The family-patient relationship is also similar to that in the U.S.. Someone in the family visits the patient every day and may have a short talk with the nurse. Less often does the family question the treatment as they do in the States. It is usually assumed that the doctor is doing the right thing. Before the arrival of insurance in Japan it was often custom to repay the doctor with gifts. I heard that sometimes even now a surgeon may receive a box of food with alot of money buried at the bottom of the box. Gift giving is an important part of Japanese custom. It is much more commonplace than in the States and I was even given gifts by people I never met previously. One reason for this generosity is because the Japanese want to be thought of as good people.

The patient population differs in that there is a lack of drug and crime related admissions and a paucity of Multiple Sclerosis, coronary heart disease and colon cancer. This contrasts to the abundance of cerebrovascular disease and gastric cancer. Except for small circles in the big cities, drug use in Japan is almost non-existent. Trauma is usually due to a car accident (common), and not crime related. The lack of drugs and crime is due to the intolerance of this by the justice system as well as by the attitudes of the people in respect of the law. It is usually quite safe for a woman to walk alone or ride the train alone at night in Tokyo. The worst that might happen is that a drunk man would verbally harass her and perhaps try to rub his hands along her body. With enough protest though he would usually be discouraged.

Although the Japanese are nonviolent people, one reason they have a history of warmaking in their past is due to their loyalty and unquestioning of authority. Their previous desire for eastern domination stemmed from their belief that they are the superior oriental race and, given a cause and an order from a superior, a Japanese man must fulfill his duties. Laws are more strictly enforced in Japan than in the States. There is less of a "free wheeling" attitude in Japan than in the U.S. For instance, when a car goes over the speed limit a loud ringing sound is emitted from the dashboard compelling the driver to slow down [this was abandoned in later years].

The Japanese have many adaptations for living in their crowded society. Crime is not tolerated. The bus and train systems are well developed and run on time. Efficient use of space is seen in the cities. There is little litter, graffiti, and defacement. Highways are well kept and many have sound barriers to reduce the noise pollution. Not all is perfect though as one may see vehicles spewing black soot out of their exhausts on the same highways that are designed to keep the noise in. Traffic jams can also become astronomical. Poverty is much rarer than in the States. Because it was so rare to see a homeless person in Tokyo, I snapped a picture of one at a train station. He wasn't too thrilled with this and began to chase me. Fortunately he was somewhat ataxic and couldn't catch me, but he threw his umbrella at me (he missed).

Both the Japanese and American people must realize there is much to gain from cross-cultural interaction. Too often we visit another's country and don't bother to make friends with the people or learn about the culture. Americans can learn from the Japanese the benefits of really caring about one's job and the end product. We can learn how to have patience with people and with respect to our short-term profit mentality. We can leam how to respect our laws in order to eradicate the crime and drug problems we experience, and also to soften the impact of industrialization on the environment. We must both learn to increase our knowledge of other languages, cultures and customs, and to build personal ties with other peoples.

The Japanese can learn the importance of expressing one's individuality and opinions, and lowering one's social sensitivity. They can learn to express their feelings and desires, and not to be shy in situations where shyness is a disadvantage. To respect the importance of the married female work force and the desires of those women who want to have careers. To become more efficient at decision making and to see the importance that is placed on leisure and family time in the U.S.. They can also learn that a "free wheeling" spirit can be good in certain situations, and they can learn the benefits of having foreigners assimilate into society as we have in the States.

It is also fun to study in another country and it may contribute much to one's own personal growth. Before I conclude, I would like to mention a couple of areas that future American students may find troublesome. Both relate to our ability to speak English fluently. Although I was happy to help them with their English, some people will use you as a language target just to practice, or to impress others that they can speak some English. Most of the time they will help you with Japanese in return for speaking English with them but, there are always those people who will speak English to you (even if your Japanese is better than their English) and not respect that you are in Japan trying io speak in the native tongue.

There is one American who is a medical student at Tokai who has lived in Japan for 10 years. He is married to a Japanese doctor, and can write, read, and speak Japanese fluently. I was able to meet with him once and he told me that often he is still spoken to in English by the Japanese professors. One of the problems for him is that (besides that he feels it is impolite) often he cannot understand clearly what they may be trying to teach him or what they are asking him during oral examinations because their English is rusty. This is an other example of the difficulties in assimilation into Japanese society.

