Hospital Special from the Tiger's Gate.

As my Ox Hammer is particularly fond of me, god knows why, she likes to use our trips to Japan to have my health checked. She claims that it is best to have the Japanese system do the job because, not to put too fine a point on it, she wouldn't trust an English doctor with a garden snail. She would also rather fly to Japan than enter what she considers to be the unclean territory of an English hospital. As regular readers will know, I have become a big fan of Japanese hospitals and now consider myself a "yellow belt" expert in their administrative systems.

As you will appreciate, the process and administration of a Japanese hospital is not something the tourist is invited to enter and photograph. However, in the interests of science and with a concern to advance the medical profession in the U.K., I was rude enough to obtain some covert snaps which I will share with you now.

Cost is always a factor in health care provision and one of the big costs in the NHS is collecting money it is owed for treatment. This may surprise you all when you believe that the NHS is a free state provision, however, there are procedures and circumstances which need to be paid for, not least our trade in hospital tourism. In Japan the system is a very, very simple one; you pay 30% of the cost. If you are sensible you insure that risk, if you don't want to do that then you rely on family savings. Of course there is social security to cover those in desperate need (I have had to shut the door and type those words "social security" very quietly because HMiL doesn't like them being used in the house) but the exact extent of its provision I am unsure of.

Two things I do know is that I actually like the idea of paying 30% of your medical bill. It seems to me to be a very sensible organisational posture, after all, when things are free people tend to use them liberally but when they have to put their hand in their pocket they tend to be more circumspect and that can only be a good thing. I believe it a very workable position because the charges are very low by comparison to the UK (by that I mean the amount of money the NHS is charged by doctors, drugs companies etc., for their services and goods.) I mean, at the moment a doctor in the UK wont get out of bed for less than the money it costs to fill the Bentley with petrol.

The other thing I know is that as a foreigner using a Japanese hospital I get to pay 100% and there is no negotiation or possibility of claiming a family tie. I am a foreigner therefore I pay full whack, don't like it, then go somewhere else. I also think that is reasonable and ever the more so because the costs are so reasonable. In England, when I want any private treatment, I need to see my financial adviser about a new mortgage on the house before I get anywhere near a doctor. In Japan I walk straight through the front door confident that the service will be great, the administration an example to be lovingly observed and the treatment is first class.

The Torranoman Hospital in Tokyo

The cause of my visit to the hospital was a concern over a couple of lumps which have appeared in my body. As a man of 55 you can start to imagine all sorts of stuff when odd formations appear but generally I am not that concerned as I was pretty certain that these were just "fatty tissue". Nothing to get excited about. But when you add into the mix that my father died in his mid sixties from aggressive lympoma then there are some grounds for a general level of concern. As far as the Ox Hammer was concerned it was a medical emergency.

My visit to my GP ended briefly with him saying "I am not concerned about this at all.". Rather than provide any explanation of the possible condition he decided to then investigate whether I had been actively searching for "lumps". This particular tack was so insulting to me that I just left. I had woken up that morning and, as you do, scratched my chest with an accompanying yawn and found a lump that I hadn't known was there before. So I slipped down to the GP Surgery to get it checked out. What I got was a rather arrogant man with a dismissive attitude suggesting that I might be a hypochondriac . Not a single question about why I might have a concern or an inquiry about family history, no discernible concern for the patient.

Ox Hammer's verdict: "I will get you checked by proper doctors when we are in Japan."

So at 08.45 a.m. (regular readers will remember that on entering a hospital in Japan I make detailed notes) we entered the lobby as shown above. This is the reception area and differs from the English hospital experience immediately. As you can see above there are a range of counters in the entrance but these are just the inquiry desks. The reception itself is around the corner to the immediate left of this image. There I counted 7 reception staff at the counter dealing with people as they come in. Maximum waiting time about 6 minutes if there is a queue. They take details, provide relevant form, co-ordinate a file which is colour coded and filled with the information before being passed to one of the fifteen staff sitting behind the counter working on computer terminals.

