Category Archives: Medicine

Some impressions after getting a herniated disc in Tokyo

So the last week and a half has been pretty harrowing. The morning after an official company function I woke up with excruciating pain running down my left leg, like something was stabbing me from my thighs down to my toes. It was persistent, constant, and intense. With the help of Mrs. Adamu I was able to just barely walk out to the street, call a taxi, and get to the orthopedist.

Because I had recently been on a long bike ride with my full weight on the seat for about 4 hours, I was sure I broke my tailbone. Turns out that was not the case—the doctor said I had a herniated disc! The prescription: a bunch of drugs, plus a regimen of stretches and an order to lose some weight.

By the time I reached the clinic, most of the initial pain was gone, reduced to mostly an aching in my Achilles area. Since then it has tended to be worst in the morning, easing off gradually from there. The pain has dulled a bit each day, and now I feel much much better.  According to the doctor, I am one of the lucky cases whose hernia will likely be eradicated by my white blood cells. Otherwise I could need vascular injections or even major surgery. Here’s hoping that won’t be necessary.

Since this happened in Japan, the experience is perfectly germane for MFT. So here are some observations:

  • The doctors were not the horror story I hear about – My doctors (I started with a young doctor and then switched to the clinic director) were patient, listened to my bad Japanese (and explained things to me and my wife very clearly in Japanese without making a big deal of it), and gave advice that seems to have worked perfectly.

  • Japanese painkillers are weak, on purpose – The pain drugs they gave me didn’t seem to do much. For those first four days I just basically ached without relief. This is by design, apparently. The clinic director explained that in Japan the consensus is that painkillers should not be over-prescribed to avoid their side-effects, specifically stomach irritation. This experience plus some other doctor visits have confirmed this tendency. It’s enough to tempt me to trot out that line about Japan having an “endurance” (gaman) culture. My mom was not happy to hear this and told me to take extra Advil if necessary, but for the most part I stuck to the doctor’s advice and toughed it out.

  • Japanese hospitals can be crowded – After hearing that the clinic did not open until 8:30, we waited until around then to show up. Big mistake. By the time we arrived, the waiting area was already packed with patients, mostly elderly (understandable in an orthopedist). Thankfully the pain had become more manageable by then, because we ended up having to wait hours and hours to see someone. Which brings me to my next point…

  • The iPhone rules (and so does the iPad) – On that first day, I used an iPhone app to call the taxi, e-mailed and called coworkers to let them know my situation, looked up possible diagnoses while I waited, and generally killed time. Then over the next few days when I was basically stuck on the couch, I used the iPad (and TV to a lesser extent) to entertain myself with My Chinese Bride, YouTube, and Twitter. A laptop would not have worked in my case because I needed to remain in one position to stay comfortable.

  • Commuting with a disability is NOT easy – After four days out of commission I was ready to try commuting to work, initially with a crutch for support. My office was very understanding of my situation and nice enough to let me come in late all last week to avoid rush hour, which was a godsend. I have a new appreciation for anyone out there riding public transportation with any kind of physical disability in Japan. The society is not built for them, and the infrastructure built to help them is generally not respected. Healthy people storm the elevators, meaning that slow people like myself always have to wait for the elevator to make a second trip.
    And that brings me to the train situation. As anyone following my Twitter feed will know, finding seats on the train has been probably the most frustrating part of this experience. Even with a crutch, it is a crapshoot as to whether anyone will offer you a seat. I counted four kind souls in total, which according to one of my Twitter followers is a pretty good batting average. Due to the pain, eventually I stopped waiting and just straight up asking people as soon as I got on. Usually people complied readily, but I could see how the disabled could feel worn down by having to grovel to strangers just to get from point A to point B.
    Eventually, I stopped needing the crutch but brought it around with me anyway to avoid confusion when asking for a seat. And speaking of seats…

  • The “priority seat” system is stupid and should be abolished – As visitors/residents of Japan know, almost all Japanese trains set aside a section of seats as “priority” meaning that the elderly, physically disabled, and pregnant women should be given priority to sit there. But this doesn’t work and is a misguided idea to begin with. For one thing, when the seats are full of healthy people and a disabled person comes on, you have the problem I described above.
    But the worst part about these is that it corrals the people who need the seats into one section of the train. For whatever reason, the train companies decided that the physically disabled etc. don’t deserve to sit anywhere else on the train. Why not just make all seats “priority”? In my experience, I never knew which section of the train would have priority seats, and in many cases they weren’t near where I got on. So instead of limping over to the priority area, I would just go ahead and ask someone in the regular seats to get up. According to Wikipedia, Hankyu and a few other railways have figured this out. And last but certainly not least…

  • Having a caring and understanding wife is the best – Mrs. Adamu has been my lifesaver through all of this. She accompanied me to the hospital and took care of me when I couldn’t get around freely. That was awesome.

