clinic anti-nausea medication was given to most people with nausea. Similarly, nearly every pregnant women with a headache (none of whom had any symptoms of a runny nose or cough) were diagnosed with sinusitus and given antibiotics. Vaginal discharge was given a slew of medications to cover yeast, bacteria, and STDs because they didnt have a microscope to diagnose if there were any disease at all.

I cant judge, especially since they have much lower rates of antibiotic resistance.

Next week I will do pulmonology.

Thursday, April 21, 2011

Weekend of soccer and Tiwanaku

Facebook pictures are up. I was able to fill this last weekend up with some cultural events, both old and new.

I took a trip to the old capital of the Andean region called Tiwanaku. It is thought to be the most powerful city from roughly 1000 BC to 1000 AD. It was a economic and religious center. It is thought that human sacrifices of the gruesome type were performed. A lot of the buildings and statues were destroyed by the Spanish to "modernize" their cultures. They used the stones of the temples to build churches and beheaded statues, etc. Academics still dont understand how they built a lot of the large temples with the techonolgies at the time.

I personally had a great time as I really haven´t had much experience with ruins this old.


The next day, I went to a soccer game. There are 2 teams in Bolivia, Bolivar and The Strongest. They were playing each other making for a big rivalry so some of us students decided to go. We got about the best seats in the place for 10 dollars. I bought a jersey for 5 dollars and of course routed for that team, Bolivar. Bolivar did win so it was a good day. The ends of the stadium held the hard core cheerers that were constantly singing, jumping up and down in unison in support of their teams. While certain areas of Souther America are a little famous for violence at soccer games, Bolivia seems to be pretty tame. I was surrounded by families with little kids. It was an excellend venue.

Next trip on the schedule: Uyuni salt flats.

Wednesday, April 13, 2011

Weekend in the city

I didnt take any trips last weekend, so I stayed in La Paz. I like having time at my homestay so I have time to chat in Spanish with my host family. They are extremely nice and have the patience to work with my Spanish. My host dad has a house out a ways from the city that he is building, all by himself. It is very impressive. He is making the cement pillars for support, buying and shaping the iron girders, planning the whole thing out. He was a civil engineer when he was working. So we took the form of public transportation out their and gave it a look. Hen then showed me around the touristy parts of the city that have all the markets for souvenirs, the giant old church (St. Francisco Cathedral), while we were looking for some parts for his house. He really likes oldies so we watched some dvds that he has of some of his favorite artists: Paul Anka, Enrique somebody that apparently was the Mexican equivalent of Paul Anka, and The Platters. I know my dad would have had a good time joining us that evening. A quick note about public transportation. Traffic is so bad here that I cant imagine owning a car here. The roads are constantly congested and as I mentioned in my last post, the traffic laws seem flexible. Similar to many countries, most of the public transportation is conducted by vans that fit a lot more than they look like they would. They are only about 25 US cents to take. There are a few busses that are even cheaper. The vans look like they will stop in the middle of the road any time someone wants to get on or off. There really is only 2 things that I am not a huge fan of in Bolivia that I have experienced so far. Littering, and honking. I have personally witnessed littering a number of times, people just throwing packages on thr ground or out of their car. I heard it is just common here from people who live here. Its not something I can understand. Honking here is soooo common. Everytime traffic causes a car or 20 to stop, every car just honks until it goes, which is pretty much all the time. Honking has lost all meaning in this city as it is just one honk after the other, as far as I can tell. But dont get me wrong, I like many and most things about this city and country. On Sunday, I went to the local Latter-Day Saint church. Someone here told me that Mormonism is the second most common religion here, next to Catholicism. I would believe it, as I saw some LDS churches in some very rural places on my trip over 1 week ago. The church I went to was huge. I arrived 30 minutes early, but ended up being later, because I found out I was waiting in the wrong chapel. They have 2 entire chapels and churches in 1 building to accomodate more people. I could only understand bits and pieces, but I had a good time. There are always lots of nice people at church. One of the biggest differences was timing. I had heard that punctuality isnt stressed in much of Latin America. People slowly streamed in at the beginning of church and I dont know if it is normal, but we ended a good 30 minutes late. That being said, I look forward to going next week if possible.

