industrious ants

All about a life in motion.

Month: May, 2011

In Sickness and In Health


Two weeks ago, on a gorgeous Sunday morning, Matt took off early to go surfing. Just driving out to his favorite beach takes half an hour, and even on days where the waves are bad, he’ll stick it out in the water for at least a couple hours. So when I heard the car roll into the parking lot uncharacteristically early, I knew something was up. I watched as he emerged from the car with a frustrated look on his face and a 2-inch bloody gash across the top of his head. Asking him what had happened almost seemed redundant, because we’ve had more than one discussion about how sharp the fins on his surfboard are, and it seems to be a fairly common injury among surfers. In some ways he was lucky that the fin got him across his skull, and not a fleshier part of his body where the cut could have been much deeper and wider, or worse, across his face.

After jumping on Skype and assessing the damage with his dad (a doctor), he finally heeded my original advice that a trip to the emergency room was warranted, and that stitches were probably inevitable. It’s not what he wanted to hear, but he conceded willingly. The hospital we visited was a simple clinic that deals with cuts and breaks. The facility was a bit older than other’s in town, complete with a 1960’s institution-green paint job, but they were one of the few places open on a Sunday, and they got the job done quickly and efficiently. 7 stitches and no surfing for 10 days. Matt was bummed. Donning on his head a large bandage and a mesh net that made him look like a tough prison inmate, we headed home. I made him a greasy meal of eggs, sausages and chocolate chip toast to try and raise his spirits some. He dug out his favorite hats from the closet and that was the last that many people saw of the top of his head for the next couple weeks.

Typically, neither of us is the sort of person that goes running to see a doctor. Matt grew up with his own personal live-in physician, so I think he just became accustomed to turning to his dad for medical advice. Later, when we lived in Minneapolis, our insurance was quite limited (read crappy), so we self-medicated and home remedied ourselves whenever possible. Even in Japan, where the care is mostly subsidized by the government, we try to ride things out so as not to inconvenience Japanese speaking friends with the hassle of translating, not to mention that sometimes getting sick here draws negative attention. We first arrived in the country smack in the middle of a swine flu epidemic that was spreading through our prefecture. Teachers wore surgical masks religiously and the size of my classes slowly shrank as students started dropping like flies. Disinfectant sanitizer was everywhere and anyone who so much as sneezed was given the evil eye. In the middle of all this, I woke up one Saturday in a hot sweat and found that I could barely lift myself out of bed. We were fresh in the country, barely knew any Japanese and were edgy about the early impressions we were having on new colleagues and friends. I never went to see a doctor out of fear that I would be immediately shipped back to Canada and blamed for bringing the virus with me from abroad. To this day, I can’t say for sure if I had the swine flu, but whatever it was, it was powerful enough to knock me out cold for the entire weekend and left me feeling exhausted for weeks after that. It also happened to be contagious, because I ended up giving it to Matt, who can attest of its great strength. We both threw as much orange juice, weak over the counter Japanese meds and sleep at it as we possibly could. I have never missed Nyquil and Tylenol so much as I did then. Eventually we bounced back, but it was a miserable, drugless, recovery.

The first time I actually visited a doctor in Japan, I wasn’t even sick. Every year my school requires teachers to do a mandatory health check. Depending on your age, you must take a variety of tests. Mine included a urine test and blood work, as well as a chest x-ray, sight and hearing test. Older teachers have to drink barium milkshakes and get their guts inspected. You can even apply for an optional MRI if you are willing to pay the extra 100$. Overall, my results were good, but I was pretty surprised when I was told that my blood sugar levels were too low and that I should be monitoring them closely. They letter grade your check-up here, like a high school report card, and I scored a C on my glucose levels. My family has a history of diabetes, so the results sent me into a mini panic, until I talked to Matt’s dad who took a look at the results and said that by North American standards my sugar levels were just fine. Actually, they were the sort of results most people envied. To learn that two developed nations could have such different standards of measuring a person’s health was an eye-opener and it would not be the last time I encountered differences in our systems of diagnosis and treatment. At first, it made me somewhat distrustful of the Japanese level of health care.

