Episode three, in which our heroes face many hardships

So we filed the paperwork for national health insurance on Tuesday and our insurance cards, including the supplemental children’s insurance cards, arrived like clockwork two days later. It’s good to be covered, but we hoped we wouldn’t have to use them anytime soon…

In retrospect, we should have guessed that someone would get sick fairly early into the trip. The trip itself was exhausting and we were of course all jet-lagged. And although everything was new and exciting, a break in familiar habits and diet can always have an impact on health. On my study abroad trips, I inevitably have a student or two get sick early on in the trip, though it’s rarely bad enough that we need to sick medical attention. So let’s just say my skills at navigating the Japanese health care system are a bit rusty. And it really does take a good bit of familiarity with the system in order to make things work the way they are supposed to.

First, because of the national health insurance, people go to the hospital for almost everything, including the common cold. You can buy some drugs at the drug store without a prescription, but they are pretty minimal and they cost a lot more since they aren’t supplemented by insurance. So of course people go get checked out at the hospital for even small illnesses and if by some chance it’s something more serious, well, it’s a good thing they got checked out. This is a feature, not a bug, of the system. Of course, we self-medicating Americans aren’t used to this, so when Jocelyn had a fever on Friday morning, she just took some of the ibuprofen we had brought with us and went back to bad. When the ibuprofen wore off and the next dose didn’t have any effect, I visited the drug store to see if I could buy some Tylenol, where the pharmacist on duty said they had some, but we should really go visit the hospital instead, just in case it was the flu or something. Silly pharmacist, thinking he knew best what kind of medical care we self-reliant Americans needed. Visit the hospital for a little fever? Ha! So instead we tried some of the acetaminophen-based cold medicine we’d brought with us, and that brought the fever down so that Jocelyn could sleep. Surely that’s all she needs…

That wasn’t all she needed. The fever kept coming back, along with a splitting headache, aches all over her body, some nausea during the night… finally we decided that going to the hospital might not be such a bad idea around midday on Saturday. Because we were without a car, we called our landlord and the son gave us a ride to the hospital. Of course by now it was outside regular consultation hours, so we had to go the emergency room, something we medical-bill-fearing Americans would usually avoid like the plague… unless we actually had the plague. It turns out Jocelyn did have the plague, or at least its modern equivalent: the flu. Influenza is pretty widespread in Japan right now, we learned, so it would really be a good idea to come in and get checked out as soon as possible when symptoms arise. And why the hell weren’t we all wearing masks?

On the streets and in the trains, you see a lot of people wearing surgical masks as a matter of course. Some of them are sick and don’t want to infect others. Some of them don’t want you to infect them. And some of them just find them terribly comfortable and think everyone will be wearing them in the future.

So the doctor gave us all masks (which Mikki flatly refused to wear, resulting in a protracted argument in the hospital parking lot) and prescribed Jocelyn drugs: five days of flu medicine and separate drugs to treat her fever, pain, and nausea. Total cost of visit and medication: around $35. Jocelyn would still be contagious for a few days, though, so we just hoped that none of us would catch it from her…

No such luck. Eli had a minor cough in the morning but no other symptoms, so we sent them off to school as usual. Then around midday I received a call from Eli’s teacher saying he was achy and running a fever. Damn! I told the teacher I’d be there in ten minutes to pick him up, grabbed the kid’s insurance cards, and hopped on the bicycle to go pick him up. At least the hospital where we had taken Jocelyn wasn’t far from the kids’ school, and I had just been there two days earlier so I knew the ropes. Finally something would be easy…

Once again, it seems that I had forgotten everything I once knew about navigating the Japanese health care system. Hospitals have set, rather limited hours for open consultation and the rest is set aside for appointments. By the time I picked Eli up and walked him on the bike to the hospital, those hours were over. Instead, they could recommend a nearby clinic. Japan has a lot of small clinics, each dedicated to a specific kind of medicine. So if you have an eye problem you head to the eye clinic, and if you have an illness you head to internal medicine. And, of course, they all take the national health insurance, so no worries. Except that each of them has different consultation hours that you need to know before you go or you could end up just missing them or waiting hours for them to open. I was happy to have a recommendation from the hospital…

It turned out to be a terrible recommendation. I described Eli’s problem and they decided an internal medicine clinic would be best for him. They even did a search on the computer for which ones in the area would be open at that time and made a copy of the directions and hours for me. How considerate! Except it turned out to be a surgical clinic. Luckily I noticed this and gave them a call first. It turns out they do have one internal medicine consultant on staff, but he doesn’t come in until 5pm. Okay. I went back to the consultants at the hospital and described the problem and they found another clinic for me though it was, they said apologetically, “a bit far away.” Still, better a far away clinic that was open than a nearby one that was closed, right? So we grabbed a cab and went there… where we were told that they didn’t treat children. I would need to go to a pediatric clinic. Of course I would! I’m sure I would have figured that out myself if I’d tried. But instead I just took the hospital’s recommendation, figuring they knew best. I was so frustrated, and Eli was completely exhausted and feverish and just wanted to rest while I kept dragging him around to different places. This was definitely the low point. The clinic gave me a list of other clinics in the area, including two pediatric clinics, but they warned me that most pediatric clinics don’t have consultation hours until late in the afternoon, after kids are out of school. Plus, since this clinic was “a bit far away” from where we lived so were all the other clinics they recommended. So instead we just grabbed another cab and went home, where I could let Eli rest and where I had the resources to look for another pediatric clinic closer to home.