Tuesday, April 12, 2011

Pictures

I have taken most of my picturew with my phone and with my laptop acting funny, I have had to rely on my facebook app to upload pictures. Here is a public link. http://www.facebook.com/album.php?aid=2321810&id=2410201&l=ac7617ef91

Week 2 in hospital

I have seen some new and familiar diseases in the hospital this week. We see a bit of HIV and TB. I have seen these before, but the main difference is how advanced they get. I think it is because these diseases are often picked up sooner in the US. People that live in rural areas have a harder time making it to hospitals. I have heard of and seen patients that have relied on traditional healers which has delayed the doctor visit. Here is a list of traditional beliefs that was given to us in a talk by one of the Boilivian doctors. (disclaimer: this talk was given in Spanish and is my translation, take it for what its worth) This is not a list of bad beliefs, just of beliefs. However, some of these do not improve the health of the Boilivian population. 1. To take and rely on herbs and teas, different ones for different types of pain. I believe chewing on coca leaves is good for stomach pain. 2. To take herbs and teas to get a baby to be born sooner. 3. I am not positive on the translation, but toss a pregnant women around by putting her on a blanket and throwing her up and and down to help the baby. I didnt understand the Spanish on how it was supposed to help the baby. 4. No bathing until 45 days after birth for the mother. 5. No light or sunshine 45 days after the birth. I think this has something to do with evil spirits. 6. Wrap the baby very tight with multiple layers. 7. Do not cut the baby`s fingernails as it has a connection with them becoming robbers. 8. Calling on spirits of dead people for help. 9. Using massage on particular points of the body to relieve stress and pain. 10. The mom makes all the medical decisions and gets all the respect and honor. There are times that I hear diseases as a possibility, or on the differential, that we would not consider in the US very often. We saw a cyst on an xray, and the doctor thought it could probably be a hydatid cyst, a type of parasite. I saw a little girl recovering from leishmania today, another type of parasite I have only read about. Today is Childrens Day in Bolivia. Per my little Internet search, it said it was to highlight the exploitation of children and declare their rights since many children are forced to work at very young ages, etc. What I have seen is a lot of balloons and clowns and games throughout the city. In the hospital, we were visited by famous soccer players from the top soccer team in La Paz, clowns, and people in zeebra costumes. One of the players I had seen on tv the previous week. I clearly was not as excited as the Bolivian medical students who knew them well, but it was fun to be a part of. A quick random fact: in Boilivia, the traffic is crazy. Lanes seem somewhat optional, like turning left from the right lane, red lights also seem optional. And there is often no stop in traffic so you just kind of have to cross the street when it seem the most possible or when there are so many cars they are forced to stop. I kind of try and stick close to a Bolivian person and do what they do. The government or somebody recognizes this and since they apparently refer to the striped crosswalks as zeebras, they have these volunteers in zeebra costumes control the traffic. I saw a car stop in the middle of the crosswalk after the light was red, and 3 zeebras surrounded the car and kind of waived their flags and shook their heads. I have to say, I like it.

Sunday, April 10, 2011

Night out on the town

I decided to join some other students who went out to a restaurant that has live music and dancing, traditional style. It was very entertaining. The first half was traditional Bolivian dancing. It is somewhat similar to Spanish and Mexican dancing but has its differences. I heard it can be called Andean dancing, as a lot of the culture comes from areas surrounding the Andes Mountains. Very fanciful costumes were probably the most unique part. Other students took pictures which I will try to get soon. At times, they invited us up to join the dancing, which I was able to take part of. The second half was a live band. It was 4 guitars of diffent sizes and drums. They were all very good and did great harmonies. Much of the crowd was from Latin America and knew a lot of the songs that were played. Our table of North Americans and Asians was a little more quiet as we couldnt sing along and did not understand all of the jokes, as everything was in Spanish as you would expect. They would ask where everyone is from and play some songs from your country. They played Only You (the old romantic song) and some Elvis for the US. I really enjoy being home in the early morning and evenings because that is when my host parents have time to chat. I am trying to balance getting out and seeing the city and enjoying some Spanish with my host family.

