Yesterday, thanks to the invitation by Dr. Higuchi Michiyo, I enjoyed a rare opportunity to give a lecture to, and to exchange views with, 11 graduate students from 10 Asian countries in Graduate School of Medicine, Nagoya University.(Young Leaders’ Program. Course in Healthcare Administration) There were many more people in the audience. Below is the Lecture resume. I hope the contents could interest some of my non-Japanese friends overseas. The Japanese problem depicted here will surely be your problem in 20-30 years. July 12, 2013 Nagoya University Graduate School of Medicine Special Lecture Series: Social Mobilization for a Health Program/Policy Challenging Health Gaps/ Inequities --- Healthcare for Homeless People in Sanya Toru Honda, MD Asakusa Hospital, SHARE share.or.jp 1. Icebreaking How elderly persons are treated and cared in your country? 2. Is Demography a Destiny? A Japanese Case; ・Health Transition in Japan for the past 100 years ・Rapidly changing Demography in Japan ・A dismal but realistic future for us boomer generation: Living old, alone, ailing, often poor and even demented could be the norm in 21st century Japan. 3. Japanese Nursing Care Insurance System since 2000 ・Home-based care: Helper service, Home-visiting nurse, Bathing service at home ・Facility-based day care and rehab service ・Facility-based short-term (a few days to two weeks) ‘staying overnight’ service ・Mid-term to Permanent nursing care home for Elderly and Demented Persons 4. Primary Health Care(PHC) and NGO/SHARE ・PHC is a philosophy and an approach to health care based on principles of human-rights, universal access and community participation. PHC was first integrally stipulated by Declaration of Alma-Ata in 1978. Its manifesto is symbolized by ‘Health for All’ ・In all fields of activity, SHARE has tried to incorporate PHC as a guiding principle and fundamental methods. ・We are currently active in Thailand, Cambodia Timor Leste and in Japan. ・Our main areas of activity are Health promotion, School Health Education, MCH grass-roots level leader formation and HIV/AIDS. ・ Since the early years we have been involved in voluntary activity for homeless persons in Sanya area and health promotion/counseling activity for foreign migrant workers in Japan. 5. Two great mentors for SHARE are Dr. Wakatsuki Toshikazu and David Werner Wakatsuki was an excellent surgeon but at the same time a great educator/organizer for rural health movement in post-war Japan. Based in Saku Central Hospital, Nagano prefecture, he stressed the importance of not only the curative side of medicine but also prevention and awareness raising of the people toward healthier lives. He developed many innovative approaches to health promotive/educative activities long before the concept of PHC was initiated by WHO. Thanks to Wakatsuki, Nagano Prefecture ranks best for several consecutive years among 47 local governments in terms of healthy longevity with the lowest medical cost. David Werner is himself a disabled person since childhood (he suffers from congenital muscle atrophy). As a biology teacher he was enthralled by natural beauty in Sierra-Madre mountainous areas in Western Mexico and got befriended with poor villagers and started joint health activities with them in early 1960s. Their efforts bore fruit as easy-to-understand, practical handbooks for health care and community rehab such as ‘Where There Is No Doctor’ and ‘Disabled Village Children’ and these books have been utilized by millions of people worldwide. 6. Sanya – a model for 21st Century ‘Caring Community’ or simply a dying community? Sanya, a downtown area in Tokyo used to be notorious for its thousands of day-laborers and homeless persons with hundreds of flop-houses. During the period of 1960s to 80s, when Japan was economically booming, these people contributed tremendously to the country as a cheap workforce engaged in so-called ‘3D labors’ (dangerous, dirty, difficult). But these proud people have now gotten old and frail and are no longer able to work. Today, most of them who are still alive are relying on social welfare. They are mostly suffering from chronic illnesses and lead a very lonely life without family bonds. 7. A Case study on a patient with Alzheimer’s and Aspiration Pneumonia Mr. X, 81 year-old man, has lived in Sanya for several decades as day-laborer but he lost his job at the age of 63 because of chronic low back pain and COPD induced by his heavy smoking. He applied for social welfare and was accepted. He continued to live in the same flop-house. But for the past year he gradually developed dementia and urinary incontinence. The manager of the flop-house tried to kick him out because more and more Mr. Y posed nuisance to other guests in the flop-house. One day he developed high fever and was rushed to our hospital by an ambulance. It turned out that he had Aspiration Pneumonia. Question: If you were his caretaker, how would you decide his treatment options and his long-term care? Especially, how are you going to feed him? Where will he be taken care of hereafter? 8. Community health care Coordination/cooperation Network among various health sector stakeholders in Sanya Facing these difficult problems and critical circumstances in Sanya and surrounding communities, many local NPOs/NGOs, which are mostly affiliated to Christian, Buddhist faith-based organizations and labor movements have come to join their hands and started kind of health care network for the purpose of providing humanitarian and decent life support services for these people. Sanyukai, where I work as a medical volunteer is the representative of such NPOs. Since the establishment in 1984, Sanyukai clinic has taken care of more than 110 thousands cumulative patients for the past 29 years, completely free of charge. 9. How to secure decent housing with caring service for poor, ailing elderly persons? ・’Guru-guru Byoin’ (or Round-and-round Hospitals) or the quagmire for sick elderly persons trapped into the institutional ‘black hole’ (Inaba) Proper housing and provision of care are the most pressing need for those in risk of being absorbed in this eternal trap/’guru-guru’ . 10. The Inverse Care Law by Dr. Julian T. Hart and ‘Nothing About Us Without Us’ In 2008 WHO issued two historically critical documents, both of them stressed the importance of reviving PHC in 21st Century. One is ‘World Health Report: Primary Health Care: Now More Than Ever” Another one is “Closing the gap in a generation： Health equity through action on the social determinants of health“ In this context, I would like to draw your attention to two key concepts in PHC in 21st Century, ‘The Inverse Care Law’ and ‘Nothing About Us Without Us’. 11. Discussion / Q & A Session
Posted on: Fri, 12 Jul 2013 22:32:16 +0000
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