So thankfully I seem to be getting better and might not have to worry about this stuff for much longer. But I have definitely gained a newfound appreciation for a lot of things, not least the medical system and the people who have to ride the trains with a disability.

I am interested to hear your Japan medical stories in the comments. Is my case the norm or more of an outlier?

Benefits of Bilinguilism

From last weekend’s New York Times:

Bilinguals, for instance, seem to be more adept than monolinguals at solving certain kinds of mental puzzles. In a 2004 study by the psychologists Ellen Bialystok and Michelle Martin-Rhee, bilingual and monolingual preschoolers were asked to sort blue circles and red squares presented on a computer screen into two digital bins — one marked with a blue square and the other marked with a red circle.

In the first task, the children had to sort the shapes by color, placing blue circles in the bin marked with the blue square and red squares in the bin marked with the red circle. Both groups did this with comparable ease. Next, the children were asked to sort by shape, which was more challenging because it required placing the images in a bin marked with a conflicting color. The bilinguals were quicker at performing this task.

The collective evidence from a number of such studies suggests that the bilingual experience improves the brain’s so-called executive function — a command system that directs the attention processes that we use for planning, solving problems and performing various other mentally demanding tasks. These processes include ignoring distractions to stay focused, switching attention willfully from one thing to another and holding information in mind — like remembering a sequence of directions while driving.


Over the last couple of years I have seen quite a few such articles, discussing the cognitive advantages that the bilingual brain has over monolingual speakers, in addition to the obvious practical benefits of simply knowing more than one language. However, all of the studies mentioned in this article and all of the ones I can recall study native bilinguals, rather than those who became fluent in a second language as a late adolescent or adult.

This raises the obvious question: how much of the ancillary benefits of bilingualism, i.e. increased cognitive flexibility and prophylactic protection against Alzheimer’s and similar degenerative neural diseases, are seen by mature learners of a foreign language, compared with native bilinguals?

I strongly suspect that such studies have been done, but it is also possible that the entire field is still so new that they have yet to get that far. Does anyone recall seeing anything on this?

Want to help out a medical team from America?

I was forwarded an email from an American medical group that says they have experience working in the 2005 SE Asian tsunami zone, Haiti after their recent big quake, etc. and are now looking for some locals to help them with things like supplies for themselves, transportation, other logistics. Please contact them if you think you can help.

My boss Steve is a former paramedic from NYC, and he and some other paramedics do periodic missions to disaster zones:

http://www.nycmedics.org/

As I understand it, it’s kind of a DIY-style operation, which allows them to move really fast. After the earthquake in Pakistan, they got into remote areas way ahead of anyone else and did a lot of good work.

So, he’s coordinating a trip to Japan and wanted to know if you have any contacts anywhere near Tokyo that could help them with logistics and such. For example, they might need a place to crash, rides, probably a translator, and I’m not sure what else. I’m sure any info or insight you can provide would help.

-Jesse


We’re not quite ‘DIY’ as we do coordinate and work within the overall establishment of the relief effort, but Jesse’s right about our particular mission description, which is to find the underserved communities within the affected area quickly. From experience, we’ve found that these scattered relief ‘deserts’ persist for as long as month after an event of this scale and so we try to get to them quickly and work there until the larger efforts catch up with them. So we send teams of 4-8 MD’s, RN’s, PA’s, and Medics in pretty quickly and they need to be able move pretty quickly(aka, without proper logistical planning) So local contacts that can be called on to help a team are incredibly valuable. If you have any ideas, let us know.







Thanks,

-Steve






Here’s a link to a form that people can fill out if they can help. I will also add you as an editor to that form so you can make any changes to the language that you think would be helpful.

