Made in Japan

When an all too often purchase included a “Made in Japan” label, it was regarded as an inferior cheaper copy of US manufacturing products in the 50’s and 60’s, decades before Japanese goods were known for their quality and design. Living in Long Island, New York, Italians, Jews and a smattering of African Americans were the only groups that I had any familiarity with. However, there was one Japanese girl in my elementary school that I still remember vividly with her pigtails, posing pleasingly for her annual school picture. She was born and raised in the US so there was little to learn from her about Japanese culture, even if I was motivated to do so.  And anyway, I wasn’t particularly known for my social skills at the time, a characteristic that has unfortunately lingered with me throughout my life. 

It took moving to Hawaii to begin to understand sukoshi about Japanese culture.  With over a quarter of the population having Japanese ancestry and a growing expatriate population coming to invest in a second home during the booming years of the Japanese economy, or to escape the repressive expectations of Japanese culture, particularly aimed at women, Hawaii provided more than a snapshot of Japanese culture.  While in general, American freedom of expression and behavior was a contagion that attracted an increasing horde of Japanese, it is interesting that regardless of the motivation, most Japanese living in Hawaii retained a profound respect for the culture, behavior, and decorum of their motherland.  The US was an OK place to live, but its decadence, diversity and self-destructive behaviors would never replace the forbearing roots of their Japanese culture and humanity.   

It took an invitation to participate as a visiting professor at Chubu Hospital in Okinawa to teach the local pediatric residents and faculty members on two separate occasions to begin to appreciate Japanese culture.  Okinawa, as it turns out represents the origins of the historical migration of many Japanese immigrants to Hawaii. It represents a typically shorter, distinctive genetic variety of Japanese that is characteristic to this day of our Hawaiian Japanese residents. It is also the home of a longstanding relationship with a US military base, Naha naval base as best I remember. And it was my experience coupled with my later more frequent and recent experience as a visiting professor in Yokohama, Japan teaching at the Yokohama Medial Society and at the Shin Yokohama Women’s and Children’s Medical Center that truly shaped to this day, my work ethic and sense of professional responsibility.  In a sense, I got more out of my experience in Japan than those I had promised to teach about neonatology and high-risk infant care.  I sometimes wonder whether the picture that they had of me in the front lobby of the hospital still stands as one of their “Advise Doctors”.

One of the long-lasting and endearing characteristics of Japanese culture, the reverence for one’s elders and senior members of society, as it turns out, stands as one of the roadblocks in teaching medical education in Japan. That is, patient rounds are generally held with a “sensei” whose words are taken as gospel. Not much discussion after a command is passed down from a seasoned veteran of medicine. It would be in fact rude to question their wisdom and authority. To be sure, when Japanese doctors come to the US for training, it takes some time for them to adapt to the interactive discussions and freedom to question authority and or provide additional or opposing diagnostic scenarios that more adeptly decipher medical enigmas facing the treating team of healthcare workers - tasked with the care of their ever-evolving cohort of patients. (Sadly, this American tradition of Socratic back and forth discourse is seriously under attack.  Indeed, it is disheartening to witness the progressive deterioration of free speech, challenging public discourse, articulating unpopular opinions, and respectfully debating opposing views including in the practice of medicine, as the woke movement in the US infects just about every aspect of human life including medicine. But we will leave this discussion for another time or just hope it goes away on its own accord!)

Nevertheless, this reverence for hierarchical tradition and respect for the elderly is rooted deeply in Japanese culture, permeating much of Japanese behavior and civility, and ostensibly for much of the positive aspects of community life easily observed throughout the country. Having just started a two-week cruise of nine cities in Japan, the contrast with the US could not be more striking.  An insular society filled to the brim with native Japanese, cultural norms are imbued from birth into every aspect of life and behavior. The streets are safe, day and night, crime is rare, and everyone, young or old, male, or female is safe to wander the streets or public transportation without trepidation. No homeless or homeless encampments, the streets are devoid of even a hint of refuse, every street is swept, train stations are immaculate and kept up to date, and the news is filled with politics but not of the latest train derailment or mass killing, as we have become so familiar with in the US.  

But is this Japanese cultural indoctrination all positive? Clearly, we didn’t think so when the common lore in the 60’s was that the Japanese were great at copying American products but short on innovation. In such a strictly rule based society, is it no wonder that individual freedom of expression would be stifled and even discouraged?  Regardless, this storyline is never so simple or one-sided, and there are many personal stories of Japanese, particularly those moving to Hawaii escaping this repressive society and expected conformity, that demonstrates a growing trend in Japanese culture, particularly when it comes to women. Other trends have emerged in Japan itself, with a growing number of young women who eschew marriage and the burden of nearly continuous servitude that embodies its role. To be sure, the WSJ recently reported that 27% of Japanese women have never experienced childbirth by the age of 50. Many choose to pursue a career or live at home and spend the fruits of their labor on personal items, in a sense prolonging their adolescence and dependence on their family for support and comfort, often at the consternation of their family. To emphasize its significance, the fertility rate in Japan is 1.34, when 2.1 is needed to sustain a stable population. 

