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Return to Pediatrics

When I came to Japan in 1964 as part of an exchange of doctors - by agreement between the Japanese Ministry of Health and Welfare and the British General Medical Council - it was decided that my practice should be in Kobe. This was because there were at that time many foreign doctors in Tokyo, but not so many in the Kansai, and most of the foreign residents who worked in Osaka had their homes in Nishinomiya, Ashiya or Kobe. There were then many more foreign businessmen stationed in Osaka and Kobe than there are now, and my practice started from small beginnings, mainly among the British community. I had spent the previous three years training to become a pediatrician, but when I accepted the assignment to work in Japan I realized that I would have to extend my practice to general medicine, for there would not be enough foreign children to enable me to specialize. Furthermore, when I arrived in Kobe I soon realized that there was a great demand for medical treatment of foreign seamen, and this soon became the backbone of my practice. In numbers, I was treating slightly more seamen than residents, and of the residents there were more adults than children. For this reason I had to stop calling myself a pediatrician, though children remained my special interest.

Later, there were three further developments, in contrary directions, one of which reduced still more my opportunities to treat children, while the other two increased it.

First, there was a decline, gradual at first but constantly increasing, in the number of foreign families with children in the Kansai. The reasons for this were economic: Japan was perceived, rightly or wrongly, to be an expensive country to live in, and one by one foreign businesses withdrew their expatriates from the Kansai and replaced them with Japanese staff. Some businesses, in particular banks and shipping agencies, closed down their Kobe branches altogether, so that whole families disappeared from my practice and were not replaced. (This process was much less marked in Tokyo, where foreign businesses tended to keep a core of expatriates - not to mention the large numbers of embassy staff from all countries.)

The second development, more favourable to me, was that I became known to the Osaka consulates of other European countries, so that I received many more patients - including children - whose first language was not English. Fortunately I had already worked in the American Hospital of Paris and had some experience of international practice, which is what I would have chosen to do if I had not started as a pediatrician. So, in a sense, in coming to work in Japan I was returning to my first choice.

Finally, and most importantly, in 1974 I had the good fortune to be appointed school physician to Canadian Academy, which is the largest international school in the Kansai. This brought me back into the world of pediatrics. For the next 34 years I made weekly visits to the school, mainly to treat students and staff, but this soon came to include parents, other children and anyone who happened to live in the vicinity of the school. The type of pediatrics differed greatly from what I had been accustomed to in the past: instead of infants and young children I was mostly involved with those at the upper end of the pediatric scale, and with teen-agers who were more young adults than children. This was a very rewarding experience. Although Canadian Academy is an English-language school, the proportion of students whose first language was not English rose constantly, in accordance with the general trend of the times, so that Indian, Filipino, Chinese and Japanese students began to constitute a majority, as the numbers of American and British students declined. The overall influence, though, was American. In spite of its Canadian name (it was founded by Canadian missionaries) it has become, in effect, an American school.

One of the first things that struck me there was the difference in the student-teacher relationship from that which I had previously regarded as normal. In my youth, teachers were treated with a respect which was not always sincere but which had to be maintained, at least outwardly. We always called them 'Sir' and gave them a sort of salute when passing them outside the classroom. I shall never forget my discomfort when I was asked to be present at an interview of a particularly difficult student with the headmaster of Canadian Academy. Instead of standing at attention, as I expected, the student sat down, crossed his legs, shook off a sandal and started to pick at the skin of his toes. I could hardly resist the temptation to shout 'Stand up!' - but it was not my job. I soon learnt that American ways were not the same as British. The absence of a school uniform also made a difference. I was often shocked at the sloppy appearance of the teen-agers and wished that someone would tidy them up. However, I began to realize that there was also a good side to the American way of education: the students were more free to discuss their problems with the teachers and even to consider them friends. Now, after personal experience of the old-fashioned British way and many years in close contact with the American way, I find it very hard to decide which is the better. I am glad to have been able to see and appreciate both. Above all, I consider myself fortunate to have been brought back to pediatrics by this long and circuitous route, so that by the time of my retirement I could once again claim to be a pediatrician as well as a general practitioner.
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