Summer Internship: Michael Burke

Konnichiwa from Japan. This summer I am interning at Kameda Medical Center in Kamogawa-shi, a small town on the southeastern coast of Japan. For the past several years John Wocher, the Executive Vice President of Administration and Director of International Patient Relations at Kameda, has offered an Iowa student the opportunity to come to Kameda and observe how the hospital operates and partake in a project of their choosing. You may be wondering how Iowa has had an ably prepared Japanese speaker for the last several years. Well, Japanese is not a requirement. In any situation where translation is necessary, I have had an interpreter with me. Things can get a little dicey when I'm not at work, but for the most part people are willing to try to speak English with me.

Kameda Medical Center is comprised of several components including the general hospital (900+ beds), the clinics (~20 beds), and the rehabilitation hospital (~60 beds). Kameda is owned and operated by the Kameda family and has been for more than 350 years. It is most common in Japan for physicians to own hospitals, as is the case with Kameda Medical Center. Physically, Kameda is located about 100 yards from the Pacific Ocean; they have a new patient tower with all private rooms (K-Tower); two older towers with private, semi-private, and shared rooms (A and B Towers); a rehabilitation hospital with private and semi-private rooms; and a multi-specialty clinic.

Most of the same services are available in Japan as you would find in the United States. Different services come at different times as approval is required by both the FDA in the US, causing delays, and the Ministry of Health, Labor and Welfare (MHLW) in Japan, causing delays. Due to the many cultural differences between Japan and the US, both countries utilize different techniques to appeal to their patients. Japanese patients have become accustomed to a more communal lifestyle so it is typical to find multiple beds in a room. Of course, newer hospitals give the option of a private room with an added surcharge because it would not be covered by National Health Insurance (NHI). The NHI system is unique to Japan in that all services at all hospitals and clinics in the country are reimbursed at the same rate. All enrollees pay monthly (typically this amount is deducted from their paycheck) and they are required a 30% co-pay at the time of care.

My time so far has been spent rotating through various departments throughout the hospital to get a better idea of how they operate. This has been a very unique and beneficial experience for me. Not only do I get the benefit of asking unlimited questions of all the chief nurses, department directors, and attending physicians, but I am able to identify opportunities where they might be able to improve or opportunities where US institutions might be able to improve. In addition to rotating through various departments in the hospital, I am also touring a variety of healthcare facilities unrelated to Kameda Medical Center (Navy Medical Center, public facilities, academic facilities), visiting an off-site healthcare consulting firm for a week in Osaka, and will have the opportunity to observe and scrub-in during surgery.

As I said, the culture and customs are very different in Japan. One of the main differences I have noted throughout my rotations is the methods for and levels at which they control pain. With support and interest from my preceptor, I have chosen to examine this further and look into the drivers of this reduced pain control and the effects it may have on patient outcomes.

If you would like to read more about my summer at Kameda go to: http://training-in-japan.blogspot.com. Overall, I am glad I came to Kamogawa for the summer and look forward to developing new relationships.