Saturday, April 9, 2011

Patient log

As part of our program, we are asked to keep a blog of our experiences in the hospital, including the types of patients that we see. Since I already, have a blog, I am just going to add it to my personal one. I have spent 4 days in the hospital so far. I spent it in the division of infectious diseases. I am hoping i will see some cases that I wont really see in the US. I have seen and heard of patients in the hospital that I hadnt seen in medical school. For the most part, the hospital is fairly similar to US hospitals. I have been going to the main referral hospital for children in Bolivia. At this time of the year, they are beginning to enter winter, and have a lot of bronchiolotis-RSV patients, a viral infection of your smaller airways. There are also patients with meningeal tuberculosis, adenitis, pneumonia, and some other infections. We had a grand rounds (basically a presenation in the auditorium for all pediatricians) where they discussed a case of rheumatic fever. When you get strep throat and it isnt treated, it can turn into rheumatic fever, which is a serious infectious that can effect the heart, joints, skin, and other parts of the body. That is the main reason to treat strep throat. It is very rare in the US. We also had a referral for a little girl who has bruising all across her legs for no reason (there is no suspect of abuse), called purpura. We just found out her platelet count (the part of the blood that keeps us from bleeding) is normal. I gave a little presentation in Spanish on what can causes this and on a benign tumor we saw called a nevus sebaceous. There are times that I understand most of what is being said and there are times that I understand nothing. The times that I understand most is when they are discussing a topic that I already know about. I have the most medical experience out of all the students here so they often discuss topics that I already know. Overall, my Spanish is slowly coming along. I can often carry 1 on 1 conversations about simple topics or medical topics, but that is about it. My grammar is decent, but my vocabulary is not too good since I havent really been studying for too long and havent taken formal classes where they pound new vocabulary. I have noticed enough progress to not get discouraged at least.

Thursday, April 7, 2011

Weekend trip to the island of the sun

Over the weekend, I joined a couple of other students on a trip to a place called Copacabana. There are a few in the world now, but the first was in Bolivia. It is a popular tourist location with lots of restaurants, shopping, and it is on the water and a beautiful location. I am afraid the camera I brought wont turn on so I am using my phone for my pictures. I cant find an easy way to upload them to picasa, so I am just using facebook for now. I uploaded a bunch of the photos on facebook, so for those with access, feel free to take a look. We spent most of the time travelling as it was a little far for a 2 day trip, but the travelling was full of natural beauty. I am in a place at a very high elevation. There are lots of lakes, fields, and snow covered mountains. We took a bus and a boat to get to Isla del Sol, or Island of the Sun. According to Incan tradition, this is where the sun was born. We were able to see an ancient Temple of the Sun, which was built about 1250 AD. The oldest ruins were built in about 2200 BC. I will post more pictures once I get them from my friends. There are many islands in the area. It is in the famous Lake Titicaca, which gets its name because it looks like a puma hunting a rabbit. It is the highest commercially navigable lake in the world. The islands are all very and to use them for farming, they built terraces into the sides, like giant steps. It was said to have taken hundreds of years. Unfortunately, it still didnt work very well and most of them are not used today.

Friday, April 1, 2011

Eating in Bolivia

So far I have loved the food here. There is a fair amount of fresh fruit and vegetables used and always a lot of flavor. Breakfast we usually have milk, tea, and bread. The bread here is not bought in loaves but in separate pieces, kind of like rolls but flat and a little larger. Sometimes we have eggs. My host mother always makes fresh juice with her blender. My host family eats quite early as they leave for work from 6 to 730 am. Lunch is the biggest meal of the day. It is often a little late, from 1 to 2pm, and is very large. It is one of the biggest cultural differences that is easy to see. Most people return home from work and eat lunch with their family, and return to work later. All of the offices I see have office hours from like 8 to 12, and 230 to 6. It is a given that there is a break for lunch. We have had several different items, some familiar and some knew. There is almost always a salsa type of spice that we can put on. It is homemade salsa and is delicious. The spice level may be too much for many Americans but for me it is often just right. They dont use too much meat either. It seems to me a fairly healthy diet. Dinner is light, often just some bread or leftovers from lunch. I have been told that due to the high altitude (we are up in the mountains) it is hard to digest at night. For me, I always like a large lunch and light dinner any ways since my stomach feels better that way in general. I have to say, the food and eating schedule seems a great fit for me.

