Discussion With CSIS: Health Policy and Restructuring Japan After ‘3.11’

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As I have mentioned earlier this year on my web site, we, the Health and Global Policy Institute (HGPI), are collaborating with CSIS, a well known Think Tank of the United States, on health policy issues.

The topics for our collaboration for this time are: 1. Payment System of Hospitals and 2. Application of ICT.

Since we now have drafts of the reports on the two themes, I came to Washington DC to jointly present interim reports and discuss the issues with the invited specialists from outside.

I arrived at Dulles airport from Narita at 10:40am, and headed directly from the airport to CSIS.  We discussed over lunch on the ‘recommendation for the restructuring of Japan’ which CSIS started to develop after ‘3.11’.

This theme is very complicated, to say the least, and there is no end in our discussion.

However, I enjoy discussing. Health care system issue is a huge problem and it takes a tremendous amount of time to achieve any reforms.  We are searching for realistic policies and the ways to apply those policies in order to bring about the desired changes in the existing systems.
 
It seems to me that the key is how to use the ‘3.11’ as a chance agent to restructure current social system.  Of course, we must develop good and deep understanding in the broad range of the public, and the process of how we do this is very important.

Japan has huge burdens; aging society, chronic diseases burden, expansion of income disparity, stagnating economy, and on top of that we are at the brink of bankruptcy.  We have hardly any time left for reforms.  If we do not turn this great crisis of ‘3.11’ to an oppoutunity for big chance , I seriously think that Japan could collapse.

 

An Interview with NBR

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My opinions on the response of Japan to the 3.11 Tohoku Earthquake and Tsunami Disaster and the Fukushima nuclear disaster have been posted on the NBR website. This interview is entitled “Moving Forward: Relief Efforts, Health System Reforms, and Japan’s Role in Global Aid”.

Among the things that I discuss in the this interview is the establishment of an independent, international task force, to examine Fukushima nuclear disaster, which also serves to halt the loss of confidence and damaging rumor mongering in Japan.  The establishment of such task force is critically important, thus the government must take immediate action, and adopt a stance designed to learn from the mistakes of the past and share those lessons learned with the rest of the world.

I just want to ask you, dear readers, what message did you take away from this interview?

Interviews of a number of other friends (ref.1)and acquaintance have also been posted, and I encourage you to take a look.  Not an awful lot of news in English gets out of Japan, so many in the general public overseas look upon Japan with uncertainty because they are unsure of what is going on. 

However, we are in an age of new tools and venues for communication.  I, myself, have decided to try to send out at least half of my messages on Twitter in English.

 

 

Washington DC: A Solid 30 Hours Visit and Sense of Fulfillment

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I left for Washington DC on May 9th (Mon), right after the ‘Golden Week’ holidays.  Arrived at 2pm on the same date, checked in to the hotel, took a brief rest, and headed to the Carnegie Institution of Science to see Dr Richard Meserve (Ref.1), a long time friend. Dr. Meserve is also one of the key persons of the nuclear power plant policies of the United States, so I came to see him to discuss issues related to the Fukushima nuclear plant.  I understand that Mr Fujita (in Japanese), member of the House of Councillors, visited him just recently, too.

After the visit which was for about 40minutes, I went on to CSIS.  Here, my purpose was to discuss with them the progress of the project with our HGPI  (Ref.1),  which I have reported to you earlier, (click here for the video), as well as to discuss how we could collaborate on the “Japan’s Recovery Plan After ‘3.11’”  by CSIS announced on April 20th.

After having a discussion for about an hour, I went to the National Academies of Sciences. Here, my focus was to exchange views with experts of the Science Academies on nuclear power/radiation and international relations; Drs Michael Clegg (Foreign Secretary), John Boright (Executive Director, International Affairs), Kevin Crowley (Senior Board Director, Nuclear and Radiation Studies Board), Richard Bissell (Executive Director, Policy and Global Affairs Division) joined.  I have been in touch with both Michael Clegg and John Boright for about a decade or so, from the time when the scientists started to be active in presenting policy recommendation for the global age, when I was serving as the vice president and later the president of the Science Council of Japan; and of couｒse in the last two months on Fukushima.

