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Emergency Medicine

Japan With Kids - Forums: Health Topics: Emergency Medicine
By Admin on Thursday, May 9, 2002 - 9:35 am:

Study finds few centers for late-night pediatric care

Wednesday, May 8, 2002
TOKYO ELess than 20% of 360 designated regions across Japan had medical facilities that can provide emergency pediatric care after midnight or on holidays as of April 2001, according to a Health, Labor and Welfare Ministry survey released Tuesday.

More than half of patients at such emergency care facilities are children, but the number of centers capable of providing sufficient care is very limited, the survey shows. (Kyodo News)


By catherine gough on Tuesday, August 6, 2002 - 11:26 pm:

Could anyone advise me which would be the best hospital for emergency care - we have just moved to Uehara and I have a 4 year old child.
100261.2731[at]compuserve.com


By Sherri Leibert on Wednesday, November 6, 2002 - 4:45 pm:

I would like to let everyone with kids know about THE BEST hospital (with an emergency department) for kids in Tokyo.
It is called the National Center for Child Health and Development in Setagaya-ku, Tokyo, Tel: 03-3416-0181, http://www.ncchd.go.jp/
near Seijo Gakuenmae Station on the Odakyu Line.

My 17-month-old daughter spent almost 3 months there as an inpatient for a rare blood-related immune disorder. I speak almost no Japanese but the doctors there trained in the US and spoke English quite well. The facilities are excellent and rival anything you will find in North America or Europe. There is no doubt, this is the place to take your child for medical treatment in the Tokyo area.

by Admin - Here is the full address as well as some pages in English:
2-10-1 Okura, Setagaya-ku, Tokyo 157-8535 (opened March 2002) http://www.ncchd.go.jp/English/English.htm
The name of this hospital in Japanese is: "Kokoritsu Seiiku Iryou Center"


By Lisa on Wednesday, November 10, 2004 - 10:26 am:

Hello everyone,

Last Sunday afternoon, I got a call from a foreign friend whose son cut his chin. Not a life-threatening emergency but she wanted doctor to look at it. As it was a holiday, she couldn't take him to her regular hospital with English-speaking doctors (Seibo). She doesn't speak Japanese so I spent the next 45 minutes on the phone with various clinics and hospitals and got the real "run around" -- the child needs a pediatrician, the child needs to see a surgeon, someone needs to speak Japanese, etc. Finally, Ikebukuro Hospital reluctantly "allowed" her to come, provided the mother could speak Japanese. She had her Japanese health insurance card and we felt the injury would speak for itself. Not so. Because my friend couldn't WRITE Japanese, the receptionist turned her and her son away.

My friend waited in tears for me to arrive by cab. We got past the receptionist only to find the doctor could speak English very well.

I made an emotional plea with the doctor to instruct his staff to please help foreigners out! He seemed quite disgusted that the whole thing happened and came out again to apologize before we left.

As a result of this, I have two questions.

1) Do you need to call ahead to the hospital to ensure the hospital will take you in an emergency? Can you just show up?
For foreigners who do not speak Japanese, it is SO easy for the "gatekeepers" to simply say go find another place.

2) Does anyone have recommendations for English-speaking facilities for EMERGENCY adult/pediatric care in Toshima or Shinjuku? (Otsuka hospital requires someone to speak Japanese; Seibo doesn't have a pediatrician on at nights or Sunday afternoons.)

Thanks for your help.


By Scott Hancock on Wednesday, November 10, 2004 - 2:12 pm:

Lisa-
Sorry to hear about your friend's difficulty. Sorry to say, it isn't too surprising. The ways of Japan medical system are varied.

One alternative in such situation is to call an ambulance. Sounds extreme, but one thing that seems consistent is that the ambulance people are quite used to coming for seemingly trivial things. It's actually abused by the general public, but if that's what you need to do to get care, then so be it. Not that they will speak English, but they will find an emergency room to treat the problem. Also, it's within the National System and doesn't cost.

At the other end of the cost spectrum is Tokyo Medical Surgical Clinic. http://www.tmsc.jp/
They do not take national health, and they are expensive. But, they speak English and are available 24 hours (but gets even more expensive off-hours).

I don't get why a cut chin would need a pediatrician, but there you go with the mysterious ways.

To answer your question about gatekeepers - yes. They can. Otherwise, you'd call them "welcomers". Hopefully, someone else in that area can come up with a better answer.


