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.
By By KEIJI HIRANO
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