They had understood well about the purpose of my visit, and it helped much in having a very constructive discussion.  It is very important, especially at time of crises, that you have such good personal relationship with mutual trust with experts of the world.

I do understand that there are many hurdles, but we must be aware that the Fukushima Nuclear Power Plant issue is not only in itself a great issue to the world, but how Japan handles this and all of the other problems that stem from it – such as risk management policies and their deployments, the effects of radiation on health, environment, agricultural or industrial products, or emission of radiology to the ocean – the entire response of Japan as a whole is being watched by the world.  When unpredictable crisis issues arise, the way the nation reacts and handles is a test and determines, like it or not, the most fundamental credibility of that nation.

In such circumstance, setting an independent commission consisting of international experts is a crucial, very important political process in securing the credibility of a nation today.

Look, for instance, at the BSE problem in Great Britain that started in the 1980s.  It took nearly 20 years for them to regain trust, even after they referred and acted to the independent EU committee and waited for their conclusions.

As the world goes global, international credibility/mutual trusts of nations is becoming increasingly important, and in this context how Japanese government reacts to the nuclear power plant issues, how it keeps the process of treatments/decision makings open, transparent, subjective is evermore crucial.  However, I regret to say that the government, companies, media, and the scientific community of Japan failed to recognize this at all. Therefore, it seems to me that they are unable to make any trustworthy, speedy actions or decisions and focusing instead on domestic circumstance, making policies that are too nearsighted.  The world at large recognizes somehow not-so-appropriate responses of Japanese leadership, which underlies, in my view, a quick decline of the reputation of Japan and spreading of unfavorable rumors or misinformation that harm the Japanese products and industries.

Next morning from 7am, I had a breakfast with Ambassador Fujisaki, and then spent the rest of the day having discussion with 10 or so of experts of an Aging Society Think Tank.  At lunch time I enjoyed a short but nice conversation with Dr John Howe, President of Project Hope, who just arrived at Dulles Airport from Johannesburg, and Drs Darrel Porr and Frederic Gerber (Dr. Gerber also came directly from Johannesburg) who was with us in Japan just last week, thanks to the thoughtful arrangement of HE Fujisaki.

After the lunch, I returned to continue discussion and made my presentation, then at 5pm, just before the closing, left for the Dulles Airport to fly to Zurich via London where I will head for St Gallen.

My visit to Washington DC was only for about 30 hours, tightly packed schedule, but it turned out to be an extraordinarily fulfilling stay.  I thank Ambassador Fujisaki and his staff at the Japan Embassy in Washington DC, and many others for their kind and wonderful support.

I hope this trip will be of some help to the current situation of Japan…..

 

Project Hope: New Team Arrives from US

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I have been reporting to you on Project Hope several times in this site.

A new team consisting of 5 members arrived from US in the afternoon of May 6th (Fri), the last day of the consecutive holidays we have in Japan as “Golden Week’.  We started the next day with a briefing.  George, who had also participated in the relief activities in Iraq with Fred, his predecessor, took initiative at this briefing.

I decided to join in the party in Saturday evening. All guests were Japanese, but two of them were doctors currently working in Missouri and NYC, and 3 (1 of them was male) were nurses at UCLA.  They all have medical license of the US. Dr. Shimabukuro, whom have I introduced to you earlier, advised them to participate in our project.  Dr. Kaku of PCAT who was with us last time, and a medical student of Todai who just returned from Iwate were present, too.  Dr. Hayashi is working in Iwate now.  This time, as was the last time, PCAT is supervising and advising the Japanese side.　

This new team plans to be in Japan for 2 weeks to visit several areas in the Iwate Prefecture.  There activities are truely encouraging.