As I stood at the counter observing the process I noticed one key point, nobody appeared to be having a private conversation. Everyone was working away at the task in hand. Within 9 minutes of my un-announced arrival at the hospital I was on my way to see a doctor and before I left reception my notes were slipped into the transport system and were sent to that department.

I don't want to go on too much about the process here because I have written about it before, suffice it to say, within two hours I had seen a doctor and had two medical procedures including an ultrasound scan. The doctor had pronounced all to be ok but only after he had explained in detail what the situation was. He then also said that I should be referred to another department just to make sure all was ok.

We returned to the reception, a further appointment was made and we then proceeded to leave. Now, for my medical friends who I know have a keen interest in these stories, now we get to the crux of this tale from Tokyo. before you leave you pay for your treatment. Once again the photos here are blurry and shot on the sly but I did want to show you a level of organisation which is just the finest example of sensible management I can think of.

As you can see in the image above there is a "Fees" counter which is in the entrance/exit lobby. My visual calculation was that there were about 1500 people receiving walk in services that morning (150 doctors on duty and 10 people in each queue). As you can see in the image above there were three people at the counter but if you peer you will see the heads and screens behind them. Obviously I made the head count and there were twelve desks with computer terminals and ten of them were manned. As the counter staff take the record provided by the reception as you leave or book further treatment, they then provide you with a ticket number and pass the record back for processing at one of the desks.

You then walk across the lobby to where a row of ten machines await to take your payment. A big screen has the ticket numbers flashing when the account is ready to be paid. We waited less than two minutes before our number flashed on the screen and we walked forward to the machine where the Ox Hammer presented the hospital card issued in my name.

This slips into the machine and up on the screen comes the details of the treatment and a breakdown of the cost.

Then all you have to do is select whether you want to pay cash or credit card. So there you have it, comprehensive attention to detail, superb customer service, friendly faces, genuine respect for the incoming patient, speed of service and an holistic prevention based approach all capped off with a management of the finances to ensure payment is swift. Imagine, in well under three hours from just walking in, hospital reception, two medical procedures, doctor meeting, book further investigation and payment made into hospital bank account. Well just like any English hospital I suppose, except for a few points, ahem!

And the cost, well it was 7000 yen, about £49 and that was the 100% rate.

Finally, the point I love to make across the blog is about Japanese customer service. I am back here again and in every interaction I have as a customer I am left open mouthed at some of the small instances of care and concern. here, as I have said before, the customer is king, back in the UK the customer is just the cattle herd of the consumer slaughter yard, where the merciless stripping to the bone of the customer is managed for the sake of the shareholder.

Happy New Year: Next up, the trip to the Fox Temple ( a real treat for the true follower of this blog).

Me and My Ox Hammer

I love wandering around Tokyo with my Ox Hammer (see above) and do try to speak as much Japanese as my fluency level permits. Of course my cockney accent is a bonus as it helps with with some of the technicalities of this relatively easy language to pick up. True, the fact it uses three different sets of characters, Hiragana, Katakana and Kanji, rather than one simple alphabet does provide a bit of a challenge but for a seasoned man of culture like myself this presents no obvious challenge.

A seasoned man of culture in Mushashi Koyama

Take for example the word for wife, 奥さん ; okusan, which when used with the more formal ending sama produces the appropriate word oxhammer with cockney pronunciation. I often wonder if this word is the finest example of the subtlety of Japanese humour or actually a statement of their literalism! There are other ways of saying "wife" such as 妻 ; tsuma but I have a preference for 山の悪魔 ; yama no kami, which refers to the fact that your wife will grow horns if you make her angry!

The Hat that Keeps the Horns In

The hat of the traditional wedding dress of Japan also makes a cautionary point of naming itself appropriately. Japanese language is for me, a wonderful journey of discovery. What it is I am actually discovering though is anyone's guess!

