The Excursion to Yamagata



One summer weekend, I suddenly decided to take a trip to Yamagata Prefecture. A talk about Matsushima with my colleagues was the motivation for my trip. When I said to them, “Matsushima had such a marvelous view that even Basho, one of the best haiku masters, could not describe it”, I happened to realize that I had never seen the marvelous view about which Basho composed a haiku. It is a temple famous for his haiku:
“Shizukesa-yaiwa-ni shimiiru semi-no-koe” (“Such stillness The sound of cicadas Seeps into the rocks”)
(Haiku is a very short form of Japanese poetry in 3 lines of 5-7-5, only 17 syllables, with Kigo, a reference to the season word and Kireji, an evocative cut off phrase.)


Actually, I had been to hardly any places in Yamagata Prefecture except Zao. I had the image of Yamagata as follows: in spring they enjoy cherry blossoms, in summer they bear the intense heat, in autumn they enjoy imo-ni (a local specialty of Yamagata Prefecture: a type of soup made of taro, some other vegetables and thin slices of beef or pork) and in winter they survive the severe cold in onsens (hot-spring bathing). I thought it was not good to be lost in fantasies about the prefecture I had never been to as I lived in a neighboring prefecture. Moreover, I could take off from work on the Sunday of that weekend for the first time in 2 months. I could not miss the opportunity to take the trip; therefore, I hurriedly went back home to get ready for the trip and left for Yamagata.


As I had expected, Yamagata Prefecture was very close, and it took only one and half hours from Koriyama City to Yamagata City. First, I ate hiyashi-ramen (Chinese noodles in cold soup). It was delicious and refreshing, and the ice in the soup did not lessen the flavor.


After lunch, I went to the old Yamagata Prefectural Office. I was interested in this building because a certain movie was shot there. It was built in the Taisho era (1912-1926); however, it is still in a good state of preservation. It must be very difficult to maintain such a massive and modern building in the present day.


While all of this was going on, it became dark in the evening on the first day of the trip. After I had imo-ni and locally brewed sake, I went to bed.


On the next day, I got up early and first went to Yama-dera Temple to pray. The temple is known by many people by the name of Yama-dera, however, its official name is Hoshu-zan Risshaku-ji Temple. As its common name indicates, I had to climb up 1015 steps towards the top of the mountain.


Basho composed the haiku of summer there; therefore, I thought that summer was the best season to visit the temple. And this was the perfect choice. Cicadas were singing above the worshippers eagerly climbing stairs. It was far from silent because of many worshipers, and still I felt the atmosphere which had inspired Basho.


After I worshiped in the temple, I ate hiyashi-niku-soba (cold buckwheat noodles with beef) and drove to Zao.


I had been to Zao before, but it was perfect weather to visit it again and drive up the mountain to Okama which is often invisible because of the weather. Fortunately, I enjoyed the beautiful scenery just as I did the previous time I went there.

And then, I took a bath at the great open-air spa of Zao Onsen (Zao Hot Spring). I had a good soak in the 100% fresh-flowing hot-spring with the smell of sulfur surrounded by nature.


On the way to Yonezawa City, I dropped in at Inu-no-miya Shrine and Neko-no-miya Shrine (Dog & Cat Shrine) in Takahata Town to pray for my three beloved dogs. The dog and the cat which guarded the village were enshrined. Many people visit this shrine for their dogs and cats to have memorial services or pray for their health. I saw many photos of their pet dogs and cats.


In Yonezawa Ctiy, I went and prayed at Uesugi Shrine where Uesugi Kenshin, the God of War was enshrined. This shrine is also related to his retainer and general, Naoe Kanetsugu, who became popular by a Taiga Drama (A Taiga Drama is the annual, year-long serial TV drama of Japanese historical fiction broadcast by NHK, Japan’s public broadcaster).


Moreover, when speaking of Yonezawa, many people must think of Yonezawa Beef; therefore, I enjoyed a gorgeous dish of Yonezawa Beef for an early dinner at a restaurant called “Yonezawa-gyu-tei Good”. I was extremely satisfied with my 2-day and 1-night trip.