These activities, as they expand, will support the recovery of the disaster stricken places, people’s health, and eventually the creation of new Japan.

I firmly believe that such activities in an open, international team will eventually, though slowly, change the mind-set of our youths to be a global citizen.

Our Collaboration with Project Hope Continues

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Click here for the photos of the disaster stricken area the doctors visited

I reported to you in my recent posting that our HGPI (Health and Global Policy Institute) and Impact Japan have been collaborating in a project with Project Hope since ‘3.11’.

 

Two teams joined us already and had been to the stricken zones of Sanriku several times.  Dr. Shimabukuro returned to Japan again (but then went back to UCLA right after…) to join for the second visit.  Several other Japanese doctors working in the U.S. are also participating in our Project Hope team.  They all are a great help.

 

At the breakfast meeting of HGPI, consisting mainly of the member companies, I  quickly reported how this project is going on.  Then, Drs Frederic Gerber and Darrel Porr introduced the background of the Project Hope, followed by an explanation of some of their activities of this joint project.

I closed the meeting with a brief comment on the basic ideas  on how to make plans for the health care in future.
 
The meeting was very well received by the participants.  Given the situation of the disaster hit area, we think this project will continue for quite a long period of time and therefore are planning another breakfast meeting for larger audience, and ask the members of this Project to give briefing sessions in the future..

 

Drs Garber and Porr left Tokyo off to Iwate Prefecture immediately after our breakfast meeting.

 

Then, 4 days after their return to Tokyo, we had another De-briefing.  This time, they met the governor of Iwate Prefecture, with an extensive discussions sessionwith the administration of Iwate Prefecture. Drs Hayashi (in Japanese), Kaku (in Japanese), and Yoshida also participated in this De-briefing.  I became acquainted with these three doctors at the PCAT who joined our re-briefing session, and George who just arrived Tokyo from Project Hope to join us.

Dr. Gerber told me that he was leaving for South Africa the next day to participate in the inauguration of planning of Nelson Mandela Children Hospital  (Project Hope is playing a leading role here, too).
Dr Hayashi is working in international settings (in Japanese) including MSF (in Japanese), Dr Kaku (in Japanese) is working in Haiti and other places, Dr Yoshida is currently working at Harvard School of Public Health and also is a mother to 4 children.

 

They are all working, thus thinking, globally, so their conversation resonated very well. Good Thing.

 

 

Encounter at San Diego and An Unexpected Reunion

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IMG_3046 

I posted the other day on a meeting in San Diego in early April.

In one of the panels at the meeting, I talked about Project Hope, a Disaster Relief Project for the East Japan Disaster.  One of the participants came to me after the panel to ask about the details, and we had some discussion over what we have been doing with Project Hope.   The person was Dr Raymond Basri from New York.  He had a strong interest in disaster relief, and had participated in many disaster relief activities in the past including Afghan Wars and Hurricane Katrina.  Dr. Basri is also known for taking leadership at the ditching of an airbus at the Hudson River, New York City.

Dr. Basri and I have been exchanging e-mails several times, and then, I suddenly received an e-mail from him saying that “I plan to come to Japan 4 days from now, and hope to bring my daughter (an undergraduate) and son (a high school student) with me to visit the stricken area.  My daughter accompanied me at the Katrina time, but my son has no experience yet of being at the disaster area…”

I have been involved for these 3 weeks in the collaboration with Project Hope, ie, 3 doctors in the team 2, for 3 times to the stricken area.  We had meetings before and after each visit for briefing and de-briefing of their reports and following discussions.

With this background, I was fortunate enough to have help from many related people, and managed to have Dr Basri and his children arrive today at Narita, in the afternoon of Saturday, 4 days after receiving his e-mail.  They then transited to Haneda (it was at this point that I finally succeeded in getting in touch with them by e-mail and cell phone - truly at the very last minute…) where I met the three (photo above) before getting on board the flight to Akita.  I had 30 minutes for briefing and handing the local maps.  They will be picked up by a car from Akita to Miyako-city.  All of the arrangements were completed just a day before their arrival, very risky, but we somehow managed.  The family was to arrive at Miyako-city at midnight.