By Cornelia on Wednesday, November 10, 2004 - 3:24 pm:

As best I understand it, the system is a network of carefully allocated limited resources. And yes, Scott is 100% correct that to get the best outcome one goes by fire department ambulance. Some hospitals have their own ambulances as well. But you want the fire station ambulance because that is the one with the paramedics (who do not have treatment powers anywhere near as advanced as in the USA or Canada) with full access to the emergency care hospital selection flow plan. There are a limited number of designated extreme trauma units for Tokyo (called: "Advanced Unit of Emergency and Critical Care Medicine (CCM)). A cut chin would not warrant entry into any of them unless perhaps they were having a really slow day. But one of them is the Nihon-i-dai hospital in Sendagi across from Nezu Jinja (look under the section on Hospitals).

Another way to go is to have a relationship with your child's pediatrician that includes her/his home phone number (or mobile number). My daughter had an allergic reaction on a Sunday which consisted of whole body extreme itchiness. We called her pediatrician who called the hospital where she works (and where we see her) and paved the way for our visit on foot 10 minutes later for a simple consulatation and a strong antihistimine injection. So we were not turned away _because_ we have a relationship there. (I most definitely do not read or write Japanese and can communicate in only the most rudimentary fashion!)


By Lisa on Thursday, November 11, 2004 - 10:54 pm:

Thank you Scott and Cornelia for your replies. The whole event has made me realize how vulnerable we are as foreigners here in Japan when it comes to the medical system. And the need to have a plan, especially with children, in case of an emergency.

A good Japanese friend in my area told me Joshi Idai (Tokyo Women's Medical College) in Shinjuku will take patients without a prior phone call. I'm not sure about their level of English, but I'm going to advise my friend to take her emergencies there from now on!


By Scott Hancock on Thursday, November 11, 2004 - 11:43 pm:

Lisa-
Just be clear about what you are depending on there.

I had an experience there where a colleague was taken there with pneumonia on a Sunday night. They confirmed he needed to be admitted - but not there. Since they had no bed for him, he laid in the lobby for a few hours until I got there to have him moved to another hospital I had to find.

So, I have a somewhat negative feeling about Joshi Idai. And it does have a high reputation. My experience just shows there is little you can depend on being consistent.

Probably not unique to Japan. FWIW


By Jack Bayles on Friday, November 12, 2004 - 5:26 am:

I have never gone to a hospital or dental school and not found a caregiver that spoke enough English to get through the problem. I live in the countryside. I think the city would be the same or better. I know for a new arrival it feels like they are in a sea of non-communication.


By Sherri Leibert on Friday, November 12, 2004 - 7:02 am:

Please see my message above about the NCCHD (only for kids though). They have THE best care for children, emergency or otherwise.

We had a terrible experience at Joshi Idai in Shinjuku (my daughter was there for about 4 weeks). I would not recommend it unless you had no where else to go. It is filthy dirty and badly equipped -- like getting treatment in a Victorian hospital that hasn't been cleaned since Queen Vic died.

Having said that though, the doctors were competent and did speak English--so emergencies only, then get yourself out of there as soon as you can! My daughter had to stay as long as she did because she was too sick to be moved.


By Lisa on Friday, November 12, 2004 - 8:32 am:

Thank you again for your replies. I am stunned, Scott, that you had to find another hospital for your friend as he lay in the lobby at Joshi Idai. I just can't comprehend how medical staff can turn sick people away. Or at least help to find another hospital. I'm curious where your friend landed up -- St. Luke's?

Jack, I used to live in Ibaraki, and it's true, as long as you had a health insurance card with Japanese on it, staff didn't turn you away. (I still had some horrible medical experiences.) My good Japanese friend said that people in the countryside in Japan are very different from people in Tokyo (helpful, friendly vs. cold, self-centered). I think this is true with the medical system, too.

Sherri, how nice to bump into you here. I remember what you said about the Children's Hospital in Setagaya and it's true, the time I've been to Joshi Idai I couldn't believe how cramped and yucky the conditions were there. However, I agree that the doctors were very competent and wonderful with my wriggling 2-year-old son.

OK, Joshi Idai for minor emergencies. NCCHD for bigger ones.

Back to my friend, she told me her husband once was taken by ambulance to St. Luke's and needed to be admitted. Because he was brought by ambulance, his first two nights were free at St. Luke's. Has anyone heard this before? It was new to me.


By Victoria Morehouse on Friday, November 12, 2004 - 9:40 am:

I'd like to re-emphasize Sherri's comment about NCCHD. It really is the best hospital for emergencies. The 24hour emergency room is fully functioning at all hours.... not the typical after hour skeleton staff like in many hospitals. They will immediately evaluate each child as they come in. Even for simple colds, if your child has a fever over 40degrees, a doctor will see you almost immediately. Not only do most of the doctors speak English, they also have English versions of most of the forms. The nurses are very kind as well. Didn't even bat an eyelash when my son vomitted all over her uniform.

