Staying healthy in Japan

Features Health - September 9th, 1988

by Elyse M. Rogers

Azabu Hokenjo

For years I’ve been trying to find out more about medi­cal and health services offered by wards (ku). I knew they were there, because I knew of some Japanese who took ad­vantage of those services and occasionally would hear about a foreigner who did so too.

Unfortunately, my attempts in the past were never success­ful, because I would get a name or number to call and then that person would not understand my query or say that such services were not available at that place. And, of course, they didn’t know where I could possibly find such services…

At any rate, the problem was happily solved when I walked by a new office one day and saw the sign in Eng­lish which said Azabu Department of Public Health. So, although it was later in the day when most of the staff was gone, I explained that I wanted some information and a phone number. A nice work­man went and fetched a pam­phlet for me. And sure enough it had the services listed and a proper phone number. So, I was finally able to arrange an interview with Izumi Yoshikawa, M.D., Ph.D., head of the Disease Prevention Section.

A NEW BUILDING WITH MANY PARTS

Before telling you about the public health service depart­ment, let me explain that this new, Azabu Ward, three-story building, just opened in 1987, houses other ward services as well. There is a branch ward office where you can do some ward office business. I check­ed and you cannot get or renew your alien registration (toroko shomeisho) there, but rather have to go to the main ward office.

There’s also what’s called the Azabu Civic Center. This contains rooms available for use free of charge to organiza­tions in Minato-ku. Rooms (and even one auditorium) must be reserved in advance.

The building even contains a small restaurant on the sec­ond floor that is open to the public. On the third floor, there are rooms for rehabilita­tion programs, such as occupa­tional therapy for those who have had strokes. There are two six-month programs a year, limited to 20 persons. Although any person is eligible for the program, I understand that names arc submitted and people are chosen to attend by the medical staff.

The entire building is cheer­ful, airy and spacious. Much of the open feeling is due to a large courtyard in the middle of the building that has, if you can believe it, large rocks the sides of which are painted gold. (I asked several people if they knew the meaning of this painting, but no one seemed to.) The lovely building is a far cry, I understand, from the previous building (a few blocks away) that housed the services for 30 years prior to their move.

I should emphasize that all the programs and services of­fered in this building and in other Minato-ku ward offices arc only for people who live in the Minato-ku Ward. Dif­ferent wards have different programs, although many have similar types of programs. If interested, call your own ward office. (Ward office numbers are listed in the English lan­guage Yellow Pages telephone directory, available at most bookstores that carry English-language books.)

PUBLIC  HEALTH PROGRAMS

There are two parts to the Public Health Service at the Azabu Hokenjo: 1) Environmental health services and pro­grams, and 2) Health Services. Both are interesting and offer services that can be of use, so I’ll explain them in detail.

Environmental Health Services

In this branch, they do many of the same types of work that local public health services do in the United States.

1. Food handlers and restaurant inspection. Food handlers and restaurant owners must get approved by this department and, every year, restaurants in certain areas are checked for cleanliness, proper dish-washing techniques, food storage, etc.

2. Water testing department (kankyo eiseika). Last year I wrote about the Tokyo Water Department and explained they were in charge of the purity of water in the main system. However, once the water enters a multiple-storied building, with a water tower, the Water Department is no longer in control. It is up to the owner to maintain the purity of the water inside the building. Many foreign residents who live in such “mansions” have expressed concern about their water supply, wondering if tanks and pipes were suitably clean.

I mentioned that such in­dividuals could have their water tested at their local hokenjo, and now I have more data to give you. This is the way you go about gelling water tested (remember—this is only for people who live in apartments where their water comes from an internal sup­ply):

a) Go to your local hokenjo and get the proper bottles. See the end of the article for Minato-ku hokenjo offices. If you live in another ward, call your ward office for the address.

b) Put water samples into the bottle or bottles. Be sure to allow the water in the tap to run for 3-5 min­utes before filling the bot­tles to be sure you get an accurate sample.

c) Take the bottles back to your hokenjo office, to the office of kankyo eiseika. At the Azabu office you do this on Tuesday morning, between 9 and 11 a.m. since that is the day they do test­ing. (Be sure to find out the proper day in other wards.)

d) Pay the fee. In Azabu the fee is ¥5,600 for the testing. It’s about the same in other wards but, again, check your own ward of­fice.

e) Receive the report. If you ask, the report will be mailed to you, or you can pick it up. The report is in Japanese, of course, so you’ll have to get someone to interpret it for you.

Now comes the difficult part. If there is a problem, it is up to you to talk to the owner of the building and ask him to “clean up his act.” In rather confusing Japanese fashion, even though there are regulations regarding the water supply, the local office has no power to enforce—only “to suggest.”

According to Mr. Ninagata, bad samples have been rare.

Health Services (Yoboka)

Perhaps the most interest­ing, at least to me, services belong to this category, since they are directly in the medical prevention and health category. The staff at the Azabu center includes three physicians (in­cluding Dr. Yoshikawa, who I interviewed), and six public health nurses.

a) Mother/child health service (boshi hoken).

