(Team member: a registered nurse and an English class coordinator at a Baptist church)
Thanks to R.I., I had the wonderful opportunity to participate in homestays and to have an enriching learning experience for 5 full weeks in America.
As I look back on the people and places I have visited during my hectic schedule, I recall with deep emotion a panorama of condensed experiences and valuable encounters. I feel as if North Carolina is my second home.
I was able to talk directly with people working at business enterprises, schools, welfare organizations, etc.. I was given an opportunity to learn so much that will certainly assist me in my own future work.
Among these many fields of endeavor, what was of particular interest to me was medical care and welfare. Therefore, I'd like to report about issues in terms of communication that I learned through these particular encounters.
I'd also like to extend my deepest gratitude and praise to the marvelous people of R.I. District 266 who planned this study and exchange program for us and to all those wonderful folks of District 769 who ceaselessly attended to our every need in North Carolina. Thank you all so very much. (April 24, 1991)
I visited 4 hospitals, 2 doctor's private offices, and 4 homes for senior citizens. In a word, the American medical system is extremely efficient.
First, the average number of days for hospitalization is incredibly few. Normally, patients spend 2 days for appendicitis, about 2 weeks for general heart operations, and only 1 or 2 days for child-births. This is partially due to a high cost of hospitalization caused by well-equipped nursing system and the fact that most rooms are private rooms. However this system is quite effective in a sense that there is a strong awareness for the importance of rehabilitation and that in-hospital contagion can be easily avoided.
Secondly, community doctors cooperate with hospitals. The cooperation of the doctors at clinics, infirmaries, and offices in further patient care and medical follow-up after release from hospitals becomes quite necessary. When these doctors send their own patients to hospitals, hospital head physicians cooperates with private doctors in patient treatment, greatly facilitating post-release follow-up. Facsimile and microcomputers are used for the communicating information.
Thirdly, they have efficient information processing systems. Computers are set up in every ward and key location. For example, when a patient's past medical history is required, a nurse can access that patient's data on a computer in the examination room simply by using the patient's ID number and password. One advantage of the American systems is tendency to adopt new and improved methods readily so that the tasks are handled at maximum efficiency. By using computers, it is no longer necessary for doctors and nurses to organize and paste the bulk of test result clippings onto the patient's medical records or have a chance of ripping them.
Furthermore, hospital personnel can search and extract only the most essential examination data by using computers. While Japan's high technology is in no way inferior to that of America, it is most unfortunate that such technology is little used at hospitals and other medical facilities.
Fourthly, the quality of American medical personnel is high. In the first place, the status of nurses in hospital wards is different from that in Japan. In addition to nurses, nurses' assistants and medical office staff can be found in the average hospital ward, and head nurses have their own secretaries.
To provide essential patient care, nurses manage the operations of all the hospital wards and have nothing to do with such routine duties as cleaning and processing invoices. Thus, nurses are able to completely concentrate on patients. Assistants even work the night shift, taking care of the routine ward duties, so that nurses can spend more time at the patient's bedside.
Besides nurses, hospitals are staffed by such treatment specialists as X-ray technicians, medical test experts, and physical therapists. Since each of these specialists is responsible for his or her expertise and its application to treatment, patients present little unwarranted burden for doctors, effectively allowing faster and more effective treatment and patient care. Eliminating loss as much as possible to provide sufficient, essential patient care is the basic idea of the American medical system.
The American medical system is very attuned to new developments. Not only does the system invest in computer technology and establish medical care teams, but it is ceaselessly adopting new policies concerning the patients themselves.
I visited one Baptist hospital where the patient's parents were allowed to visit the ICU for the newly born around the clock. This hospital is the community's pediatric center where serious cases are brought.
There was, of course, opposition to adopting this system. Nurses had carried out experimental studies since about 10 years ago to show that it makes no difference in the rate of contagion due to visitors not wearing surgical masks and gowns or due to bringing toys for the children from outside making it possible to adopt 24-hour ICU visitation. Child abuse which has become a major problem in America is the reason behind establishment of this system. Insufficient parent-child bonding when infants are separated from parents right after birth has allegedly triggered an increase in child abuse after release from the hospital.
Mickey Mouse dolls and teddy bears wearing hand-knitted hats on their small heads are placed between ECGs and respirators. Since respirators are handled by specialists, it is sufficient for the doctors and nurses in charge to simply watch out for these machines. Nurses wear uniforms with unique styles. Nurses wearing white pants and a colorful t-shirts is a common sight. Their appearances give off a cheerful and functional image.
On a somewhat different note, joint operations are also often seen at the offices of private doctors. Two to five doctors will have offices in the same building. Because of off days and vacations, doctors will sometimes share offices and medical equipment like X ray machines. Sharing data concerning his or her field of expertise with other medical offices in the building is extremely practical and economic. In pediatrics, doctors wear plain clothes so that children do not frighten. Also, diagnostic explanations and methods of treatment are not discussed in the examination room, but are held in the more relaxing environment of the doctor's own private office with the family members.