Our group’s facebook page is http://www.facebook.com/NYCMedics and our website is http://nycmedics.org

Our ‘specialty’ is to move quickly to find the underserved areas of the relief effort, which we are absolutely sure are many. In the South Asian earthquake in 2005 and in Haiti last year, there was a tremendous need that was ‘invisible’ to the press and large organizations for many weeks after the event. So we move quickly with a motto of ‘light & lighter’. This model requires help from local resources and our teams often sleep in the homes of strangers and work with anyone who will help them get the job done quickly. So a database of local contacts would be really helpful:)




Thanks for the help,


Who can and can not donate blood in Japan

[Correction: Accidentally typed Australia at first below, should have been Austria all along.]

There has been a lot of confusion over who exactly is allowed to donate blood according to Japanese regulations, especially foreigners. To try and clarify the situation I have translated the entire list of categories of persons who are NOT allowed to donate blood in Japan, from the Japanese Red Cross official web page.

The biggest confusion is regulations relating to foreigners, especially because of mad cow disease aka spongiform encephalitis (Creutzfeldt–Jakob disease).

The following categories of people are BANNED from donating blood in Japan.

Please do not clog blood donations centers if there is even a chance you fall into one of the following categories, and instead find some other way to help.

Please also note first of all that ANYBODY who has entered Japan in the last four weeks may NOT give blood.

First, the rules relating to BSE/Mad Cow Disease

To clarify the below rules, please calculate your TOTAL amount of time spent in ANY of the countries in categories 1~4 during the relevant risk period for that country. If your total period of time in a high-risk country during a high-risk period is equal to 6 months or more than you are banned from blood donations for life.

Similarly, if you have spent a total of 5 years total in any of the countries listed in all 6 categories during risk periods, then you are banned from blood donations for life in Japan unless a new medical test in the future causes the regulations to change.

Please note that no countries in North or South America are on this list; despite the worries over Canadian/US beef it was never transmitted to humans.

  1. Anybody who has spent a TOTAL of 30+ days in the UK between the years 1980 and 1996.

  2. Anybody who has spent a TOTAL of 6+months in the UK between 1997 and 2004. (Note: Also include period of stay under category 1,3,4 in this total.)

  3. Anybody who has spent a TOTAL of 6+ months in Ireland, Italy, Holland, Saudi Arabia, Spain, Germany, France, Belgium, Portugal, between the years of 1980 and 2004. (Note: Also include period of stay under category 1,2,4 in this total.)

  4. Anybody who has spent a TOTAL of 6+ months in Switzerland between the years of 1980 and 2004. (Note: Also include period of stay under category 1,2,4 in this total.)

  5. Anybody who has spent a TOTAL of 5+ years in Australia, Austria, Greece, Sweden, Denmark, Finland, Luxembourg, between the years 1980 and 2004. (Note: Also include period of stay under category 1,2,3,4,6 in this total.)

  6. Anybody who has spent a TOTAL of 5+ years in Iceland, Albania, Andorra, Croatia, San Marino, Slovakia, Slovenia, Serbia, Czech Republic, Vatican City, Hungary, Bulgaria, Poland, Bosnia, Herzegovina, Macedonia, Malta, Monaco, Montenegro, Norway, Lichtenstein, Romania, between the years of 1980 through the present day.  (Note: Also include period of stay under category 1,2,3,4,5 in this total.)

Next the rules relating to blood parasite diseases.

  • Anybody who has entered the country in the past four weeks.

  • Anybody who has entered Japan after visitinga malaria high-risk area within the last year. This is true even if you were only at a resort area of the country. HOWEVER, if you have been specifically tested for malaria and been found negative you may donate blood.

  • Anybody who has entered Japan after living in a malaria high-risk area within the last three years.

  • Anybody who has ever lived in a region known for Chagas Disease, AKA American trypanosomiasis. (This is a blood parasite like malaria.)

  • Anybody recently returned from Africa or who has lived in Africa and ever tested positive for African trypanosomiasis (African sleeping sickness.)

  • Anybody who has ever tested positive for babesiosis, another blood parasite most commonly found in tropical regions such as Africa or Latin America.

  • Also anybody who has engaged in medical work, research, field work, etc. in any regions known for similar diseases should not donate blood.

Last are other categories of persons who may not donate blood.

  • Anyone who has or has had heart disease, or malignant tumor,

  • Anyone who has rheumatic fever or is on antibiotics due to risk of rheumatic fever

  • Sufferers from any convulsive disorder

  • Sufferers from blood-loss related diseases such as hemophilia or purpora.

  • Asthmatics

  • Stroke victims

  • Anyone with medicine allergies, nephritic syndrome, chronic inflammation disorders.

