The profile of the month is chosen by the MSIF editor. The June Profile is Naomi Banno.

Naomi Banno

I was struck down with multiple sclerosis (MS) in 1986 when I was aged 18. Since that time, I have been confined to a wheelchair for extended periods and was hospitalized 15 times in Japan.

I have repeatedly received pulse therapy, which is a kind of steroid treatment. Despite its strong side effects, the therapy worked well on me. Recently some interferon drugs, which can prevent recurrences in some people with MS, have come onto the market in Japan. In multiple sclerosis, preventing recurrences is very important. Even though we know that steroids lessen the likelihood of recurrence, it is difficult to use our bodies to compare the effect of interferon. We would also be reluctant to inject ourselves. In Japan, however, more than 1,800 MS sufferers have used interferons.

Several years ago, the number of MS patients in Japan was at 8,000, although the figure is on the increase and may have reached 10,000 according to an announcement from the Ministry of Health, Labor and Welfare. Many older people have myelitis-like MS, while younger adults, possibly due to their Westernized eating habits, are becoming more susceptible to progressive MS with lesions in the brain. In the Japanese healthcare system, despite recent changes, patients still tend to follow the doctor’s directions regarding any examinations and medications. Many Japanese people continue to believe that a good patient is one who follows the doctor’s advice and accepts whatever examination or treatment the doctor specifies, without complaining. It seems that patients in Japan live in a psychological and social environment that prevents them from asking questions or refusing consent. In other words, you cannot say the word, “No.”

After growing up in this environment, in September 2002 I had the chance to live in the United States to study social welfare. For a person deeply rooted in the Japanese culture and identity, this was the beginning of life under the American healthcare system, that turned out to be both bitter and enjoyable. The hospital staff were willing to explain the examination data and treatment plans, and patients are able to either consent to or refuse any examination or treatment. You do not need to hesitate to ask any questions, which is very good. However, it also means you have to make your own decisions and take responsibilities for your choices. This freedom often requires making tough decisions, instead of relying on the doctor’s directions, as in Japan.

The division of American healthcare into many job assignments seems to me rather like nonsense. In Japan there is no such excessive division, and it makes me realize we have a healthcare system that provides flexible and thoughtful services. For example, a patient may want a nurse to help him go to the toilet. In America, it may take twenty minutes to arrive after the buzzer is pressed. However, in Japan, it is often the case that a nurse or even doctor who is not in charge of the patient will step in to provide assistance if the nurse looking after the patient is too busy.

The United States and Japan have completely different systems for insurance, the accreditation of doctors, the procedures for renewing the accreditation, and so on. The insurance premiums are not very costly in Japan as everybody belongs to the insurance system. In the United States, you have to pay considerable insurance premiums and medical bills, although they guarantee you good support. Needless to say, such expenses can be offset by social security. As far as medical expenses are concerned, however, I think Japan has a much better healthcare system. Since I joined the university’s student insurance, I do not have to pay medical bills except for medication.

There is one aspect of the American healthcare system that I find both good and bad. ER performs examinations considering any possibility, and does not allow the patient to return home without the cause of problem being identified. A system like this may prevent patients from dying due to inadequate medical treatment. On the other hand, there is another type of healthcare where at least 99 percent of patients are saved from having to undergo a lot of examinations and the diagnoses of many doctors. Instead, the patients receive only the minimum number of examinations and diagnoses necessary and are allowed to go home in two or three hours. The latter example is exactly what the Japanese healthcare system tries to achieve. If a patient thinks they have a broken bone, the doctor analyzes the X-ray that the patient has requested. If a broken bone is diagnosed and there are no other problems, the patient has the injured area set in a cast and they go home. This would not happen in the United States. You cannot leave ER until the staff have considered all of the possibilities, aiming at providing better healthcare. Would you choose the Japanese or American healthcare system?

Two things made me happy to receive medical treatment in the United States. First, you can get drugs to eliminate fatigue. Second, you feel naturally that healthcare professionals are supporting you. In the United States, the healthcare system, welfare, and NPO activities provide MS patients and their families with educational programs. In Japan, the availability of such wide-ranging support or educational program for MS patients and their families is much more restricted. Having said that, I realize what makes Japanese culture so wonderful whenever I see doctors and other healthcare professionals exercise so much care and compassion. I cannot say whether I prefer the American or Japanese healthcare systems. If I am informed enough to make a good decision by myself, I would prefer the great skill and expertise of the American doctors. But, since I’m not informed in that way, I like the way the Japanese healthcare system provides more flexibility. Ideally, it would be good to combine the benefits of the American healthcare system with those of the Japanese system. Knowing both Japanese and American healthcare, I want to experience the good aspects of both systems.

I hope I can pass on what I’m learning on social welfare to Japanese MS patients and their families in the future. With that in mind, I am currently studying in New York University. I will return to Japan from May until August 2003, then I will go back to New York and continue my studies.

Naomi Banno, is the representative for Japan on the Persons with MS International Committee