Doctor Doctor! (病院へ行こう!)

“Hello, my name is Ben and I’m an asthmatic.”

(Group voice) “Hello Ben.”

“Well, I’ve been without a puff of my meds for going on two weeks now…”

(Collective nods and murmurs of acknowledgement)

-----

Yesterday was spent on a near all-day medical adventure that culminated with the filling of my very first Japanese drug prescription.

I arrived at the Ehime University Hospital at 9:30 in the morning. I began by filling out a registration form with my name and contact information. In Japan, the patient must also circle the specific medical area for which they are seeking treatment that day. There are separate symptom cards for internal medicine and for everything else (such as, eyes, pediatrics, etc.).

I selected the long string of kanji that referred to the lungs and respiratory system on the internal medicine card. Check-in was as easy as handing the receptionist my info form and national health insurance card. I was then instructed to take a seat and wait.

During your first hospital visit, you are given a unique magnetized data card that stores your name and contact information. Thus, repeat visits simply require you to scan your card at one of many automated check-in machines. The machine accesses your file and spits out a slip, telling you when and where your appointment will be held.

I was instructed to go to the internal medicine wing and sit in the “waiting room.” The area wasn’t so much a traditional “room” as it was a series of chairs and benches lined up in the hallway. I must admit that it was a little odd to see so many people of all different shapes, sizes, and ages queued up in such a small space. The entire hospital seemed flooded with outpatients. My boss later told me that hospitals in Japan usually get crowded on Mondays and after holidays.

When it was my turn to be seen, my name was called and I was brought into exam room #14 and greeted by Dr. Chika Sato. She was very friendly and had read over the note provided by my American asthma doctor explaining my symptoms and current medications. She didn’t understand one of the English words that my doctor had written in his description. Turns out, neither did I. Humorously, we both laughed and took out our electronic dictionaries in order to gain a better understanding of the vocabulary word, me fishing around in English, her in Japanese.

She asked me some generalized questions about my asthma, listened to my breathing with a stethoscope and conducted a peak flow reading. It was just like a trip to the asthma doctor back home, albeit entirely in Japanese. Based on my experience, going to the doctor in Japan without a working understanding of the language would prove to be very difficult, as no one generally speaks English. If you must go and are not fluent conversing in Japanese, it might be best to bring along someone to act as an interpreter.

Dr. Sato said my saturation was a little low and told me to come back in a month for a follow-up visit. With that, she wrote me my prescriptions, smiled, and said I could go.

I made my way to the payment counter and subsequently experienced the biggest sticker shock of my life. I paid a whopping $9.52 for my entire checkup at the hospital. Since Japanese national health care pays for 70% of any medical care or prescriptions, this means that the grand total for the visit was only a little over 30 bucks. In America, this exact same asthma checkup at my local clinic would have run me into the hundreds of dollars, even with insurance coverage. I guess this explains the general lack of Ferrari driving dermatologists cruising around the streets of Shikoku.

The hospital automatically faxes your prescriptions to a pharmacy of your choice for easy pickup. I had mine sent to the pharmacy conveniently located across the street. All that was left was to stroll over and pick up my medication.

My current asthma medicine is the Advair Diskus (500/50 strength) manufactured by Glaxo Smith Kline. It is a combination of the two drugs Serevent and Flovent that I used to take via separate inhalers as a child.

Prior to leaving for Japan, I visited my neighborhood pharmacy to fill a prescription of Advair to take with me. Since I was without medical insurance, the pharmacist told me that the price for a single inhaler with a one-month supply of medication would be over $300. After some button pressing on the computer, he was able to bring the price down to somewhere in the ballpark of $280.

The price was simply too high for me to pay. I walked out of the pharmacy without my medication and left for Japan a few days later. I had no choice. In this case, I could only feel genuinely grateful that I didn’t have to take the medication everyday in order to live.