•   When a woman dis­covers she is pregnant, she goes to the ward office and receives a booklet (boshi techo). At the same time she receives two ”free tickets” for routine health examina­tions at four months and eight months of pregnancy. These include blood tests, blood pressure readings and routine examination.

She can use these tickets at any Minato-ku doctor’s office or outpatient hospital center.

She also receives a post card which she will send to the hokenjo when her baby is born.

•   After her baby is born, the hokenjo office will call and, if she would like, she can have a public health nurse come to the home and examine the baby (within the first month) free.
•   Well-baby clinic ser­vices. The mother may have her baby examined at the hokenjo office free of charge at the following ages: 3 months, 6 months, 9 months, 1 year, 18 months and 3 years. All she has to do is show her booklet for those examinations. Such free ex­aminations can also be obtained at any doctor’s office (or hospital outpatient department) in Minato-ku, just by showing the booklet. (Even  though  the hokenjo theoretically oversees child­ren until they enter school they do  not  provide  free examinations for ages 2, 5 or 6.)

During these examination or clinic times, a variety of ser­vices are offered, including routine protective shots that the child will need for school. (Again, in Japanese fashion, there is a law that all children must have certain protective shots before attending school, but there is no penalty or enforcement if a child does not get the shots.)

Well-baby clinics are held at certain hours on certain days, so times should be checked. And, of course, check with your own ward office for the types of services offered in your ward.

There is also a free dental check-up for children under four. Again,  you simply present your booklet to receive this service.

The day I was at the Aza­bu Hokenjo, a well-baby clinic was underway. And it was de­lightful and impressive. Child­ren were everywhere and there was even one youngster squir­ming in the dental chair hav­ing his teeth examined. The children looked happy and healthy. What was particularly impressive were the little desks lined up in several rooms where the nurses and doctors were talking with the patients, explaining good nutrition, go­ing over growth charts and ex­plaining test results.

b) Health examinations (seji hoken)  (I would call these physical exams, but Dr. Yoshikawa wasn’t com­fortable with that, since he feels they are just check-ups and not thorough like examinations.) These “mini-physicals” include blood pressure, height, weight, routine chest  X-ray, blood work, urinalysis, etc.

For all age programs, the patient receives a health book­let, (kenko techo) which includes not only the results of the examination  (with  space for about five yearly exams so he/she can keep for compari­son) but has health hints as well, on dental care, self-breast examination, good nutri­tion, etc. (in Japanese).

• The under-40 program. This is offered annually to those under 40. There is a fee for this program, which varies according to the tests done; however, Dr. Yoshikawa estimated the fee at ¥1,000-2,000 which is cer­tainly modest. This program is the one exception for Minato-ku residents only: it is open to any Tokyo resi­dent (since there is a fee).

Examinations for this pro­gram are held on certain days in the month. In the letter you are given dates to come, and in the every-ten-day publica­tion (in Japanese) put out by the ward and distributed with the Japanese newspapers, also has the dates. You can also call (in Japanese) and get the times.

•   The over-40 program. This program is also offered annually but is free of charge. According to Dr. Yoshikawa, every resident in Minato-ku who is over 40 is sent a notice of this ser­vice automatically. The ex­aminations are similar to those described above (mini-physicals) but there are two special, more complete examinations which are offered to residents during their 40th and 50th birthday years.

•   The over-55 program. This is a more extensive annual examination program and, although the hokenjo oversees the program, it is actually carried out else­where. It works like this: the over-55 person goes to the ward office and receives a special card and is as­signed to a doctor in Minato-ku. He then goes to that doctor and receives his an­nual examination. (The doc­tor assignment is done at the main ward office (kukakusho)—not at the hokenjo office.)

All these services are very Japanese in that they are of­fered through Japanese publi­cations and only Japanese is spoken at the offices and in the health programs. However, they welcome foreign residents of Minato-ku, so those who speak Japanese or who have a Japanese spouse or friend willing to accompany them might want to use these varied, free services.

• Mental health testing. I was told I hat for “brain problems” for people over age 40, they have a free testing program. These test­ing programs are limited, however, and offered only at certain centers, so one would have to call for information. (Language—Japanese.)

c) Health information programs. They offer a wide range of health programs and lectures from “Stop Smoking” to nutrition advice, etc. They even have a kitchen where cooking demonstrations are given. Regarding the “Stop Smoking” program. I asked Dr. Yoshikawa if they had many people attending the class, and he said, “not too many.” He did add. however, that many times the smoker’s spouse (the wife) would attend the class because she was interested in getting her husband to quit!

MINATO-KU HOKENJO LOCATIONS

There are three hokenjo locations in Minato-ku. The one I visited is just down the street from the Roi Building in Roppongi. Address: Roppongi 5-16-45. Phone 408-6146. The other two are in Shiba (Mita 1-4-10, phone 455-4701) and Akasaka (Minami Aoyama 1-5-15, phone 405-9191).

Odaiji ni!