It was Matt’s mysterious rash-incident that loosened me up a bit. A couple weeks after arriving in Japan, Matt’s chin started turning red and bumpy. His goatee hid it for the most part, but anytime he shaved the area we could see that there was obviously something not right happening there. Over the course of 4 or 5 months he tried everything, from peroxide to anti-fungal creams. Nothing worked at ridding his chin of the strange rash. I thought for sure it had to be a sub-tropical infection of some sort. We unofficially dubbed the ailment the Chin-Kansen, a play on the name of the fast Japanese trains, the Shin-kansenkansen, meaning both ‘main line’ and ‘infection’. Fearing that his chin-kansen would spread faster than a bullet train, we finally recruited a Japanese speaking friend who accompanied us to see a local dermatologist. The doctor’s diagnosis- vitamin B deficiency. His remedy – vitamin B pills and a topical vitamin B cream. He also told Matt not to shave for a while. I thought the guy was a certified quack and that his prescription was absurd. Obviously, what my husband really needed was some serious antibiotics or strong antifungal meds. How could that ugly red splotch have anything to do with a little less spinach in his diet? But after a week of the treatment, the rash cleared up almost completely and it hasn’t been an issue since. I was utterly dumbfounded.

Since then, I’ve been a bit more open-minded about doctors in Japan. It’s a good thing too, because between the two of us, we have probably visited close to every sort of hospital in town. I guess it’s not that surprising seeing as Matthew is a fairly active guy, and as of late, I’ve been a fairly pregnant gal. Matt has had a total of 11 stitches sown into him in Japan; 7 for his head, and 4 for his leg when he needed a strange growth removed last year. He also had a minor car-meets-bike accident, which resulted in a thin layer of skin from his heel being torn off his foot. In the end, it just needed some cleaning and disinfection and a day or two of using crutches.

Aside from Matt’s most recent surfing adventure, being pregnant has been the most intensive health issue we’ve dealt with in Japan up to date…and it’s obviously far from over. In less than a month I am scheduled to give birth. It’s one visit to the hospital that won’t be a surprise. It won’t matter if there is a translator at my side, or a personal understanding that everything happening to my body is completely normal, I know it will be overwhelming. I hope I don’t yell at anyone, and I really hope that Matt doesn’t pass out.

In light of all this, it’s a good thing that we have had a chance to test the waters of the local system over the last couple of years. Coming to a point where I feel like I can trust the medical professionals involved in my care helps a lot. The last thing I want to do be doing on the birthing table is second-guessing all the procedures happening and cursing at all the masked faces trying to help me (but maybe the cursing part is unavoidable on this sort of occasion). Of course, I don’t want to just blindly accept everything either, and there are definitely aspects of medical treatment in Japan that differ from what I grew up with and would prefer. Thankfully they are not big enough to make me want to run back to Canada to have this baby. The only reason I would choose to be home for the birth is to be closer to my family, but logistically it wasn’t the most convenient option.

People ask me if I am scared or nervous about having a baby in Japan. Overall, I don’t think so. For me, what’s scary is the actual ‘having a baby’ part. Whether I have it here or there, it’s going to come out in the same way babies have come out since the beginning of time…painfully, messily, and miraculously, at least that much I know is true. As for the medical side of things, I’m not really nervous. For one, Miyazaki prefecture is rated as one of the top regions in the country for obstetrics, even higher than Tokyo apparently, which might have something to do with the higher than average birth rate in these parts. In any case, that alone gives me some peace. Other than that, if I ever feel any doubts, all it takes is one look at the World Bank Infant Mortality list to feel a little more assurance. If I was in Afghanistan or Mali or Chad, maybe there would be statistical reason to worry, but I’m not. I’m in Japan, and I feel pretty fortunate to be here.

