Medical Care in Japan – First Impressions

Keiko located a Japanese MD who understands/speaks English just minutes from our condo.  She accompanied me to our first visit 10 days ago.  We were both pleased and impressed with Dr. Saito, who had done an internship in Lexington Kentucky.

Dr. Saito briefly reviewed my current medical history, did a physical exam including an EKG, and inquired about my Rx requirements.  With no medical issues, we scheduled an appointment for today to establish a revised Rx (conforming to Japanese standards/availability) and discuss any other medical issues.  The cost of the visit … less than U.S.$5.00!

I am proud to report that I successfully negotiated both my first solo visit with Dr. Saito and the local community pharmacy today without Keiko’s assistance!

The appointment was “just like home.”  Dr. Saito and I have quickly established a very good relationship with, to his credit, no communication problems.

Since I developed a respiratory condition from the recent rainstorm, he first did an examination and prescribed antibiotics and a throat soothing remedy.  Together we then reviewed and agreed to a renewal of my blood-pressure Rx with one minor adjustment.

Finally, I asked about an annual flu shot (influenza shot here) … and he did need to speak with Keiko on the phone at that point to clarify some Japanese regulation relative to a foreigner receiving a vaccination.  In any event, I have an appointment to receive the influenza shot.  (That he was also familiar with the every 5-year pneumonia vaccination I receive has added to my confidence.)

After successfully paying for the medical appointment (less than $2.50,) I was off to the local community pharmacy located on the ground floor of the same building.  The building also houses a number of medical specialists and all are associated with the highly regarded nearby Mitsui Hospital.

At the pharmacy I also had no issues as the staff’s English language capability far exceeded my Japanese.  We had a few laughs and successfully completed the transaction.  My cold remedy drugs were ready immediately; I will return tomorrow for my regular daily Rx.

I anticipate drug prices to be comparable to the U.S. based on the comments of my seatmate on the flight to Tokyo who was a U.S. drug company sales representative.

I paid about $16.00 for the three 7-day antibiotic Rx.  For my primary Rx, the major difference is that instead of a 90 day Rx in the U.S., in Japan you can only get a 30 day supply.  I was paying $60.00 in the U.S. for the 90 day supply and I expect my three month costs will be similar in Japan.

However, given that I do not need to make a $25.-$40 co-pay for every visit to an MD as under my prior Medicare plan, the very low charge to check-in with a local MD is a gift worth receiving each month!

Also, the “super-senior” health care plan that covers me in Japan is 60% less expensive than my medicare advantage plan in Maine and provides services far in excess of anything available in the U.S.  In the U.S., one would need to pay a very high price for comparable private care not covered by Medicare.

My experience to date is that Japan’s national health insurance system is a model the U.S. should consider when the government gets serious about revising Medicare and the Affordable Care Act.

Lonely in Tokyo?

While my relationship with Tokyo spans 20 years, including an extended work-related living experience in 2001, living here now opens a new and challenging page in my life.

One of the largest and most populated cities in the world, statistics alone fail to define Tokyo, a dynamic, complex and vast metropolis.  Despite my knowledge of the city and understanding of Japanese culture and social customs, I am overwhelmed.

Tokyo is a study in contradictions.  Every day is filled with diverse and incongruous experiences.  I see things that amaze me and amuse me; startle me or sometimes scare me.  I experience things I can understand and things that confound me.  Although I understand that the way Japanese think about things is conceptually different and sometimes totally opposite of what I am used to, it is easy to become confused and at times uncomfortable.

I am an experienced global citizen.  But, everywhere I turn, Tokyo tests my confidence and curiosity.  It is easy to wonder:  “Ko-ko wa do-ko? Wa-ta-shi wa da-reh? Na-ni mo wah-kah-nai!” (Where is this? Who am I? I don’t understand anything!)

In truth, I also frequently feel quite lonely.

Some of that feeling reflects having left my daughters and ten grandchildren in the U.S.  Although we were geographically separated even in the U.S. the emotional impact of an additional 6500 miles of separation plays heavy on my heart.

As a foreigner the general awareness of being different, a “stake that sticks out,” also contributes to this feeling.  It is obvious in the occassional glances or an apparent indifference that you sense you are different and perhaps you don’t quite belong here as you go about your daily life.

It is easy to forget that everyone in Tokyo is very busy and the intensity of life here exceeds my expectation of normality.  I try not to take it personally.

Of course, my language deficit is the other major factor.  While I have a relatively deep understanding of the culture, it does me little good as my inability to communicate in Japanese leads to a sense of social isolation, frequently even as an unintended consequence with family members.

On the plus side, since much of what Japanese communicate is non-verbal, through careful listening and observation I can generally understand enough to get a sense of what is being said.  Nonetheless, it is easy to feel like the fifth wheel.  I often sit quietly and enjoy the wonderment of it all; being grateful for having the opportunity to experience a new and exciting life adventure.