The activities of volunteers in hospitals should not go unnoticed. Over 500 volunteers are registered at every general hospital we visited. These volunteers offer simple services by selecting times and days that are convenient to them. The simple but time-consuming services such as moving patients around, taking them for walks, and helping with meals are handled by volunteers. At the reception desks of every hospital, there were female volunteers ready to show visitors to their destinations. I met a Rotarians pushing patient's wheel chair. In fact, hospitals could not fully function without these volunteers.
As can be clearly seen from the efforts of hospital volunteers, Americans strongly support welfare services. It is largely due to their Christian spirit, however it owes its source of energy to the fact that volunteers have pride and awareness that they are serving the society, and that their activities are recognized as valuable social services. In any case, what is most worthy of our praise here is their attitude to tackle every existing problem together instead of letting it go unnoticed.
I also visited United Way Agency. The United Way is a national service organization which provides a variety of services from old peoples homes or correction house for the youth to nursery schools serving the teenage mothers. United Way activities are supported by the work of countless volunteers and such community economic cooperation as donations by residents of any given area. United Way staffers perform their services with a clear understanding of their mission and with a sense of pride.
The last place I visited was the Food Bank, a civil assistance organization also active throughout the U.S.. I visited the Winston-Salem group which was in the process of moving from a warehouse on loan from some company to their own facility. Their operating funds were, of course, provided by individuals and the area's businesses. The Food Bank collects grocery items which just reach their expiration dates from party stores and grocery stores such as Lawson or Daiei (one of Japan's largest grocery store chains). They then supply these items to charity organizations at fixed, low prices.
In order to purchase the food from the food bank, one must apply with a proper procedure and receive a permission. Soup kitchens which provide the homeless with one nutritional meal everyday obtain the majority of their food from the Food Bank. At the food bank, mountains of merchandise from inventory clearance and factory surplus products are seen creating an amazing sight. Young staff members from various institutions come by car to purchase these goods. They look for desired articles and take them to the cash register. Behind the cash register is a middle-aged man verifying the purchaser's permit and weighing and pricing the food. Everything is sold at a very low fixed price. Part of this money goes to the facility's operating costs and full-time staff personnel costs. Still, the majority of the operating costs is donated by individuals and businesses. From this, it is clear just how much the community's businesses are actively involved in handling volunteer services. This is one important way for the businesses to gain tax deduction while making connections with the local community.
Although welfare and assistance services are flourishing, problems are equally thriving in American society. The number of homeless people in some American towns reaches a few hundred people, an inconceivable number for Japan. While government give aid for the unwed mothers so that they can go to school while having their children looked after, no remedy is taken for the fathers' actions causing the same unfortunate mistake to be repeated. Most unwed mothers have only 1 parent. About 30% of the high school students drop out every year. These dropouts are unemployed and are susceptible to drug use and crime. This is not happening in an undeveloped society like that of India or in African nations. Even though everyone has an opportunity to be educated, many people cannot even answer simple arithmetic problems.
In the U.S., an independent minded land of opportunity, the successful people can enjoy living in a large house while having enough time for vacationing. While her people do not tend to save a large portion of their income, having plenty of land and resources makes America a much wealthier country than Japan in a sense. In the consumer oriented society such as the United States, economy develops by manufacturing goods that are to be frequently replaced by the new model. Goods found in American stores are much more varied and reasonably priced compared with Japan because of it.
Even with comparable salaries to ours, Americans can enjoy a somewhat richer lifestyle. They have well-managed welfare systems and efficient education systems. In spite of those conditions, American society is diseased with growing domestic problems. Many families are on the road to destruction because its members are overly preoccupied with their own rights. It is not easy to restore family relationship once it is destroyed. The children are the first to suffer from this destruction. Child abuse, unwed mothers, high school dropouts, all of these problems ultimately stem from the family problems. Welfare services cannot solve the problem as long as the ultimate cause remains intact. The number of people suffering from family problems will increase making the whole issue more serious.
In spite of civilization's great advances, the human heart continues to degenerate. We have the technology to explore space and manipulate genes, yet we destroy forests and trees which protect human race, and consume chemical additives which affect our health. Everyone is aware that there is something wrong with this approach to life we are taking.
Perhaps we in Japan may learn something about the direction we should take by observing America. We may be able to learn enough to prevent ourselves from repeating the same mistakes. I think it is vital to develop methods of mutually understanding each other and exchanging accurate information between two nations.