On Sunday, the next day, Dr Basri and his family visited a number of places, and we asked the people at the site to distribute the supplies he brought.

After staying two nights at the area on Saturday and Sunday, they will be leaving for New York from Narita in the late afternoon of Monday.

I thank all who kindly helped me for the arrangement despite such a very short notice.

A Speech in Expectation of Empowering Women

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I arrived at Haneda from San Diego early in the morning.  This day, I ended up corresponding all day for the Project Hope.

Supporting system for disaster relief in Tohoku seems to be gradually getting into order, and more aids, although far from enough, are coming in to the stricken areas.  Needs for medical care is changing rapidly.  Now, there are more needs for handling of chronic disorder rather than acute illnesses.  Equally becoming important are mental supports for the children and elderly.

Project Hope decided in the end to go to the stricken areas as well as the Fukushima area.  Everyone is working very hard to contact relevant sections and offices in order to arrange the trip.

Dr. Shimabukuro decided to come back to Japan from UCLA again, and is busy getting into touch with people.  In between, she even wrote an article to USA Today.  Dr Shiabukuro is such a hard worker!

As for myself, I had to give a lecture next day at the luncheon hosted by the ‘Women’s Committee’ of the Tokyo American Club (TAC) on ‘Women Empowerment in Japan’, so to my regret missed the opportunity to go the disaster hit area with our Project Hope team. 

At the TAC luncheon, I was seated next to Mrs Roos, wife of the U.S. Ambassador to Japan.  I had the privilege of talking much about the quake and Fukushima issues with her.  The activities of the Ambassador can be followed via twitter and you will easily see how much he is dedicated.  By the way, all of the participants at this luncheon were women except for myself and Mr Lee, the President of TAC.

I opened my lecture by saying “Thank you for inviting me to TAC luncheon seminar to discuss ‘Gender Empowerment here in Japan.’ But, I must say that I am disappointed because today my audience consists of only women except for me and TAC president and what I speak to you today must be addressed rather mainly to men and you women know well many issues I will be talking about”.  I also distributed a list of references.

I said that the challenge is how to shift from ‘society of men’ to ‘society of gender equality’ and ‘gender empowerment.’.  In fact, Kathy Matsui of Goldman Sachs have written how her analysis show that if the Japanese society succeeded in encouraging women to take good part in workforce, the Japanese economy is expected to grow by 15%.  For details, please refer to ‘Womenomics’ which I included in the reference list.
 
As you may notice, I am raising this issue again and again in this website.

At San Diego ? Gathering With the Youths

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On the day before the last day of San Diego, I had a small get-together party from 9 pm with young Japanese who study at UCSD and work at other places. 

Among those who came, 5 people were undergraduates at UCSD, 7 were students at the graduate school, and the rest were those working at venture businesses.  Several of them were the same people as those who came in February when I was here (Ref.1), but for those who were not able to make it then, it was a good opportunity for us all.  We had so much to talk about that time just flew to midnight..
 
Students came from various backgrounds.  For example, the 4 out of 5  undergraduate school were exchange students from Keio, Gakusyu-in, and ICU, and the remaining one student came to U.S. after high school..  All students were wonderfully energetic.  By the way, 4 of five were female.
 
On the other hand, most of the graduate students were enrolled in the Master’s course.  They were originally from the Japanese government and public offices.  A few ‘independent’ PhD course students joined us, too. One whom I know for some time was an American from CONNECT, also joined our last gathering of February.

So, we used as the common language ‘broken English’, but actually all spoke pretty  good English (many of them lived some time overseas in their childhood ? it would be hard to get along with all the classes without a reasonable command of English).  Everybody had lots to say.  Half of the students were female.  They were all very energetic.

For your information, Maki-kun posted a report about this gathering with a photo attached on his blog (in Japanese).  Thanks.