You can check out world infant mortality rates here:
http://data.worldbank.org/indicator/SP.DYN.IMRT.IN?cid=GPD_55

Our health care adventures will surely continue as we approach a chapter in our lives where we don’t just have to care for ourselves, but for the life of a new third party. Hopefully we will continue to remain optimistic about the care we receive in Japan, and that it will prove itself worthy, but likely there will be bumps along the way. I suppose it goes with the territory of neither speaking Japanese nor the secret language of Shrill Baby Screams. In time, I hope we can master both. I’ll keep you posted on our progress.

May 26, 2011

Taking Care of Business

Working hard so we can keep swimming in circles.

 

Japanese people work hard.
I must have said this at least a dozen times before, but it’s probably worth repeating because a person’s job in Japan can take precedence over everything else in their lives, from their families to even their sanity. It can be hard to fathom the extent of this reality until you immerse yourself in the system for a little while.

I had heard about the workaholic nature of the country before, but had a hard time noticing it when I first arrived. I did note the differences in customer service though. In comparison to Canada, it felt like I could walk into any 7eleven here and be treated like a queen just for buying a pack of gum. Back home, I’ve literally had my change thrown at me instead of politely handed back. Other than that, I saw no huge differences right away. I gathered that the locals in town enjoyed going out to eat because restaurants were always busy. It looked to me like people were enjoying life and perhaps many were. However, I’ve discovered over time that the popularity of eating out might not equate to a leisurely society bent on having a good time, but rather a people who are too tired or busy to cook for themselves, or who are even socially obligated to attend dinners out with colleagues.

It’s been a slow learning experience, and in the beginning I was pretty naïve. At the busy school where I work, things didn’t seem all that out of the ordinary to me. I knew from the beginning that my position as an Assistant Language Teacher (ALT) would hold less responsibility than that of my colleagues. The others taught more and worked longer days, but I felt it was probably justified as they received twice the vacation time I did and certainly made bigger salaries. I had no real complaints about my work arrangement and none of the other teachers complained about theirs. So like I said, I wasn’t entirely sure where all the stories about people losing their minds or working themselves to death were coming from. Not yet anyway. There is only so much information one can gather from being a fly on the wall, especially if you are a fly that understands next to no Japanese. Basically, my first six months in Japan were like watching the movie Lost in Translation on mute. Lots of great visuals, lots of interesting looking people, a few good guesses about the plot, but almost zero understanding of what was actually going on.

Over time, the volume has been slowly turned up. Almost 2 years in, I feel like I have a much better picture of the education system. More trust has been built between friends and coworkers and they generously share some of their deeper thoughts and stories with me. I can understand more of the language, both verbal and body. All this reveals a much more complex working environment than I was first aware of.

It would take me all day to put down onto paper what I think I know about the Japanese working environment, and still there would probably be huge gaps and discrepancies. My school is probably the only example I could describe with some sort of accuracy. Teachers here begin their day early, as some classes start at 7:30am. Saturday classes happen about 2 to 3 times a month. On average, they teach about 15 to 17 classes a week. When they aren’t teaching, they are correcting papers, furiously flipping papers and marking away with their magical red markers. There is an endless amount of worksheets and tests being formatted and photocopied. The 45-minute lunch break is an illusion. Most teachers usually eat their meals during the first 15 or 20 minutes and then spend the rest of their time meetings with students, either correcting tests and worksheets or reviewing class schedules. Classes finish around 4pm, and then more students line up outside the teacher’s office for one-on-one meetings if any further study issues need to be addressed. These are the immediate responsibilities of a Miyazaki teacher, and there are definitely more.

Most teachers are assigned various roles within the school system. Some are heads of departments, such as the Math department. These departments usually meet every week and they must attend and lead them, or administrate any department events. Others are assigned positions as home room teachers. This is a big responsibility. In a sense, they become substitute parents, as they spend more waking hours with their students than parents do. Any discipline or counseling one might need falls on the shoulders of the home room teacher. At least once a year there is a parent teacher meeting that takes place, but parents don’t come to the school for it. At my school the home room teachers use summer vacation time to personally visit each of their 40 student’s homes. It is a tiring and time-consuming process.

