Lining up to buy train tickets for a pleasant autumn trip to the countryside, Paul Lee turned around to witness a sight that turned his family vacation into a nightmare.
He saw his mother, Catherine Chuen, lying unconscious on the floor of bustling Odakyu Shinjuku Station. She was foaming at the mouth and struggling to breathe, having suffered a heart attack.
It was about 9 a.m. on Oct. 5 -- the fifth day of a short break in Japan for the Singaporean family, which included Lee's wife and child.
Chuen was in critical condition, with doctors fearing she might never wake from her deep coma.
But good fortune and medical expertise meant that on Nov. 4 -- her 69th birthday -- Chuen was permitted to fly home and tuck into the Singaporean food she craved.
Station employee Masahiro Inada swiftly restarted her heart using an automated external defibrillator (AED), and a Taiwan employee at the station's tourist information office was on hand to interpret.
Doctors at the Tokyo Women's Medical University Hospital gave Chuen hypothermic treatment -- a method of cooling the body to slow the metabolism and prevent brain damage -- and performed a successful triple bypass operation on Oct. 16.
"We realized we were at a center of excellence for heart treatment," said Chuen's daughter, Tessa, 38, who came to Japan after hearing of her mother's condition. "We weren't aware of this when we first came here, of course."
Prof. Kenji Yamazaki, the doctor who led the surgical team that performed the life-saving operation, said, "Ms. Chuen was lucky in many ways."
One stroke of luck was that AEDs are prevalent in Japan. According to a study sponsored by the Health, Labor and Welfare Ministry, 206,994 AEDs were installed across Japan in December 2008. Of them, 72 percent were located at train stations and other public facilities so ordinary people as well as trained staff at the facilities can use them.
Not all foreigners requiring emergency care are as fortunate as Chuen, and many face language difficulties and challenges -- not least the matter of paying the bill.
Hiroyuki Tsukui, Chuen's chief doctor at the hospital spent six years in Pittsburgh. "Having lived overseas and experienced medical systems in other countries, we see the difficulties in going to a hospital [overseas]. You may not know what to do to see a doctor or even where to go first. There is little such information in Japan," he said.
Moreover, with only a limited number of hospitals staffed with doctors who speak foreign languages, much hinges on location.
According to Ryoko Suzuki, an official at the Association of Medical Doctors of Asia (AMDA) International Medical Information Center, various Web sites list a considerable number of doctors who speak foreign languages in urban centers, but linguistic help can be hard to find in more rural areas.
The Japan National Tourism Organization's Web site lists by region medical facilities with staff who speak English or other languages -- the lists are long for urban areas, but short for the provinces.
Suzuki warns, however, that these hospitals do not necessarily offer help around the clock. "It may be a little difficult for foreigners to actually go to those [Web] sites and use them," she said.
But services are available to provide language assistance to foreigners.
The AMDA center provides such a service. It has telephone advisers who listen to medical problems, find hospitals and ensure foreign language-speaking staff are present for appointments. It also provides medical interpretation over the phone between foreigners and doctors in seven languages besides Japanese: Chinese, English, Korean, Portuguese, Spanish, Tagalog and Thai.
Both the AMDA center and Tokyo Women's Medical University strongly urge foreign tourists to take out medical insurance -- something Chuen and her family must be thankful they did prior to their journey.
"The insurance covered the whole medical operation for my mother... and one traveling companion," Lee, 39, said. "At most, we'll have to pay a couple of thousand [U.S.] dollars. The doctor indicated it would have cost about $100,000 had we not been insured."
Her doctors also might have been put in a bind had she not been insured as the hospital's management could have insisted that the Cardiovascular Surgery Department cover Chuen's costs from its budget.
Under the Medical Practitioners Law, doctors cannot refuse a request for treatment without a justifiable reason.
But the fact she was covered allowed Tsukui to say, "We felt comfortable treating her."
Yamazaki explained further: "If we provide treatment and find out later the patient isn't insured, we'd get in trouble and be given a hard time [by hospital management]. On the other hand, if a patient is insured, we can concentrate on treatment because the insurance company would cover the cost."
While foreigners without insurance can pay by credit card, both the number of hospitals that take credit cards and the cards accepted are limited, according to the AMDA center.
Mark Colby, chairman and chief executive officer of Colby Group International Inc. and an expert on the business of medicine in Japan, feels that hospitals would need financial stimulus to improve services for overseas visitors.
"The bottom line is that money talks." Colby said, comparing the financial side of emergency medicine to currency trading in that both take a tremendous amount of investment and preparation for very little return.
"If there were some kind of reimbursement associated with translation services, it would certainly be the panacea and certain hospitals would have a Philippine flag [or] a Chinese flag to [show that they] offer those services [specifically to people of those countries]," Colby added. "But right now, I think, it's pretty much on a voluntary basis."
INFORMATION
--AMDA International Medical Information Center
Tokyo: (03) 5285-8088
Kansai: (06) 4395-0555
http://amda-imic.com/
--Himawari (Tokyo government institution information): www.himawari.metro.tokyo.jp
--Japan National Tourism Organization medical facility list: www.jnto.go.jp/eng/arrange/essential/emergency/list/hospital.html To see more of The Yomiuri Shimbun, or to subscribe to the newspaper, go to http://www.yomiuri.co.jp and www.yomiuri.co.jp/index-e.htm Copyright (c) 2009, The Yomiuri Shimbun Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
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