The topic naturally included the recent quake and tsunami disaster, including the ways how the Japanese government and TEPCO responded on Fukushima nuclear power plants.  I noticed that the students had many points of views which only “independent observers from ‘outside’” will have.  This is no wonder, since they are all living away from Japan as an ‘individual’
 
As I have been pointing out repeatedly in this blog and elsewhere, the best way to have eyes and senses to see and feel Japan objectively in the global context is to go ‘out’ as an ‘individual’, and better while you are young.  It is very important to do so if you wish to develop good sense of ‘global citizen’ and own career.

That being said, however, the largest concerns of the undergraduate students were the anticipated handicaps they risk for ‘job hunting in Japan’. This doesn’t make any sense.  I have to say that they are being mind controlled.  Isn’t this awful?  Tomorrow’s world is a world where the values are very different from the values of today and the past.  In a ‘flat’ world (and the world is inevitably going to increase the speed of ‘flattening’), ‘uniqueness’ or ‘being different/distinct’ is a positive value, that would be considered as the strength of each individual.  There is no sense in limiting ‘field of work/actions’ to Japan only.  Such were the points I made.

Then we had various discussions on how to build careers, and I think we succeeded in sharing some specific images.

I carried several copies with me of my book with Yoko Ishikura, ‘How to Build a Global Career’ to distribute.  Also, I informed them that her new book ‘Global Career ? How to Find a Unique You’  (published in Japanese only) will be coming soon, but actually, the book was published precisely on that same day.

I look forward to seeing how the future of youths such as they will be.  These people are truly the big asset of Japan.

 

American College of Physicians: From San Diego

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Here I am in San Diego to attend the annual meeting of the American College of Physicians (ACP).  Last year it was in Toronto.  This is my 3rd visit to Southern California (Ref.1) this year.

Since we founded ACP Japan Chapter 8 years ago, I have served as the Governor for two terms, which was an exceptional arrangement.  I am relieved that I am leaving this position of the Governor this year without any problems. 

During these 8 years, the Japan Chapter grew to have more than 1,000 members, with significant increase in Student Members and Associate Members.  Some of our activities focus on education, on female doctors, and on volunteerism, some of which led to ACP awards which I take as the manifestation of recognition by ACP of the Japan Chapter.  I thank all members and leadership of Japan Chapter for their dedications.

Because of the East Japan Disaster, the annual meeting of The Japanese Society of Internal Medicine was cancelled.  Subsequently the ACP Japan Chapter meeting which is annually held during the same period welcoming the President of the ACP was postponed at present..

Consequently, not as many Japanese members were able to join the meeting in San Diego this year.  However, at the Convocation of new Fellows, 5 physicians from Japan (among them was Dr. Gremillion, a leader of the medical education at Kameda Hospital, who organizes annually a highly stimulating session named ‘Clear at a Glance (Ichimoku Ryozen)’ at the Japan Chapter meeting) were present. As they stood in response to the announcement of the name of Chapter ‘Japan’, I was touched by a long and warm applause that arose from the entire audience filling this large auditorium…

I participated in 3 panels; a student from Yokohama City University who was selected for the poster session joined,. as well as Drs. Ishiyama and Kato whom I saw last year were also present.  Drs. Ishiyama and Kato are currently working as ‘hospitalists’ (in Japanese) in medical centers in St. Louis.  They both happen to work at the same city but did not know each other until I introduced them to each other last year at Toronto.  I was happy with the reunion.

The reception of the Japan Chapter turned out to be a very nice gathering thanks to the attendance of many friends of the Japan Chapter, including former and current Presidents of the ACP; their presence are customary every year to our Japan Chapter annual meetings since our inauguration eight years ago.

However, like others, I could not get my mind off from what was going on in Japan, so I kept myself pretty busy getting in touch and talking on phone with people at American Academies, Japan Embassy in Washington DC, or other related contacts.

