Nurse and graduate student, Osaka University
Sponsored by the Osaka-Umeda RC
Our D-2660 GSE team left the Kansai International Airport on September 3, 1999. I don't know if it was because of a sense of being delivered from the extremely busy and rushed schedule I had before our departure, but rather than a sense of uneasiness, I was filled with happiness that I was finally getting to go to the United Kingdom, a country I had longed to visit. I don't think I understood at the time the real significance of what people meant when they said that this GSE trip would be a very valuable experience for me.
I want to thank everyone in the Rotary Club who gave me this very valuable opportunity, and everyone associated with the program. The things I experienced are extremely important to me, not only in relation to my career, but my whole life as well. I would like to share with you, now, some of my actual experiences as a member of the GSE team.
When you hear the word "England," what thoughts come to mind? In my case, the word brought to mind things such as milk tea, scones, chocolate and food that doesn't taste so good. In regard to things not related to food, many things, such as grassy parks, always carrying around an umbrella because of the inclement weather, old buildings, the Great British Empire, the Royal Family, the National Health Service, and nightingales came to mind.
But the terrible weather I had been worrying about didn't materialize. We had pleasant weather, and I only needed my umbrella one or two times. Fortunately, we were blessed with lovely weather, and my time in England was very comfortable. There were some team members who were slightly dissatisfied with the food, but, personally, I found the food to be better than I had imagined it would be. Of course, compared to Japanese cooking, the number of ingredients available for making meals is limited, but I was able to enjoy the food. In particular, I thought the tea and some of the sweets and baked goods were very delicious, and I always looked forward to tea after my meal. At times, I had five or more cups of milk tea in one day. Even now, I long for some of the mint chocolates which were often served after tea or coffee, and here in Japan I imagine myself eating them. Desserts in the United Kingdom are much larger than here in Japan, and quite sweet. But the scones were much more delicious than the ones we can get here in Japan, and since I enjoy baking, I was able to get some recipes from my host families that will help me make delicious deserts here in Japan.
As a rule, we changed host families every three days, and this was the only aspect of the GSE program that I regretted. There just wasn't enough time to spend unhurried time with our host families. If we could have stayed at one place just a bit longer, I think we could have experienced deeper interaction. Still, I did make use of the time after supper to sit and talk with my hosts. I enjoyed talking about Japanese culture and learning about the United Kingdom, but one thing was a cause of much distress, and that was religion. At one home, the husband went and got an encyclopedia, opened it up to the section on Japan, and showed it to me. This encyclopedia contained information about the culture and geography of all the countries of the world, and it said under the religion heading that apart from a few percent of the Japanese population who are Christians or some other religion, 80% of the Japanese are Buddhist and 70% are Shinto! So he asked me, "Just how do they handle statistics in Japan?!" When I am in Japan, I
understand the religious situation, but when I was asked about the religious views of the Japanese (who aren't really conscious of religion so much), I was really put on the spot. I explained to him that the statistics were the result of the fact that Shinto had been the religion of Japan since ancient times, that Buddhism came in later, and that they now exist together. I have my doubts, though, as to whether he understood what I was saying. The impression that stuck with me most strongly when discussing religion was the fact that the British are becoming more and more non-religious. One of my hosts told me that while many British people would call themselves Christians, not all of them go regularly to church every week, and unconsciously many people were becoming more and more non-religious.
In addition to religion, we also talked about social problems. Some of the major social problems mentioned by my host families were drugs, teenage pregnancy, and the breakdown and decay of schools and education. I felt that, though there may be differences in the degree and background of social problems, the ills being faced by the advanced nations of the world are more or less the same.
During my one month in the United Kingdom, I was able to travel widely throughout northeastern England, and I saw many wonderful buildings and much natural beauty. I was also able to get a taste of British culture.