  • Anyone currently experiencing extreme hunger or sleep deprivation.

  • Anyone currently taking prescription drugs, except for those such at vitamins with no harmful side effects.

  • Pregnant women or breast-feeding mothers.

  • Anybody with a fever, specifically temperature of 37℃ or higher

  • HIV, hepatitis infected persons (free AIDS testing centers link)

  • Anyone who has ingested marijuana or other psychoactives within the last year

  • Any man who has engaged in homosexual behavior

  • Anyone with a history of sex with anonymous partners

  • Anyone who has been treated for hepatitis A within the past 6 months. Also, since it is often transmitted by shellfish, anybody whose family member has been treated for hepatitis A within the past 1 month. Hepatitis B and C stay in your system, so you are permanently banned.

  • Anybody who has ever RECEIVED a blood transfusion. (Due to the possibility of viruses as yet unknown to medical science.

  • Anybody who has gotten a body piercing (ears included) within the past year.

  • Anybody with a piercing on a mucous membrane such as the lip, tongue, nose, no matter when you got it.

  • Anybody who has gotten a tattoo within the past year.

  • Anyone who has been vaccinated using an inactive vaccine within the past 24 hours for diseases such as influenza, Japanese encephalitis, cholera, hepatitis A, pneumonia, whooping cough (pertussis), tetanus (may not be a complete list)

  • Anyone who was given anti-HBs human immunoglobulin in combination with a hepatitis B vaccine, anyone who was given an emergency rabies vaccine (that is, after being bitten) within the past 1 year.

  • Anyone given a vaccination for mumps, rubella/German measles, Bacille Calmette-Guerin (tuberculosis vaccine), or other mildly active vaccine (live attenuated) vaccine or any hepatitis B vaccine within the past 4 weeks.

  • Anyone vaccinated against smallpox within the past 2 months.

  • Anyone given an antisterum for tetanus, snake bite or other poison, gas gangrene, botulism etc. within the past 3 months.

  • Anyone who has had dental surgery that caused bleeding within the past 3 days.

The mass graves of Toyama Park (well, almost)

Suburban Tokyo park may hide a terrible wartime secret, The Australian, January 15, 2011:

IF you knew nothing of its sinister history, you could pass by a thousand times without casting a second glance at Toyama Park.

Situated in Shinjuku ward, in the heart of Tokyo, it is an affluent area of hospitals and universities, a place of trees and tennis courts where old ladies take slow walks with elaborately groomed poodles. A tramp dozes in the winter sun in a deserted children’s playground. A vacant plot, where an old apartment once stood, lies cleared by bulldozers. There is nothing to suggest Toyama Park’s past, and the wartime secret that may soon surface after seven decades of silence.

According to the recollection of elderly witnesses, Toyama Park is the site of mass graves, the improvised burial place of the victims of one of Japan’s most notorious war crimes.

Unsurprisingly, this article is subtly misleading in several ways. Toyama Park is within walking distance of Shinjuku if you have good legs—inside the Yamanote Line, between Waseda University and the Shin-Okubo Korean district, so not really “suburban.” It is split in half by Meiji-dori; the western half wraps around the north and west sides of the engineering campus of Waseda University, while the eastern half is crammed between apartment buildings, schools, and the National Center for Global Health and Medicine, an enormous hospital complex currently in the process of being completely rebuilt. Many of my in-laws live nearby, and the National Center is where my wife was born.

The fact of the graves is also hardly “hidden” or “secret” any more, since the article mentions that bones were unearthed in the area starting in 1989. And a quick reference to a two week old Asahi article in Japanese confirms that the graves are not actually in the park, which is owned by the city of Shinjuku, but rather at various adjacent sites which are owned by the national government.

The National Center sits on the site of what was originally the Army Medical College and Army Hospital, and so it had relations with Unit 731, which used some of the base’s land to dump bodies. The Asahi article describes three sites, the first being underneath what is now a dormitory for the Medical Center. It sticks out into the middle of the park but is technically outside its boundaries. The other two sites are on the east side of the hospital, well outside the park. One of these sites is underneath what is now the quite sinisterly-named Infectious Disease Surveillance Center, and the other is underneath another government employee dormitory.

Since the article and accompanying map will undoubtedly expire, I have made my own (clearer) map in Google Maps, with relevant Japanese quotes regarding each site from the Asahi article.