I don't recommend going to NCCHD for regular doctor's visits as the hospital is meant to treat children from all over Japan with serious illnesses. The wait can be terribly long, not to mention saddening to see so many sick children.

Also, this hospital is good for high risk pregnancies or complications with either the mother or child. They are one of the few hospitals in Japan which routinely offer epidurals, however, they generally don't have room for people with normal pregnancies.

http://www.ncchd.go.jp/English/English.htm


By Admin on Friday, November 12, 2004 - 11:28 am:

Joshi Idai has been further remarked upon at:
Hospitals With Pediatric Wards http://www.tokyowithkids.com/discussions/messages/35/755.html
Do read this!


By Kit on Friday, November 12, 2004 - 12:28 pm:

I've been following this thread with a lot of interest. I wanted to suggest that it's very helpful to have emergency numbers stored near your phone, along with a list of basic Japanese vocabulary words for likely childhood accidents (cuts, sprains or breaks, high fever, lack of breath, etc.) which you can cull from The Japan Healthbook published by
Kodansha International. I've lived here for a great long time, and I know that when your child or loved one is experiencing an emergency, even perfect ployglots can't always think straight.

Here's the phone number for the Fire Department Ambulance: 119
(Just different enough from US and England emergency numbers as to be confusing in a panic situation...) If you are uncomfortable with letting the firefighters dictate the hospital you will go to -- and they will; you cannot choose -- and if you are able to take the patient to a hospital yourself, here's an option for Tokyoites:

Call the Tokyo Medical Center: 03-5285-8181 English-speaking operators are on duty from 9 am to 8 pm every day. They can check to see which "toban" hospitals (the ones on duty at that time) are closest to you, and you can then choose. At the very least, it is wise to know the locations of the biggest hospitals in your area, the Japanese name for them (taxi drivers are clueless about "St. Luke's", for example -- they know it as Seiroka Byoin) and how to pronounce it. It's a godsend, as Cornelia mentioned, to establish a relationship with a doctor connected to one of these hospitals.

Though it seems a strange way to go about things, I've heard that if you've taken your child into a hospital previously (on a legitimate complaint, of course), you already will have filled out the basic entrance paperwork and have a patient I.D. card. This may influence admittance. Doctors I spoke to about this were understandably reluctant to verify, but they didn't deny it either. The idea is to "prep" the "gatekeeper" so you can get on to the more receptive doctors quickly. Having said this, I think you have to update your "key" at least annually, but I'm not certain on that point. Anyone out there with details/ experience?


By Tara on Friday, November 12, 2004 - 12:55 pm:

> "If you are uncomfortable with letting the firefighters dictate the hospital you will go to--and they will; you cannot choose" <

Just a clarification--
This is not true. You can indicate which hospital you would like to go to, assuming (i) it accepts persons brought by ambulance and (ii) it is in the designated range of the ambulance squad involved. In my immediate area the designated hospital is a disaster waiting to happen. We know to specifically request one which is a 10-min drive inthe other direction.

Tara


By Scott Hancock on Friday, November 12, 2004 - 12:58 pm:

Lisa-
My friend was being "cared for" in the lobby - he wasn't totally abandoned. But, they didn't have a way to find him another room for some reason. I think it was because he was a visitor and not part of 'their system'.

I ended up finding a bed for him at Kokusai Inryou Center (mentioned in positive detail elsewhere here). The were competent, but no English. I ended up being the interpreter for this person's intake interview!

I figured we were in a good place when, after I pushed for "the most expensive room", we got a huge one that they said Diet members use. On the other hand, because it was 10PM, there was not a crumb of food available. Had to go outside and bring it in.
Every expereience is different!


By Lisa on Friday, November 12, 2004 - 5:04 pm:

Again, thanks to everyone for their responses.

Kit, I agree that it's difficult to think straight when someone you love is hurt. When my son dislocated his elbow, I couldn't get anything out in Japanese! Thankfully a lovely Japanese friend went with us to the seikotsu-in clinic. A list of handy translations and phone numbers beside the phone is an excellent idea.

Scott, I'm glad to hear your friend the visitor did receive medical attention. No food at 10PM at the hospital doesn't surprise me -- good thing there's a convenience store every 200m!


By Bethan Hutton on Friday, November 12, 2004 - 6:14 pm:

My two cents on emergency medicine:
We once had to take our son, then aged about 3, to a doctor late at night at a weekend when he had a very high temperature and was screaming in pain. We called ahead to Juntendo Hospital in Ochanomizu (a big general hospital with a good reputation), went by taxi, and were seen almost immediately by two doctors. It turned out to be just a bad ear infection, so they just dispensed fever/pain relief medication and antibiotics on the spot and that was all fine. There was quite a bit of paperwork as we hadn't used the hospital before.