I bought some sweets as gifts at Sato-ya which is a long-established shop with a 190-year history and famous for noshi-ume. This shop developed new products such as sweets made from chocolate and yokan made of leaves of kuro-moji.


[1] 梅の果肉をすりつぶしたものに、砂糖と葛粉か寒天を混ぜる。
[2] とろ火で[1]を煮た後に乾かす。
[3] 竹の皮で挟む。

Noshi-ume is a jelly-like sweet made from the mashed flesh of Japanese apricots.
(Noshi-ume is a famous confection representing the Murayama region in Yamagata Prefecture and Mito City in Ibaraki Prefecture.)

How to Make Noshi-ume
[1] Mash the flesh of Japanese apricots and add sugar and kudzu flour or agar powder.
[2] Simmer [1] and dry it.
[3] Put [2] between bamboo leaves.


I did not have enough time to travel to the Shonai or Mogami Regions. I am sure that there are a lot of places and delicious foods that I do not know yet. I will definitely take a trip to Yamagata again.




Reflection on Two and Half Years in Fukushima



Almost two and half years have passed since I started working in Koriyama City, Fukushima Prefecture. I will be transferred to a hospital in the Kanto Area soon. I, myself, requested to work in Koriyama as well as my transfer as a medical office member. My two and a half years in Fukushima have been very fulfilling with many precious experiences.


First, I was surprised to find all the people, not only nurses and medical clerks but also patients’ families and people in the city, were gentle and kind. When I was working in the center of Tokyo, people sometimes spoke to me using severe language though this might be hard to avoid in the medical practice. However, it has hardly ever happened in this hospital. I never expected to make very close relationships in my time there; therefore, my Fukushima life has been very comfortable.


Next, I was surprised that Koriyama is very rich in food. In spite of it being an inland area, I could enjoy fresh seafood as well as fruits such as peaches and grapes. Meat including Fukushima beef and Egoma pork and vegetables including asparagus and snow peas were also delicious. Above all, the rice and water were wonderful; therefore, there were many kinds of excellent sake. Its local dishes have unique and fancy tastes: ika-ninjin (slices of surume. dried squid, and carrot boiled and seasoned with soy sauce, sake and sweet sake), kozuyu (a soup of dried scallops, various vegetables and tofu seasoned with soy sauce and sake), Kitakata ramen (Chinese-style wheat noodles served in a soup made from pork bone and dried fish flavored with soy sauce in Kitakata City, Fukushima Prefecture).


Of course, not everything was wonderful. Four and half years had already passed after the Great East Japan Earthquake occurred when I transferred to Koriyama City. However, the city still bore the scars of the earthquake. The radiation level in the city where I lived was below the standard level; nevertheless, the surface of the ground in the park nearby was decontaminated. Moreover, the environmental radiation measured levels are reported on TV or the radio every day.


However, 7 years after the earthquake, I got the impression that bad rumors and excessive fear caused much more damage rather than any possible harmful side effects of radiation in and around Koriyama City. Subsidies were provided to the inhabitants near the nuclear power plants, but the whole of Koriyama City was outside of these areas. I felt very sorry to see people suffer from this damage without even getting some kind of subsidy.


When I watched the recovery process from the disaster, I think that the excessive support for the disaster area could be a sort of “curse”. As supporters say even more, “They need support for the immense damage caused by the accident at the nuclear power plant”, Fukushima Prefecture continues to be labeled as a “disaster area”. Many people try hard to continuously measure the level of radiation from farm products even from the areas which don’t need decontamination so that they can dispel false rumors. It is this labeling that damages those people with harmful rumors. Of course, I understand the necessity of continuing support; however, I also think it is important for supporters to try not to obstruct people who are working hard to rebuild their lives. I hope that they can proudly announce someday, “Fukushima has almost finished our reconstruction now”.