View Unit 731 gravesite map in a larger map

My own suspicion is that the issue is not swept under the rug out of spite for the Chinese, or out of lack of atonement for World War II; it is swept under the rug because the area is heavily populated (including a number of large public housing buildings) and plays an important role in Tokyo’s and Japan’s public health infrastructure. In Japan, nobody wants to live next to graves, much less mass graves, much less get a checkup or operation there. So it’s one of those things that’s easier not to think about.

Are the Japanese crazy like us? (And by “us”, I mean “Americans”)

Ethan Watters is the author of “Crazy Like Us: The Globalization of the American Psyche,” and recently appeared for a six minute interview on the US comedy show The Daily Show. Curiously, much of what he talked about focused on Japan:

The Daily Show With Jon StewartMon – Thurs 11p / 10c
Ethan Watters
www.thedailyshow.com
Daily Show
Full Episodes
Political HumorHealth Care Crisis

The author raises this question: Is the American focus and treatment on understanding mental health (depression, schizophrenia) a “cultural” export? His answer is yes, and describes how, in treating symptoms that are believed in American culture to be “mental sickness,” we replace some symptoms that are in fact cultural characteristics in other societies. He ends up spending much of his six minutes on the Daily Show interview talking about Japan and criticizing the American “export” of mental health treatment to Japan. He says:

“Japan is actually a very sad culture. They think of sadness… almost as a religious state, as a way to get moral guidance…”

I read more about Watters book, and found some of the numbers that he uses to back his book. One is that GlaxoSmithKline and other drug makers funded favorable medical studies to sell treatments for depression in the Japanese market, with huge success—GlaxoSmithKline’s sales in Paxil went from nothing in 2000 to topping $1 billion in 2008. 27 books were published on depression from 1990 to 1995, but 177 were published from 2000 to 2005. Meanwhile, the Crown Princess is reported to be suffering from depression. So “depression” as a disease and syndrome, as opposed to a result of Japanese cultural characteristics, is now widely recognized in Japan, although I would argue that there is still much more stigma attached to it than in America.

Yet he goes on to say that Japan is perhaps the biggest copier of the American model. This seems to be absolute lunacy to me. Yes, Japan is a sad culture. The Japanese people are much more pessimistic and cynical about their future and their country’s future than any other Western developed nation. (I’ve seen stats to this effect but nothing that I can link to—feel free to weigh in on this point.) But first of all, they are still no where close to institutionalizing mental health on the educational, social, corporate, and government level. And second of all, is this the “Americanization” or “modernization” of mental health? While I think there is an excessive and too broad a focus on mental health in the United States, where everything is deemed to be an issue of mental health, I think that Japanese culture and society still has far too little emphasis on psychology, counseling and mental health.

A Tragic Comedy in Ass Surgery

Some narative was inaccurate and corrected on the instruction of the author—Curzon

My post from last summer criticizing Japan’s medical system is still generating comments, so I thought it an appropriate time to share this guest post, authored by a friend and reader on his recent adventure through Japan’s medical system.

* * *

Back in August, I began to develop a massively painful cyst under the skin situated above my buttock and wanted to see a specialist. The ordeal was a real pain in the ass.

Continue reading

Take the LDP stress test, courtesy Ichiro Kamoshita

My current lower house representative in Tokyo’s 13th district is Ichiro Kamoshita, an LDP man who is now seeking his sixth term in office in the August 30 general election. He’s also a licensed psychiatrist who’s written more than 90 self-help books.

Early polls show him facing an uphill battle against DPJ challenger as anger at LDP rule rises, but that doesn’t mean he’ll go down without a fight.

To help promote some of his policy ideas as he seeks re-election, Kamoshita has borrowed a fun idea from the Scientologist playbook: stress tests! Those who visit his website or receive one of his pamphlets can take a test entitled “Working 2.0” (働き方 2.0).

The test asks, “Is your mind stressed out?” (心のストレス、たまってませんか?). To answer, the reader must go through a list of symptoms and check all that apply. Here is the full list:

  • I feel like meetings and discussions are actually meaningless

  • I keep working hard but I remain poor as ever

  • I have at some point felt like throwing it all away

  • I sometimes feel like I want a life where I can spend all day looking at the ocean

  • I sometimes feel like I want to liquidate the past and start over from scratch

  • I can more or less predict what my life will be like in 20 years

  • I have been doing the same exact job ever since joining my company

  • I have recently stopped chatting with family and coworkers

  • I have at times felt suddenly lonely in closed-in spaces such as the subway or elevators

  • I have called someone just to hear their voice, only to hang up after the second or third ring

  • It has become painful to go back and forth between home and work

  • It makes me jealous to see the empty trains heading the opposite way during rush hour.

