A visit to the Tokiwa Foundation in Iwaki, Fukushima

Author: Deepika Shrestha

Editor: Akihiko Ozaki M.D., Asaka Higuchi R.N.

On December 6, 2017, I visited Iwaki city, which is located in the southeastern coastal area of the Fukushima Prefecture, Japan. The visit to Iwaki was memorable to me. I was lucky to visit multiple facilities belonging to the Tokiwa Foundation, the big healthcare group located in this area. Coming from Nepal, a lot of things looked new to me, and I would like to thank the entire staff at the Tokiwa Foundation for this opportunity.

This trip was kindly coordinated by my friend, Asaka Higuchi, a researcher at the Medical Governance Research Institute (MEGRI) in Tokyo. We boarded the Super Hitachi, a bullet train that connects Iwaki and Tokyo, for a two-and-a-half-hour ride. This experience was really exciting to me, as I have never used such a fast-public-transportation system. At Yushima Station, our destination, we were welcomed by Mr. Kazuyuki Sugiyama, who works in the General Administration Division of the Jyoban Hospital, a core institution in the Tokiwa Foundation group. Mr. Sugiyama belonged to the Kendo Club when he was a student of the University of Tokyo. Kendo is a modern-Japanese martial art that uses bamboo swords (shinai), Asaka’s boss at the MEGRI, Dr. Kami, also belonged to this club a couple of decades ago and has known Mr. Sugiyama since their university days. Mr. Sugiyama has been a friend of Asaka’s for a long time. He took us for lunch and explained that he majored in architecture for his master’s degree at the University of Tokyo. He was fascinated by the atmosphere at the Tokiwa Foundation, where the staff works in a good and cheerful atmosphere. Now, his ambition is to improve the care and hospitality for hospital patients by using his expertise in architecture.

Image 1. The entrance to the Jyoban Hospital, part of the Tokiwa Foundation group, with Mr. Kazuyuki Sugiyama

Image 2. The dialysis and PET center, with Ms. Asaka Higuchi

On the same day, I had a chance to visit the nursing headquarters at the Jyoban Hospital. Ms. Fukiko Takagi, the head nurse at the hospital, kindly took time to see me, and we talked about the differences in nursing care between our two countries. I also met three nurses from Vietnam who were working and studying hard for the Japanese license examination. I was surprised to find that the Tokiwa Foundation helps foreign nurses learn nursing skills and the Japanese language, which could possibly allow them to work continuously in Japan. Actually, after coming back from Japan, I was pleased to learn that one of them had passed the Japanese-nursing-license test. Another interesting discovery was that a hot spring facility exists for the hospital staff, which may be unique to Iwaki city (a place well-known for its hot springs).

Image 3 - 6. Facilities at the Yushima Nursery School

One of the other places I visited was the Yushima Nursery School, which is operated for the children of the hospital staff as well as the residents of the nearby area. The babies and children are given proper care for their age groups. The infrastructure was also built to be baby friendly. It was surprising that the hot spring is for babies as well. It is called “Ashi-Yu” (foot bath). The working mothers leave their babies in the morning and pick them after work (in the evening, in many cases). Here, the children are able to receive toilet training and nutritious food and experience various activities such as art, music, playtime, and sleep.

After dropping in at the nursery school, we went to Naraha Tokiwa En, a nursing home for the elderly, which was built after the 2011 Fukushima nuclear disaster. According to Mr. Yoshikazu Kida, the head of occupational therapy department, most of the residents there are above 65 years of age. Only a few were bedridden; others were physically weak or walked with the help of crutches or a walker. Also, the voluntary staff assists them with their daily life activities. Various services are provided to the elderly. For instance, physiotherapy helps them restore body functions and there is also a rehabilitation service and occupational therapy. In addition, diversional therapy helps them utilize the time and also helps prevent mental illness.

    Image 7, 8. The members and the Kanaya Nursery School facility

We also visited the Kanaya Nursery School, which is located near Naraha Tokiwa En. Ms. Yuku Akutsu attended this trip, and she helped me learn about the facility and the activities conducted there. There is a trend of increasing obesity among preschoolers and school children, possibly because of the restriction on outdoor activities for fear of radiation exposure after the disaster. Therefore, the school helps them enjoy physical activities after school. Various indoor and outdoor activities are available there. The children are often brought to the nursery after school by a vehicle and picked up by the parents after their work.

These services were very impressive to me, as many of my colleagues in Nepal who are mothers face problems caring for their babies. This kind of service is necessary in Nepal as well to support those mothers so that females can pursue their careers and professions.

    Image 9. Nagaya’s exterior

    Image 10, 11. Inside Nagaya with a resident and Dr. Morita

On the next day, we traveled to Soma City in the northeastern coastal area of Fukushima and visited the Soma Central Hospital. There, Dr. Tomohiro Morita took us to Nagaya, which is a collective residence for the elderly who are about 80 years of age and live by themselves. Every resident has his or her living space with a bedroom, dining room, kitchen, bath, and toilet so that their privacy is well protected. Washing machines are shared among residents in the dining hall. There is a big living room used as a shared space where they sometimes eat lunch together. It has been pointed out that social isolation has become a most critical problem after the disaster, especially among the elderly people who returned home from the shelter or the places they were evacuated to. So, this residence was built to help them get out of the isolation and spend good time with their neighbors.

Dr. Morita visits Nagaya once a month for general health screening. He told me that communication is an important element in operating his work in a positive way. I saw a number of shopping stalls when I visited this facility. Some of the residents buy their groceries there. In Nepal, most people live with family members (three generations). Elderly people are attached to their grandchildren and interaction between them helps improve the power of their memories. In the future, Nepal is also going to face the same problem because many young people are migrating to foreign countries for education and job opportunities.

    Image12. The solar power system in Soma City

Later, we went to see the solar-power system in Soma City, which is located in a northeastern part of the city. These facilities were built on the agricultural lands that were flooded when the tsunami hit there. It provides renewable electricity to city facilities and appears to be an important effort to alleviate the emission of greenhouse gases.

Then, we traveled to Minamisoma City and visited the Minamisoma Municipal General Hospital, where Dr. Yuki Shimada showed me the core equipment used by the hospital, such as the whole-body counter (a device that measures the internal-radiation exposure) and the hospital’s rooftop helipad, which can be used for the transfer of sick patients who need more intensive care at a tertiary care center in the urban area. Dr. Tomoyoshi Oikawa, the hospital director, briefly described what he and his hospital experienced throughout the disaster. His post-disaster effort was really impressive. I was also able to meet with Mrs. Rika Igarashi, a vice president and nursing director of the hospital, and Mayumi Nagano, a deputy-nurse supervisor. I discussed my background with them, namely my birthplace and profession. It was a great opportunity to share my knowledge about the nursing education and practice in Nepal. Mrs. Igarashi briefly explained the services provided at the Minamisoma Municipal General Hospital.

Image 13 : Photo with Dr. Shimada (neurosurgeon) and Mr. Tanaki (technician for the whole-body counter)

Image 14: Photo with Mr. Oikawa, the hospital director

Image 15: Photo with the Minamisoma Municipal General Hospital’s

nursing staff

I would like to thank my friend, Asaka Higuchi, for arranging this visit and all the members of Dr. Masahiro Kami’s group, who provided me with such a valuable experience. I am very grateful to all of them.

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