When touring the environs of Kagoshima, I noticed tree lined streets neatly lining the main thoroughfares of the city.  A good number of these trees were sculpted in a traditional bonsai looking layered and/or spiral staircase looking pattern typical of the iconic Japanese garden. Later that day we visited a beautiful Japanese garden, part of a historic property and home of a famous shogun. The garden was lined with sculpted bonsaied trees, bridges and waterways, stone structures of oriental designs, koi, plants, flowers, and rolling mounds of flowing terrain, distinctive, beautiful, and serene.  So much different than western style gardens, which to some degree allow the expression of living things to show their distinctive properties without fully constraining their shapes and appearances. True, trees and plants are cut back to maintain a certain balance in the garden but not nearly to the extent as those of its Japanese counterparts.  One wonders whether Japanese gardens are indeed an expression of a more profound element of Japanese culture, one poised at controlling their inward and outward emotions, boundaries, and environment to the extent possible with directive resolve.  

Nagasaki was on the list to visit. I was ambivalent about visiting the Atomic Bomb Memorial and Peace Park. It was indeed an emotional experience for me, much in the same way as the War Remnants Museum was in Ho Chi Minh City which recounted in graphic detail the damage the US inflicted in Vietnam during that war. Still, learning more about the horrific effects of the nuclear bomb was never one of high priorities, but you can’t help it when you visit ground zero and revisit the details of August 9th, 1945. It forced me to think about my birthday, November 18th, 1946, less than one year later, how I missed the Korean War because I was too young, and how I missed the Vietnam War because the US military stopped inducting young doctors in 1972, the year I graduated medical school. I luckily (or unluckily) missed any possibility for military service which I have always thought of as a series of lucky flip of the coins in my life.  

The experience of the memorial was indeed emotional - reading account after account of how Japanese families were torn apart in a matter of an instant from the bomb. Stories and poems and pictures of bloodshed and devastation were on display for those to witness as long as they could stand the graphic detail. When the museum was later discussed by the cruise ship resident historian, he broadcasted that the museum provided a one-sided view of the devastation devoid of context as to why the bomb was dropped and the circumstances surrounding Japan’s cruelty in war related activities.  He drew the contrast to Germany who has since acknowledged and apologized for the sins of the Nazi occupation in WWII.  While thought provoking, I’m not sure the purpose of this memorial was to describe the historical context, rather than to resolve for an overarching theme of global peace, across countries and continents as the only positive resolve one can arrive at from the needless death and devastation, which to the people of Nagasaki, will never be quelled by any military justification or rationalization, regardless of reason and or consensus.  

right hand points to danger of nuclear weapons, left hand symbol for peace

The most heart wrenching......

seven continents holding hands in peace

ground zero

# of victims to date

But is the nature of man likely to change or will war permanently plague the destiny of mankind. I’ll let others answer this question. Those who know me can easily predict my own answer to this question and I’ll leave it at that.

Several days later we spent the day in Niigata.  One of the most striking things in retrospect from our travels through Japan has been the presence of so many senior citizens – walking the town, driving buses, as tour guides, as small bento shop owners, etc. Everywhere we felt their presence, slim, healthy, and energetic – all reasons to marvel at their vitality and strength of purpose.  You seldom see such health and alertness and agility in seniors of equivalent age in the US or most any places other than the Asian countries.  Perhaps senior citizens from Asia have earned the respect they receive by their community!

It is impossible to encompass the many interesting moments in our two-week Japan adventure. I think the last item I would like to address is the one that was also an issue on my first trip to Japan, but at that time, it was the sticker shock of any item for purchase. In the 70’s and 80’s $25.00 could buy you a cup of coffee and a donut.  Today, the dollar is strong making it very easy to travel in Japan. Everything cost about half or less what you would pay in Most Anywhere, USA.  What a pleasure to return to the days when the dollar is strong and spending a few bucks on tasty noodles or taking a cab to the cruise terminal does not set one back an arm and a leg.  If that were so, I would be traveling only on one leg and no arms. Not much fun to be constantly hoarding what little money we have to spend for the time in Japan.  Instead, my yen to travel to Japan leaves little worry about the yen I will part with on this adventure.