Thursday, March 31, 2011

Hola from La Paz, Bolivia

I have arrives safely in La Paz, Bolivia. It was a bit of a wild week to get from Japan to Bolivia. I got a high fever the day I was supposed to leave but managed to keep it down with medication to last me through the flight. As soon as I arrived in the US, a stomach virus manifested itself and kept me bedridden the whole time I was in Seattle. I managed to recover just in time to go to Bolivia but could have used some more time to rest and prepare. It is not easy to get to La Paz from Seattle. I had 2 layovers on the way there and will have 3 layovers on the way back. My last flight was delayed about 4 hours (in Miami). 1 week with 2 time changes and 2 redeye flights has left me a little disoriented but that is just improving now. I am in Bolivia for 6 weeks to study Spanish so that I can be more prepared and be able to take care of Spanish speaking patients as soon as possible. If I recall correctly, the childrens hospial in San Diego has upto 70% Spanish speaking patients. Unless I want to rely on a translator every day of my life, I better get some Spanish skills. I have always wanted to learn Spanish and am excited of the prospect of being fairly fluent by the time I am done with my 3 years of residency in San Diego. The program is through a organization called Child Family Health International. I chose this program because it combines Spanish school with working time in a childrens hospital. It has a great reputation. Northwestern University even offers funding to train in a developing country. This week I am purely working on my Spanish and starting next week I will daily be spending time in a pediatric hospital or clinic. I am staying at a homestay with a family of 4. They are roughly the same age as my family with a daughter and son who are my age. They are extremely nice. I have formed somewhat of a routine where I chat with the father every morning and evening. He has the patience to work with me through my elementary Spanish. Luckily, Spanish has so many similar words that we are generally able to have concersations on fairly complicated topics. Since I have mainly been using the Internet and mp3s for studying and have had relatively little speaking experience, I am able to say far better than understand. I hope that my listening and uderstanding skills will make vast improvements over this 6 weeks. I have my own room but will get a roommate this Saturday, another student of he same program. I am fairly old for the program as I think most students are either premed or early in medical school. It is of course hard being away from Keiko and Taisei but this is kind of a trial for us. I can see myself in 2 jobs with very different schedules in the future. Many public health jobs require long periods of travel but while you are home you work a fairly regulated 40 hr week, as they are usually government jobs. If I work in a university hospital then I will likely work far more than 40 hours a week, but will travel little. This experience may help me know if I can still enjoy travelling even with a family. Keiko keeps me updated with pictures and videos. They are having a great in Japan it seems.

Farewell Japan

I had a great time taking it easy in Hiroshima for 3 weeks. I was able to spend more time with Taisei than I ever have, eat lots of good Japanese food, and try and prepare for Bolivia by studying Spanish. We met up with some of Keiko´s friends, went out to all of our favorite restaurants, did a bit of shopping. I love shopping in Japan. In America, I always struggle to fins something that is only slightly too big. In Japan, my size is always available and affordable. I started to learn the Japanese game of shogi. It resembles chess is someways, but has some major differences that made it fairly difficult to learn the strategies. Keiko´s dad is quite a big fac so I thought it would be a great way to spend some time together. He of course killed at it every time but I had a great time learning. I actually won once, but only after getting some hints and being able to take back some moves. I am a little hooked on it now, and have downloaded it onto my phone so I can play against a computer (who also usually beats me). Taisei really looks like he will walk soon, but it didn´t happen by the time I left. I am hoping he can put off his first step and first words until we meet up again in May. Hiroshima remains completely safe from radiation. However, just to be on the safe side, Keiko and Taisei may come back to the US early.

Sunday, March 20, 2011

My destination for residency

Keiko and I will be going to San Diego for the next 3 years. We are very excited. We are also sad that we will be away from any family. The residency and hospital seem as good as any in the country and I think Keiko will be very happy in San Diego. There are many Japanese people, it has wonderful weather, and I there is also a decent LDS population. I hope there will be some Japanese LDS members in the area.

