by liberal japonicus
It is another example of ObWi synchronicity that Sebastian writes about fears just before I went under the knife (that's a phrase) If you really want to crank those fears up to 11, aim for a long convalescence in a hospital. I suppose you can become accustomed to it, but getting old isn't the problem, it's getting helpless. I'm on the mend, and I should be back to ADL in a week or so. Interestingly, according to that wikipedia page, another acronym for ADL was DEATH (dressing/bathing, eating, ambulating (walking), toileting, hygiene) Wonder why that didn't catch on. But Sebastian's post plus a close up encounter of when ADL is not a given really make things jump out at you.
I'm at a university hospital for this prostectomy, using the Da Vinci machine. Since everyone is talking about their age, I'd suggest that dealing with prostate enlargement earlier is probably better than what I did, which was ignore it until it got really bad and then found I had cancer that I may not have needed to treat, but the prostate was twice the size it is normally, so I opted to have it removed. If I had dealt with it 5 years earlier, I might not have had to have the surgery.
Obviously, at a uni hospital, with students around following the doctor, student nurses on rotation and such, it's nice. The ones who want to be doctors seem to be on a short leash, I've got a student nurse who seems to have a lot of time and is just shadowing people to see what to do. Seems like a good system. They need a 4 year degree (don't know if a 2 year degree is a possibility) but they have to pass extensive tests to become nurses, so they don't have a problem that they have in a lot of Japanese education where the entrance exam is the main hurdle.
There is a concept in Japanese called omotenashi, which is poorly translated as hospitality. Japanese like to break it out to explain why they are so nice, but it's a double edged sword, and it can be controlling, telling you how to eat your dish and keeping track of all the minute rules involved with just about every social interaction. . There are, it seems to me, a lot of foreigners who make Japan their home. I've got no way to quantify that number, but in talks I give to folks beginning their Japan soujourn and deciding if they want to stay, I tell them not to assume that everyone stays because Japan is such a wonderful place. That is not to say it is not wonderful, but it seems that a lot of people stay because of an impression of sunk costs. I realized this when I was in Vietnam with a group of students and teachers and we went out for pho, the heavenly Vietnamese noodle dish. With the bowl of noodles, you get a bunch of leaves, lime slices and other stuff. I started asking my dining partners how I was supposed to eat it, do I put the leaves in first, how many lime slices to squeeze, yada yada yada. Finally, one of them said 'just eat it the way you like'. While I'm sure part of my epiphany was due to the noodles, another part was realizing how much one gets in a groove in Japan thinking how certain things had to be done in a particular way. The idea of going to another country and relearning all that, or even going back to your home and trying to figure out what has changed, become daunting.
As I'm not having any complications (so far), I only have the occasional visit from the doctor so most of my observations are about nursing. I've got no idea how realistic medical shows are about how hospitals work, but even taken with a grain of salt, nursing seems better paid and 'easier' here. That "easier" requires some qualifications. It seems to me that nursing, at least as it works in Japan, looks a lot like blue collar labor. Before I go any further, I don't want anyone to assume I'm looking down on blue collar labor. In fact, I think one of the big problems of our modern world is that we don't give blue collar work its due. So when I say that nursing in Japan seems to be blue collar work, I'm not dismissing what they do.
And when they do it (with the technology backing them up and the previously mentioned omotenashi), it is quite nice. Each nurse has an ipod set up with face recognition. Everytime they administer a drug, they either ask me my name or scan the bar code on my wrist band. The face recognition records their face, and they also take a picture of whatever they are administering, down to the lowliest saline solution. They have a cart with a networked Thinkpad where they record my blood pressure, temp and oxidation level so the doctor has a full timeline of the patient's condition if it goes south.
The demographics of nursing is pretty interesting. Almost entirely women, this is a university hospital that is quite busy, so the nurses tend to be in their 20s. The general pattern is to work and then leave the job to marry, or to move to a smaller hospital that is not as busy in the late 20's/early 30's. I asked if people come back to work after getting married and having children and was told no, not really, which is not surprising, because the Japanese mother's workload in education is quite extensive.
I've heard that there are shortages in nurses in the UK and US, and there are also shortages here, though not to the level that I have read for the UK. However, the nurse shortages here are exacerbated by the difficulty that foreign nurses have in working here in that they have to pass not only all the nursing tests, they have to reach a very high level of Japanese fluency not only to pass those tests but also to pass other language tests. I, despite living in Japan for 30 years, would have difficulty passing them as well. In jobs that don't require that level of medical knowledge, that of care workers who "just" have to assist in ADL, there are still huge hurdles. This reinforces a belief I've had, that if we were able to invert the wages, so that people who handled children and taking care of the elderly had the highest compensation and people who got to do easy stuff like teaching university students were towards the bottom, we might have a more just society.
My last observation is that there is really no way in a civilized society that a health system should be for profit. Because if it is, there are going to be so many opportunities for someone to cut corners or boost revenues by cutting back on something that you get to a point like Lord of the Flies. My hospital stay after my prostatectomy is ten days to 2 weeks. In the US, it's 24 hours after the surgery. So yeah, maybe I'm a stupid liberal ignoring the wellspring of our entreprenurial energy, but if that energy is generated by making it more and more expensive to spend time in a hospital, maybe we've got the balance wrong. But if the goal is to profit, then you are going to have things like this: Not criminal, but making it so everyone else has to pay a cost.