I had an impression that although everyone was concerned with the damages done by the tsunami, in terms of the nuclear problems, they were worrying more about the ways of Japanese authorities and leadership.

Getting to know people across national borders, making friends with them and building trusts between each other is an asset that I would never exchange for anything.

 

Medical Team Goes to the Quake Stricken Zone, A Girl from Okinawa Takes Action to Repay Kindness

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Many medical professionals are responding to the needs of the quake stricken zone.  Many find information source via internet much useful than the news coverage.

Medical institutions such as Japan Medical Association (JMA), universities, hospitals, Ministry of Health, Labour and Welfare, Red Cross, Hospital associations, Tokushukai group were quick to take actions after the disaster.  Because of the experience of the great Hanshin earthquake all organizations including organizations related to dialysis (where needs are highly emergent in moving and accepting patients) compiled their full capacity　immediately.  University hospitals and other major medical centers like Red Cross that function as the center of medical care in the quake/tsunami hit area – in Iwate (at Sendai, Ichinoseki, Morioka), Miyagi, Fukushima prefectures were all working so hard together.
 
Aids from overseas arrived and among them were the Japanese doctors working at overseas who temporarily returned to join and help these natural disaster medical care network of the stricken area.

What comes first is the condition of the site.  We must be aware that, because of the tsunami, many hospitals and clinics vanished in seconds.  This is a very different situation compared to cases hit by the earthquake only.  I understand that Israel, for instance, sent a whole package of medical units just like at the wartime.  I also hear that the Japanese authorities were quick in giving permission to overseas doctors to provide medical care in Japan.  I would like to congratulate them all for their hard work.

The United States initiated the ‘Operation Tomodachi’, sending us much personnel and relief supplies.  They are being a great help.

Our team at HGPI and Impact Japan was busy for these several days in responding to the requests from the Disaster Relief NGO, Project Hope.  I am deeply thankful for the great help from everyone.
 
What we are doing now is seeing doctors who had just returned from Tohoku, trying to get the picture of what is going on at the site, gathering information.  Those actions are of course important, but the problem is that we can not find the ‘foothold for collecting information from the local area’.  In a sense this is understandable because this disaster has multiple adverse conditions such as damage, scale, access to the site, or weather.
 
At Fukushima they have another totally different problem caused by the nuclear breakdown.  Here, the need for medical care seems to be now shifting to the chronicle stage.  I think that, from hereafter, very important issues which involve social factors such as mental care of children (especially orphans) and elderly will gradually emerge to call people’s attention.

I would like to introduce to you one heartwarming story.  It is about Dr. Shimabukuro, a Critical Care Fellow at UCLA Pediatrics Department, whom I was introduced earlier by my friend at UCLA Pediatric Department.  She is originally from Okinawa and by a sheer coincidence happened to be in Okinawa when the quake came.  She took a quick action.  After finishing a lecture at an academic conference in Tokyo, she joined in a medical relief team and headed to Iwate.

I kept in touch with Dr. Shimabukuro, and arranged a meeting in the evening with her who just returned from Iwate and the three physicians who just arrived to Tokyo in the afternoon as the advance group of the American medical team.

The American medical team headed to Iwate early in the next morning, returned back to Tokyo at 2 am, and we had a briefing early in the morning after they took a few hours of sleep.  Then, we continued the discussion for 2 days, contacted relevant people via phones, e-mails, and other means to figure out the next possible actions.

Many people are working together in search for the best way to help and support.  I am truly grateful for their willingness to be of help.

By the way, Dr. Shimabukuro wrote reports about her experience at Iwate and managed to have it printed on the LA Times and Bruins, the newspaper of UCLA, in a very timely manner.

Los Angeles Times
UCLA Bruins

This series of actions by Dr. Shimabukuro apparently reflects her strong wish to pay kindness back to her mother country.  She is a native of Okinawa, spent her childhood in Okinawa and had high school education, went through college and medical school in the U.S., is currently working at UCLA as a medical doctor.