We start around June 20th. I was pleasantly surprised to find about half of the 18 interns (first year residents) who will be joining me are male. Pediatrics is a very female-dominant field these days, but I have found that I get along very well with other males who choose a relatively low-paying specialty.

Rent appears to be pretty high and I think expenses will be one thing we will have to struggle with a bit. The rent in San Diego appears to be pretty high and a resident's salary is not much. I imagine we will have to live a little distance away and buy an extra car for commuting to be able to afford the rent for a family our size.

I'll post more as I learn more.

I'm off to the US in 2 days and will be in Bolivia in a week.

Sunday, March 13, 2011

Impressions of being a doctor in Japan, the Japanese medical care system

The last 7 pictures are of Keio University hospital.

These are the responses to a form I had to submit to my school after finishing my time in Japan as a medical student. It is a little detailed but for those interested, feel free to peruse.

I had a very thoughtful and detailed schedule set up for me before I arrived to the hospital. I rotated in the pediatric department. I worked Mon-Fri, 9-5pm on average. It was divided into 10 half day blocks. Keio has 3 pediatrics wards: the NICU/step down unit, hem-onc and cardiology, and general pediatric floor. I would generally show up for morning rounds and then would have a discussion or see patients for the rest of the half-day block. Many days had special conferences or meetings that I would attend. The schedule was very flexible so that I could change it as I wanted. I requested more outpatient time and was given several days to see various outpatient pediatric clinics. I requested to see the ED and was able to spend a day in the ED. On my application, I made it known that I was interested in infectious disease and public health. I was included in the weekly infection control rounds and weekly HIV rounds. I sometimes attended the infectious disease outpatient clinic, also. Every day was different so it is hard to describe the “typical day.” Regular rounds I attended were morning NICU rounds 1x/week, daily review rounds in the pediatrics general ward, and the most educational rounds were probably the teaching rounds that happen twice a week. Once a week the chief and associate chief of pediatrics each take a half a day and have most of the pediatrics patients presented by a student or resident to them and the rest of the rotating medical students. The professor then critiques the presenting and asks questions about the patients while making educational points. Other attendings and specialists are present to answer questions as needed. When a very interesting teaching point or something that no one knows the answer to comes up, the topic is assigned to a resident to present to the department later. I feel that these rounds were very educational and could be quite useful in America. Once a week (on Tue evenings) there is pediatrics teaching conference, probably the equivalent of grand rounds. Here all the assigned topics during teaching rounds are presented along with grand round speakers and other topics that come up.

Most visiting students are given living quarters a short walk from the campus. Since I brought a wife and child with me, we had to find our own living quarters. It was about a 30 minute walk from campus. The dress code is the same as most hospitals in America. White coat, dress shirt, and tie.

I was assigned a specific mentor during my time there. He was a pediatrics infectious disease specialist. He provided me with his home and cell number and went 110% to make sure I was comfortable 24 hours/day. He invited me to conferences that were in neighboring prefectures that he thought I might be interested in and paid for my train fare if we travelled together. He answered all my medical and Japanese medical policy questions, or referred me to someone else who could answer them. He created my whole schedule and adjusted it. Since I trained at the CDC, he even pulled some strings so that I could talk to people at the CDC equivalent at Japan.

At other times, there was usually someone there to help answer questions when I didn’t understand the language or just had something I wanted to know in each ward I rotated at.

Since I had studied Japanese for 10 years and lived there previously, my language made it possible for me to participate in rounds. I am not sure what adjustments are made for those with limited Japanese language skills. All physicians have English skills and there are a good proportion that have trained in America.

I did not get to see patients independently. You only can observe patient-physician interactions as far as I know.

My wife and I would love to live in Japan at some point. I wanted to find out what kind of opportunities there would be to work in Japan if I wanted to work there. I found out that I would have to pass the Japanese national board examination for medicine but if I did, I could probably find a job there.

There are some aspects of working in Japan that make it less appealing. Japanese doctors work very long hours. During residency, they have no days that they don’t have to come to the hospital unless there are special circumstances. The pay is significantly less than salaries in America, often less than half.

I am very interested and may be involved in public policy at one point so the following are things I learned about the Japanese health care system that may affect how I approach health care policy or possible practice in the future.