I heartily enjoyed myself in Fukushima Prefecture. People around me were very nice and helped me a lot. I cannot thank them enough. I will soon go back to the Kanto Area, but I would like to visit Fukushima again to return their favors.






Studying English in Oxford



Nearly 10 years ago, I studied at Oxford University to improve my English. I have a lot of memories of my first experience to go abroad alone. I spent my school days at Oriel College Campus and stayed at the dormitory of Oxford University. On the day I arrived in England, I remember travelling by myself from the airport to the dormitory by bus and train was very difficult. The campus, covered with fresh green grass, was far more beautiful than I could have imagined and there was a church and also a pub on the campus.


As is often said about Oxford, “The town is located in the university”: the campuses of Oxford University are dotted around the city, and the whole town was full of a young and cultural atmosphere. This university with a long history was established at the end of the 11th century, and it made up of a number of colleges including oriel college. Many members of the Oxford University alumni have become notable in a variety of fields, ranging from prime ministers of many countries to Nobel prize winners. The stately buildings are now famous as filming locations for “Harry Potter”. I was deeply impressed that Lewis Carroll, the author of “Alice’s Adventures in Wonderland”, and Edwin Hubble, one of the greatest astronomers in history studied in those buildings.


In Oxford, I studied English with students from a wide variety of countries: Spain, Italy, France, Russia, Turkey and Taiwan. Most of them were in their early twenties, so I had a precious opportunity to interact with foreign students of about the same age. Most of the teachers were British people and their lessons were not only English grammar but also included debates, introduction quizzes and recreation. In Japan, American English is generally used for many English learning materials, but during this time I was constantly immersed in British English every day. At first, I had a little difficulty to listen to British English because of a lack of experience, but later I got used to it. Even now, I can understand British English well that appears on the BBC news or in movies thanks to those lessons.


Speaking of life in England, pubs are indispensable. I often went to pubs with foreign students during my stay. I learned that at a British pub people usually sip beer at room temperature, so I enjoyed sipping lukewarm beer and talking with my new friends. As England is at a higher latitude, it is still light even around 9:00 p.m. when we left the pub, and the town was safe, so we didn’t have any problems.


Besides the pub, we went to many places including Stonehenge and a sushi bar. Despite cultural differences, I really liked to interact with the other students: an Italian guy cooked genuine pasta for us, and another guy from Taiwan played the guitar. They seemed to really enjoy my tea ceremony performance in kimono (Japanese traditional costume). We got along very well with each other during our stay in the same dormitory in English which was not our native language, and we still keep in touch through SNS sites.


I acquired a lot through intercultural interaction. If you consider studying abroad, I highly recommend a program in which students from various countries join. In addition to improving linguistic ability, you will enjoy cultural interchange which you cannot experience by a mere sightseeing trip.







Public Health Issues in Laos and Thailand



In July 2012, I went to Laos and Thailand with some of my classmates for 10 days to learn about Southeast Asian public health. We flew to Bangkok where we caught a connecting flight to Udon Thani, and entered Laos by land, though there were direct flights between Japan and Laos. It was around a 30-minute drive from the border between Thailand and Laos to the capital of Laos, Vientiane. We visited the JICA Laos Office and were lectured about the contents of their activities. At that time, there was no medical school in Laos so that doctors could not be trained inside the country. Therefore, JICA supported the establishment of a medical school. At the same time, they improved the situations of sanitation and nutrition, spread checkups for pregnant women and deliveries in hospitals, and many other efforts.


We went to the market in the downtown area which was relatively safe so we had no dangerous experiences there. The same paper diapers and detergent which were seen in Japan were sold there. We tried a medicinal herb sauna, a local specialty, which was a very interesting highly-heated sauna with a strong fragrant aroma. After we left the sauna, we naturally felt more comfortable even in the sweltering open air.