Poster on the wall

For example, this poster on the wall in the tube (metro) caught my eye today. The graphic style is just so Japanese and carries a really charming naive quality but tells it like it is. If you see a little green man jump onto the track and turn orange with bubbles coming out of his head as he lays before an oncoming train then scream and press the emergency button. One could wonder why it is we don't have such buttons every three meters (like they do in Tokyo) on the London Underground. Such an obvious and useful aid to civilised life, you would have thought, would be an essential of station safety furniture. No doubt there is a good reason for their absence!

Boris to ban yobs on grounds of intellectual copyright

Next up from Tokyo will be a journey around the Fox Shrine and some more hospital adventures with dramatic photographic evidence. Wishing you all a Happy Christmas. J & A

Japan, Nagano and Honourable Mother in Law

Compensation is a very strange idea when you get to think about it. Essentially it is about an idea of one thing which gets replaced by something else and thereby satisfies a sense of loss. For example, my house burns down and the whole of my extensive collection of 20th century antique toothpicks, some hardly used, are destroyed. After a certain amount of strife and argument with the insurance company, who fail to understand the value to history of my collection, I am given a lump of cash, not a big lump, more of a bump actually, but it is my compensation for my loss. The toothpicks were my idea of an important historic collection and they were replaced by an electronic transfer to my bank account and thereby one idea is replaced by something else and I am compensated. Hmmmm.

We have just returned from the very, very best ryokan onsen  I know of. Yep, I have provided a link there but it is only to distract the unworthy. In order to get to this ryokan, just north of Nagano, you can go by train, a very good choice, or you can drive from Tokyo. I have the privilege and honour of being able to drive Honourable Mother in Law (HMiL) and on this occasion was fortunate enough to be joined by her brother, Honourable Uncle in Law (HUiL). This addition to the entourage was very welcome for two reasons, firstly that I was driving his car rather than hiring one and secondly because he served as a distraction for HMiL. This latter point is actually crucial.

You see, my wonderful wife, for all her superb qualities, couldn't navigate her way out of a paper bag. HMiL also has a certain difficulty with geographic location. My wife has a habit of lacking to plan ahead when she sits in the passenger seat and directs as an acre of map is tussled with. What this means in practice is that I can arrive in the right hand lane at a set of traffic lights, the first car on the grid so to speak, and as we are sitting waiting for the lights to change she will say, "We need to turn left here.". I have sort of got used to this over the years and so don't even bother to stress when faced with such dilemmas. Well that is not always true because my wife has one other problem, when she says left she can actually mean right and vice versa. She does tend to confuse these two complex philosophical notions.

I put this down to the fact that being Japanese she has no real concept of left such as "left field" or "left wing" or, in the case of food, "left overs". Japanese people really tend to like things that are right, both in fact and in nature. Everything else to them is really wrong and that just wont do, so when my wife says left she probably means right, but not always. Consequently, driving in rush hour Tokyo can prove somewhat challenging.

The challenge is enhanced when HMil is in the car as well. As mother and daughter the pair of them disagree as a matter of course. The reason for this disagreement is that in reality it is only the ability to conflict which separates them from each other, any worthy study of character and behaviour may well conclude that they are the same person disconnected by some weird temporal flux. Obviously they disagree in Japanese, they disagree with rising voices and they can even start to get really snappy with each other. Honourable wife will tell me to turn right when she means left, HMiL will disagree and say I need to turn left when she means right and the map will be waving around across the windscreen as lorries and buses are thundering either side of me down a three carriageway road.

Sometimes I find this a bit stressful. But there are compensations!

The picture above shows you exactly where I was at 09.30 this morning. High up in the mountains north of Nagano, in an old a venerable ryokan, a Japanese style hotel, and sitting in one of the outside onsen baths, a stone lined pool of volcanic hot water filled with minerals which soften the skin and mellow the soul. I am going to guide you around this little piece of heaven and tell you all about it from my own perspective. If ever you are in Japan, if you are a traveller who seeks culture rather than familiarity, then this is one of humanity's special places and a visit is strongly advised.

