Apr 06: Further Complication

Here’s what you don’t want to see if you visit Takayama:

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That’s the hallway of the emergency room of the Takayama Red Cross Hospital. We spent our morning exploring the health care system of Japan as represented by this local hospital. I won’t leave you in suspense: Tracie is basically okay but still does not feel well and we may end up cutting our trip short.

The long version of the story starts late last night. Tracie was still not feeling significantly better, and noticed two things: first, her symptoms were roaming from one part of her body to another, although mercifully her lungs were staying clear. (For those of you who are not as intimately acquainted with Tracie’s medical history as some of us, Tracie has a long history of asthmatic bronchitis, pneumonia, allergies, and other ailments of the respiratory system. If she gets a cold, it’s bad; if it moves into her lungs, it’s Very Bad.) Second, and more disconcerting, she noticed a strange rash on the palms of both hands.

By morning she decided to call her mother (who is staying at our house to look after our cats, one of whom has his own interesting medical conditions) so that she could call Tracie’s doctor to obtain his opinion and advice. A couple of hours later she called again and his word was “given your history, go to the hospital. Now. Do not pass Go. Do not collect 200 yen.” (Okay, I’m embellishing a little.)

So, we got the people at the front desk, who are very polite and helpful although their command of English is somewhat erratic, to call us a taxi to take us to the hospital. Upon arriving there we asked the ER attendant whether he spoke English. He didn’t seem to speak much but he produced a bilingual form that had checkboxes and little descriptions such as “I feel very tired”, “I have pain”, “I have a cough”, “There is a problem with my stool”, “I think that I might be pregnant”, “I would like to purchase pills to make my manhood larger”, etc. (Yes, I’m embellishing again. Sorry.) So I filled in Tracie’s name and checked off the appropriate checkboxes and we were shown to a bench in the hallway that you see above. While we were waiting I reviewed the scant collection of translations in our guidebook and in my PDA for words and phrases appropriate to medical situations.

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A short time later a young female nurse appeared with a thermometer, and not long after that she reappeared to escort us through one of the doors. Unfortunately I didn’t take any pictures of the actual examination rooms or other areas; hopefully you understand my reluctance to snap photos while the medical professionals and Tracie attempted to understand each other with a small number of English words and some amount of gesturing.

The first doctor took down all of Tracie’s symptoms and other information. This was our first opportunity to watch someone enter Japanese on a computer. I’m still not sure how it works. After that he somewhat bashfully admitted that he was “only a surgeon” and that he needed to refer us to a “medical doctor” who was more familiar with internal ailments.

After a brief delay we were joined by a very young man who turned out to be a “medical doctor”. They talked at some length and decided that Tracie should have her blood drawn and a chest x-ray taken. Later they decided to do an EKG also. I missed out on what was apparently a very amusing situation when the doctors had to ask Tracie, with much apology and bowing, that she had to remove her shirt and bra. (“I don’t think my breasts have ever been bowed to” she told me.)

After running through these data-gathering exercises, we were taked upstairs to wait. After 20 or so minutes we were taken to see the same doctor again. He had reviewed the x-rays and the results of the blood test and EKG and went through the data with Tracie. In short, everything looked fine. There was still some concern about the rash on her hands, so we were told that we would see a “skin doctor”.

While we were waiting a couple of minutes for what we thought would be the skin doctor, we had a rather amusing exchange with a small gaggle of female nurses. The youngest noticed me peering at my PDA (I was hoping to find a translation for “cortisone”) and asked in hesitant English whether it was some sort of dictionary. I explained that it had a list of phrases and demonstrated by reading in hesitant Japanese “my wife is sick”. This produced peals of laughter from the nurses, a series of bows, and the declaration that I spoke very good Japanese. I bowed back. Tracie then taught the young woman to say “dermatologist” which is a mouthful for a Japanese person because of the presense of both R and L sounds.

Digression: it’s a stereotype, but the Japanese really do have a hard time with the L consonant present in English and other languages. I’ve been told that it’s a phoneme that simply does not exist in their language, just as German doesn’t have English’s TH sound and English doesn’t have German’s umlaut vowels and glottal R sound. If your native tongue doesn’t have a phoneme at all it’s particularly difficult to learn to utter that sound because your ear isn’t even trained to hear it. A Sikh friend of Tracie’s once demonstrated that his language has five different vowels that all sound like AY (as in “cake”) to an American ear, but are quite distinct to native speakers of his language. R is the consontant closest to L to a Japanese ear, so unless they have considerable practice they pronounce Ls as R.