On the next day after we arrived in Laos, I flew to Pakse, an eastern town in Laos, where there was another office of JICA. Here we were lectured by the members and we also visited the hospital. Basically, there are no local general practitioners, so sick people have no choice but to go to public medical facilities: county hospitals, prefectural hospitals or health centers. JICA has been energetically conducting an awareness campaign for health as well as medical care for diseases despite the serious shortage of human and material resources. Besides Japan, many countries such as France and Germany support medical care and public health on both issues of trained staff as well as equipment and supplies. However, what is much more important in terms of support is to make Laotians independent in the future, so they have also been focusing on staff training.


On the other hand, there are problems from a sanitary aspect: in a village, we saw houses which had livestock such as pigs and chickens under the floor. Doctors hardly ever visit places far from urban areas, so shamans play the role of doctors. It is likely that the intervention of medical care is not going smoothly in those areas.


After we stayed in Pakse for several days, we flew back to Bangkok. We visited a slum near the port and a health center there. We were shocked to see people living in houses on the river which was covered with waste. The slum seemed to be too dangerous for general tourists to visit though we finished our visit without any trouble thanks to the guide. The health center in the slum was barely supplied with equipment or material resources. People had to wait a long time just to be prescribed only medicine.


On the contrary, the Thai government gives high priority to medical tourism for foreign visitors. There are even high-quality medical institutions for VIPs. We visited one of them where advanced medical care was initiatively given and was ready for high quality services to people from various countries. There was even a Japanese doctor working there. I could not help thinking about the gap after seeing both the inadequate medical care in the slum and the advanced medical care for medical tourism.


It is quite difficult to solve the very complicated problem of public health in Thailand and Laos because the problem is closely associated with social conditions. However, the situation has gradually been getting better in cooperation with medical staff from developed countries and local people using various aid from developed countries including Japan.






Swedish Medical Practices



Using an exchange student program of my medical school, I went on a short-term study abroad program in Sweden. I studied at the University of Gothenburg in Gothenburg, the second largest city in Sweden. I received training at the Internal Departments of Gastroenterological Medicine and Infectious Disease, and I spent my spare time observing emergency outpatient treatment. At the Internal Departments of Gastroenterological Medicine, I mainly practiced upper and lower gastrointestinal endoscope operations and outpatient care. At the Internal Department of Infectious Disease, I observed various interesting cases, from tuberculosis which was familiar in Japan to diseases peculiar to South America or Africa, because Sweden has many immigrants from all over the world. Through the training, I could acquire extensive medical knowledge and clinical experience; moreover, I directly understood the great differences with regards to medical treatment between Japan and Sweden.


As for the general image of Northern European medical care, especially with regards to Sweden, two points are often mentioned: “Medical care is provided free of charge or at a minimal cost to the patient.” and “No incapacitated elderly patients can be found”. These statements are surely true in themselves but I myself found various problems with them.


First, it’s no exaggeration to say that “Medical care is provided free of charge or at a minimal cost to the patient” because taxes cover most medical expenses in Sweden and citizens shoulder only a small amount of the expenses. Even foreigners who live for a long time in Sweden can receive financial help for medical expenses in proportion to the length of their stay. This wonderful system provides an equal opportunity for medical treatment to even the poor. However, there is a big catch: “There is no opportunity for quicker or more advanced medical treatment even if the patient is willing to pay for it themselves”. I think that in Japan, new patients without letters of introduction are accepted by many hospitals of their own choice and receive medical care more speedily than in any other country. However, in Sweden even if a family doctor finds something wrong with a patient, it takes a very long time to make a close examination except in urgent cases. For example, if a family doctor finds a melena and suspects large intestinal cancer, the patient must wait for at least six months to have a lower gastrointestinal endoscope operation for a close examination. Nevertheless, no matter how much the patient is worried or however much one pays, the waiting time cannot be shortened. Swedish people are dissatisfied with their medical care system but many of them seem to think “We have no choice but to accept this system because the medical care cost is very low,” or “We must wait long for our turn as everyone else does.” In Japan, many people complain strongly against a long waiting period and go to other hospitals.


