Wocher Letter: 6/27 | Who is Dan? and other FAQs | What to Bring to Kameda | Our Great President | 8/7/2000 | 8/2/2000 | 7/31/2000 | 7/23/2000 | 7/17/2000 | 7/12/2000 | 7/9/2000 | 6/30/2000 | 6/26/2000 | 6/20/2000 | 6/8/2000 | 6/6/2000 | 6/3/2000 | 5/31/2000 | Japanese Healthcare | Contact Me
Dan's Adventure in Japan

End of the first month in Japan

[I am writing this after the journal entries for the week of 7/3. The
information is being taken from notes. I put off writing this a little
longer than I expected due to the trip to Tokyo. I hope this eases any

I had a major event on Saturday, July 1. I made an attempt to climb Mt.
Fuji. I thought this would be fairly easy and treated the event rather
lightly. The night before, a small group of people went out for yakitori
and drinks. The yakitori is skewered meat and vegetables. Kamogawa has an
excellent yakitori shop with a wide variety of choices. Mostly, we ate
chicken and fish. It was the second time I had been there and it was as
good as it was the first time. Much beer was also consumed, along with a
Cuban cigar. I am not a big cigar smoker and do not smoke cigarettes, so
this was a rare event. It was the second cigar I had ever smoked. Alas, a
Cuban cigar is one of those things you cannot pass up. The evening ended
relatively early and I retired to prepare for Fuji, early the following

I was to go up Fuji with the Swansons, a family whose patriarch is the
Director of Medical Education at Kameda. The family consists of Todd
(Director of Med Ed), Eileen (his wife), Matt (15 years old), Isaac (13),
and Sam (10). I arrived at their house at 7:45 AM. They were a little
slower in getting started than I was, since Wimbleton was on the night
before. The matches START at 11:00 PM here and go through the night. I can
understand why they were a little tired. Just prior to 9:00, we set out.
The drive to Fuji was around 4 hours. It went by fairly quickly with a
variety of good conversations. The Swanson kids are really sharp and are
very mature and polite--a real pleasure to deal with.

When people climb Fuji, there are several possible approaches to it. You
can approach from two different sides of the mountain. You also have the
option to start from the base or from Station 5. Station 5 is about
half-way up the mountain (or 6000 feet of the 12,387 foot mountain). Most
people choose to start from Station 5, and our group was no exception. I
knew immediately upon getting out of the car, that I was in trouble.
Though I had barely moved, I could feel the difference in the oxygen content
of the air. We had very little time to acclimate to the altitude before
climbing. By about 1:30, we started our ascent.

The mountain is composed of volcanic stones. This is a difficult surface to
walk on, but when you ascend at a sharp angle, it is even more difficult.
My legs remained strong, but the altitude proved to be extremely trying.
Spending your life in the flat midwest and the last month at sea level is
probably not the best training for this. As we ascended, the group
separated. Matt went far ahead of the others, largely the product of living
in Boise and regularly climbing mountains. Sam and Todd were the next
group. I climbed with Eileen and Isaac. The last two groups were not far
apart. We rested frequently, but with the altitude, it was difficult to
recover quickly and carry on. The pattern up the mountain was: climb, rest,
climb, rest, look how far I had come, take a picture, look how far I had to
go, climb, rest. The altitude problems, of course, got worse as we
continued. The air got thinner and rest was needed more frequently. We
eventually made it up to around the 11,000 foot level. Nearly four and a
half hours passed from the start to end of my ascent. Todd and Matt decided
to continue on to the summit. I chose to stop. The altitude was completely
killing me. I rested for a while and began to make my way down.

I partnered with Sam (the 10 year old) and began to make my way down. My
objective to prove to myself that the altitude coupled with the angle was my
enemy on the way up. The way down requires a lot of care to assure that you
do not injure your ankles and knees. With my objective of proving myself, I
chose to climb with Sam. Young kids don't have the concerns that others
have about damaging their knees and ankles. I knew he would essentially run
down the plane of volcanic rock. We made it down to the bottom in under an
hour and a half. We slid and slipped much of the way down, but managed to
avoid any major problems. The pace we kept and the approach we used to get
down made me feel that I had redeemed myself from the shaky climb.