In my case a couple of times I had to see a gynecologist in a serious hurry, and both times called ahead to St Lukes (where I was already registered from previous treatment a couple of years earlier) and was seen immediately I arrived. Both times were weekdays but outside normal clinic hours. I think it does help if you are already registered somewhere, and even more if you know what doctor to ask for and they happen to be on duty, but I have heard of people not registered going to St Lukes in an emergency and getting good treatment. I have always had good experiences there, apart from occasional long waits if you turn up without an appointment in a non-emergency situation.


By Kit on Friday, November 12, 2004 - 11:25 pm:

Tara, consider yourself fortunate. The three fire ambulance stations I interviewed (and I am fluent in Japanese) stated specifically that you cannot request a hospital. Same answer from the Tokyo Medical Center, and from a friend of mine who is a firefighter in Setagaya-ku. But, as you can tell, there are vagaries to the system. I suppose that you should try to request, in any case. But to tell people that they may expect to be taken where they wish to go in a fire department ambulance is misleading. But try? Why not?


By Joy Grace Salcedo on Saturday, November 13, 2004 - 6:59 am:

Hi Kit, maybe I am considered as well as fortunate, when I requested for an ambulance and I could hardly speak Japanese but they ask me first which hospital do I want to go. There are about two or three hospitals near my place but still they ask me and brought me to the hospital I'd chosen and what surprises me, when I reached the hospital, they sent an English speaking volunteer from another fire department ambulance until my husband gets to me.


By Cornelia on Saturday, November 13, 2004 - 9:46 am:

Written policy and actual practice in general do vary. The written policy is there to back up any disagreement between fire department and service recipient. Especially in situations where resources are stretched to the limit (for example in a natural disaster situation, or even a very local disaster such as a 60 car pile-up on the highway). A lot depends on what is wrong with you. If you just got smashed up in a motorcycle accident they will take you to the closest available CCM unit. Chest pains place a very high priority on speed to initial treatment. The ambulance crew may assess the situation better than the patient (and then again they might not). There is a flow chart of decision making that influences the choice of hospital, but in general, the ambulance staff will wish to try to take your requests under consideration. (Rule of thumb, do not go out of your way to be annoying to them.)

I, coming from the USA, where you generally get a bill for your ambulance experience, didn't know that it was free here, and took a taxi to Tokyo University Emergency room. I was processed quickly, examined by a youngster with limited experience and told I could go home. I politely asked if I might wait until the pain subsided because I was not ready to walk yet, which was OK'd. Then the pain increased and I started dry retching, and the real examination finally started. Older more experienced specialists came in from other parts of the hospital, etc. (by now it was about 9 am so they were now arriving at work). Finally I got the one thing I needed most just to be able to think and to function, relief from the pain, around 10:30. Then a diagnosis and a follow-up appointment in their clinical division.

My overall conclusion. It was worth the trip to that hospital because there are more doctors on hand, especially once the day starts, so hopefully at least one of them will figure it out! They all had English under their belt in some form or another, even though most of them were reluctant to speak it. The support staff is even more reluctant, but I didn't have to deal with them at all when I went through the emergency room. I just handed someone my hoken card and things got done somehow. Finally, I got a diagnosis I could live with (until then the thought of "cancer" had crossed my mind).

I certainly got a better diagnosis then I did at my usual local provider a week earlier, a small hospital which is perfectly adequate for routine stuff (non-emergency) and I certainly will continue there because it is only 3 blocks from my house!

It's really hard to decide sometimes if something is an emergency or not. Given the high level of health care available in this country, I think when we are not sure, we should err on the side of caution and treat the situation on hand as an emergency. I was suspicious that my problem was not a severe emergency (as in "am I dying?"), but my thinking was muddled by things like "I've got a kid to raise." and "I've got to be able to work."


By Kit on Sunday, November 14, 2004 - 10:42 am:

The fire department is truly
amazing, and I am glad that
they honored your wishes, Joy
and Tara. My friend who works
for the department has said
that this has been a problem
in the past--big arguments
over where to go, I mean.
Regardless of what they may
wish to do--and I think that
they'd really like to respond
without question to your
emergency and hospital
choice--they are not always
able to do this. And to expect it
automatically is taking a risk. I
hope your experiences mark a
new trend; however, it's not
their "official" policy. Still, your
posts give us all hope that that
policy will change (or already
has at grassroots level).