Results

Here is my paraphrase translation of the results

If you checked 0-3 items: You’re the type who is good at dealing with stress. As someone with the capacity to process pent-up emotions, you realize it’s not worth it to get mad at your idiot boss. You know you can either take action or ignore it.

4-7: You need a mental detox. Just as removing toxins makes your skin look healthier, removing stress will make each day brighter and help you become better at many things. Why don’t you try and talk with friends or those around you about the things that worry you? Talking to someone will help you sort out the things that have been going back and forth in your head when you were thinking about them all by yourself.

8-10: Try and improve your lifestyle. Stress is the worst when you cannot escape it. You might need to switch jobs, take a vacation, or do something to get out of the group of people you are having problems with and break with the status quo. You might benefit from vegging out in the bathroom for 30 minutes or skipping a day of work sometime.


How did you do on the test? You can take it in Japanese here. I think I got around 4, but then the test seems designed to put everyone in that range. Who hasn’t thought about living at the beach?

Kamoshita’s plans for you

After the results, the next page is a list of labor-related policy proposals (note that at this point the reader still doesn’t know this is a political pamphlet, let alone from LDP man Kamoshita). They are:

Telecommuting – With almost 70% of workers in the services sector, it is possible for more and more people to work using technology instead of commuting to an office.

Working closer to home - Under this proposal, people would have two homes – a small room in the city close enough to their office to let them get their by bicycle, and a larger weekend house in the country where they’d rest on holidays and retire in old age. This would eliminate the issue of packed commuter trains.

More flexible working hours - By allowing flextime and diverse employment schemes such as temp work, people would be able to choose their working style while being eligible for the same social programs.


Kamoshita understands

In the final two pages Kamoshita reveals himself, tells of his own experience, and pledges to fight for the hard-working salarypersons of Japan.

You see, until age 44 Kamoshita also had to ride crowded trains to work. He even occasionally had to get off midway due to the stress (thankfully he got elected in 1993 and has probably never ridden a commuter train since).

***

According to the Yomiuri, Kamoshita wrote this pamphlet himself and is immensely proud of it, noting that this original pamphlet might be the first of its kind in Japan.

For a politician, maybe. But unfortunately the Japanese Scientologists have beat him to it!

Spanish flu was not Spanish

With the swine flu suddenly in the news, some might wonder why the authorities are so frantic to stop the disease in its tracks. For context, it might be worthwhile to mention the modern world’s worst disease outbreak, the deadly Spanish flu of 1918 that killed tens of millions. 

But ironically, the “Spanish flu” almost certainly did not originate in Spain. 

The only reason it acquired the name was because of Spain’s neutral position during World War I. Other countries at war instituted press restrictions, and the decision was taken not to report widely about the flu epidemic out of fear it would hurt morale. Since Spain had no such restrictions it was the only country in Europe reporting an outbreak, hence fooling observers into thinking that’s where the flu had come from. 

(Source: Read in yesterday’s Yomiuri)

Mr. Chang – Mr. Oyama

After having my aching knee MRI-ed and examined by a sports medicine specialist at Kyoto University Hospital last week and been told that the problem wasn’t particularly serious and that riding a bicycle should be safe, I decided to finally go and buy one. I asked a Japanese girl I know who is a bit of a bicycle otaku to accompany me on the shopping trip so I would be decently advised in buying something a few times the price of the crappy mama-chari I rode during my previous two periods of residence in Kyoto, and she took me to a shop she likes inside the Sanjo Shotengai. After picking out the bike I wanted and the accessories that needed to be attached, I went out to the east exit of the shotengai to withdraw some cash at the 7-11 and grab something to drink.

With a cold drink in hand (Thursday was a bloody hot afternoon in Kyoto), I sat down on the bench just outside the convenience store next to a middle aged man smoking a cigarette, in the typical fashion of a 50-ish Japanese guy who would be hanging out with a cigarette in front of a 7-11 in the middle of the afternoon, and looking over his envelope of documents. I had my headphones on, listening to some podcast or other, but the man said hello, and having an hour to kill before my bike was ready I took off the headphones and talked to him for a bit.