The feeling of being lonely passes and I move on to overcoming my limitations and making the best of the good fortune to be here at age 76 with my wonderful wife, a lovable loyal dog, family and friends.

Recognizing that I will never have very good Japanese language skills, I am trying to learn how to be a better communicator through more effectively using common phrases to expand my communication skills.

Thanks to Toma, it appears I am having some success with this approach.  There are many people walking dogs in our neighborhood and Toma attracts a lot of attention from the pets and their owners.  These encounters are “safe” opportunities for me to test my language skills.  Combined with the familiarity that comes with being a “regular,” the encounters are increasing in frequency and growing in number.  I believe this experience will help m build my skills and confidence.

For more formal conversations or in situations where I need assistance, I also have a technology tool, Pocket Talk.  The device translates English to Japanese and Japanese to English at the push of a button.  While handy, it is a poor substitute for speaking the language and even in tech-savvy Japan, not a good way to build relationships.

Right now I am focused on learning my local area before taking on the rest of Tokyo (at least solo).  Walking to explore the neighborhood and discovering the world between the condo and the train station (the gateway to everything else in Tokyo) has uncovered hidden eateries, cafes, bakeries and all types of shops.

The local 24 hour Don Quixote discount store (an anything you ever needed or wanted, or didn’t, store) is a unique experience that I just love to visit and browse.  The ever present convenience store is a Japanese version of U.S. comfort food. Indeed, the 7-11 store steps from the front entrance to our condo building is my go-to place when I need a sense of my former home.

Next month I plan to begin taking a series of Tokyo walking discovery tours.  I recently found two books filled with fascinating information and directions to explore the city.*  They both provide background information one needs to fully appreciate the past and present context for each walk.  The walks include not only the “must-see” historic sites and other cultural attractions, but also visits to interesting neighborhoods, buildings and other architecture of note, parks and gardens, and other sites of this vibrant city.

I will be posting my notes and photographs from these discovery walks on my website (

I have always found Tokyo a very English-friendly place and Tokoyites very willing to help when you need to interact.  That their expectations are set very low regarding my language skill and cultural sensitivity is a help.  And, preparations for the 2020 Tokyo Olympics are greatly enhancing foreign visitor friendly signage, directions and other forms of visible assistance. Unless I have a very senior moment, getting lost should not be a major concern.

Tokyo––29 Walks in the World’s Most Exciting City; Tokyo Maze––42 Walks In & Around the Japanese Capital


Our furry little friend has adapted quickly to life in Tokyo.  He handled his 6500 mile trip from Boston to Tokyo via Frankfurt like a seasoned traveller.  While the nearby park makes for an enjoyable place to walk, Toma also likes walking the city blocks.

Nearly every morning and evening, Toma joins me as we accompany Keiko to and from the local train station for her daily work commute.  He sits patiently waiting for her in the evening, drawing a smile from many other commuters.

Last weekend Toma took his first train rides when we went to Chiba to visit Keiko’s mother.  He enjoyed his little travel bag that can be rolled or carried in a front facing position so he can see us.

And today, he had his first Japanese grooming experience.  We found a convenient veterinarian that also provides grooming service.  Toma is comfortable in his new home and proud to be a Tokyo resident!

Rugby in Japan? –– The Interesting Understory

Knowing that the Japanese love their sports teams, I was still surprised at the level of interest and enthusiasm in the Rugby World Cup and the Brave Blossoms, Japan’s national rugby team.

From my perspective in the United States at the time, most of the pre-World Cup news coverage concerned the potential rowdy behavior of rugby fans coming from around the world and worries that the nation’s beer supply would be sufficient!  I knew little of Japan’s rugby history or the composition of its national team.

Arriving in Japan as the Rugby World Cup started it quickly became evident that Japan’s relationship with rugby and its national team was a far more complex story.

The following editorial from The Japan Times addresses the very interesting understory of rugby and Japan.  It highlights information about the sport,  its current popularity and the issue of diversity.

The Japan Times – October 16, 2019

Brave Blossoms step up their game

With a 28-21 victory over Scotland Sunday night, the Brave Blossoms, Japan’s national rugby team, qualified for the Rugby World Cup quarterfinals for the first time. Japan prevailed in an exhilarating display of speed, execution and, ultimately, brute force, taking a deserved lead in the first half and then holding off a determined Scottish side as the clock ticked down. The nation is celebrating as the Brave Blossoms head into the knock-out games and contemplating lessons from the team’s stellar performance.

