Travel time back to Canada for Xiaojie, Jodi and Dr. Garcia. Fang Fang is going back to China for a week’s visit before going back to Canada. Sarah is joining her two sisters for a two-week tour of Japan before coming back to Canada later in July. We will miss Wayo and everyone we met there!
Today is our last day at Wayo! We met at 9:00am to work on our outstanding reports and discuss issues and perceptions of the last three weeks. Each of us prepared our speeches of gratitude at the farewell lunch. Ikuko-san arrived at 10:00am for our evaluation of the 3rd week and 3 weeks as a whole in detail. We shared more stories and observations about our individual experiences here in Japan. We couldn’t believe how much we accomplished in three weeks and we are all very sad to leave the friends we made. Despite our language barriers, we were able to develop such strong friendships and networks with the great people of Wayo. We will miss all the friends we made including Ikuko, Reiko, Sainaa, Momoko, Aney, Yuka, Masako, Izumi, Yumiko and so on.
The farewell lunch started off with speeches from the head of the International Students Office (Hattori sensei), President Keshida and Yumiko-san. Then Dr. Garcia and all of the Brescia students gave a speech to express our gratitude. After the speeches, it was time to enjoy a delicious lunch which included a variety of Japanese dishes (oishii!). Following the lunch we were showered with presents from Wayo University. We all felt so grateful for the presents and this experience of a lifetime. We will never forget these last three weeks!!
This morning we attended Reiko’s Clinical Nutrition Lecture. Today’s specific focus was on Chronic Kidney Disease. Throughout the lecture portion of the class the students followed along with what Reiko was lecturing by highlighting and writing keynotes in their textbooks. Once the lecture topics had been covered, the students independently worked on a case study following the SOAP method that we, as Brescia students, also recognized. The activity involved role play in groups of 2, one as the client and the other as the dietitian. During this time we worked on the same case in English with Sainaa and Momoko. We discussed comparisons between Canada and Japan’s standards for anthropometric, biochemical, clinical, and dietary data. We all brought forth great conversation and we had fun talking about something that we all have a strong passion for and interest in. Once we had worked through the case as much as we could without using their reference handbooks that were in Japanese, we showed gratitude to the students as well as Reiko for allowing us to attend their class.
In the afternoon we met Ikuko at the Konodai Station bound for Hikarigaoka. After 3 weeks packed with amazing experiences we have grown increasingly appreciative for our guides through the subway and railway systems. We are especially thankful for the amount of energy, organization and care Ikuko-san has put forth into our schedule. It is because of her and other Wayo staff that we have been able to see so much of the Japanese culture in 3 short weeks that none of us had imagined to be possible. Once we had arrived in Hikarigaoka after following Ikuko through the maze of a subway system so quickly, we walked to the Public Health Center in Nerima, Tokyo.
At the Public Health Center we were welcomed by the Dietitian who introduced us to the process that we were a few short minutes away from observing. Masako met us there and joined us for the day. Masako has been wonderfully kind translating for us throughout the past 3 weeks. She makes sure that when people are having a conversation in Japanese to involve us by letting us know what is being said, what concerns are being shared and what information is valuable.
Today the Public Health Center was hosting an event for 3 year old toddlers. In each distinct local government, parents receive a notice of invitation for their child to attend this event when they are approaching their 3rd birthday. The government mandates a health check for children 1, 3, 6, 12, 18, 24, and 36 months old. Mothers receive a medical booklet to track the growth throughout the first 3 years of their child’s life and this allows the government to also keep records and statistics of the youngest population. First, a Dental Hygienist presents the importance of teeth brushing and interactively demonstrates how to brush them properly. Second, a registered Dietitian presents to both the parents and children on the importance of involving their toddlers in grocery shopping and in the kitchen. She asked the parents to get their child to pick out a fruit, a vegetable and milk while at the grocery store in order to introduce them to nutrition. She also asked parents to begin to involve their 3 year old in cooking practices and emphasize food safety. It was so interesting to see how well structured and appropriate this process was for children to begin learning about their own health. Third step was a one on one counselling with a Public Health Nurse. The nurse followed a questionnaire for each child to cover basic information but she also allowed the parent to address their concerns to make the conversation more personalized to the child. Step four was for measuring the child. The next step we observed involved a medical examination by a physician. The final stage we observed was for the children to have their teeth cleaned by dental hygienists and checked thoroughly by a dentist. About 30 children were in attendance all at once, which also meant siblings and parents too. This process was so very well organized and truthfully it looked fun for the children – at each stage there was a different activity for them to be entertained.
At the end of the day, we were able to ask questions about the process and express our appreciation for allowing us to observe their event. Today we had learned so much more about how important the health maintenance of Japanese citizens is to the government of Japan.
