Postcard from Kobe, Japan

4/11/2008

Today we arrived at the Port of Kobe, and went through the most extensive immigration procedure yet! We all had to walk through a temperature screening machine (to assure that we did not bring any flu from Hong Kong), then be electronically fingerprinted and have our pictures taken. It was almost noon before the ship was cleared; mostly it was standing and waiting.

Our journey today was with Jim and his students to the Kohu Psychiatric Hospital in Kobe. The bus ride through Kobe revealed a city much like American cities in terms of traffic and types of
automobiles (the Japanese drive SUVs and mini-vans like Americans, not the tiny cars we’ve
encountered elsewhere). A nice difference were the elevated walkways for bicycles and pedestrians which keep people away from the traffic and encourage walking and biking – an idea we should adopt!

We received our first insight into Japanese culture on our way to the hospital – our interpreter called on her cell phone to inform the hospital that we were on our way and would arrive in about ten minutes. She was told that we were not expected for another 30 minutes, so informed us that the driver would drive us around for half an hour as it would be impolite to arrive early.

It is the height of the cherry blossom season in Kobe, so we had no complaints about taking a tour of the beautiful trees. When we arrived (right on time) we were given a tour of the facility by a young resident, Dr. Iijima, who wore a white mask over her mouth and nose (we observed many people wearing masks around the city, and were told that it is because they have hay fever and wish to keep the pollen out of their bodies). The facility was bright and spacious, with flowers and artwork throughout, and each unit had areas for arts and crafts, computing, music (with a piano and several guitars in each room), and karaoke! There was a large gymnasium,
gardens with fountains, and a generally pleasing setting.

After our tour (which lasted exactly one hour) we adjourned to a lecture hall, where Dr. Nakamoto, a psychiatrist, had prepared a powerpoint presentation for us. We were amazed to learn how different the Japanese mental health care system is, not only from the US system, but from every other country we have visited so far. The average length of stay in a mental health facility in Japan is 330 days (contrasted to 7–10 days in US), with many patients remaining in hospital for 10 years or more. And here’s the kicker (Eliese and Dawn are you reading?) – the
patient to nurse ratio in the acute units is 2 patients per nurse!!!!

The Japanese government provides universal healthcare, that covers about 70% - 90% of healthcare costs for those that are employed (the unemployed receive full coverage until they can pay). Dr. Nakamoto said the government is trying to encourage the psychiatric facilities to follow the world model by reducing stays, and was starting to close wards within each hospital to achieve that goal, but the doctors here are reluctant to let patients out unless they are either cured or have a community program to support them. He said they have been trying to change their model, but progress has been slow. A real eye-opening experience for us…

After our return to the ship, we attended a reception where the officials of Kobe presented the ship’s captain and crew with tokens of esteem for choosing their port. The highlight of the ceremony was a drumming demonstration by a group of students using fat sticks and big drums of different sizes – a powerful performance!