Nurse at the Osaka University Hospital and the Graduate School
of Nursing,
College of Nursing, Art and Science, Hyogo
Sponsored by the Senri Rotary Club
Introduction
I think I was able to learn many valuable things through my GSE trip to the Netherlands, not just in regard to my career, but also regarding how I should live my life as a human being. I am so very thankful for the opportunity to be a part of this GSE program, and I would like to share in this report some of the things I learned and gained through my experiences in the Netherlands.
Before Leaving for the Netherlands
After it was decided that I was going to be a member of the GSE team, I had just four months to get ready before we left for the Netherlands. During that time, the main thing I did was prepare our presentation and get to know the other team members. Part of that involved learning a number of things regarding how I should help others get to know me and how I should go about getting to know other people. Also, I was given a number of opportunities to think about myself and my role on the team and in the presentation, being asked questions such as, "And what will you be able to do during our presentation?" I thought about the five weeks I would be in the Netherlands, and about how I must never forget that I had certain responsibilities and obligations to fulfill while I was there.
What I Learned in the Netherlands
Through my vocational study trips
Before I went to the Netherlands, I particularly wanted to learn all I could about nursing there, so I worked hard to gather all the information I could. But, it was very hard for me to do this. When I finally arrived in the Netherlands, all I knew about nursing care there was that many women prefer to have their babies at home, and they have regional health care systems there. That's all. I remember thinking, "It's hard getting information about the Dutch medical system, etc. from books, but when I get to the Netherlands, I'll be able to learn from the things I see and here there. Wow! I want to learn lots of things!"
I visited the following places for my vocational study:
/2 large-scale, general hospitals (I was able to observe an
operation in the pediatrics department.)
/a regional home doctor's pharmaceutical practice
/an old age home, children's health center (I was able to observe medical check-ups
at an elementary school.)
/the home of a woman who just had her baby at home; an exercise class for mothers
who had their babies
/facilities, schools and youth centers for the handicapped
In addition, I was able to learn about the district's physical therapy methods thanks to the kindness of my host family, and I was also able to visit an elementary school and special education school, sit in on classes, and have some interchange with the children. I would like to mention here what I learned about the Dutch approach to medical treatment, particularly in regard to the work of nurses.
First, in regard to the comparative populations of Japan and the Netherlands, the birth rate is higher in the Netherlands and the death rate in Japan is lower. I think many in Japan would think that the pediatric medical care system in Japan is superior to that in the Netherlands. To be sure, it may appear to be so if one looks merely at figures and percentages, but in regard to the problems we face today, such as child abuse and the mental health of Japanese children, I think the most important thing is the substance of a children's health care system. And from what I saw of the deep-rooted health care system for children in the Netherlands, there are a number of things that Japan should learn from the Dutch and incorporate into our own health care system.
I would like to take a look now at the Netherlands' health care system for children, breaking it down chronologically in the life of a child.
Birth
About one third of Dutch children are born at home with the assistance of a midwife. In Japan, such births accounted for just 0.l% of all births in 1997, which is completely different than the Netherlands. The number of midwives in Japan and the Netherlands are almost the same, and as far as facilities are concerned, there is little difference. In response to my questions, the new mother I visited at home said, "I was able to relax when I had my baby here at home. There is no need to go to a hospital to have your baby. Giving birth is a very natural thing." I think the way the Dutch view birth is very different than here in Japan. Also, in the Netherlands, health insurance covers pregnancy, birth and after-delivery care by visiting nurses as well. (There are differences depending on the type of insurance and home situation, but visiting nurses generally offer 64 hours of care, from 3 to 8 hours per day.) I got the impression from what I saw and heard that they have a follow-up care system provided by the local government. In the home I visited, the husband was there, and he learned (from the nurse) how to give the baby a bath, and he was doing the housework for his wife too. In the Netherlands, it is possible for husbands to receive three days paid leave from work when their wife has a baby. This system helps get not only the mother, but the whole family involved in the birth, and its influence on the family relationship in the future is also good. I envy the Dutch when I think of how things are here in Japan. I wasn't able to meet her, but I heard that the midwife comes to the home around the 8th day after birth to give the baby and mother a physical check-up. Sometime between the 5th and 7th day, a district nurse visits the home to explain to the mother about the 8th day check-up and the one month check-up.