Eli went to bed and I hopped on the computer to look for a pediatric clinic, finding one just a ten-minute walk away that also started seeing children at 3pm rather than 5pm like most of the others. Eli was asleep by this point and I would normally have just wanted to let him rest, but since Jocelyn had the flu I felt more urgency at getting him to be seen. Jocelyn had brought Mikki home from school by this point, so I went and got us a cab and all four of us headed to the clinic.

Finally THIS was the medical experience we’d been looking for. There was a separate section to sit for kids with fevers and we set Eli there while I checked him in and started taking his temperature. Since Jocelyn and Eli both had it, we decided to take Mikki’s temperature too, just in case… and we immediately moved her over to the “fever zone” as well. Both kids got tested for the flu and, although Mikki’s test was inconclusive, given the circumstances the doctor decided to prescribe her flu medication as well. The pharmacy was right across the street and we were able to pick up their medication in just a few minutes. And, as they had said at the city office, the kids’ visit was only $5 per child, including medicine! In the end the most expensive thing about the experience was the cab fare. And now we have a children’s clinic we trust just ten minutes away. The end of the day felt a lot better than the middle had.

It’s now five days later and the kids took the last dose of their medicine this morning. They are now officially flu-free and can head back to school on Monday, which is a good thing since we’re all going a bit stir crazy. I think we’re all tired of our lives being on hold, and we are eager to get on to a schedule. But for now it’s the weekend and we’re going to head out to do something fun. More later.

Episode two, in which the children become educated

So our plan was to give the kids a week to acclimate to Japan and get over jet lag and then start sending them to school on Monday of our second week. That was the plan…

After getting the paperwork all filled out on Tuesday, I gave their school a call mid-morning on Wednesday, figuring I’d try to come in and talk to the principal, get a list of things we need, etc. Well, the principal had other plans. He had apparently been informed that our paperwork was complete the previous day and had actually expected them to show up that morning. Since the school day had already started, he recommended that we come in the next day instead. No need to plan ahead, he said, just show up fifteen minutes early to discuss a few things and they can start the day. Wha? That’s it? I travelled 6,500 miles to get here and you want me to just throw my kids into Japanese school with no planning? Well, okay I guess.

So that’s pretty much what we did. The principal seemed to be taking this whole “weird foreign kids coming to our school” thing in stride, so I decided to do the same. We did take them in to buy the basics, which in this case meant the school gym clothes and yellow hats for walking to school, but other than that we decided to put things off until the next day.

What every fashion-forward Japanese elementary school student wears for gym class
Note the 東 symbol? That means “East” as in Suita East Elementary School. Yes, our kids once again attend school in East.

The next morning the four of us set out for their elementary school. Near the beginning of our walk, we saw a lot of kids wearing suspiciously familiar yellow hats gathering not far from our house, and figured that the kids in the neighborhood must gather there to walk to school as a group every morning. The walk took about twenty minutes and although it was near a fairly busy area it seemed very safe, with a pedestrian bridge at a strategic point to cross over both train tracks and a busy road. Once the kids get used to the route, I don’t see any problem with having them walk it with the group. When we arrived at the elementary school, we were escorted into the principal’s office, which looks like every other principal’s office in Japan and, according to J, in Taiwan as well. But the principal was very friendly, very welcoming, and very eager to help the kids start almost immediately. We met the kids’ teachers, learned about the systems for communicating with them via notebooks sent home with the kids, talked about a few things the kids would need… and off they went to class. Just like that. They just walked off and joined their classes. It felt very surreal, but I liked the fact that the school staff were treating it so matter-of-factly. It helped me put aside my doubts and just accept that this was just a part of the experience. Of course they just went off and joined the class. That’s what they were supposed to do.

Jocelyn has a good breakdown of their first day on her site, so I’ll just link to that here and move on to the rest of the week.

Long story short, the kids walked to school with the rest of the kids rather than with us the next day. Eli also wanted to walk home with the other kids instead of us, so we let him, but we went to pick Mikki up. Both of them were also taking the whole thing in stride, and we didn’t get much from them about what went on all day except the same old brief responses we get back in the US. Eli made friends almost immediately and even went out to play with a kid from the neighborhood after school the second day. Mikki was a bit less outgoing than we are used to her being in a more familiar environment, but I think she’ll open up soon too. The exposure to a completely foreign environment has also spurred the kids to a renewed interest in learning Japanese, and we have them both working on hiragana practice in lieu of the actual homework. All in all, the first three days went extremely well, and I’m sure the next few days would have gone well too if not for, well… that’s a story for another blog post.

