Palliative Care in the Land of the Rising Sun

Dr Richard Sloan, Medical Director of Weldmar Hospicecare Trust, discusses just one of the many countries he visited in 2009 during a six month sabbatical.

For six months last year, I was fortunate to have been granted leave from my day job to take a six month sabbatical. The aim was to have time out to refresh my mind, contemplate the meaning of life and work and to visit contacts I had made before in other countries. One such contact was Yugo Narita , a consultant neurologist, who I had met at a Motor Neurone Disease conference in Japan several years ago. That had been my first visit to the country and I found it fascinating. I vowed to visit again sometime in the future. Now was that chance.

Japan is a fascinating mixture of modern and deeply traditional. The densely populated cities are crammed into the sparse coastal plains, modern buildings and flyovers almost dwarfing the many ancient Buddist and Shinto shrines which are reminders of ancient Japanese culture. Everything is very ordered and polite. Coming back to the UK was a bit of a shock, especially the indifferent attitude of staff at the supermarket checkout.

The public Japanese health system is very comprehensive, paid for out of taxation like our own. Also like us, the government is grappling with spiralling health costs against a backdrop of recession with falling tax revenue. In hierarchical Japan, patients revere doctors and what they say goes. A bit like things used to be here in the “good old days”.

Yugo is in the forefront of Japanese doctors who recognise that this subservience on the part of patients can have a down side. Many patients with motor neurone disease are hitched up to a permanent ventilator when their breathing muscles become weak. Whilst this keeps them alive indefinitely, the rest of the body’s muscles continue to become paralysed. With the patient unable to communicate, patients are trapped in their own bodies and totally dependent on family members or carers.

Whilst some patients definitely do want to carry on surviving as long as possible, Yugo believes that many would not, were they given the choice. He and others are leading the drive to involve patients and families in the delicate discussions over life-prolonging interventions so that they can understand both the advantages and the disadvantages and make an informed choice for themselves. The principles of symptom control learnt through palliative care in the west are an alternative to ventilation in easing the distress of breathlessness.

I had the pleasure of visiting Yugo’s workplace, the University Hospital of Mie, about 4 hours south of Tokyo by bullet train (ie. 7 hours by British rail norms). He and his nursing colleagues are very keen on picking up on the skills we have learnt and encouraging the growing palliative care movement in Japan. The UK is seen by the rest of the world as having the most comprehensive palliative care system in the world. Like everywhere else, the grass always appears greener from a distance than it actually is and I had to explain that services in this country are still patchy and post-code dependant, especially for illnesses which aren’t cancer.

Experiencing work and life in another culture is fascinating and helps reflection on both the good and the not-so-good back home. Whilst there is much to be done to improve the lot of palliative care patients in the UK, there’s a lot we take for granted too. We can all learn from each other and I’m sure the links with Japan will continue.

Dr Richard Sloan, Medical Director, Weldmar Hospicecare Trust