Yesterday I purchased an Advair Diskus asthma inhaler in Japan. The dosage and manufacturer are identical. The only difference is literally that the Japanese product has kanji characters on the label. I paid $26.14 for a one month supply. I couldn’t stop shaking my head as I paid. I was truly in disbelief.

I brought up the subject with my boss. She said that the $9.52 I paid for my hospital check-up was actually pretty high by Japanese standards. I genuinely burst out laughing. According to her, even cancer drugs typically run less than $100 per prescription. $100 for medicine is so astronomically high by Japanese standards that the hospital will often conference and give you advance warning if it is likely you will have to pay that much.

In summary, I am a foreigner living in Japan. Despite being a foreigner, the government has granted me the exact same universal health care coverage afforded to citizens. Yesterday I was able to receive a hospital checkup and fill my prescription for well under $40 USD.

To all those who still oppose the idea of universal health care coverage for all Americans, all I can say is,

It’s time for America to cut the bullshit and get on board!

B.E.W.

My Japanese Advair Diskus asthma inhaler.

Animal House (とべ動物園)

Happy Autumn Equinox Day!!!

Since yesterday marked yet another seemingly random Japanese national holiday, I had the day off. SCORE! With no grand plans in mind, I headed off to the Tobe Zoo. Tobe is a town neighboring Matsuyama City and is famous for its zoo and also its pottery (known as tobe-yaki in Japanese).

The Tobe Zoo is a pretty popular tourist attraction here in Ehime Prefecture. In fact, one of the adult students in my faculty class was telling me how her children love visiting the place to see the giant hippo. She recommended I go. Indeed, the Tobe Zoo seems to be the amusement area of choice for the average Ehime family. I can safely report that there were no fewer than 10 billion children screaming, laughing, crying, and running amuck inside the zoo grounds.

While I have only been to a few zoos in Japan, I have yet to leave the experience without harboring a feeling of general uneasiness. One of the main aspects that bothered me about the Tobe Zoo (it was the same at the bear habitat I visited in Hokkaido) was the feeding / performance aspect.

Since animal food dispensing vending machines are located throughout the zoo, the whole idea is that patrons will buy bread / chips / fish etc. and chuck it at the animals as they beg for food. I didn’t know tree monkeys in the wild ate curried rice chips. Half the time the food doesn’t even make it in the cage due to bad aiming on the part of the gawking visitors. In these cases, you’ve just effectively taunted and teased the animal. I’m sure that’s great for the psyche.

While I am by no means a veterinarian, several of the animals also looked sickly and malnutritioned. I felt sad when I saw the matted coat of the orangutan, the rotting tusks of the elephants, and one very skinny gazelle with its ribs protruding.

While it is always fun to point at your favorite critters and snap pictures of all the animals, there is something about Japanese zoos that doesn’t mesh well with my sense of kindness towards animals. I suppose one could easily argue that any zoo, no matter the location, is cruel and unnatural for wild animals.

Maybe I’m bringing too much of my foreign (Western) mindset to the experience. I don’t know. I mean, the tons of Japanese families at the park seemed to be having a simply great time chucking chips at the monkeys.

B.E.W.

The front entrance to the Tobe Zoo (とべ動物園).  Any unhappiness with a tourist attraction quickly fades when the admission fee is a mere 300 yen.

Flamingos!  I could put them on my lawn, assuming I had one that is.

Her evil-looking glare sort of bothers me.  I make it a rule of mine to never trust pink creatures, they'll get you every time!

Presenting to you the most beautiful and majestic creature on this crazy little planet we call earth.

Penguins at play!

Drying off after a cool dip.

This seal is waiting patiently for one of those delicious vending machine sardines at 100 yen a pop.

This one has taken the more direct approach of loudly barking nonstop until fish end up in his mouth.

Just your ordinary run-of-the-mill llama.  They also had standard horses and raccoons on display as well.

This ugly South American Tapir was the animal that decided to do an about face and spray pee all over me.  Look at him smiling, he's happy about it!

Me speckled with drops of tapir urine.  Having already received such a special souvenir, I didn't even bother with the gift shop.  