Besides the reasons of wanting to practice and to impress, there is another reason why the Japanese will often speak in English to you if they can. This is that some do not want to accept the fact that foreigners have the ability to master their language. They may also feel very funny or uneasy speaking in Japanese to a foreigner because it is unnatural for them not to make the native/foreigner distinction on the basis of language. If they feel very strongly in this last regard they may pretend they cannot understand you or not pay attention to you if they cannot speak English. This only happened to me a few times. Once I was with a Japanese medical student friend at a store and was asking a saleslady some questions in Japanese. She would not reply to me and kept looking at my friend for information. Afterwards, he apologized to me for her impoliteness and told me that my Japanese was perfectly understandable.

There was also the situation in which people could speak English reasonably, but would only speak Japanese for fear that I or others would think they spoke strangely or were incompetent. The other problem is that from time to time you may be asked to correct some papers they write for English medical journals. This did not become a habit, and I corrected a few, but it might take up some time if you don't set the limits. There are many professional services for this in Japan anyway.

I would like to conclude this reconnaissance of a medical students view of Japan and state that study abroad is the most fruitful experience one may have in the quest for knowledge. Tokai University filled the requirements for this quest to be most successful. I was treated very well by the people in the hospital and there was a genuine concern for my education to be prosperous. There was also much effort made to see to it that I was able to travel and see some of the country. Many Japanese doctors had some of their training in the U.S. and they liked to treat me like a visiting professor. At an end-of-the-year party thrown by the Dept. of Neurology at a hotel in Tokyo I was asked to sit in the front row next to all the renowned Japanese neurologists during the group picture.

I was also treated as a special guest at the medical school's graduation. After the ceremony all the students took a bus to Tokyo for the reception at a plush hotel. Here all the students line up at the entrance to the ballroom and applaud as the parents and faculty come in. We enjoyed a buffet dinner and then we all went to a small nightclub that was rented out for the second party. A big favorite here was to play Bingo. The most popular student got to be M.C.. At this party I was asked to go to the stage and introduce myself to the guests. I said some greetings in Japanese and all I could see was a lot of flashes as everyone wanted to take my picture. The festivities did not climax with Bingo however as we all made our way to the next party at a small pub that was also rented for the night. The number of party goers began to thin out but that didn't stop the fun. At this party everyone is invited to sing for the audience to their favorite Japanese songs that are played with out the words on the house stereo system. The microphone is coupled to the stereo too and before long everyone becomes a pop star for the night. This particular system also had a video that ran along with each song. Because I didn't know any Japanese songs I had to sing acapella. I sang "People Are Strange" by the Doors. This singing custom is only about 5 years old but it is very popular (called "karaoke").

In the U.S. we treat a very heterogeneous population of patients and sometimes loose sight that a person's culture may influence his perception and reaction to disease. Behavior that seems strange or abnormal to us may be perfectly normal and healthy to people from another culture. By study in Japan I have seen how cultural attitudes can effect the patients and their families and have come away with a more heightened awareness of the relationship between one's psychosocial framework and disease.

In summary then, I have seen different attitudes toward disease, their treatments and diagnosis. I have seen the Japanese research techniques and the Japanese work ethics. I have experienced the rich culture that Japan has to offer in their every day activities, in the study of Buddhist philosophy, in the temples and shrines, and in the study of Japanese history. I have made many new friends that I hope to be able to host in the U.S., and I am proud to call Japanese my second language. I am happy to call my exchange experience a success and an invaluable learning encounter of the highest degree. This will most certainly be an experience that I will remember for the rest of my life.

he Japanese university threw a goodbye party for me where speeches were made, I was presented with a diploma certifying my studies in Japan, and I received the Tokai University Medal of Honor. My medical education has been graced with this prodigious experience, and I hope to see this program continue and flourish in the future for many students, both Japanese and American.


In the United States I would like to extend my thanks to Dr's. Ashikari, Goldstein, and Kline, for believing in me as a student and allowing me the chance to represent New York Medical College as the flrst exchange student in Japan. Especially to Dr. Ashikari for helping me with my flight arrangements and for mediating between the two schools.

In Japan my thanks go out to Dean Sasaki, Dr's Goto, Mori, Ozawa, and Mrs. Eto, for their administrative help and friendship. Dr's Shinohara, Osuga, Takizawa, Yoshitoshi, Takagi, and their staff in the Dept. of Neurology. Dr's Makita, Iwasaki, Kano, Nakamura, Hosaka, Ohno, Mizoguchi, Miss Shimada, and their staff in the Dept. of Psychiatry. Yoko Norihisa, Osamu Horie and all the other medical students I befriended in Japan. Special friends Kaori Ishii, Dr. Gerd Stehle, and Cheryl Hermanson. Minasan domo arigato gozaimashita.