WEST MET EAST…I’M ON MY WAY HOME

Boarding starts in an hour, so I just got a bit of time left in beautiful Japan. I’m in the ANA-lounge (specially lounge for ANNA-doctors :-)) now, writing this last blog of my Nobivac Global Vet Exchange Program. It’s been a marvelous experience! In the almost twenty years that I’m a veterinarian now, this absolute is one of the most remarkable weeks in my professional career.  So first of all I’d like to thank the MSD/Merck company for giving me this wonderful opportunity. Especially I would like give my greatest regards to Karin Jager, Jolanda Janssen, Marjan van Kampen, Marco labordus, Joep Bolwerk, Michono Umemura, mr. Kondo for all their effort, trust and time.

Besides that I can’t thank Dr. Fujii and all his team members enough for the inspiring and  motivating time I had while staying in their animal hospital. So thank you Dr. Koichi Fujii, Dr. Ayoko Usami, Dr. Madoka Mikuni, Dr. Kousuke Izawa, Dr. Ryuta Nakabayashi, Ami Suetsugu, Akie Shishido, Ayaka Sakai and Arisa Fuse. I think you’re great!

So what about these last days? Yesterday morning I spend on the clinic taking care of the hospitalized animals and doing consultations. And guess what…the “dead” cat of Thursday is doing better than ever. Full of life and looking for attention. His name is Lion and I think Madoka (and the rest of the staff) fought like one for him! And the owners were off course very happy with this remarkable result. It’s all about this bond between animals and humans. “Making people happy, by making animals better”; that’s where, in my personal opinion, our beautiful profession is all about.

After this last morning on the clinic we had lunch together and after that it was time for the “let’s make picture” moment. We made a few and with pain in my heart I said goodbye to all and assured them they’re always welcome at our clinic in Nijmegen. Such nice collegues!DSCF9858

What are my main observations in the last week. My number one remark would be that Dr. Fujii’s hospital, his way of doing things, his services and his bonds with clients and staff are for 80% the same as ours in the Netherlands. They have the same passion, ambition, issues and topics. There are much more similarities then that there are differences. It’s the ‘Pareto-princip’ of 80-20.

My awnser to the starting question of this exchange program “Are vets completely different around the world?” would be: no!

Dough there are differences, in my opinion they’re al ‘minor’ ones. I name a few:

  • The size of the dogs. In Japan mainly toy-breeds. The biggest dog I saw was 15 kg, a Goldendoodle. Koichi will be surprised seeing our European giants!
  • Japanese people will ‘decorate’ their pet with all kind of things, like jewelry, mini-sweaters or even dye the hairs. Odd to see for a Dutchman, but I think it’s a sign that they care.
  • Japanese vets are quite technology-driven. Lots of veterinary hardware, ECG’s, CT’s, scopes, ultrasound, “microwave”, analyzers and so on…. Bloodtesting during general health checks is very common, and I think we can learn from that.
  • Japanse vets treat there patients with more patience, serenity, quietness and time. Aldough it was sometimes very busy in the clinic it never become hectic or chaotic. I think we can learn from that!
  • In the area of medication there are remarkable differences in the use of antibiotics, steroids, foodsupplements and vaccines. Japan has no “tailor-made” antibiotic and vaccine approach, but Koichi was very eager to learn more about it. We talk quite a lot about this subject.
  • All pets live in house and only go out to walk. Always on the leach, while traffic is to dangerous. Cats will be inside the home all of the time. So I the practice hardly any traffic-accident emergencies.
  • The different approach to euthanasia. In the East it’s only to be done if you’ve run out of all (and I mean all) options. Owners will not be present in the clinic when their pet is put down to sleep. In the whole week I did not see one case of euthanasia, all the animals which deceased during my stay, died naturally.

So these are my main observations, but I’ve got 12 hours in the plane back home to reflect a bit more. I’m going to post this blog now and leave this beautiful and intriguing country with its nice people.

I’m also happy to go home again to see my wife Astrid, daughter Willemijn and son Pepijn. And not to forget my “furry daughter”  Bente, our Labrador. I’ve missed them all this last week.

I’m gonna catch my plane now……east, west, home’s the best!

THE CAT WITH TEN LIFES

In earlier blogs I mentioned the enormous dedication of Dr. Fujii’s vets. “As long as there’s life, there’s hope”; must be their guidance. In illustration to that was a severe case coming in early this afternoon. We just had finished lunch when one of the technicians reported that a cat was on his way to the hospital, because it had stopped breathing. When the patient arrived it was just one small step away of cardiac arrest and a next life (cats have nine lives, according to the old Egypt culture).