Even big cats like this jaguar here need their beauty rest.

Action shot of a panther on the prowl.

This is right before the tiger started pacing back and forth, growling, and gnawing at its on leg.  I think it was aggetated by the flash on my camera.  I'm sorry tora-san!

I'd lounge around all day if I were a lion too.  Especially in the shikoku heat!

Sticks make great play toys.  I miss my kitties Simon and Theo!

Great, so now they decide to warn you about the whole "getting pissed on by the animals" possibility.  A little too late in my case.

Severely malnutritioned looking gazelle.

Me waiting to catch a glimpse of the hippo, affectionately named "kaba-san" or "Mr. Hippo" in Japanese.  He is one of the star attractions at the Tobe Zoo.  The posters and pamphlets always show him opening his huge four toothed mouth in order to graciously accept carrots.  The carrots are available for purchase from a vending machine next to his tank.  I guess Mr. Hippo wasn't too hungry this afternoon...  

I guess kaba-san is not into the whole picture-taking / hamming it up for the crowd scene.

This was the best shot I got of the antisocial kaba-san.  My encounter certainly wasn't like the one pictured on the pamphlet.

Zo and baby zo.  Hey, you've just learned an animal name in Japanese!

This was the elephant whose tusks looked like they needed some serious periodontal maintenance.

Rafiki here doesn't look too pleased to meet my acquaintance.

I absolutely loved this monkey! He looked so wise and all-knowing with his fluffy white beard. He must be the Yoda of the Tobe Zoo monkey community.

Mister bear here doesn't get to go back home to his posh mansion in To-on City like I do.

This is my "MAN!" tofu purchased today at the supermarket. The full product name is actually "handsome man" tofu. Women should not even look at the packaging! Since I purchased a fair amount of groceries, I got two free spins of the prize wheel. I won both times and walked away with $15 in vouchers.

Update #1: The tofu was very creamy and soft with a light musky flavor. It paired well with green onions and ponzu. However, I fear that the musky flavor might be a little too strong for other dishes.

Update #2: My fridge decided to die on me right after I bought all my nice new food. What bad timing! Without the luxury of refrigeration, today became official "drink your milk and eat your tofu before they spoil" day.

Scenery

Below are a few pics I snapped while walking around the vicinity of my apartment.  Check them out for some shots of Japanese nature in action!

B.E.W.

The picturesque mountains of To-on City.  One of these days I'm going to go hiking up there with a professor who is in one of my faculty English classes.  He knows all the trails and wildlife up there.  He says the thing to watch out for are packs of wild boars (inoshishi). 

The dry riverbed near where I live.  There's a neat little picnic area nearby where elderly Japanese people seem to congregate no matter the time of day.

Here is a picture of a particularly neat looking cloud I saw.  I thought it looked like a giant foot squashing To-on City!

According to its packaging, Black Black chewing gum from Lotte has a "high-technical excellent taste and flavor."  I picked up a pack at the local conbini (convenience store) this afternoon.  Black Black's claim to fame is that it is the world's first caffeinated chewing gum.  Each stick also has a bunch of other junk in it like tea extracts and ginko.  I guess it's sorta like chewing a Red Bull.  

Having jammed four sticks in my mouth, I can report that any sort of "pleasant" flavor is only temporary.  After the sugary coating has warn off, Black Black gives you the sensation that you're chewing a mixture of Binaca and charcoal.  I'm not sure how much caffeine resides in each stick.  Maybe it wasn't the best idea to chew a bunch of this before bedtime...    

I guess you can go to this place to pre-order a tombstone for that special relative you can't wait to see gone.

Alcohol specific vending machines seem to be slowly fading away from public places, though you still see some here and there.  This machine sells sake varieties in white peach and grape.

Since it was pouring rain, I decided to buy canned oden (Japanese wintertime stew) from the vending machine. Ever since I first saw this stuff in Akihabara, where it is insanley popular among the otaku (nerd) culture, I've always been hankering to try some. The can actually came out piping hot, so you could eat if right away it you wanted. I saved mine for dinner.