While the popularity of rugby in Japan trails well behind that of baseball, soccer, basketball, martial arts and other activities, the sport has a long history in Japan. The first matches — a version, at least — were reckoned to have taken place in 1863, when foreign military personnel slogged through the mud in Yokohama. Japanese picked up the sport with conviction at the turn of the century and there are reports of games between Keio University and Yokohama foreigners soon after.

Today, Japan has the fourth-largest number of rugby union players in the world. There are 125,000 Japanese rugby players and 3,631 official clubs. That history and enthusiasm have been slow to translate into world standing, however. The national team has long been relegated to tier-two status. Critics blame the size of Japanese players; a demand that young athletes compete in only one sport, a requirement that directs them into more popular games; poor university programs; and a league that is not truly professional.

Nevertheless, the Brave Blossoms have slowly climbed the international ranks. Their breakthrough moment arrived four years ago when the team defeated South Africa’s Springboks, one of the world’s best teams. That was only Japan’s second victory in 24 World Cup matches, and a win that some have called the biggest shock in rugby history. Meanwhile, in 2009, Japan won the rights to host the 2019 World Cup, the first Asian nation to have that honor.

Whether a result of the home field advantage or the team’s maturation and development, the Brave Blossoms have had a spectacular run. They won all their Pool games, defeating Russia, Ireland, Samoa and finally Scotland. The Brave Blossoms’ appearance in the quarterfinals is the first time that a tier-two team has performed that well since 2007, when Fiji managed that feat. One thing that cannot be credited is the luck of the draw. Ireland was the world’s No. 2 ranked team (when it faced off with Japan) and Scotland has bested the Brave Blossoms in seven consecutive matches; this is only the second time the Scottish team has not made the World Cup quarterfinals.

Some credit the Japanese team’s makeup for its success. World Rugby rules are liberal, allowing a player to join a national team after just three consecutive years of residency. This year, only 11 members of Japan’s 31-man team have two Japanese parents; 15 come from six other countries, South Korea, South Africa and New Zealand among them. This is the largest number of “international” players on any Japanese rugby team.

A pool of talent is only half the equation, however. Those skills will be wasted if coaches and management can’t incorporate them into a unified team. That demands a two-way process: Ensuring that individual skills are accommodated, and that players understand, appreciate, respect and conform to the team’s character. After all, this is a team that represents Japan in international competition. It has done the nation proud.

Some see the Brave Blossoms’ success as a lesson for the country. Historically, Japan has not been welcoming to foreigners. Today, there are a record 2.67 million foreign residents in Japan, roughly 2 percent of the population. Nearly 1.5 million foreign workers were registered in Japan in October 2018, a 400 percent increase over a decade. That growing presence does not mask tensions; sometimes it exacerbates them. Diversity is increasingly prized in Japan but integration and assimilation remain elusive. The Brave Blossoms’ performance is a sign of the opportunities that await and the advantages to be won if Japan does more to embrace foreign nationals and give them the chance to contribute.

The big question is how long good feelings will endure. Everyone loves a winner and the country is rallying behind its team. Yet rugby remains a tough sell in Japan. The number of people who play the game has fallen by a quarter over the last 15 years, to 90,000. It will be difficult to entice skilled foreign players to Japan given current low levels of professional play and players’ salaries. Splitting the season with established leagues elsewhere in the world is unlikely to work since it is a punishing sport and leagues limit the number of matches to protect players.

These are future concerns. For now, we salute the Brave Blossoms and wish them success in the quarterfinal against South Africa on Sunday.

A Sad But Joyful Weekend in Japan

As the nation struggled to deal with the massive devastation and loss of life caused by the catastrophic typhoon over the weekend, many were also cheering the dramatic 28-21 victory of Japan’s rugby team over Scotland to reach the quarterfinals of the Rugby World Cup.

After Typhoon Hagibis, the most powerful typhoon to hit Japan in decades, brought record-breaking rainfall to half of the country’s prefectures, the full scale of damage caused by flooding and high winds remains unclear.

According to a report in The Japan Times, the embankments or levees of 47 rivers were breached, there were 146 mudslides reported, and thousands of homes were hit by muddy flood-water and electricity and water outages throughout the country.

On Sunday evening, attention was also focused on Japan’s success in the Rugby World Cup. The Brave Blossoms, Japan’s national rugby team, qualified for the Rugby World Cup quarterfinals for the first time and will face South Africa’s Springboks, one of the world’s best teams, in the quarterfinals this coming Sunday.

While the popularity of rugby in Japan trails well behind that of other sports, the nation is celebrating the Brave Blossoms spectacular performance.

Despite a recent 41-7 loss to the Springboks in the run-up to this World Cup, the support of Japanese fans remains enthusiastic and hopeful that the so-called “Brighton Miracle,” when the Japanese team beat the Springboks 34-32 at the 2015 World Cup, could be repeated. Stay tuned!