Dr. Madoka Mikuni immediately jumped into action and with the help of technicians and junior vet DSCF9802Kousuke Izawa, she directly managed to get an intravenous line into this total apathic cat. For those of you who have no veterinary background…..getting an i.v.-line in a “normal” cat is quite a challenge, but getting an i.v.-line into a convulsing cat with no blood pressure what so ever, is considered to be an art. Within a few minutes Madoka managed to take blood samples, got two (one spare, just in case of ;-)) i.v.-lines dripping and gathered  the most important parameters, like body-temp, heart-rate and blood-glucose.

DSCF9845The concentration and dedication of the team was amazing.Hardly any talking or commands, no single sign of stress or pressure, only full focus on this extremely critical patient. All kind of machines (we’re in Japan) were connected to the cat. A ‘microwave’ was rolled in to heat up the poor little tiger, several infusion pumps, an ECG, an pulse-oxymeter, even a hairdryer to blow hot air was used to get this cat back to life. And after 20 minutes  the efforts started to pay off and the cat was slowly doing better also due to a variety of injections, such as glucose to fight the extreme hypoglycemia. During the whole timespan dr. Mikuni had been constantly evaluating her patient, checking the parameters and calculating all therapeutic doses.

Within three quarters of an hour this dedicated team had managed to turn the poor dying, comatose creature into a silently mauwing cat, coming to consciousness. A combination of amazing perseverance, superb concentration and fabulous team-work made a little miracle happen.

And maybe a cultural component as well. In the last days I found out that death is a quite a taboo topic Japan. Death of humans and death of animals. For example, in Japan two religions are common. Shintoism, for the time you’re alive and Buddhism after you’ve passed away. Dr. Fujii explained to me that the euthanasia of a pet in Japan is pretty different than in other parts of the world, while pet owners try to avoid this as long as possible. And (generally speaking) Japanes people don’t want to be present in the practice when an animal is given the gentle death. So this maybe also an extra reason for Japanese veterinarians to do walk the extra mile and do everything in their abilities to avoid a pet passing away.

DSCF9869After this interesting feline case and some surgery, Koichi and his team had prepared a special “practice dinner” for me. Superb sushi was brought in on large plates, combined with delicious salads and a diversity of Japanese culinary delights. But I think I already blogged about the great food out here. Unfortunately also this great evening came to an ending after the traditional “let’s make picture”-moment. On my way to the door I took a quick glimpse at the cat of that afternoon. It turned around and showed all signs of doing much better.

“In old Egypt cats are considered to have nine lives”; I thought, while a walked to Koichi’s car…….. “Due to Fujii-vets this cat got an extra one!”

TOKIO-TOWER, TEMPLES AND APPLES

DSCF9763Every wednesday (the third day of my visit to Fujii-Vets) the clinic is closed. This gave us the opportunity to spend some time to discover the interesting Tokio-area. I’m very lucky having Dr. Kochi Fujii being my guide. He arranged an awesome program.

Dr. Fujii is a remarkable colleague. Not only is he (as British people would say) in every inch a gentleman, he’s also very innovative, open for new ideas and easy to communicate with. But above all, he’s a very intelligent and educated man. Besides DVM, he’s also a MBA and a PhD.

He developed a new, successful operation on MPL (Medial Patella Luxation). Instead of deepening the trochlea, he changed the kneejoint by taking a v-shaped piece out, turning it 180 degrees and putting it back in place. In this was the trochlear rim becomes higher, preventing the patella luxating. He came up with the idea while cutting an apple. He cutted out a v-shape piece, turned it half and placed it back. Eureka! Maybe Koichi is de next person becoming famous due to an apple, after Isaac Newton, Robin Hood and Steve Jobs 😉

Besides his excellent professional competence, Koichi is a natural leader. You can tell when you observe him in his practice team. He’s a good listener, helps his colleagues in a nice, natural and emphatic way, but he’s not afraid being clear and strict on his juniors when needed. By the way, that only happened once while I was here. He’s leading his team in a very respectful , motivating and mindful way. Things can be learned from that!

Koichi is also a great sportsman by playing golf, cycling, competing in triathlons, skiing and the Japanese martial art of Kendo. But above all he has a sharp sense of humor and he’s good fun. We’ve been laughing quit a lot these passed days.

So we started our ‘Tokio-morning-tour’ early, by hopping on the train into the city center, where we would DSCF9719take the Hako-sightseeing bus. Tokio in morning rush-hour is a pretty intense experience for a European. Thousands of people going to work and trains so full you can barely breath. But everyone behaves very disciplined and everything is organized like a Seiko-watch. Unbelievable. No delays, no complaints, no graffiti, no vandalism, nothing going wrong.  Excelspeadsheetism!

