One area of Japanese life that most people (including myself, until recently) are curious about is television. There are longstanding parodies of it on American TV ("What a brave corporate logo!") resulting in strong preconceived notions of what it's like. These preconceived notions I had proved to be fairly accurate. The commercials are strange and often leave you bewildered about the product being advertised. My current favorite is a commercial for a mystery product featuring a tremendous sumo wrestler in a pool with a small child crawling on him. The screen fades and is replaced with a picture of the same people in a smaller pool. Happy music plays in the background. No product is shown at any point. Hmmm....

There are two things I will watch: baseball and a morning show. The Chiba Mariner (not a typo) is the home team, so I like to watch their games. The morning show has a clock in the upper left corner and weather reports with a colorful map. I have no idea what anyone talks about, but they usually have some wacky antics that make me smile before I leave for work. This morning, a woman was running around in a field holding a model rocket while a bunch of Americans launched their own model rockets and tried to figure out what she was doing. She was far too enthusiastic for her own good.

In addition to making observations about TV, I have been sprucing up my dwelling place. I am living in the dorm that the paramedics live in. The apartment is fairly small, but is nice. I am actually cooking my first meal in the apartment tonight. I am having prepackaged sushi from the grocery store and some noodles. Unfortunately, the directions for the gas range and noodles are in kanji characters and I can't read them. If you don't hear from me again, you will know my experiment in Japanese cooking was a failure...(Addendum: I made it through dinner and it was good).

Earlier this week, my curious side got the better of me after work, and I took a three hour walk around Kamogawa City. My objective was to check out the ocean and see what kind of shopping was available. I ultimately decided to eat dinner at Denny's (much different from the American version) and shop at Jusco, a large department store. Eating first seemed to make sense, since I didn't want to have groceries in Denny's. I prepared for this journey by perusing the restaurant section of my Japanese language book. As I walked into the restaurant, the waiter approached me and said some words that I did not anticipate. My preparation had proven inadequate. Eventually I found out that he wanted to know if I wanted smoking or nonsmoking. Once I was at my table, ordering was easy. The menu had pictures of all the food along with their prices in yen. I tried a beef teriyaki dish with green peppers. It was fairly good. I was pleased with how that went and moved onto Jusco.

Jusco is a four story department store. When you walk in, an expanse of groceries is visible across your entire field of vision. I wanted to pick up a few things in the other sections, so I went upstairs to see what was available. The second floor appeared to be the clothing area, so I skipped it and went to the third floor. The third floor held items that you would expect to see in nonclothing sections, so I was confident that I would be able to find my basic needs there: paper, pens, a clock, and some AAA batteries. The paper, pens, and batteries were very easy to find. The clock was somewhat more difficult. I looked around the floor of similar goods for almost 45 minutes (if you can't read the signs, it's much more difficult to be sure you didn't miss something). I did see that cellular phones sold for around 100 yen (less than one US dollar) and may return to purchase a couple of them. However, my mission to find a clock was more important. I went up to the fourth floor. There was a bowling alley, video games, and vending machines (including beer and smokes) so I turned my eyes toward the second floor. There was a clock shop tucked away in the corner. To get a basic alarm clock with a power cord, I had to spend between 4000 and 10000 yen ($40-$100). The model I chose cost 5600 yen ($56). If I bought a similar clock in the US, I would probably spend no more than $30. I was beginning to see how expensive Japan was. After some failed communication with the staff of the store, I found that the clock shop was a self contained business within Jusco and I had to pay for my clock in the department. After buying my clock, I picked up some groceries and left. My adventure that night was quite enough.

The problem with the Japanese language, from this foreigner's perspective, is that words in the language do not sound the least bit familiar. In German, Spanish, and French you can understand some words based on their similarity to English. I really respect people who are able to speak both languages, since they don't build on each other at all.

Work has been a lot of fun. The first few days have been spent exploring the holdings of Kameda Medical Center. I am starting to feel quite a bit more comfortable with the facilities. They are doing a lot of great things there, including their world famous electronic medical record. However, there are a lot of things that strike me as an American. People do not wear gloves when treating patients or handling lab samples. There is a feeling of invincibility. That is somewhat justified. Kameda has had only five patients in the last ten years that were HIV positive (in a facility that sees over 2300 people per day and has 800 inpatient beds). Mr. Wocher (my preceptor) has been very helpful in explaining Japanese healthcare and contrasting it with the American system. He has also been encouraging me to observe procedures being done in the clinical departments. I will be spending half days with some members of the clinical staff next week with the help of an interpreter. I also have some projects in the works that are described in more detail for my fellow health administration people below.

Tomorrow, Mr. Wocher is making a presentation on a naval base. I am going along with him on the trip. We are going to try to see some of the warships the navy has there. I am hoping to see a submarine and an aircraft carrier. All my History Channel watching will finally pay off. Since Mr. Wocher was in the Navy for many years, we should be able to see some things that aren't on the general tour. It should be an interesting experience.

In addition to work, the four Americans working at Kameda (Mr. Wocher, a physician resident, the director of medical education, and me) went out last night. We started off at a traditional Japanese barbecue. We had many kinds of meat and vegetables cooked on kabobs. We also had these fish that were soaked in a sweet, brown liquid and blackened. The whole fish was brought out, minus organs. The head was still attached. The meat on the fish bones was very tender and sweet. It was all excellent. We also had several beers (except for Terrence - the physician resident and designated driver) and drank several pitchers of sake. The sake was served cold and had a fruity flavor. It was less harsh than the warm sake I had at Sushi Popo in Iowa City. I hope to have some more before I leave.

After dinner we went to The Dolphin, the local karaoke place. I had never been to karaoke before, but I made a promise to myself to try everything I could in Japan. There is a section of the inch-thick karaoke book that has a list of songs with English lyrics. You pick the songs and write their corresponding number on a sheet of paper. The bartender comes around and picks up the papers and enters them into the computer. I ended up going third in our group. All told, I sang about half a dozen songs (i.e.. Paint it Black, an Ozzy song, Proud Mary, Piano Man, Hungry Like the Wolf). It was a lot of fun. It continued to be fun as my sake induced haze wore off.

It looks like we will be doing some deep sea fishing this weekend. This is one of Mr. Wocher's favorite activities. I am primarily interested in being on a boat in the ocean. It should be a fun time this weekend.

If you are not a Health Management student, this last section could probably be skipped. I want to let those folks know what I am working on for my internship...

Mr. Wocher has been showing me a couple of projects he is interested in having done. First of these projects is the development of an effective Internet strategy for Kameda. Though Kameda has a very advanced electronic medical record, they have very little service to their patients provided through the web. In addition, they are interested in using the Internet to market Kameda more effectively. They are currently ranked as the 9th best hospital in Japan and wish to take advantage of this ranking. I have already made some preliminary recommendations and will develop these further with Mr. Wocher and Dr. Swanson (an MD, MPH that I have been working with quite a bit). Basically, the Americans have been left in charge of the Internet strategy. Dr. Swanson and I are both leaving in August, so we want to get the staff (particularly the physicians) interested in developing this after we leave.

I have also been preparing for work on a project to reduce the number of Vancomycin resistant infections at Kameda. Japanese doctors almost always use antibiotics on patients, resulting in a lot of unnecessary and inappropriate use. The final project relates to LASIK eye procedures and whether they are worth doing at Kameda. LASIK has not been approved in Japan, but has been undergoing some pilot use. My role in that project will be to project utilization of the service. Once I get through the orientation period, I will be able to work on these projects more.

That's the story, in a nutshell.