On the other hand, my extremely limited reading on the topic suggests that all Japanese phonemes are familiar to an English speaker, which is good news for those of us who would like to learn Japanese. So far my ear confirms this, although I have noticed that the Japanese roll their Rs slightly.

Shortly thereafter a woman who we took to be the skin doctor appeared. She turned out to be someone with an excellent command of English that had been called out of some recess of the hospital to act as a translator. Interestingly enough she spoke with a slight British accent, as did the woman at the tour agency I contacted to help us rearrange our hotel and travel arrangements. She was very pleasant and made the rest of Tracie’s exchanges with the staff considerably more efficient and comprehensible for everyone involved.

She took us to yet another waiting area and apologetically explained that we would have to wait about 30 minutes because there were other people already waiting. Throughout these pauses I was sneaking off to call the tour agency and guzzle a Coke to get some sugar and caffeine into my system since I hadn’t had breakfast.

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Barely 30 minutes later were moved closer to the skin doctor and chatted with our translator about our travels and Tracie’s illustrious medical history. During this exchange we discovered that she had this really cool electronic translation dictionary that folded up into a flat box a bit larger than a large PDA, but with a usable QWERTY keyboard and good-sized LCD.

The dermatologist peered at Tracie’s hands, then examined them minutely with a loupe. After it was established once again that this odd rash was present only on her hands, he rendered the opinion that it must be some sort of allergic reaction to something that she had touched. He prescribed cortisone cream and sent us on our way.

Our translator ushered us to the main lobby and we waited while she handled the paperwork for billing. We paid her in cash (she apologized for being unable to take a credit card) and wished us well for the rest of our trip. She was such a sweet person and such a help to us. We took a taxi back to the hotel, and Tracie has been resting since. She feels somewhat better, and certainly relieved that nothing interesting was found with the x-rays or blood test.

Now, consider the implications here: We walked into an ER and within ten minutes were seen by a doctor, without showing any proof of medical insurance or any other ability to pay for treatment. We were there for just over three hours. In that time Tracie saw a self-effacing surgeon, a doctor of general medicine, a dermatologist, and had a blood test, two chest x-rays, and an EKG. The results of all of these tests were produced and examined while we were there. Tracie was entirely happy with the quality of the diagnosis and the manner in which the information was provided to her–as in, she saw the x-rays and the actual data and the doctor interpreted it for her. She’s quite familiar with the meaning of the results of a blood test and hence was able to confirm that the doctor knew his stuff. The prescription for the ointment was filled and presented to us, and we paid and walked out. The grand total for this exemplary medical service? 17,093 yen, or about US$145. This is in a hospital in a relatively small city, not a facility in a major metropolitan area. We mentioned to our interpreter how astonishingly inexpensive this was compared to American hospitals, and that you may not even be admitted to an ER if you don’t first show proof of insurance or other means to pay. She was aghast.

Imagine seeing a doctor, let alone three including a specialist, for $145–plus the lab work, prescription, etc. We were amazed and impressed. I can’t say that we originally planned to evaluate the medical system here, but having done so I will travel here again with full confidence that we would be able to obtain treatment easily if we needed it. I deeply regret that Japanese visitors to the United States unquestionably cannot expect the same.

Tracie just reminded me that when we were in Basel and had to see a doctor, he provided all of our medicine for free from his office stash and all but declined to be paid. If you harbor any doubt that the American heath care system is not f—ed three ways to Sunday, try getting sick in Switzerland or Japan and compare and contrast the treatment you receive. The American system is making the insurance vendors and the lawyers rich while the citizens go without health care.

As for our plans now: we were supposed to catch a bus at 9:30AM to take us to Kanazawa. Obviously we didn’t make that bus. We are staying another night in Takayama; fortunately the hotel is able to accomodate us. We will stay in Kanazawa for one night and then travel to Kyoto as originally scheduled. After settling in at Kyoto we will evaluate Tracie’s condition and decide whether we want to return sooner than planned. We’re hoping that Tracie will feel better by the time we arrive in Kyoto. The rash on her hands already seems to be dissipating somewhat.

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