My vocational study theme was "The role of visiting nurses in community health care programs." During my time in England, I had vocational study trips planned by the Rotary for six days, but one of my host families kindly worked things out for me to have another day to do vocational study. I visited three hospitals, two hospices, three health centres, and was given the opportunity to make the rounds with a visiting nurse as she visited her patients in their homes. At all the homes we visited, I was warmly welcomed even though they had no idea I was coming, and I was able to get a feel for the strong sense of trust that exists between the people in the community and the visiting nurses. In particular, my experience resulted in a kind of culture shock for me because we do not generally have such a system of health care workers visiting patients in their homes. The United Kingdom's system of health care, medical treatment and welfare is different than the Japanese system. Basically, the British system is supported by taxes and provides, as a unified public service, a wide variety of services related to health care, treatment and welfare. Citizens register with a local doctor (general practitioner), and if they have some health problem, they go to him or her instead of to the hospital. Many of the health services are provided free of charge. Two things I was particularly interested in were the services for the elderly and those for the needy, such as the unemployed.
The United Kingdom has been providing health care from "the cradle to the grave" much longer than Japan has, and is now facing a serious problem taking care of their many aged citizens. One way the government dealt with this problem was to enact the Community Act (which is similar to nursing insurance here in Japan) in 1993, which gets the elderly to check out of the hospital as soon as possible and provides them with health care at home. In the United Kingdom, as in other European nations and the United States, it is normal for the children to leave home after they grow up, and there are very few homes in which three generations live together. In addition, the elderly have a strong sense of independence, and you don't see many people who want to be looked after by their family.
On the other hand, I was told that the number of families in which the bond between family members is weak and the children want absolutely nothing to do with taking care of their aged parents is increasing. The elderly live under a variety of conditions in the area I visited. Some live in their own homes, some in "shelter houses" (row homes with someone living there who takes care of the houses), some in "residential homes" (homes where those who need some health care live), and some in "nursing homes" (for those who need nursing care).
I have seen many different facilities in Japan, such as rest homes for the aged, long-term nursing care facilities, and health care centres for the elderly, but compared to these, the facilities provided for the elderly in the United Kingdom have a much more homey, friendly atmosphere. Here in Japan, we tend to attach much importance to providing full care, but I think as far as our patients are concerned, "good care" involves much more than that. For example, in nursing homes in England, I saw almost no one who was just lying there in bed (of course, there is a difference between our two countries in regard to how many people are available to provide personal care to the patients), and the residents have their own room and are surrounded by items they brought with them from their own homes. In the United Kingdom, they place great importance in providing the elderly with a place to live that is as close to "home" as possible, and that is how it felt to me. Of course, Japanese nursing homes have their good points as well, and I don't think that our copying the British way in everything will eliminate the problems we have in Japan. But, I saw many things that we could learn from, and I feel that by adopting those good points here in Japan, we could make the care we provide even better.
The area I visited in during my time in the United Kingdom has both unemployment and crime rates that are among the highest in England. The unemployment rate in the area I visited when accompanying the visiting nurse had, at one time, been as high as 45%, and at the time I was there, it was still 20%. Many of the people in this region live in public housing complexes called "council houses," and are living on their unemployment benefits. The homes where I stayed, and the places I visited while sight-seeing, were very different than here in Japan, and I saw many places that gave me a glimpse of what it was like during the time of the Great British Empire. However, what left the greatest impression on me was the life-style of those living in the region who could not be called "well-to-do." At first glance, the United Kingdom appears to be a wealthy nation, but in reality, there is a large gap between the rich and the poor, and it appeared to me that this gap is widening. During my visits with district nurses, health visitors and community psychiatric nurses, I saw some of the homes where the most needy live, and I felt like I had caught a glimpse of the dark side of life in the United Kingdom. The latent needs of Japanese citizens for the important role carried out by visiting nurses are becoming more and more obvious now, and I thought it was wonderful how, in the United Kingdom, the citizens (including the needy) have such easy access to the health and medical welfare services provided by the government and how the government provides the services that are necessary as the need for them becomes obvious. Of course, there are naturally some negative factors to providing such free, public health services, including the enormous costs and the fact that the services cannot be provided unconditionally under any and all circumstances. Still, there are a number of things to be learned and applied as we begin, here in Japan, to move toward the establishment of public health care and welfare services centered on locale.