Understanding Japan and Japanese people is in itself an art form for us from our grubby western "civilisations". Remember what Gandhi said when asked what he thought about western civilisation. He responded that he thought it would be a good idea.  The picture you see above is the starting point for breakfast in the Sekiya Ryokan, a study of this picture (you can click on it to enlarge) will reveal a standard of presentation which is crafted from within a deep love of food. The chef at this Ryokan supplemented his Japanese cuisine by also training in Italy and so the table at this heavenly palace has the most subtle undertones of a European style but only as a brush stroke of mastery rather than a palette.

Perhaps we need to look at our own standard offering, the Full English, as a comparison to begin to understand where it is we are slacking somewhat!

You can of course also click on this picture to enlarge it but I would suggest that it is probably best not to. These two images begin to demonstrate the gulf in not only our understanding of food but our appreciation of it and before any of you food lovely middle class neo gourmets start tossing off a few radishes in my direction I have a culinary tip for you: get stuffed. Maybe the Full English as shown is the lowest common denominator and there are Japanese equivalents of junk food but the point is that food in England is a business, at all levels, whereas in Japan it is a cultural obsession. That is something an English foodie wouldn't understand unless they read it in an article in a quality newspaper's lifestyle magazine right next to the adverts for very expensive restaurants. No, in Japan food ranks equally with Buddhism,  Shintoism and money as being an essential element of a healthy cultural life.

The cultural experience of Japan is what the Ryokan is all about, it is a traditional Japanese hotel wherein there is precious little accommodation, if any, for European standards. If such provision is made then it would usually cost a hefty premium and really underlines how stupid such people are that would search out the genuine Japanese experience and then ask for it to be adapted to their needs. The picture above is of the "cleaning stations" where you sit on your stool and thoroughly clean yourself before you enter the pool of volcanic hot spring water. There is something really strange about this practice when you come to it as a European. Bizarre if you are English and used to soaking in your own dirt and calling it a "bath". Personally I find this process of cleaning almost akin to spiritual cleansing. Sitting on that small stool, all the necessary soaps, shampoos, conditioners etc., at arms reach, hot water pumping out of the shower, do you know, getting really clean is just such a pleasure before you have the luxury of bathing.

 

This picture is of one of the indoor onsen pools. That water is beautifully hot and the minerals it brings forth from the earth as it bubbles up directly into the Ryokan makes the skin soft and warm. On the wall you will find a notice advising that it is very dangerous to enter the onsen if drunk. The problem here is that if you spend more than fifteen minutes in the water you can actually start to loose consciousness. The rest I can leave for you to work out. There is something in the onsen experience which is deeply spiritual, it is a moment of calm in the rush of life, and this point being understood then it is natural for the Japanese to ensure detail in the experience:

One of the two outside terrace onsen pools at  Sekiya Ryokan and is that not just a picture of delight.

The above picture is of the tub, one of my favourites, as it looks out over the mountain side. Laying back in this really does make you think that it is possible to feel at one with the world and leave all the little troubles of life behind.

But should you feel the need for a more completely private moment then you can always slip into your own private onsen bath set just against the verandah of your room. Now really, isn't that just a peach?

And, of course, the rooms in the Ryokan are rich in the simplicity, an oxymoron I know but when you experience it you will know what I mean, of the traditional Japanese architecture. Here, Honourable Uncle in Law, Jiro-san, takes a cup of green tea as we sit enjoying being there.