When I asked his name, instead of just telling me, he reached into his wallet and pulled out, to my mild surprise, an Alien Registration card very much like mine. I say very much, because there were a few important differences. The first being that, as the card of a Korean national permanent resident, the fields for such information as “Landing date” and “Passport number” were filled with asterisks instead of numbers, and the name field contained both his legal Korean family name of Chang (I will leave the personal name out) as well as a Japanese family name of Oyama, in parenthesis and with the same personal name for both.

Mr. Chang was born and raised in the south part of Kyoto, where the so-called Zainichi Koreans are clustered, and described himself as “basically half-Japanese” despite having Korean citizenship and speaking Korean. He is the oldest of three children, at 55, with a younger brother practically half his age at 29 who is currently in graduate school at Kyoto University and a younger sister in the middle, around 40 years old. He mentioned that when he was younger his Korean was good enough to do simultaneous translation, for which he would practice by reading the Japanese newspapers aloud to himself in Korean, but these days he has gotten a bit rusty. Although he was actually born with North Korean (DPRK) citizenship, he changed it to South Korean (ROK) years ago, as traveling abroad is extremely difficult for DPRK citizens. He mentioned having visited New York, which I presume would have been virtually impossible as a North Korean. He also spoke more English long ago, when for a time he lived with an English woman who had no interest in learning to speak Japanese (or, presumably, Korean, although he did not even mention that possibility) but says that these days he would not even be able to string a sentence together.

Now essentially retired, aside from having to take care of certain kinds of corporation registration and tax documents such as the envelope he was holding, he is the owner of three different companies, which include several drinking and eating establishments in Kyoto, Osaka and Nagoya. He started with one izakaya 30 years ago out in the “sticks” of southern Kyoto, then opened another in Nagoya, and now at the end of his career has reached a high level of success as owner of a highly priced Gion hostess bar.

He was quite keen to talk about how the hostess club is an important part of Japanese culture, the high pricing of and lack of sexual availibility therein often baffles and angers foreigners. He mentioned that on a few occasions foreigners came to the club, and were then outraged at the final tab, not understanding that this was not the sort of place one goes for a drink if one is the sort of person who worries about the tab. There was a specific anecdote about a Turkish man who, while not outraged about the price per-se, was quite angry that such a sum of money did not allow him to bring one of girls home with him. The problem, Mr. Chang explained, was that in the West there is not such a clear distinction between businesses which provide girls for “fun” (i.e. hostesses) and those which provide girls for sex. In his own country, the Turkish gentleman would be able to take the girl home for a night of what he might consider “fun” but in Japan, there are entirely separate businesses which cater to the physical. This is, he said, the modern version of the Geisha system, which in the past also separated the working girls into those for higher and lower pleasures.

But Mr. Chang does not actually spend time in any of his bars or clubs anymore-not even the hostess bar in Gion. He has cancer, and it has metastized beyond the realm of surgical efficacy, not leaving him long for this world. As owner he takes care of the paperwork, but no longer does anything one might actually call work. The pain of the cancer is often intense, and he has trouble sleeping at night. He is close with a singer in Tokyo, who sings to him over the phone when the cancer pain keeps him up at night, until the gentle voice lulls him to sleep, with the reciever falling off to the side.

He never had any children, but he wanted to do something positive for the world, to “make up for [his] sins.” To that end, he has become the official sponsor of an AIDS hospice in Chiang Mai, Thailand, whose several-dozen residents are all, as he says, his children. Although he is the active sponsor, he was not the sole fundor. To gather funds for the community, building their bungalows, providing their education and health care, he went around to all of the “shady characters” he knew from his business dealings over the years- the fellow bar owners, the real estate people, the local yakuza-and strongarmed donations out of them. “Think about what you did to get that money,” he says he told them, “surely you can spare a few yen for this.” It turned out that they could. Tragically, every time he visists there are “those who are no longer there.” He can afford to make them comfortable and provide some level of treatment, but the drugs cocktail that keeps wealthy first-world AIDS patients alive indefinitely is still too expensive in mass quantities.

And so it was time for Mr. Chang to pick up his laundry and drop his papers off at city hall, and for me to pick up my new bicycle. He asked if I would be willing to give him some English refresher lessons, so he could have some simple exchanges with the foreigners that came into his establishment, despite having said that he no longer spent any time there. While I do not normally have any interest in English conversation tutoring, I gave him my phone number.