This morning we met at nine o’clock before heading to the computer lab to attend a class on nutrition education practice taught by Yumiko sensei assisted by Saho and Sayuri. During this class we were able to make nutrition education materials to help get the public interested in learning about healthy eating and a balanced diet. We were guided on how to make an “origami” which outlines the three basic food groups; animal products, carbohydrates/starches and vegetables & fruit. All of us were very impressed with the nutrition education materials as they are so creative and effective for teaching.
After a quick lunch before we took the train to the National Institute of Health and Nutrition in Tokyo. Here we were able to listen to four top researchers explain what they study (e.g., dietary guidelines, physical activity, communicable diseases, energy expenditure guidelines) and how it has affected Japan’s public policies on nutrition. All of us were extremely interested in learning about Japanese nutritional policies and programs. We observed a human metabolic chamber in use which most of us have never seen before. The experience at the NIHN was both fascinating and unforgettable. We left the institute with many great resources and handouts that we can’t wait to share with our fellow students in Canada.
We went to observe the school lunch program at the Inakoshi primary school in Ichikawa this morning.
We met with the dietitian of the school who introduced us the school lunch system in Japan, where dietitians are involved in every primary and secondary school. The responsibility of dietitians in schools is to provide nutrition education through the school lunch program, foster desirable eating habits, and advocate for a healthy diet for families and the community. Their job includes managing the school lunch, giving nutrition education to students and providing counselling and alternative food options for those with food allergies. The dietitian showed the food guidelines for that school, in which she set objectives and made teaching plans for students in different grades. She also made the meal plan for each month throughout the whole year, incorporating seasonal foods and considering school events. Each specific meal plan needs to fulfill the energy and nutrition requirement set by the government. The lunch for today was steamed rice, small roasted fish, eggplant with pork, white gourd, “miso” soup, citrus jelly and milk. There was also a food tray display at the entrance area, so that when moms come to pick up their children, they have the chance to check the foods eaten and have some knowledge of the healthy seasonal vegetables. The lunch meals for about 200 students/staff are prepared by 6 workers working in the school kitchen.
We attended the nutrition class given by the dietitian to the students in grade 6 on how to taste food (she used a peach confectionery) by using the five senses. She discussed in a very lively manner how sensation affects the eating experience. The students showed a high interest in this topic. At lunch time, the food was served by a team of 5 students from the class. The serving group had to take the food (and cutlery) for the whole class from the kitchen. Before serving, they washed their hands, put on white coats, masks and caps. After lunch, they also cleaned and wiped the tables, and disposed of the garbage for cycling. We were so impressed by the school lunch program in Japan. We think it is a good way to build healthy eating habits among children! How we wish this system could be run in Canada in the future!
In the afternoon, we visited the Fujitsu clinic, a medical facility for employees and their families, in Musashinakahara and we were briefed by the company dietitian on the most common nutrition-related health problems of employees. She also showed us the online assessment forms that employees fill in before their appointments with her and she was happy to report that the nutrition counselling she provides seem to be effective in alleviating some of the health issues. We were also welcomed to visit the Fujitsu Technology Hall where we witnessed the technological progress the company is making particularly in the computer and telecommunication technologies. Of particular interest was the new “Wandant”, a kind of pedometer/health recorder for pet dogs which can monitor their physical activity and some health measures such as body temperature.
In the morning, we had a nutrition care management practice class. It is hard to have a class in Japan without speaking Japanese, but it is always good to know how the class is organized here. Once again, I saw the TA check the attendance at the beginning of the class. They go through the names and make the check mark. One practice I really liked about this class was the estimation of the food weight by hand, with 20 different food and food models passed around. Students estimated the weight by looking and holding them in the hand. Since measuring spoons or cups are not always available, having a rough sense about the food weight is very important in the energy and nutrient calculations
Monday afternoon is the third and the last food lab we attended. Therapeutic clinical nutrition practice is held in a smaller cooking lab which has similar structure with Brescia’s. Taga sensei is a young looking gentleman. Students in my group even clapped his shoulder when they were talking to him. Their cooking labs usually have 5-6 students in a group cooperating to make a whole meal. One big difference about this lab is that there was no demonstration about cooking. We experienced the language barrier again as most Japanese students only speak a little English and the recipe we got is in Japanese with ingredients only which made it difficult for us to understand what to do on our own. Fortunately, we could still use unspoken and sign language to communicate and we were able to help with the cooking of a reduced protein and sodium for a renal diet.
A visit to Tokyo Disney Sea, the Science museum and Mt. Fuji capped the week for some of us. We had good luck with a few hours of sunshine after a rainy week. We found so many different flavored popcorns all over the park; favorite flavors are corn, milk tea, caramel, black paper, curry. Disney Sea has a very unique snack, a steamed bun with three flavors – yellow tiger tail is filled with ground chicken meat; white buoy shaped bun is shrimp flavored; and the dumpling shape is pork flavored. It is a delicious and healthy choice for snack. One thing that could make the bun even better is to add chopped vegetables in the meat; therefore, with a cup tea or milk, it would be a perfect meal in the amusement park. Technological developments and nature’s bounty were on exhibit at the museum. Mt. Fuji is really a beautiful majestic symbol for Japan.
