Originally published January 2015 online http://www.aapmr.org/news-publications/newsletters
Part 1 — Before Japan
I have recently begun a 4-week trip to Japan for an international clinical and research elective, which starts on February 1st, 2015. I feel fortunate to be selected to participate in this exceptional opportunity, the first of its kind for a PM&R resident. The rotation represents the culmination of several decades of physiatry research collaborations and partnerships between the Johns Hopkins University and Fujita Health University (FHU), spearheaded by the former department chair of Hopkins PM&R, Dr. Jeffrey Palmer, one of the world’s premier experts in deglutition research and dysphagia rehabilitation.
Amidst filling up tomes of requisite administrative and legal paperwork, official ratifications of documents by both institutions, concatenations of congratulatory e-mails and discussions with colleagues at FHU about scheduling, attending national board meetings of the residents’ physician council and finishing up a demanding physiatry-consults rotation, my last two months have been a frenzy of consuming commitments. Yet, I am beyond giddy with excitement as I look forward to my first trip to Japan, a country that continues to bedazzle many with its unique cultural tapestry of traditional values interwoven with modern lifestyles and first class technological wonders: elaborately adorned kimono-clad geishas meets the Pearl Bridge across the Akashi Strait; Zen-bequeathing ancient sacred temples clash with rapidly-accelerating super-high speed bullet trains (Shinkansen) — it is a world of contradictions, simultaneously quixotic, and at once beautiful.
As part of months of preparations, I’ve been scurrying internet websites (the Japan National Tourism Organization & Trip-Advisor), guidebooks (Lonely Planet & National Geographic), blogs, social media, news-outlets — to cull bits of wisdom about what to expect. I’ve been advised to pack lightly but to stack up on winter clothing, as February tends to be the harshest of the winter months. I’ll be in Nagoya, the largest city in the Chubu region of Japan on the Pacific coast of central Honshu — the largest and main island of the Japanese Archipelago, with Tokyo as its capital. I’ve gathered that Tokyo tends to be a major tourist attraction, a bubbling metropolis of culinary delights and Japanese architectural masterpieces. Nagoya, however holds its own with grand museums, is home to the Toyota Manufacturing Plant and the Nagoya castle, which is featured in classic American films such as the Godzilla trilogy of movies. With so much to see in a short time, I plan to focus my itinerary on the major national monuments and neighboring cities of Kyoto and Nara. Excellent and reliable public transport systems promises to make for an easy adventure of inter-and intra-city travels.
A central aspect of cultural immersion during international medical and clinical rotations is knowing the local language. Coming from a family of polyglots adept at languages, I was drawn to the Japanese language’s phonotactic and phonemic vowels and picked up some basics about 15-years ago from next-door Japanese neighbors prior to moving to the United States. Having been out of practice for more than 10 years, I’ve been frantically brushing up on my rudimentary Japanese phrases, with renewed focus on medically relevant terms. I anticipate that knowing the basics would make for easier communication and more meaningful interactions during my time in Japan.
One of the things I’m curious about is how culture and societal norms shape the practice of physiatry around the globe. As a result of its historical and geographic isolation, Japan appears to remain genetically and culturally homogeneous. It is the fastest aging population of any country in the world, with about 25% of its populace constituting of adults 65 yrs or older. (1) Its life expectancies of 78.9 years for women and 73.5 for men are the highest in the world. (2) That more people are living longer presents intriguing challenges for Japanese geriatric rehabilitation, with potential lessons that could be applicable to the United States. A recent study comparing stroke rehabilitation outcomes between the two countries indicates that Japanese health insurance covers longer days of hospital stays in rehabilitation with average length of stays of 90–120 days, in sharp contrast to an average of 26 days in the United States. (3) Patients are thus more likely to be discharged home than to a nursing facility. From a physiatry resident’s perspective, this would make for a fascinating educational experience, given the potential to be able to follow disease pathology and rehabilitation of impairments for a longer duration than is possible in the United States.
Related to this, it appears that the cultural approach to disabled persons differs between the two countries. Some attribute this to the Japanese embrace of a more communal rather than atomistic individual world view. So for example, in Japan the term “welfare” has a much more broad, positive and literal meaning — it refers to promoting the wellbeing or welfare of Japanese citizens — whereas, in the United States, “welfare” has a more negative connotation; it conjures images of public dependence, charity, and poverty. The Japanese term for disability — shōgai — represents a hindrance or obstacle in one’s path and seems to capture disability, impairment, and activity limitations in one word, although they do accept the English distinctions and differentiation of these words in accordance with the World Health Organization’s international classification of functioning disability and health. (2)
With the rarity of international electives during PMR residency, the elective in Japan provides an exposure to rehabilitation systems and frameworks in a different culture. From a personal perspective, I hope to have a career that involves global rehabilitation work and this marks the nascent stages of that process. The experience promises to be a culturally enriching and academically rewarding one, which would expand my global purview of rehabilitation. I am eagerly looking forward to learning more about the contrasts and similarities of physiatry in Japan vs. US and sharing my reflections with fellow PMR residents. In Part 2 of this series, I will discuss my research at FHU involving innovative use of three-dimensional visualizing of swallowing via a 320-detector-row multi-slice CT scanner to better understand deglutition and dysphagia.
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