Rural elders give city med students advice
Village doctor gets local seniors to offer instruction in how to listen

Dr. Tetsuro Irohira and visiting medical students
listen to what Hide Saruya (left) says about her life
in the village of Minami-Aiki, Nagano Prefecture.


MINAMI-AIKI, Nagano Pref. (Kyodo) Each year some 150 medical and nursing students visit Dr. Tetsuro Irohira, 45, in this remote mountain village in Nagano Prefecture, hoping to learn more about becoming good practitioners.

Dr. Tetsuro Irohira and visiting medical students listen to what Hide Saruya (left) says about her life in the village of Minami-Aiki, Nagano Prefecture.

Irohira opened a clinic in Minami-Aiki seven years ago, when no doctors were based here, and has played a key role in the health of the 1,200 villagers, over 38 percent of whom are 65 or older.

The students look to Irohira to give them out-of-classroom lessons on being good doctors and nurses, but are surprised to find their real teachers are actually the elderly people in the village instead of the doctor himself.

"I want you to listen to what the elderly say about their lives, and realize how they have related to each other in this community, which you will never learn in medical school," he told six students who visited on their own in late March during spring break.

During the two-day stay, the students visited elderly residents to interview them about their past and relations with other villagers, and also learned how to cook local dishes and take up weaving.

Hide Saruya, 64, told the students about how she got used to village life after marrying into an old family, and expressed her expectations for the doctors-to-be.

"Dr. Irohira tries to understand what's behind the patients' diseases. I hope you will become such doctors, whom we can entrust to be present at our deathbeds," Saruya said.

In one of his lessons for the visiting students, Irohira explains how many of his patients in the village have knee pains caused by their longtime agricultural work. "You need to learn those things from daily conversations with them," he tells the students.

Irohira, who sometimes drives patients home from his clinic, said: "I consider it important to know the patients' family ties as well as their relations with neighbors.

"If a patient lives alone, I must know as a doctor who I should contact in case of emergency, and check which door I can use to get into the house after a possible emergency call."

Such daily efforts give patients much more satisfaction with their doctor, Irohira told the students, adding that medical practice in a rural community is similar, in a sense, to cultural anthropology research.

"By knowing the background of each patient, a doctor can treat them appropriately, including how they pass away. We cannot say there's only one correct answer in medical practice," he said.

Chizu Kurane, 85, another "instructor" for the visiting students, spent a day with them that included cooking, having lunch, weaving, walking and playing cards.

Kurane, who lives alone and has just started using a hearing aid, told them about her present and past life, including the years with her late husband -- who was a mayor of the village -- while walking and drinking tea.

Before visiting her, Irohira told them, "I expect you to be the kind of doctors who are able to listen to what an 80-year-old woman says about the days when she was 18."

Through the contacts with Saruya, Kurane and other villagers, the students came to realize the importance of listening to patients. Keiko Bono, 24, from Jikei University School of Medicine in Tokyo, said, "I have learned that a doctor might misdiagnose without understanding the life history of patients.

"I've found that Chizu-san (Ms. Kurane) is very active and charming. In the same way, I want to face patients by knowing their backgrounds," she said. "I want to be the kind of doctor who feels pleasure in meeting people."

The conversations with the elderly community will enable doctors to "translate medical terms into local dialects" so older patients can more easily understand their conditions, Irohira told the students.

"You're learning how to diagnose at medical school, but they don't teach you how to tell things to patients, although it's another important ability a doctor has to acquire," he said.

Takafumi Kawagoe, 28, who became a medical student at Hirosaki University in Aomori Prefecture after being an office worker for three years, said he has been further motivated by his visit to the village.

"The training session has made me realize the importance of having multiple views by studying various fields other than medicine," he said.

Megumi Sekizawa, a 21-year-old nursing student from Nagano Prefecture, said, "I've learned that we need to positively try to understand patients, rather than waiting for them at a hospital, if we want to establish a good relationship with them."

Born in Yokohama, Irohira held a wide variety of jobs, including a waiter at a cabaret and a bread factory worker, after dropping out of the University of Tokyo, but says he decided to become a doctor after a trip around the world prompted him to think he could be useful to people in rural areas.

After graduating from Kyoto University, he started his medical career in Nagano while being involved in support activities for foreign workers who were injured during construction work or got infected with HIV.

He said that even though only a few of the students to visit Minami-Aiki have actually become involved in medical care in rural areas, the visits are still useful "because the village shows the future aging society of this country."

Yuki Nakada, 22, from Jikei University, said before leaving the village, "I can now talk to patients at the university hospital by saying more than, 'How do you feel today?' I think I can definitely make use of what I've learned here after returning."

The Japan Times: April 1, 2005

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