Next, “No incapacitated elderly patients can be found” is also true. Though Sweden has an aging society of the same level as Japan, elderly people who need considerable nursing care are hardly seen in Sweden. Therefore, Swedish nursing care is sometimes introduced on TV programs as a Northern European style of nursing care. Indeed, it is wonderful that elderly people can take healthy exercise healthily, but there is also a problem: incapacitated elderly people, who are treated with gastric fistula or intravenous drip because of loss of appetite in Japan, are mostly removed from the target list of life-prolonging treatment in Sweden. In other words, when elderly people cannot move and eat, they are allowed to peacefully pass away without medical life-prolonging care. If medical personnel in Japan treated patients as in the Swedish style, many families would regard it as cruel. This problem is concerned with the issue of dignified death. It is difficult to generalize about which medical system for elderly people is better, Japan or Sweden.


In this way, the medical circumstances of Sweden are much different from those of Japan. I realized, as the proverb says, “So many countries, so many customs”, medical systems are established according to the national characteristics and social situations of each country.






Memories of the Trip to Sado Island



For 2 months, in January and March of 2016, I worked at a hospital surrounded by mountains in Niigata Prefecture (the northern part of Japan). My coworker and I went on a 1-night, 2-day trip to Sado Island in our spare time. The main purpose for the trip was to visit the famous Sado Gold Mine.


The Sado Gold Mine has been on Japan’s Tentative List of World Heritage Sites and it is one of the most famous sightseeing sites on Sado Island. The reserves of gold in Sado were said to be already known around the 11th century, yet the production of a large amount gold at this gold mine was begun by the leadership of the Edo shogunate (1603-1867) at the beginning of the 17th century. As much as 400 kg of gold was produced a year during the Edo period, and in the Meiji period, the gold mine was sold off to a private company and was mined until 1989 when it was closed because of a depletion of reserves. 300 m of mining tunnel out of a total of more than 400 km is open for sightseeing.


There are 2 courses of the mining tunnel, Sodayuu-ko(宗太夫坑)and Doyu-ko (道遊坑). Sodayuu-ko was a hand-dug tunnel in the Edo period, and it still has the profound atmosphere of those days. The digging site was reproduced with replica mechanical miners. As many students in Niigata Prefecture visit the Sado Gold Mine on school excursions, when speaking of Sado, they remember these miners. On the other hand, digging at Doyu-ko was begun in 1899 (Meiji 32nd yr) and was mined for gold until 1989 (Heisei 1st yr). Modernized equipment is now exhibited there.


After looking around the mining tunnels, we saw ‘Doyu-no-warito’ close up, which was the digging site of Roto-bori at the beginning of the Edo period. Seen from a distance, ‘Doyu-no-warito’ has a big crevice as if it was cut sharply in two, and some parts are connected to Doyu-ko. These connecting holes can also be seen from Doyu-ko. In the spring of 2017, the Mumyo-iko course was newly opened, which is an expedition through a dark mining tunnel only with a light in hand. This is an experience course in which people can realize their childhood dreams of cave exploration and allow explorers to experience a more efficiently real mining atmosphere at that time.


Moreover, near the Sado Gold Mine, there is the Kitazawa area where the facilities for refining gold from ore are located. Those facilities are now abandoned and this area is now striking ruins that remind us of Gunkan-jima (Battleship Island in Nagasaki Prefecture).


During this trip, besides the gold mining areas, we visited Shukunegi Village which became famous through a commercial film of one of Japan’s best-known actresses. We also visited Toki Forest Park where Toki (crested ibises) are raised and bred. Toki was registered as a special Japanese natural treasure and is an internationally protected bird. We saw Toki close up and were deeply moved by the valuable experience.


We fully enjoyed wonderful fresh seafood in Sado, especially Yari-ika (a spear squid) in the best season. There were also other local specialties such as Sake (Japanese rice wine) and Sado-wagyu (Japanese beef produced in Sado). Sado Island is also famous for many hot springs. This time, we stayed at an inn with a hot spring near Ryotsu Port and took an open-air bath looking at Kamo Lake and slowly unwound from our weariness.


