Get the Laser!
I was in a small, makeshift exam room constructed from a set of drab, beige curtains. The exam table must have been smaller in size than a single bed. My toes were hanging over the edge and brushing against a few mysterious looking medical machines. I’m willing to bet that they were straight out of the 1990s. They reminded me of the big, bulky computer monitors in my elementary school’s computer lab, except with all sorts of gauges and meters of a dubious nature.
“Shitsureishimasu.” A petite woman wearing a nurse’s uniform circa the American 1940s opened one of the curtains and stepped into the two feet of available space. All business, she immediately proceeded to ask me what was bothering me. I told her about the pain and swelling I’d been experiencing in my right ankle over the past few days as she nodded and made the usual agreeable noises. Then, she promptly removed my sock, rolled up the ankle of my pant leg, and left as quietly as she had entered. “Shitsureishimashita.”
I heard her entering the “room” next to mine, where she began the same cookie cutter conversation with the next patient on her list. I lay supine, staring up at the yellowish-brown ceiling, trying not to eavesdrop on the seemingly private conversations between the nurse and the eight other patients packed into the room as big as my mother’s kitchen. After a few minutes, the curtain opened once more and a man in a white lab coat walked in.
“I hear that your ankle is bothering you. It’s hard when you can’t exercise, isn’t it?” he said. Best guess: he was in his early 50s. He was wearing a pair of black-rimmed glasses and an all too familiar look. I imagined his brain cells firing off like wild, “Oh! A foreigner! How fun!”
He asked me to press the thumb and forefinger of my left hand together while he attempted to pull the two fingers apart. They broke free almost instantaneously. “Ah, yes. You have a strain in the muscle,” he diagnosed, “This will require two weeks of rest and several treatment sessions. We’ll start your first one now.“ Then, he called the nurse over and instructed her to, “Get the laser.”
I am not blessed with the ability to imagine the look on my own face, but I must have looked like a deer in the headlights of a tractor-trailer. Whatever my expression was, it was enough for the nurse to pick up on my complete confusion and terror. She quickly returned with not only “the laser,” but also an electronic dictionary.
“Kore ha reza desu.” I looked down at the tiny screen to see the words, “infrared laser.” It was just light therapy.
Cross-Cultural Perspectives on Medicine
When I first moved to Japan, I got sick. A lot. I believe there was a 14-month period in which something went wrong every month. Yes. I wish I were exaggerating.
Anyway, thanks to my multitudes of experience, I have a lot of first hand knowledge of the culture of medicine in Japan.
When it comes to health care, it is so important to remember that everyone’s interpretation of what is going on is different. We are all the products of multiple cultures and interpretive frameworks. Regardless of nationality, race, or gender, everyone has their own belief system and explanatory models cultivated from their unique and singular life experiences. Accordingly, individuals interpret disease in different ways.
In the U.S., the cultural-competence movement within the health care system attempts to reduce the cultural distance between patients and doctors in an effort to reduce health inequalities and failures. However, one of the movement’s failures has been its lack of understanding that culture is not singular and homogeneous entity.
This idea of cross-cultural medicine that transcends a one-size-fits-all belief system is interesting in the Japanese context – a country with extremely high levels of racial, social, and cultural homogeneity.
Rooted in Tradition: Judo Therapy
So let’s go back to that laser. True story.
When I hurt my ankle running (check out my blog on running in Japan here: Hitting the Pavement), a teacher recommended that I visit a “sekkotsuin” clinic after seeing me hobble up and down the stairs of the school one too many days in a row.
Before my visit, I understood the word, “sekkotsuin” to mean an outpatient orthopedic clinic. This did not turn out to be the case. Instead, it was an alternative medical clinic that I could best compare to a sports medicine practice. It’s called, “Judo Therapy.”
Judo Therapy is a co-medical profession originally derived from Japanese traditional medicine that has adopted some western medical knowledge and technology in recent years. The practice was originally called, “honetsugi,” which means, “bone-setting.” They don’t do much bone setting these days though.
Growing up within the western biomedical interpretive framework of disease, my first visit to the judo therapy clinic left me skeptical to say the least. No x-ray, no medicine – what kind of quack medical service was this? But, over the course of my treatment, I came to appreciate the “healing” I received at the clinic. It was a type of care that I had never experienced before; it was so very different from the “cure” mentality of the west.
Behind the Curtain: Visiting the Gynecologist
“Oroshimasu.” The chair that I’m sitting in begins to move. I can hear the electric motor churning away. It’s similar to a dentist’s chair – you know, the kind of chair that reclines to help the dentist get a better look into your mouth. Except at the dentist office, your legs don’t go up as your back goes down. At least, I hope that doesn’t happen at your dentist office.
I watch my legs as they disappear behind the curtain in front of me. “Kensa (w)o shimasu.” I hear the clanking of metal and my mind starts to turn in circles. What was THAT? It sounds painful. It’s a vulnerable place to be – with my feet up in the air, out of sight.
I don’t think anyone from any culture enjoys visiting the gynecologist. (I apologize if that was a massively outrageous assumption to make). Visiting the gynecologist in Japan and speaking with Japanese women about their feelings and expectations about women’s healthcare was an enlightening (and seriously terrifying!) experience.
Prior to my trip to the gynecologist, I discussed my fears of the dreaded “curtain” that I had heard so much about. It’ll be so weird not to meet the doctor before the exam. I feel really uncomfortable not being able to see what’s going on. When speaking with other foreigners – all other Americans, I believe – they shared the same level of discomfort. I was surprised, however, to find that many Japanese women did not share the same beliefs as me.
When I told one woman how uncomfortable I felt about the curtain, she was surprised to hear that no curtain was used in the U.S. When I told her about how you can expect to see the doctor the entire time and that it’s common to chat with him or her while they do the exam, she visibly blushed. The doctor is talking to you while he/she examines you…there? Oh, that’s so embarrassing.
As this was just one woman’s perspective, I’m sure that there are other Japanese women who may not agree with her – maybe they’d prefer the American way. Likewise, Americans are not a singular, homogenized people and, as such, I’m sure there may be some women out there who would love to have an iron curtain up in front of them to preserve their modesty.
These personal and cultural differences highlight the necessity of communication and individualized treatment in the health care industry.
It’s no fun visiting the doctor in any country…
Visiting the doctor can be a scary and painful experience in any country – even your home country. Attempting to get medical care that you are satisfied with when abroad…is another story. We are the summation of our cultural backgrounds – whether it be one or many. These cultural frameworks influence our interpretation of what’s going on around us – especially in medicine.
Take care, friends! I hope your unpleasant medical encounters are far and few between!
Side Note: I just realized that there’s a bit of a theme going on here that I didn’t pick up on before. Curtains. Why are there always so many curtains in Japanese medical facilities? Just some food for thought.