In particular, I want to write about the high awareness or consciousness the visiting nurses have regarding who they are and what their job is all about. Of course, these nurses recognize the problems faced in their society, but as a nurse myself, I was very impressed by the level of awareness they have regarding their field of expertise. When I mentioned that I work as a nurse in Japan, I was always asked, "What is your specialty?" In Japan, when I mention that I am a nurse, people may ask me what department I work in (such as internal medicine, cardiac, etc.), but I have never been asked what my specialty is. Another thing that may contribute to the high level of awareness among British nurses is the system of grading nurses. In the United Kingdom, nurses are given a grade or ranking, starting from "A" and going up, depending upon experience, etc. Because I passed the Japanese national nurse's test about six months ago, I was told that my ranking would be around a "D". Based upon work experience and various tests, that ranking would go up to "E" and so on. I can't say that such a ranking system would definitely be compatible with the Japanese personality or character, but I do think such a system would motivate nurses to want to improve themselves and would be meaningful in helping to arouse specialty-consciousness. In the past, they did have a junior nurse system in the United Kingdom, but it was done away with more than five years ago. There is also a movement in Japan to eliminate this system, as well as efforts to help raise the level of specialty among nurses, and I saw many things that would help nurses in Japan do this.
I also saw another system at work in the United Kingdom that we rarely see here in Japan, namely charity work. There are many charities working at hospitals, hospices and other facilities, with the purpose of helping to raise money. There is also a high level of volunteerism in the United Kingdom, and there were many volunteers working at the hospitals and facilities I visited. I was impressed by the large number of people who are aware of, and are helping to meet, the needs of society.
I have only been able to write about a small portion of the many things I experienced while in the United Kingdom. It is impossible for me to write all the things I experienced as one of the GSE team members, but I intend to make good use of all of these experiences as a nurse and member of society here in Japan.
One of the things that impressed me most during my stay in the United Kingdom was the importance and respect the British people give to their history. Of course, I felt their pride in their old, majestic buildings and traditional row homes, and I saw some things that reminded me of and hinted of the glorious days of the Great British Empire. Also, I was ashamed of how little I, as a Japanese, know about Japan.
Moreover, my interchange with British Rotarians and their families gave me many value, such as the opportunity to think about and discuss religion, culture, history, and society, and the privilege of encountering the warm heartedness of the British people.
Now, when I hear someone speak of England, things are different than before. Some of the things that come to mind haven't changed, but some have. Some images have been corrected, and many new things have been added as a result of my trip. The things I felt while I was here in Japan, and the things I actually saw with my own eyes and felt while I was there, are fairly different, which is to be expected. Another thing I realized is that when we experience something, we are only able to experience one side of it, and that is not enough. So, I think it is very important for me to ask myself anew what I should do, what would be best to do, and what I want to do with the things I have learned from my trip. I met many different kinds of people and learned many new things, which in turn will lead me to think about myself as well.
I gained many valuable experiences that would have been difficult for me to have had if I had merely gone to England as your typical tourist on a sight-seeing trip.
After completing our almost one-month long itinerary, we returned to Kansai International Airport on October 8. I think I felt more disappointment that our program had come to an end, rather than happiness at returning safely to Japan. Words cannot express the deep sense of gratitude I have for my host families, everyone in England's D-1030 Rotary clubs, and all those who kindly assisted me in England. I also want to express my heartfelt thanks to my professor, Mr. Kazuo Inamoto, everyone in the Osaka-Umeda R.C., and everyone in D-2660. Thank you so much!
Even now, several months after returning to Japan, I find myself, on a regular basis, suddenly recalling the days I spent in England. I think all the varied experiences I had in England will continue to have a strong influence in my heart and life forever. And whenever I begin to feel a little sentimental or nostalgic, I think I will choose to indulge myself by recalling some of the things I experienced in England. Of course, there will be milk tea and scones on the table!