As described earlier, Sado has many wonderful tourist spots to visit; on the other hand, this remote island had long been a famous place of banishment. Various noblemen and people of culture were deported to this island such as Retired Emperor Juntoku, High Priest Nichiren and Zeami (a Noh player and writer). Some historic sites in connection with those exiles still exist: Mano-no-misasagi is the cremation mound of Retired Emperor Juntoku, and Kompon Temple is deeply associated with the Priest Nichiren. The culture which those exiles introduced from Kyoto into Sado has uniquely developed. Various traditional performances including Noh and Sado-okesa (a folk song originated in Sado) are still deeply rooted in the region.


We visited Sado in the winter, so unfortunately, we had no chance to appreciate a traditional performance. We didn’t have enough time to see Hajiki-zaki Lighthouse and Oonogame (a 167m rock sticking out from the sea) though we had really wanted to see them. There are many other things left for us to do. We would like to visit Sado again in the near future.









Last time, I wrote about Swedish medical practices, and today I am going to write about Fika in which I am most interested in Sweden. Fika means chatting over coffee and sweets, so a relatively correct translation into English is a coffee break or afternoon tea though I can’t find a perfect English word to describe Fika. Almost all the Swedes take Fika several times a day, and naturally companies and schools have a special time for it.


Originally, the word Fika is considered to be a back-slang form of “kaffe”, coffee in Sweden, so its literal sense is to drink coffee. They actually drink a lot of coffee and many working places are often equipped with free coffee machines. They drink coffee at every Fika, so many people drink more than five cups of coffee a day. Therefore, in Sweden, the average consumption of coffee per day is among the highest in the world. Of course, people who don’t like coffee, and children, drink tea, herbal tea, lemonade or juice. Together with beverages, they have sweets such as cake, cookies or fruits. Sometimes they also have a light meal including sandwiches.


After reading what I previously wrote, you might think the Swedes just like taking frequent coffee breaks but Fika is not a mere coffee break but a meaningful custom in which they share time and space over coffee with their friends or colleagues. In Japan, we often have “nomikai” in which we get together and drink alcohol with our colleagues, classmates or club members after work or school so that we can become familiar with each other. On the other hand, in Sweden, such a drinking party is not so popular. Instead,
Fika plays an important role in the formation of smooth human relations. Because of the great regard for Fika, nonparticipation in Fika sometimes makes others think “Doesn’t he like us?” or “Is he sick?”


The university hospital where I studied never failed to have a Fika break at 10:00 and 15:00 every day. In every Fika, they spent about 30 minutes leisurely relaxing on a sofa, so they might be mistaken for loafers. However, they were actually talking over treatment plans of inpatients or discussing cases of ambulatory patients over coffee. In Japan, we talk in a meeting room with a formal atmosphere. On the other hand, in Sweden, they relaxingly drink coffee and talk about the same things as we do. As far as I saw them talking, Fika seemed to bring bosses and staff closer together. A conference in a tense atmosphere is beneficial, but when people are relaxing, they may hold a more active and franker discussion. Of course, during Fika, they didn’t talk only about their work but also enjoyed everyday conversations such as TV programs seen the day before or a newly bought motorcycle. This casual conversation also seemed to play an important role in forming smooth relationships in the workplace.


Fika was hardly skipped however busy they were. One day, around 15:00, I was observing the consultation of ambulatory patients and then a nurse came into the consulting room with coffee and cake and said, “It’s time for Fika!”. I was surprised to see the sight which would never happen in Japan, and what made me more surprised was everyone including a patient, a doctor and a nurse took it for granted. This is a typical example that Fika is very punctual and important so Fika may already be a ceremony in a sense.


As I have described, Fika has deeply taken root in Swedish culture. I wish someday Japan would introduce this culture and we can leisurely have a pleasant talk over coffee and sweets in a working place or at school every day.





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