We received explanations at each location we visited during this G.S.E. program, but there were language problems as well as difficulties concerning explanations of fields about which we knew very little. We particularly had a hard time with technical terminologies. Looking at the circumstances of these explanations, there were times where we thought we somehow grasped the overall meaning by listening to entire sentences. Looking at the pamphlets afterwards, however, we sometimes found that the meanings we had thought we understood had been entirely wrong. At almost every site, we received numerous pamphlets. It would have been better to have studied pamphlets ahead of visitation. This way, we would have been able to look up unknown words in the dictionary, making the subsequent explanations easier to follow. Even if we thought to check the meaning later, there really wasn't enough time, and by then, we often forgot what it was we had wanted to look up. Later on, we often regretted thinking "If only I could have asked a little more about that!" or "It would've been great if they had shown us this." I thought that since America was far away and thus not so easily accessible to us, observers should be sufficiently prepared. If we had some knowledge in advance, it would have been easier to absorb new information or to make a guess at it even if the explanations were in English.
In order to develop a deeper mutual understanding, however, we need more than just language skills. We need to communicate with the understanding of human relationship. For example, if the person giving the explanation is someone we already know, or if we somehow feel close to that person, then the same explanation becomes much easier to understand. Human relationship enables us to learn the new ideas even though their fields are not directly related to our own work, or to offer our view in exchange.
Establishing fundamental human relationships lets us smoothly accept our differences in language and culture. If one desperately tries to obtain only the information necessary for his business purposes, he cannot obtain the useful ideas contrary to his needs. The quality of communication depends on whether one has or does not have a relationship with another.
One of the recurring topics of conversation with host families throughout my homestays was the Gulf War. Although I was advised not to discuss the Gulf War at great length, I felt it was unnatural to suddenly change the subject of discussion, so I always spoke my mind on the matter frankly. I told them that I was strongly against wars because I learned from my parents of the misery of losing many of their friends to bombing by American B29's in World War II. I also talked about my experience with Asian people's strong reservation against Japan assisting a warring action from the time I traveled through Asian nations and associated with the residents.
There are those in America who also feel that America should not repeat the miseries of the Vietnam conflict. While they did not agree with my opinions, they understood them well. Not evading others' questions or deceiving them, directly expressing your own convictions is far more important than persuading others. Even when someone does not agree with me, our fundamental human relationship remains intact.
Even though America and Japan are in the throes of various business and political negotiations, I was surprised to discover that Americans are not aware of the general and ordinary opinions held by Japanese. In spite of the fact that over half the cars about were Japanese and stores are filled with Japanese audio sets and TVs, Americans do not know the true face of us who made all these products. There is only the image of an economic animal, an overworked people wearing glasses. But when Americans can see our true image, they open up their hearts and respond warmly to who we really are.
We both must put up an effort to associate with each other more and to show our true selves. To the extent that Americans do not understand Japanese, neither do we Japanese know America. Japanese think that all Americans are extroverted and friendly speakers. And yet, there are Americans who are quiet and say very few words. Once you get to know them, you realize that they are no different than your neighbor at home. When somebody gets to know somebody, mutual feelings are established. Once mutual feelings are established, they may then speak of their differences. And it is this that leads to mutual respect and understanding. One by one, if we start from the very beginning, international understanding is not difficult at all.
The importance of following this simple rule was the most fruitful experience I had during our visit.
I had the chance to speak with one American manager at a Japanese company who was experiencing problems dealing with a newly-arrived Japanese CEO. It was partially due to the difference of opinions between the new CEO and the previous CEO, but the essential problem was the communication.
The new CEO had been eating out at the local Japanese restaurants everyday for 2 months since his arrival in America. I then understood how much hard time this American manager must be experiencing with the new CEO. I told him about typical behavior of people in Kansai district. My point was that just as North Carolinans, being southerners, differed from the "yankees" of the north, there are different types of Japanese as well. When we had finished our talk and said goodbye, the manager told us how happy he was to have met Japanese like us. He said he really felt better and gave us a big smile. Incidentally, other members had an involved talk with that Japanese CEO about how to enjoy the American way of life. CEO's of such large firms rarely hold direct conversation with people of our status. So this is without doubt a Rotary success! And that CEO listened. I certainly hope that they are now making mutual efforts to understand one another.
During this trip to America, Rotary gatherings as well as other places have also begun to address a variety of environmental issues. Some say that we are all under pressure to make decisions of enormous importance in the history of the earth. We could not just be preoccupied with the American dreams and lose sight of these most important issues.
Japan and America stand at the world's leading edge of culture and scientific technology. How wonderful it would be if these 2 major countries could cooperate with and learn about each other. It would be great if this knowledge and technology are not to be used for the immediate profit but used to enrich each of our lives in a true sense. It is not for a material affluence born of sacrificing the populations of the third world, neither for the development of advanced civilizations as we destroy the earth that protects human life, nor for a freedom born of discarding children, but to consider the earth as a whole, and to foster relationships between people - it is for these things that we should possess the knowledge and technological power to build our future world.
If we truly seize the reality of today and try to live together with the peoples of all countries, we will likely advance unerringly along our way to our final destination.