Japan’s healthcare program has become the standard for multi-payer national health insurance systems due to its consistently low costs, easy access to healthcare, and comprehensive benefits package. Ranked 10th for overall health system performance, 1st in level of health attainment, and 6th in level of responsiveness by the World Health Organization in 2000, Japan possesses among the longest life expectancies at birth at 82 years (2003) and highest per capita number of physician visits (WHO 2005). Moreover, Japan only devotes 7.9% of its Gross Domestic Product to health expenditures while simultaneously maintaining one of the highest computed tomography (CT) and magnetic resonance imaging (MRI) technology distribution rates per capita (WHO 2005; Yoshikawa and Bhattacharya 2002).

So how does a country with an aging population provide such great care and spend so little? I am not 100% certain of the answer, but I asked everyone I talked to. The government sets the rates of payment. Hospitals or insurance companies cannot change how much is charged for 1 hospital day or a medicine. These costs are extremely low compared to America. Going to the ER will usually cost a Japanese person $100-300. Some possible answers I heard were that Japanese people go to the doctor a lot. They are not afraid to go because they think they might be sick. Perhaps they get treated before diseases turn serious. Some physicians thought it was because Japanese doctors work for little money and long hours. Some think it is because hospitals are usually 8+ patient beds/room, they often have older technology and avoid high spending. There are no IV access teams or several different nurse practitioner specialists added to the work force. Another reason might be that there is universal health care. Medical care and insurance is provided to all Japanese citizens, regardless of income. A big factor is probably that Japanese culture is healthier in general. There is less obesity, the diet contains more fish and vegetables, and people walk (to the train station) and ride their bikes rather than use cars.

There are many things I experienced that made me wonder how they managed to spend so little. They keep patients in the hospital for very long periods of time, especially for end-of-life care. I’m not sure of the laws of DNR orders and such, but it seems very hard to impossible for doctors to pull the plug on patients. I was told that even if there is a DNR order, they could still be sued. So there are patients in the hospital for 16+ years, some in comas the whole time. Even for less severe disease, people stay in the hospital longer. Women regularly stay in the hospital for over 1 week after giving birth. 1 week is common for influenza or any common pediatrics infection. CT scans and MRI scans seem pretty common and easy to order.

They also order lots of medicine for everything. Anyone who has a cough gets special cough medicine that decreases the amount of fluid secreted by the airway. Every patient with influenza gets anti-viral medication. I was told that patients strongly desire medicine so they have to give something to them.

Strengths:

-Adjust schedule to student’s preference

-Excellent attending supervision

-Lots of educational rounds, meetings

-Heavy student involvement in rounds and discussions

-Good food in area

Weaknesses:

-Might be hard with limited Japanese skills

-Little patient interaction (if you stress you want more, you can get more though)

-Expensive cost of living

Schedule this week

March 13th: Taisei's 1st birthday

March 14th: Keiko's birthday / White Day (Japanese holiday)

March 15th: When I wake up this day, I should have an email saying whether or not I matched to a residency program. It is Monday, March 14th in American time zones. I will not know which residency program at this time.

March 18th (17th in US): Email will arrive by the time I wake up that will inform me which residency program I will be working in for the next 3 years. Keiko says she already is feeling very nervous. Thankfully, it is still far enough that I am pretty calm at this point. I don't know if I'll be sleeping the night before, though. Update to come.

Japanese earthquake

As many of you have probably seen in the news, there was a powerful earthquake this last week in Japan. It was in the northeast part of Japan. It affected Tokyo, where Keiko, Taisei, and I were a few weeks ago, but did not affect Hiroshima, where we are now. We have friends in the area and are making efforts to make contact with everyone to make sure they are okay.

In church today, most of the talks were on the earthquake. One mother was talking about her daughter who is on a mission near the epicenter of the earthquake. It was a very emotional and spiritual talk. Her daughter is fine. Some of my friends at Keio said there houses took some pretty bad damage. The statue of Moroni on the Tokyo temple made a 90 degree turn. Given the possibilities, I haven't heard anything too bad.

We are all feeling very thankful to have a roof over our heads, food to eat, and our health. Please send your thoughts and prayers and any other assistance you can to those in Japan. Thanks.