Arya News - Japan`s Okinawa has a history of using medical workers called “ikaiho” to provide basic care, amid a shortage of doctors after after World War II. It was only in 2004 that a doctor was stationed on its remote Taketomi Island.
TAKETOMI, OKINAWA – Perhaps influenced by a certain TV drama, I found myself interested in meeting doctors who work on their own on remote islands. Such doctors, who live and work surrounded by nature, may also feel the pressure of having to maintain their clinics singlehandedly. One such physician, Dr. Reiko Sasao, 38, has moved around remote islands to provide medical care. I visited Taketomi Island in Okinawa Prefecture to interview her before her assignment on the island concluded at the end of July.
I flew to the prefecture’s Ishigaki Island, where I changed to a ferry and arrived at Taketomi Island. In the blazing sunshine, I walked for about 20 minutes on a road lined with houses with red-tiled roofs and finally came to the Taketomi Clinic, run by the town of Taketomi.
The island has about 300 residents and welcomes about 400,000 tourists annually. The clinic is the only medical facility on the island. When I visited, the clinic’s regular staff were Sasao, nurse Noriko Ikesue, 47, and medical clerk Yuki Tomori, 59. I asked Sasao and some patients for permission to observe how she examined them.
One morning, islander Shomatsu Une, 75, came to the clinic for an appointment.
“Is everything OK with you?” Sasao asked him.
“I feel numbness in my legs, which bothers me. I walk more than 10,000 steps every day. Maybe I walked too much because I’m feeling very good,” Une said.
Sasao interviewed him about the pain in detail and told him: “Maybe you’re walking too much. Walking is good for your health, so please continue without overdoing it. If the numbness grows severe, please let me know.”
Earlier in life, Une had moved away from Taketomi but returned to the island with his family 38 years ago. He served as a member of the local volunteer fire service for many years. He told me that people on the island have helped each other in lifesaving ways, such as by using their boats to transport patients who need to be transported to medical facilities off the island.
Okinawa Prefecture has a history of using medical workers called “ikaiho” to provide basic care amid a shortage of doctors for some time after World War II. It was only in 2004 that a doctor was stationed on Taketomi Island. Many older islanders still do not take it for granted that they can see a doctor on the island.
“We can keep living on the island without worries because there’s a doctor who listens to us carefully and gives us advice for our daily lives,” Une said.
The clinic receives visits by an average of about 10 patients every day.
“Is there anything that troubles you?” Sasao asked a 76-year-old woman who regularly comes to the clinic to treat chronic conditions, such as high blood pressure.
The Taketomi Clinic, run by local Taketomi authorities.
Sasao also quickly treated a tourist, a 31-year-old man who fell from a bicycle.
The clinic became quiet after a patient left. Many of the islanders work in tourism and do not come to the clinic in time for their appointments when they are busy. Accustomed to such situations, Sasao would read medical books and journals when she had spare time.
Knowing one’s limit
Sasao, who comes from Tokyo, graduated from a medical college in the capital in 2014. She started her career at a university hospital, and then she worked on Izu-Oshima Island, a remote island of Tokyo, for two years from 2018. She was not the only doctor at that clinic, but there she was fascinated by providing medical care, which ultimately supports people living on an island.
She returned to the university hospital during the COVID-19 pandemic. In 2021, she was appointed the leader of a COVID-19 ward at a Tokyo medical institution designated for infectious diseases. Those were stressful, nerve-racking days as she constantly had to worry about changes in patients’ conditions and give instructions even outside working hours.
She longed to work in regional medical care on a remote island and quit the university hospital in 2023. She was thoroughly exhausted from a job that made her so tense that she could not even sleep at night. She wished to have time for herself as well.
Subsequently, a Tokyo clinic providing house call services became Sasao’s base. She flew to remote islands as a part-time doctor or a substitute doctor. She also joined a research vessel as a ship’s doctor. She got the job on Taketomi Island after finding a job opportunity announcement for a limited time from March this year. Sasao switched places with another doctor at the end of July.
Dr. Sasao stands at the entrance of Taketomi Clinic.
Sasao examined patients carefully because she wanted them to regard the clinic as reliable even if it had just one primary care doctor. She would visit various shops and frequently take part in local events to live as part of the community.
While time passes slowly on the island, it was impossible for her to leave the island even over a weekend unless a substitute doctor came. She always carried the clinic’s cell phone outside the facility’s operating hours, too, in case someone called. It seemed that she must have been under huge pressure being the only doctor on the island, but she said, “I don’t feel I am working all alone.”
Since the clinic can provide only limited medical care, it is an important job for a doctor working in a remote area to decide on transferring high-risk patients to specialist doctors outside the island as quickly as possible.
At times, she discussed curious cases with doctors outside the island and received their opinions.
Knowing what one can or cannot do and deciding to ask for assistance are truly relevant to skills.
Game of life
Sasao told people on the island the importance of advance care planning, or thinking how they want to live and face their deaths and sharing the information with those around them while they are still fit.
When she spoke to them about the issue, she used the “Moshi Bana Game.” It is played with a set of cards inscribed with phrases describing various situations in medical emergencies, such as an acute illness. From cards bearing words such as, “Warm relations with people,” “Breathing is not difficult” and “Not burdensome for family,” participants choose the ones they find important.
The game aims to make people look at their own views on life and death and their philosophes on life and facilitate discussing them with those around them. About 20 people took part in a trial of the game in May.
On an island where medical resources are limited, it is possible that one may be forced to decide whether or not to leave the island to receive high-level medical services.
Among the island’s significant population of elderly people is Kyoko Hosohara, 76. She participated in the game’s trial event and became convinced that she finds happiness on the island and that she wants to pass away there, which she told her children living off the island among other people.
“Some people chose the card saying, ‘I have peace because God is with me,’ which showed me the values of the island, where people put importance on keeping sacred rituals,” Sasao said.
Helping each other
“There’s only one doctor, but I don’t feel lonely,” Sasao said. On the island, there are nurses and helpers who know the lives of islanders very well. There are also volunteer fire service members who accompany patients transported far away in emergencies. Regional medical services are maintained by a team.
The two other staff members at the clinic who worked with Sasao also came from outside the island. The islander population includes some who have moved to the island from elsewhere.