Here's the entire vending machine I spotted while walking around town. I want to carry around a jug of beer like an old-timey prospector!

A close-up of the giant jugs of beer available for 1020 Yen (I think).  This vending machine looked so old and dilapidated that I was afraid to insert money.  Still, it might have been worth it for the sheer novelty of walking away with that much booze in my backpack.

Here's the completed oden with the added grilled fish I made.  It actually wasn't half bad.

The Pumpkin King! (かぼちゃカーニバル)

The closest supermarket to my apartment is located in an outlet shopping center known as “Cool’s Mall.”  While biking to the supermarket yesterday afternoon to do some grocery shopping, I suddenly found myself smack dab in the middle of the annual Pumpkin Carnival.  Go figure!

I arrived near the tail end of the festivities, but  still had enough time to see all the prizewinning gourds.  In keeping with the traditional matsuri (festival) atmosphere, there were little booths selling yakisoba, shaved ice, and pumpkin and red bean mochi.  I bought some takoyaki (octopus balls) which were sadly not pumpkin flavored.  I ate them while looking at all the different pumpkin entries, some of which were quite creative as you can see from the pictures below.

At one point there were a bunch of guys atop a platform tossing out mystery doodads to the audience.  All the kids began scrambling and going nuts for the trinkets, so I can only guess that they were prizes of some sort.

When volunteers started circling around with donation boxes in order to, “help keep the Pumpkin Carnival alive,” I figured it was a good time to leave and continue with my previously scheduled grocery shopping.

Enjoy the pumptastical pictures below!

B.E.W.   

Just a small sampling of the different festival entries. In Japanese, the word "kabocha" can refer to both pumpkins and other types of gourds.

Here was the grand prize winning pumpkin from the 2008 Pumpkin Carnival. While taking this picture, the grower / owner came up to me and struck up a conversation. He insisted on taking multiple pictures of me posing next to his gigantic gourd. I can only hope that one of the shots ends up on the front page of the local paper.

This pumpkin was sadly only a runner-up.

Pounding out the mochi. These were filled with a mixture of pumpkin and red bean.

Smokey the Bear Pumpkin?

Prostitute Pumpkin

Gogoshima (興居島)

Yesterday Cara and I put on our safari hats and headed to the nearby island of Gogoshima for a taste of the simple life. Gogoshima is one of two islands off the coast of Matsuyama City here in Ehime Prefecture (the other is known as Nakashima). Both islands are easily accessible via a 15 minute ferry ride that leaves from a port on the outskirts of the city.

I was told that the primary function of both Gogoshima and Nakashima is to produce the mikan (mandarin oranges) that put Ehime Prefecture on the map. True to form, our hike through the southern tip of the island revealed groves upon groves of mikan trees stretching on through the rolling hills.

The main locations of interests on Gogoshima are two medium sized mountains for hiking, as well as a beach area located on the backside of the island. Gogoshima is also home to an elementary school, junior high school, and hospital, so civilization on the island does exist.

Given that there were so many hills of varying sizes on the island, it was difficult to locate those two specifically designated for hiking. I don’t think we ever found them. We did however take a long walk that took us from the port to the beach and then through the mikan groves.

I saw garden snakes, lizards, jellyfish (or perhaps something manmade that resembled a jellyfish), herons, and TONS of spiders. The vegetation on the island seemed lush and diverse, but since I know absolutely nothing about plant life, I can’t act as your botanical guide.

By far, the best thing about the trip was meeting all the kind folks on the island. Since we decided to hike away from the port area, we quickly found ourselves trekking down an isolated road in the middle of nowhere. Houses dotted the roadside to the right as waves crashed at the beach to the left.

Though we had both packed water bottles, I took the opportunity to ask literally the ONLY other humans I saw, a passing elderly Japanese couple, for a recommendation on where to get some water. After the husband gave me directions to a nearby vending machine, the wife whipped out a big bottle of freshly bought ice tea.