Photo 1 The new mother and district nurse
Photo 2 Holding the newborn baby
One month to 4 years old
Health centers specializing in the care of infants and young children provide follow-up care on a regular basis. The midwife fills out a one-page form giving the date and time of birth and other pertinent post-birth information and takes it to the center. Using this information, the center carries out physical exams, provides child care consultation (in a private room) and education (they provide books for mothers to borrow), gives vaccinations, and provides other services. The results of these check-ups, etc. are recorded in a "growth book" (it is similar to the "mother-child book" given to mothers in Japan, except it only contains information on the child) and on medical charts. The time frames for these check-ups differ from center to center, I was told, but in the town of Ede, the children receive check-ups, etc. when they are 1, 2, 3, 4, 5, 6, 8, 10, 12 and 15 months old, 2 years old, 2 and a half years old, 3 years old, and 3 years 9 months old. This is much more frequent than here in Japan. Each district has its on network of doctors, social workers, school-related people, police officers, and child care facilities. Every 6 weeks, they meet together to discuss any problems that may have arisen since the last meeting, and work as a team to deal with those problems.
Photo 3 With a district nurse in front of a children's health
care center
The health center buildings have a very open atmosphere to them, and because they are located near dentist offices, pharmacies and supermarkets, mothers are able to drop by at any time without an appointment (and at times not related to their regularly scheduled appointments) to talk with a staff person about anything they have questions about or are worried about. I think this makes it easy for mothers to get quick answers and solutions to their problems. The system makes it easy for mothers to find solutions themselves by getting some outside help before the problems they are facing become too large.
After the child is four years old, the medical charts filled out at the child health centers are given to the school doctor at the school they begin to attend. This system allows for the smooth and efficient transfer of information.
From age four
In the Netherlands, children go to elementary school from age four. For this reason, the majority of a child's health management is undertaken by the school doctor. Every child receives 6 health check-ups from the school doctor (at age 5, 7, 11, etc.). In Japan, the children get check-ups every year, so it seems to be too infrequent in the Netherlands. To be sure, the number of check-ups is small if there are no health problems encountered, but the content of the medical checks provided in the Netherlands is very different than in Japan. Each child spends at least 30 minutes in a private room with the doctor getting an eye examination, hearing test, and height measurement. Younger children have a parent present during the examination. The parent fills out a questionnaire about the family's health, siblings, the lifestyle rhythm in the home, etc. before the check-up, and the doctor talks to the parent and gives nutritional guidance, etc. based on the answers on the questionnaire and comments made during their talk. Also, the parent is asked to bring along the child's vaccination card so the doctor can make sure the child has received all the necessary vaccinations. If a parent is unable to be there with a child, the doctor writes out the child's weight, etc. on a card and gives it to the child to take home. If there is a health problem that needs to be addressed, or if the doctor wants to talk directly to a parent, he/she will call the home directly. Unlike Japan, the children receive mental/emotional check-ups as well as physical exams. If there is a health problem, the school doctor will sometimes give the parent a letter of introduction to a home doctor and will ask the home doctor to inform him/her of the subsequent exam results. The results of the child's check-up(s) are recorded on a check-up card, which is then given to the school principal. This is done after informed consent forms have been received from the child's parents. I think the Dutch go to great lengths to make sure each person's personal rights are honored and their health looked after. These check-up cards are not kept on file at the schools, but rather at a health center that has an office, and they are kept on file until the person is 25 years old.
In this way, the health of school children is overseen by their school doctor. These school doctors are completely different than the so-called "school doctors" we have here in Japan. In the Netherlands, school doctors study to become doctors, and then get an additional two years of special training after becoming a doctor in order to become a school doctor. The school doctor I met during my GSE visit serves as the school doctor for four schools. (He is overseeing 140 students.) There is an association of school doctors, and they are not just involved in giving students physical exams. They also undertake various health-related projects and are involved in educating students about health matters. These projects involve giving students information about alcohol and soft drugs. Sometimes, they put together a special program in which someone who had been a hard drug addict comes to speak to the students. (Of course, after receiving permission from the principal.) The police are also involved on these project teams.
In Japan, schools have a health room where there is a school nurse. In the Netherlands, however, there is no health room and no school nurse. Just a first-aid kit with instructions. The teachers are responsible for taking care of injuries that arise at school using simple first-aid. Here in Japan, it is the school nurse who is primarily in charge of the children's health care, whereas in the Netherlands, it is the school doctor. I think Japan should apply some of what I saw in the Netherlands in regard to school medical check-ups, the consideration of personal privacy, and the fact that health exams cover not only physical check-ups, but involve the whole family and even deal with mental and emotional health.