Futons on a tatami mat floor, if you have never slept this way then you are missing something special. On the right are the cupboards in which the sleeping equipment is stored. In the evening, you go to dinner and when you come back your futons are all laid out and the tables moved into the ante room. When you go to breakfast you return to your room to find the futons all packed away and the tables back in place. There is a quiet magic in the way it all works, it is so easy, so seamless and you, as the honoured guest, are undisturbed by the necessities of the day, for you there is only the purpose of relaxation and comfort. Should you have any stress whatsoever then the massage chair is there for you to sit in and enjoy a thorough and detailed massage. But now I am going to return to the subject of food.

We are called to dinner and shown to our own private dining room. Each of the Ryokan's rooms has its own private dining room, this is just the standard set by Sekiya Ryokan and it is not a standard which rests solely with architecture. Most impressive is the absolute courtesy, good manners and genuine politeness of all of the staff, they make you feel as though you are in a space where you are the centre of all attention. This is of course a great skill but they exceed because you are left in no doubt that their concern for your well being is absolutely genuine. These are people with a gift in hospitality.

So sit tight whilst I take you through the evening meal. Our Japanese friends who read this blog will not enjoy what is to follow. Currently most of them are trapped in a land where the concept of "fresh fish" is not known and food is presented as a slosh on a plate by surly staff. For them the pictures which follow are torture. For us, they are a memory of the last two days and for some of you they are a future you have yet to meet.

Parma Ham, smoked salmon and a selection of vegetables.

Sashumi of an unknown river fish

Seafood soup

Red Mullet with vegetables

A croquette of prawn with lentils and a wasabi mooni mash

Two scallops with a raddish and potato mash

Oh yes and the dishes keep coming and can't you just see that genuine hospitality

A fishcake and vegetable clear soup, rice and pickled vegetables

This desert was just bliss, a pear mousse with a peach ice cream 

And here we see the example of what hospitality means in Japanese. I am not showing you anything particular to this Ryokan just an artefact of culture, an artefact of generosity. You see, to fill a glass properly, without skimping, so that your good nature and spirit of hospitality is plain to see, you need to fill it to the brim. And just so there is absolutely no doubt it is only right and proper to place the glass in a small wooden box which can then catch the overflow of your hospitality and bear witness to the honour you do your guest. This allows the guest to fill his glass again from the surplus in the box. Tell me, where else in the world is the bounty of the host manifested in such an artefact.

As I said at the start of this article, there are compensations. On the way home this afternoon we managed to get lost in the Tokyo traffic. Mother said left, My Honourable wife said right, the traffic thundered by but I remained calm, at ease and slowly brought us home. After all, what exactly was there to stress about?

Watching the paint dry.

Well there are just four more days left until we get on the plane and fly out to Haneda. After the year Takayama and I have had we are both yearning for our first onsen (volcanic hot water bath). We will be in our favourite Riokan by the 15th December and no doubt I will report to you regarding the stresses and strains of having to soak for days in steaming water whilst looking out over the verandah at the most amazing mountain views.

What is also exciting my "pen" is the idea that we are flying with British Airways. Now you can call me a cynic if you like but I just know that we are going to have a hell of a time with surly staff and shortage of supplies. Still, they would have to go some to beat the disaster which Virgin Atlantic have become. Our last flight with them, and I do mean my last flight, we were informed one hour into a twelve hour flight that they had run out of tins of beer. The explanation for this shocking failure of customer service was that the flight out from London had drunk all of the beer for the return journey and as they don't stock up in Tokyo that was that.

Thankfully we will arrive in the land of customer service where the comfort and security of the paying client is the first and foremost concern. I will be assuming the position of the eager, hungry and thirsty customer keen on being served and kept satisfied. All the time I will watch and learn and then communicate to you the small humble insights into this culture on the edge of the world. In the meantime, I am sitting here watching the paint dry.

And finally, why am I so excited to be flying into Haneda? Well from our balcony we can see the planes climb into the sky and when the get about 20 seconds above the ground after take off they have to bank a severe right turn and spin around to face out to sea. I can't wait for that on our return. Other than that, as the map below shows, we are about 25 minutes by taxi from the airport and that is just brilliant.