During the ascent and descent, I noticed that we were moving much quicker
than many other groups on the mountain. I learned later that the
recommended time to climb the mountain was seven hours. The recommended
time to get down is 3-4 hours. It seems we pushed a little too hard on the
journey up. Consequently, I don't feel too bad about not making it all the
way up. Every step I took required a lot of willpower. I set and surpassed
several goals that day. The summit remained out of reach, but I feel that I
accomplished more than I thought possible when I found how crippling the
altitude was. All in all, it was a very positive experience, though I can
say that I would never do it again.

I bought a couple of trinkets at the Station 5 store before leaving. I
slept like a baby that night. I was also pleased to see how sunburned I was
the next morning. I was truly an Iowa redneck...

There was a lot more seismic activity here in the last few days. Miyake
(unsure of spelling) Island had a lava flow going underneath it. Areas
nearby, like Kamogawa, had constant tremors. There were some significant
earthquakes and many small ones. The island was evacuated. People were
allowed to return to the island after some scientists declared it safe to
return, that the risk of eruption had completely passed. On July 8th, a
mountain on the island spit tons of ash into the sky. I guess the
scientists were wrong. No word yet on the results of the eruption.

Hospital administration section follows:

On Monday, the 26th, I visited the human resources/personnel department of
Kameda. They handle the pensions, hiring, and other HR matters. They do
almost nothing with training. There are also very limited efforts to
establish any hospital rules with new employees. In addition, when a person
is hired, they never perform background checks or check references. They
base their decisions to hire on flimsy claims from the job applicants. I
also found that the handling of pension funds is a fairly easy part of the
HR department's job. Investing pension money is ILLEGAL in Japan. Since
the current interest rate in Japan is near zero, pension funds earn ZERO
RETURN. I even had a difficult time asking the question, since the idea of
investing these funds is completely alien to the Japanese. Interesting...

On Tuesday, I visited the Billing Department of the hospital. I was led
through a messy office into a back room filled with boxes. These boxes were
filled with the paper forms that the Japanese government requires hospitals
to file for reimbursement. The fact that you are UNABLE to file billing
electronically seems very backward to me. Other areas were also surprising.
The cashiers were using old-fashioned calculators to figure co-payments. No
computers to be seen at their desks...Strange that a hospital with a world
renowned electronic medical record should be using calculators to figure
copays. In spite of these shortcomings, the billing department did a good
job of assuring that their staff were able to perform any job in the
department. This model seemed a good fit for a department that is subject
to high turnover.

Wednesday, I visited a pair of departments. The facilities division was
interesting. They explained that they are forced to remodel, rather than
build, since banks cannot loan much. The economy in Japan is in poor
condition and has been for a long time. The Kameda Tower project has been
on hold for quite some time. The facilities division also was proud of the
fact that they generate their own power, though they could tell me very
little about it.

I also spent some time in Public Relations. They were mostly interested in
talking about the United States. During the short time we were on topic,
they confirmed that hospitals cannot advertise in Japan. The only mediums
they can freely advertise in are pamphlets in the hospital and the internet.
The latter is used very little. I attempted to encourage the use of the
Internet to get Kameda's name out there more. How large was the PR staff
for the 800+ bed hospital? Two.

General Affairs was on Thursday. They handle almost every function that
doesn't fit well in other areas. Important areas include budgeting and
contract making. In Japan, lawyers are almost never used to write
contracts. Through a series of questions, I found that Kameda has NEVER
been to court on a contract dispute. The budgeting for the hospital was
also interesting. The people that write the budget have ZERO accounting
experience. That surprised me. General affairs also is in charge of the
secretaries in the hospital. I learned that this is an easy job, since
there are only FIVE of them in the whole place. Almost all of them work in
the administrative area. They let slip that they are responsible for
disaster planning. I pounced on that one. They have no idea how long they
can generate power in the event of a disaster. Tsunami hits: no plan.
Airplane crash: no plan. Any disaster: no plan. Hmmm...

That's it up to this point. I am making good progress on my projects and
hope to get some more work done on them in the next few days...