Some Things I Learned from Non-vocational Study
Photo 4 Children celebrating the Queen's birthday
Children's education in the Netherlands
While we were in the Netherlands, the Dutch celebrated Queen's Day on April 30. We saw many children playing on that day. Queen's Day is similar to the Japanese national holiday celebrating the birthday of the emperor. On April 30, many people get caught up in a festive mood and enjoy the day. A lot of children gathered in the open square in front of a church, and played games and got their faces painted like cats, tigers, and other animals. The people running the program were volunteers (children and adults), police officers, etc.
Besides this, some of my host families had children, and I was able to play together with Dutch children and talk to them about many things. In the Netherlands, soccer and ice hockey are very popular, and most children play on teams for one or both of these sports. Adults are also actively involved in playing these sports. There is abundant natural beauty in the Netherlands, and many people enjoy cycling because the land is so flat. However, in recent years, just as in Japan, children enjoy collecting Pokemon cards, playing TV computer games, and doing other indoor activities. As a result, more and more children are becoming overweight.
School education
There are some big differences between schools in Japan and the Netherlands. First, schools are divided into three types based on religion: Catholic, Protestant and public. Also, there are no school clubs. After school, children attend "art centers" (such as music schools) for a fee (the local government pays 50% of the tuition), go to soccer or hockey practice, or participate in volunteer work. Also, the school children do not grow plants, take care of animals or even have swimming pools at their schools. When I heard that there are no school clubs and the children do not have the opportunity to raise animals, my honest reaction was, "How narrow the Dutch way of thinking is regarding education! Children learn many things through school clubs and taking care of animals, etc." But, instead of these activities, Dutch children learn what it means to do volunteer work. When I thought about that, I realized the Dutch system is good. I then learned that the children themselves are in charge of the volunteer activities they do, and I realized that their after-school activities are much more meaningful than what we have in Japan. This is because in Japan, club activities are directed by teachers, and you couldn't say that the children are running the clubs.
Schools throughout the nation give students the same tests, and after evaluating the scores, the children are followed-up. Those whom the board of education determines have learning or mobility disabilities are transferred to special schools. In recent years, the number of immigrant children has risen dramatically, and there are also learning problems caused by their inability to communicate adequately. As in Japan, classrooms for special needs children are not located in regular schools. But, there is a movement underfoot to start having such classrooms incorporated into the regular schools as consideration is given to the need for unified education and convenience (having such classrooms located near the children's homes). I am looking forward to returning to the Netherlands sometime in the near future and seeing how things have changed in this regard.
Lifestyle customs in the Netherlands
At the homes were I was given the opportunity to have homestays, I was welcomed as "one of the family," and I think this was a wonderful experience. I was able to learn first-hand how a Dutch family lives. (Of course, what I saw wasn't everything there is to Dutch family life.) I noticed two big differences between Japanese and Dutch lifestyles. The way in which they relate to their neighbors and the way in which the father and mother (husband and wife) share the household responsibilities.
This is probably not unique to the Netherlands, but to the West in general, but I think they often invite friends and neighbors into their homes for parties and times of fun. Such gatherings are very casual and the atmosphere is relaxed. I think the Dutch exchange information, communicate with one another and get along with each other very well at these home parties. They are able to expand their horizons and viewpoints and learn more about themselves in such an atmosphere. I also think these gatherings give children the opportunity to learn social graces and how to interact with other people. I guess Japan is starting to change a little in this regard as some people start getting together for home parties, but I think we tend to be more concerned with appearances, etc. than with truly opening up with others and sharing what is going on inside of us.
Fathers and mothers (husbands and wives) both bear the responsibility of doing housework. When I saw this, I was very envious of Dutch women. In Japan, the men spend almost no time at all doing housework. To be sure, Japanese men spend onlyabout 10 minutes a week doing housework, compared to five and a half hours per week for men in the Netherlands. I think society is changing in Japan and things here will become a little more like in the Netherlands, but it is a very slow process!
Looking to the Future and Applying the Things I Learned in the Netherlands
It has already been a month since I returned to Japan from the Netherlands. I was so busy doing things I needed to do to get caught up with my life here in Japan, but taking the time now to compare Japan and the Netherlands, I came to realize the good points of both our countries. Because of differences in our culture, it is not possible to compare everything similarly, but I would like to do what I can to incorporate the good points of the Netherlands in Japanese culture. First, though, I must apply these things to my own life. Once I do that, I think I will be able to bring about changes in my own life and in the lives of those around me.