Beyond all this, regardless of their role in their class or department, they are obligated to coach or supervise school teams and clubs. Almost without exception, every teacher (and student) is affiliated to one of these groups and therefore must join most of the practices, meetings, games and tournaments. This wouldn’t be so bad if they were only weekly events. Unfortunately, many teams practice every day, and often on weekends. Games and tournaments are often held on holidays so that parents can attend and students don’t have to miss classes. I’ve learned to stop asking my colleagues what they did on their three-day weekends, because without a doubt they were probably volunteering their time with the badminton or soccer team instead of sleeping in and eating brunch with their families.

As if all this wasn’t enough there is still the matter of the enkai. Work parties, known as enkai, are held on a regular basis. There are only a few where all the teachers attend at once, the most popular celebrating the school year’s start and end, and the winter holiday. There are many more related to specific departments and a few that mark events such as the annual Sports Day or even seasonal changes, like the ever-popular Cherry Blossom Viewing picnic in spring. The cost of attending a years worth of enkai definitely adds up. It can be hard to avoid them because they are seen as an essential part of building stronger relationships with colleagues, and many people feel obligated to attend, even if they don’t want to. Thankfully it’s one of the few work related places where people can let their guard down and be themselves, or at the very least get pissed drunk and sing as many versions of Take Me Home, Country Roads as they damn well please without being kicked out of the Karaoke room.

So, looking at all of this, one has no choice but to wonder what the overall affects are on the people that are caught within this system. Obviously families suffer. Lots of teachers remain unmarried because they find it hard to meet people outside of work. Alternatively, there’s a high proportion of teachers at my school who are married to other teachers. School is their world and marrying someone on the inside makes logistical sense. Who else would better understand the rigorous schedule and work obligations of a teacher, than another teacher? Still, it can’t be easy. Your partner may understand why you are never home before 9pm, but it doesn’t change the fact that you never see each other. A busy friend recently told me she and her husband are trying to have a baby. Unfortunately, as they are both teachers, it makes it difficult to find the energy or the time, and she is forced to plan sex into her schedule about once or twice a month. She told me a friend of hers did the same thing, strategically pre-scheduling sex about once a month, and it worked, but so far she’s had no luck.

When it comes to kids, there is usually one parent, usually fathers, who must sacrifice time with their family in order to educate someone else’s child. For reasons unknown, the latter seems to be the more admirable choice in Japan. Teachers who request less school responsibility in order to spend more time at home are frowned upon. Last year a female teacher retired from her position after only 1 year back from 3 years of maternity leave. Knowing she had two young children in daycare, the school still made her a homeroom teacher and team coach, which essentially guaranteed her a fair amount of obligatory overtime. When she confided her discontent to friends about the schools decision, she received little sympathy. Generally, their opinion was something along the lines of “If you can’t take the heat, stay out of the kitchen.”

Through all this, I am surprised at how healthy my colleagues look. They cover their tiredness well with make-up and caffeine, and whatever else keeps them moving. Still, you can be sure that the stress and pressure eventually takes its mental toll on some people. Three teachers thus far have left our school because they became sick and unable to perform their required duties. Last year, after an unsuccessful attempt to return back to his position, one of them ended his life.

I don’t want to delve too deeply into the personal affairs of my colleagues. I feel like I’ve learned things in confidence, and writing them here, even without naming my school or my town, feels like I’m somehow betraying their trust. But then again, it’s not like my school is unique. In offices and factories all across the country people devote themselves to their employers beyond what seems reasonable. Sudden death by overwork happens enough that there is actually a word for it in Japanese; karōshi.
http://www.newser.com/story/12965/japan-to-pay-widow-after-husband-dies-of-overwork.html

It’s hard to understand why the system continues to function this way, but I suppose people keep doing it out of a sense of duty or a fear of change. They aren’t oblivious to the issue though, and on occasion someone will take a break from their busy day to come and chat with me about the weather or American politics, and somewhere in there they will lament about the way things are in the Japanese work system. It usually ends there, and then we both get back to work.

May 11, 2011