When I fractured an ankle (six
years ago), I requested a
hospital nearby, but was taken
to one further away (and with
far less sophisticated
facilities) because it had less
emergency patients waiting.
In retrospect, I think this was a
good call on their part
because my injury was
relatively minor. But the
experience caused me to pay
attention to the system a bit
more carefully.


By Vincent Paul on Thursday, January 13, 2005 - 10:15 pm:

Having had in Japan severe asthmatic attacks, a bleeding gastric ulcer requiring 3 months hospitalization, a mediscus tear requiring surgery, and sundry other afflictions, I have never had much problem with hospitals here...

People who can't speak a language well can get along better by listening more... the few words your doctor or receptionist knows tend to be the right ones to get you attention if you stay calm.

Hopefully you will have only a general emergency. Once you have any treatment at a hospital, your details will be kept and you will usually be given a magnetic card.... your passport to quick admission. You want to take the time to fill out those papers and keep your card or cards in a safe place. With your Japanese Health insurance card, you will also pay surprisingly little for treatment. You can often pay less that 1000 yen for a visit. If it hasn't been mentioned yet, the government will reimburse you within the month for anything over 60,000 yen per month in any case. Use your head, and be ready for an emergency, and you're unlikely to ever be left out in the cold.


By Trupti Gandhi on Friday, January 14, 2005 - 10:09 am:

vincent,

this is a real nice post in this section after a long long time!! a real encouraging one for japanese illitrates like me!! thank you so much!!


By Bethan Hutton on Thursday, June 2, 2005 - 3:06 pm:

Article from the Asahi Shimbun - seems to confirm that emergency care for children is a problem here.

Shock finding in child mortality rate

06/01/2005
By RINTARO SAKURAI , The Asahi Shimbun

The mortality rate for Japanese children between the ages of 1 and 4 is the highest among 14 of the world's most developed countries, a health ministry survey shows.

While more children die in the United States each year, a significant ratio is due to factors other than disease, it said.

The findings prompted researchers to point the finger at Japan's emergency pediatric services.

Researchers wanted to compare mortality rates of the 20 nations with the highest gross domestic product (GDP), using mostly 1999 data.

However, China and South Korea were excluded because the World Health Organization lacks relevant data. Mexico, Brazil, Russia and India were also exempt due to delays in the spread of health-care systems.

Among the 14 developed nations, the survey found that the annual death rate of Japanese children aged 1 to 4 was 33 per 100,000. The figure is 30 percent higher than the average of the 13 other countries.

In terms of total child deaths in the age category, the United States ranked highest with 34.7 deaths per 100,000 children of the same age group. However, researchers said that was misleading because 2.44 children in every 100,000 children of the same age group in the United States died of factors other than disease.

When adjusted for such deaths-abuse and murder-Japan ranks highest for disease-related deaths, the study showed.

Sweden had the lowest death rate for children in this age group: 14.3 per 100,000. By disease, Japan outpaced the average in the 13 other nations for congenital abnormality, pneumonia, heart disease, influenza and septicemia.

The study also found that, in all other age groups, Japanese mortality rates were lower than the 13-nation average. Among people of all ages in Japan, 783 per 100,000 die annually-15 percent lower than the 13-nation average.

Tetsuro Tanaka, director of the Department of Health Promotion and Research of the National Institute of Public Health, said the study may point to inadequate emergency medical services for children.

``Japan's emergency pediatric service might not be fully functioning,'' Tanaka said.

Researchers found that Japan's medical care system for newborns might have contributed to a lower mortality rate for infants. Mortality rates for newborns under 12 months old in Japan was 340 per 100,000, which is the second-lowest after Sweden.(IHT/Asahi: June 1,2005)


By Ellie Miller on Saturday, January 14, 2006 - 1:10 pm:

Hello,
I am hoping someone can please help me with this. I am travelling to Japan with my 6 year old for 3 weeks in April. She has a life threatening allergy (anaphylaxis) to peanuts. I am a nurse and will be carrying emergency equipment, but if the worst happens, I will need an ambulance and hospital.
(I am hypervigilant about avaioding peanuts and will be carrying cards in Japanese to show food preparation staff etc. I will be on constant gaurd to ensure she has no exposure.)
Unfortunately, our travel insurance does not cover food allergy. ( am still trying to find one that does - no luck).
I need to know roughly how much cash to have on hand for an emergency.
As tourists, will we need to pay for an ambulance?
How do you pay for emergency care in Japan?
And, most importantly, please reassaure me we won't be turned away in an emergency due to lack of insurance. ( I can and will pay, but will I be believed? I speak some Japanese)
Any help very much appreciated.
Ellie


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