Coming soon: Episode three, in which our heroes face many hardships

In Japan - Episode one, in which many forms are filled out

It’s been over a week since we arrived in Japan, and it has been extremely eventful. So eventful, in fact, that I have had no time to blog about any of it. But rather than a giant all-encompassing “getting used to Japan” entry, I think I’m going to try to keep each entry focused on a single topic, even if that means writing several in a row. If nothing else, that might help me keep my thoughts straight as I try to explain what we’re going through.

As the title of this post suggests, I’ve had to fill out a lot of forms. I suppose it shouldn’t have come as a surprise that there is a lot of paperwork involved in getting a family of four settled in Japan for six months but, as I’ve said before, I’m not doing this Japan trip in the way I’m normally accustomed. When I bring students here on six-week study abroad trips, our stay is short enough that we don’t even need to apply for a visa in advance. For stays of less than ninety days, US citizens just show up in the airport to get their passports stamped. We have travelers insurance in case of any serious injuries, but for minor issues we would simply go to a clinic and pay out of pocket (much cheaper than going without insurance in the US, of course). In fact, we’re completely independent, not even affiliated with a Japanese university, which is what gives us the freedom to move from Tokyo to Osaka halfway through the trip… and to avoid a lot of paperwork. Not so this time, of course. We will be here a full six months, the kids will be in school, we will need to be insured, and I will be paid to teach a class, all of which requires lots and lots of forms to be filled out.

It may come as a surprise given the external image of Japan as a futuristic high tech society, but there is quite a bit that is still done in a very primitive way. It’s still largely a cash-based society, with many stores not accepting credit cards. It’s hard to get a handle on what’s going on without circulated flyers and word-of-mouth. And there is a lot of filling out paperwork by hand. This goes beyond just being unable to download forms or register for things online. It extends to actually requiring people to fill out a form three times the exact same way rather than simply doing it once and photocopying it. There was a moment at the airport when all our visa information was in their system and they were able to print out our foreign resident cards with all the information right at the immigration window. This process used to require several weeks after arrival, and I was very impressed at just how far Japan had come! But, of course, that card did not include our address in Japan so I still had to go to the city office to register... and find that they are still following the practice of writing the address in by hand on the back of the card. So much for high-tech efficiency.

High-tech efficiency	Not so much

At the city office, I was fortunate to have a native Japanese speaker, our landlord’s son, with me. I could probably have gotten by on my own but it would have been a lot more difficult, not just because of the language but because he was used to the process. Their family regularly houses foreign exchange students coming to study in Japan, so they know what paperwork has to be filled out, where it has to be filed, etc. and that advance information was priceless. On our arrival, they already had quite a few forms ready for me, highlighted where I needed to fill things out. These included several forms I had anticipated but also quite a few I wouldn’t have had any idea I needed until I got to the city office, including three separate forms to show that I am neither required nor eligible to participate in the national pension plan. One thing that my landlord’s son is not used to dealing with is paperwork for children, and there were a few things that he was learning at the same time I was. All you can really do in these situations is just go to where they tell you and fill in the forms they tell you without fully understanding what the point is until you’re done. At one point, we were sent to a window to fill out some forms for the kids, and I was handed an information sheet listing various ages and monthly amounts: ¥10,000 (about $100) per child per month. I decided I would just pay the fee and move on, but resolved to read the paperwork a bit more carefully afterwards to see just exactly what I was paying for. But in the course of the explanation, I realized I wasn’t going to be paying that amount, but receiving it! Apparently during the three-year window from 2009-2012 when the DPJ was in control of the Japanese government, they were able to institute a number of progressive policies, including the “kodomo teate” law that provides subsidies for “child rearing.” The subsidy is assessed monthly, but paid out every four months, which means that just before we return to the US in June, we’ll get a $800 present from the Japanese government for the support we provided our two kids for the previous four months.

Also at that window, I filled out paperwork for an extra insurance card for the kids, which confused me because I had already filled out the forms to get the whole family on the national health insurance. It turns out that kids get an extra insurance card, and if you show it at a hospital visit, the kids’ care costs only ¥500 (about $5) per visit. National health insurance is already pretty good, with the patient paying only 20% of the costs, but like the “kodomo teate” subsidy, this is another way that the Japanese government is encouraging proper care of children. I swear if everyone in the US got to actually experience the “socialism” they’re so afraid of they’d realize just how broken the US system is.

So lots of paperwork but an extremely successful day. Only two days into our trip and I’d registered us all at our current address, got us health insurance, exempted me from the national pension, got the kids registered for both subsidies and insurance, and filed the paperwork to allow the kids to attend public school. The plan was to give the kids a week off to recover from jet lag and then start sending the kids to school the following Monday… but that’s a story for another blog post.

Coming soon: Episode two, in which the children become educated