Weekend is always a good time to explore the usual Japanese life. Food tasting is a favorite way of exploring many Japanese foods.
The strict regulations to raise a Kobe cow make Kobe beef very expensive even in its original production site. Kobe beef is famous for its beautiful marbling and it iss so tender that it would melt in the mouth. “Sukiyaki” is a traditional Japanese food involving Kobe beef, tofu and vegetable. After cooking it in front of the customers, it is served in a small bow of raw liquid egg. Eating raw food is somewhat popular in some parts of Japan. Beside raw fish (in “sashimi” or “sushi”), some also consume raw chicken, squid, or half-cooked chicken liver.
We all have our preferred way of eating. Most of us prefer cooked foods as cooking makes food tender, easier to digest, and the heat applied during cooking kills most pathogens. For some, they prefer raw foods, such as raw salmon. It is therefore an individual’s choice to mimic some of these practices and try the raw foods or follow their own preference of eating cooked foods.
Today we went to visit Kikkoman soy sauce factory in Nodashi city. Kikkoman soy sauce, which originated from China and developed in Japan, has become a worldwide famous brand of soy sauce. It has branches and plants in USA, Singapore and China. They make the highest quality soy sauce, follow time-honored traditions and cutting edge technology. After watching a short introductory film about the history of Kikkoman, we visited the factory with a tour guide. The ingredients of soy sauce include soybean, wheat, salt and water. Besides them, Kikkoman also uses its original aspergillus, a type of fungus, to propagate koji mold. Koji mold is one of the most important elements in making soy sauce and plays an essential role in fermenting the ingredients.
The making process of Kikkoman includes production of “koji”, the essential base of soy sauce, mixing and aging, pressing and refining, bottling, inspection and shipment. The “koji” is moved to a tank and mixed with the salt-and-water solution. This mixture is called “moromi”, a kind of mash, which is then fermented and aged in the tank for several months. There are three types of fermented “moromi” exhibited outside the workplace, one-month, three-month and six-month fermentation. The six-month fermented “moromi” gave off the richest flavor and aroma and in attractive brown color. There are two kinds of fabric exhibited outside the pressing area. One is before using, which is white color; the other is after using, the original white color has been dyed into brown color. The soy sauce pressed from “moromi” is called “raw soy sauce”. By-products from production such as the sediment and oil are used as feeding materials for livestock and fuel for machinery operations.
It was really a fantastic field trip and informative experience for most of us!
This morning we attended the science of health lecture given by Professor Namba. He talked about the strong linkage between physical activity and human health. He illustrated how sedentary lifestyle results in the chronic diseases after middle age. He also compared the physical activities of people in different countries and different sized cities. We learned from this class that physical activity can effectively prevent life-style related diseases, reduce pressure, and improve the quality of life.
We also attended the clinical nutrition lecture given by Dr. Yoichi Sakurai. He talked about how malnutrition affected the rehabilitation of patients post-operation. For example, it was reported that if preoperative loss was less than 20%, the postoperative mortality is only 3.5%, but if the preoperative loss more than 20%, then the postoperative mortality increased to a high 33%. It is critical for dietitians and other medical team workers to try to maintain the patients in good nutritional status before and after operation. During patients’ hospitalization, the dietitian needs to take nutritional screening, nutritional assessment, making plans for nutritional management, carrying out the nutritional plan, monitoring and evaluation. We realized the importance of nutritional status on treatment of illness from this class. It was so interesting and informative!
After lunch, we went to the National Center for Global Health and Medicine. We were so impressed by the tidy and organized environment in that hospital. We were treated with a very special ice cream there! Not like conventional ice cream, which melts before it reaches the patients’ room, this new innovative ice cream does not melt in about 30 minutes. At the same time, the flavor and delicious taste are preserved. It was awesome!
We learned from the introduction that the center can provide 300 meals or more at one time or 750 meals or more per day. The center uses the nutritional component management system for its nutritional standards. This system can provide most suitable nutrition standards selected according to individual patient’s conditions and requirements.
Then we toured the workplace where they use the concept of HACCP to carry out hygiene management. The workplace is divided into food preparation section, cooking section and serving section. The food preparation section is designated as an “hygienic area”, distinguished by a different floor color. There is also a specific room for final food check. Before each meal, the dietitian needs to check the contents of the dish in that room to avoid any serving mistakes. We learned the main duty of a dietitian in the hospital is to provide appropriate and best service to patients.