Community participation in Japan

21 Feb 2011


My name is Tetsuro Irohira, a Buddhist monk from Japan.

Oh, got mistaken. I am a physician from Nagano Prefecture, deep in the mountains of Central Japan. Where the Winter Olympics were held thirteen years ago.


I am working as a physician in rural Japan, so not good at English. But I am good at communicating with villagers in their local dialect. I have been working as a general practitioner in a mountainous, remote area for almost 20 years. Since I was graduated from medical school in 1990. The hospital to which I am assigned is run by an association of agricultural cooperatives.

The fact that ours is placed under the management of villagers, means that they are my employer. This hospital, Saku Central Hospital, is famous in Japan for Rural Medicine or Preventive Medicine, because of Dr. Wakatsuki Toshikazu’s great dedication to the community. Today, the concept of community participation is commonly associated with Dr. Wakatsuki’s name. As one of his successors in Japan, I am honored to share my experiences to you.


The village to which I am assigned as a physician, and where I have been living for 10 years with my family, has neither a railway station nor a national road. I became the first doctor for its villagers, or the only physician available in my rural community. Of the village’s population of 1,000, above-60s account for 40%.


While 57 countries around the world are critically in need of health care, Japan is also facing a serious shortage of medical practitioners, and this is particularly true in the rural setting. This situation is getting increasingly worse and worse, as Japan is rapidly turning into an aging/aged society.


To tell you the reason why I chose to work in a destitute hamlet, I would like to introduce you an episode I had in traveling the Philippines when I was in my younger days. In early 1980s, I visited Leyte Island in the Philippines, as a medical student and met with Mr. Sumana Barua. Later, I used to call him “Babu.”

He was a Bangladeshi student studying in the Philippines. In fact, he was studying at the School of Health Sciences, University of the Philippines, which is more popularly known as ”UP-SHS.” This School is famous for its unique program, known as “step-ladder curriculum,” To train health workers, including midwives, nurses and doctors who would return to their respective communities and work in the rural setting. During the last 35 years, more than 80% of the SHS graduates retained in their respective communities all over the Philippines. During my visit to Leyte, I stayed in a rural community for a few days with Babu.

The way he was taking care of the villagers, made a deep impression on me. Because, as medical students, we did not learn how take care for individuals as humans, but learned how as doctors we should treat patients. I wanted to become a doctor like Babu. Soon after my graduation from medical school, I joined Saku Central Hospital, which shared the same spirit as UP-SHS in the Philippines.


For several reasons, I have stayed in a destitute rural area for more than 20 years. Here are three factors that prompted me to work in a rural community. The first reason is that there lived 1,000 villagers, each having his or her own story. I could learn a lot about life history from their tales. This is because there lived many elders. I make it a practice to visit each villager’s home everyday, and to make a call of condolence when someone dies. I was fortunate enough to become a doctor who could treat my patients truly as “humans.”

Also, I really enjoy living, and working, with them. The second reason is that I consider it my mission to disseminate the village authorities’ information to villagers. It will become a very important political task in Japan to grapple with issues on aging in the near future. I have presented my views on the aging issue in many journals, newspapers and on the website. I would like many Japanese people, including the elderly, the poor and the migrant workers, to come out with ways in which the life style may be improved.

The third reason is because I enjoy sharing my experience with the younger generation. I accept almost 150 medical and nursing students interested in the delivery of rural medicine every year. Elderly villagers also enjoy volunteering in the offer of their experience to those students, who are as old as their grandchildren. To me, it is a great motivation for me to brief my experiences to, and exchange views with, those students.


Finally, although I am living in a rural community, I consider myself as a man of global perspective...? That is to say, I am a global citizen, because I medically check people from around the world. For instance, 40,000 foreign residents were registered with the government of Nagano Prefecture, including Brazilians, Chinese and Thais. I have been delivering health care to foreign residents with HIV/AIDS. We have invited Buddhist monks from Thailand for their spiritual care. This is nothing but an example. We can do so many things in villages, things of the kind which can hardly be offered in a big hospital or city in Japan.


I should like to close my presentation with one of Mahatma Gandhi’s epigrams.

I quote, “You must be the change you want to see in the world.”

And I unquote.


Read also: Village doctor gets local seniors to offer instruction in how to listen

Tetsuro Irohira
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