She cracked it open and of course insisted on filling up our bottles. I told her to stop halfway up but she said “absolutely not” and kept pouring to the tippy top. She then instructed me to drink some and waited for me to do so, staring intently. Once I had taken a gulp and nodded to indicate my newfound refreshment, she filled it back up to the top again and smiled.

One thing I have been constantly struck by since moving here to Shikoku is the genuine kindness of everyday folks. Day to day human interactions here are so far removed from the stereotypically crowded streets of Tokyo, where everyone seems incased in their own personal emotion-proof bubble. People here actually say hello to you as you walk down the street. Someone will stop and spend the time to draw you a map if you don’t know where you are going. These random acts of kindness continue to joyfully take me by surprise.

After a number of “domo arigatos,” we parted ways with the elderly couple and headed over to a general store on the recommendation of the husband. After a few turns down dusty alleys, we entered into what was very likely someone’s home and shopped at the most makeshift convenience store I have ever seen.

The shop was run by a plump and jolly older Japanese woman with white hair. She had only one tooth and cackled laughter after any utterance whether it was funny or not. There were lots of noodle bowls available for purchase but no way to boil water, so we settled on a mishmash of pre-prepared items. The pickings were slim but the resulting menu for our beach picnic was hilarious.

It was like we were contestants on Super Market Sweep, frantically grabbing random items off the shelf in a desperate attempt to create something that resembled food. I think we ended up with fried fish cake, whole sweet red beans, bread, savory mochi, orange marmalade, and big cans of beer.

I had asked the shopkeeper about water, but she responded that they didn’t sell water, only beer or tea. Without missing a beat, she then reached into the refrigerated case, pulled out a large bottle of spring water and handed it to me, saying I could have it. I tried to refuse, but she gave me a host of reasons as to why she didn’t need it, the main one being that she prefers to swallow her nighttime medication with either tea or beer as it is, so water is useless. This was followed by assorted cackles.

Paying for our lunch was also incredibly charming and fitting given the circumstances. Since there were no prices marked on any item, I stood patiently while the older woman flipped beads on her abacus and muttered numbers out loud. She arrived at a price of near $11 US, but then recalculated twice due to “errors,” bringing the final total to somewhere over $8. I was twenty yen short while trying to pay with the coins in my wallet, but before I could hand her the bill, she said “That’s fine, that’s enough,” and let out a brief cackle as she snatched the coins from my hand. Hands down best convenience store EVER!

We had our picnic by the beach. The tide was out so there was a nice flat surface to sit on. Much appreciated was the fact that the rain proved the weather forecasters wrong and took a hike for the day. Though the sun was by no means blazing in the overcast sky, I still managed to get fairly sunburned. I didn’t realize the extent of my redness until I looked in the mirror at a department store.

In general, I find this area of Japan to be so relaxing and peaceful; I believe it has to be healing for the soul and the mind. Walking around Gogoshima, it was so easy to be engulfed in complete silence, to be surrounded by nature and not see or hear another soul. Coming from places like Seattle, and Stanford, and Tokyo, I am so accustom to noise and bustle in my everyday life. When all that noise is simply erased from the picture, the resulting calm is liberating and cleansing.

I think oftentimes silence really can be golden.

B.E.W.

The ferryboat that took us from Takamatsu Port outside Matsuyama to the nearby coastal island of Gogoshima.

This "Hinomaru" flag on the back of the boat has seen better days.

Approaching Gogoshima on the ferryboat. This will serve as the opening shot for my movie, "Letters from Gogoshima," the story of a solitary mikan farmer who sends a letter a day to Tokyo in the hope of reuniting with his estranged son.

Here is what you see when you get off the ferry and step onto the island for the first time.

Gogoshima had quite a few palm trees. It was just like being back at Stanford!

This lion creature perches on his ball and guards the entrance to the temple.