After hopping on the bus we drove to Tokio Tower and enjoyed the beautiful view ofthis giant metropolis. Unfortunately it was a bit misty, so we couldn’t see Mount Fuji. Next stop was the Imperial palace, with its white walls and moats full of Koi carp. Then quickly to the Shino and Buddah shrines and temples in the north of the city.

In one of the temples I was invited to randomly draw a little wooden stick out of a box with hundred sticks, to determine my destiny. Guess what….I draw number 1, which stands for great luck, good health and long life. Lucky me!

With all this luck (and some souvenirs) in my backpack we went to Tokio Train Station, which is supposed to be a copy of the Amsterdam Central Station. From here we took the Shikansen (bulletspeedtrain 250 km/hour) back to Shin Yokohama to go by car to Karmakura, a religious place 45 minutes outside Tokio.

Also Madoka Mikumi, one of the other vets, joint us here. Together we visited the beautiful temples, Buddha-statues and famous Japanese gardens.  It was amazing to see this centuries old culture still be in place. Very inspiring!

We ended this fantastic day with a greatDSCF9783 dinner at the “Top of Yokohama”, a famous restaurant on the 40th floor of the Sheraton hotel. Spectacular views and superb foods, like tappanyakied Wagyu beef and other delicacies, combines with a great conversation. Today has been an overwhelming experience!

Still two days to come!

MEDICATION AND DEDICATION

Last night I slept like a rose. The jetleg is gone now and I only woke up once because I forgot to turn off my phone. Stupid! In the morning I walked into the city to get some breakfast. Much better than the standard hotel morning meal with little glasses of diluted orange juice and super strong coffee due to long evaporation times 😉

So I hit the road and came across a nice little shop where they prepared fresh sandwiches and cake. I managed to point out to the guy what I wanted on my sandwich and he made it into a little party.  Real Japane cuisine craftsmanship. Making a sandwich like that is worth a Nobel prize! I made a deep bow for him, because body language is pretty important here. Luckily it’s very easy to learn.

Bow, bow, nod, nod.

With my freshly-made sandwich I walked back to my hotel where Dr. Koichi Fujii picked me up in his nice mini-car. Very handy in this crowed city with narrow roads. Amazing how many people live here on a few square miles, resulting in unpayable land prices. And if you’re able to catch a few square feet, you’re not allowed to build flats due to the earthquake risk. Except for very high buildings, because they are ‘specially designed’ to withstand one.

It’s a pretty reassuring thought while my room is on the 35th floor of the only skyscraper in Shin (New) Yokohama. But Japanese people don’t live with the idea that anytime an earthquake can strike, just like Dutch don’t live with the fear of collapsing dikes and a big flood. It’s just the way it is.

Arriving at the practice we had a nice morning program. Some health checks and vaccinations but still time enough to share experiences and ideas. In Japan rapid use of medication is far more common than in the Netherlands. With the (s)lightest indication of any infection, antibiotics are given.  Better save then sorry, is the professional Japanese opinion. And I’m not giving a verdict, I’m only seeing different approaches.

Also the use of steroids is more or less standard procedure. It’s first choice to inject steroids, instead of non-steroids, which is the Dutch standard. Again, not good or bad, but different!  Finally the use of multivitamins, food-supplements, amino-acids and other substances is fairly common. Every medication is given in exactly the right doses. The electronic  calculator is the main tool in the pharmacy. Japanese vets are very precise and strict when it comes to giving the exact and right doses, where we in Europe have a tendency rounding up or leveling down to ‘handy’ numbers of 10,15 or 20 kg and so on.

20141111_153340 (2)After lunch I had the honor of giving a presentation to the Fujii-Vets and some MSD-directors about the book I wrote with Theo and Jolanda. I talked about the importance of practice communication. Altough there are cultural differences, in my opinion 80% of the book is applicable to the Japanese market, which Dr. Koichi Fujii confirmed. We had an inspiring dialogue afterwards, about how to transfer the knowledge of the book into a “Japanese approach”.

In the late afternoon a dog with enormous convulsions was brought in. It was the owner’s first visit to dr. Fujii, after visiting another vet for a couple of times. Dr. Koichi Fujii is rather famous in this area. Koichi’s father was a vet too and the practice is in family-hands for decades now. Everything in the practice is done thoroughly and always with the purpose of finding a diagnosis and prognosis.

So the whole team focused –with enormous dedication- on this poor dog. Infusions, blood sampling, echo, oxygen….everything was done, but finally complications developed. Sad ending of a satisfying day. Gonna hit my pillow now. I’ll keep you posted.

‘Haihai’ from Shin Yokohama…………….35th floor 😉

THE MORNING AFTER…

20141110_081253This is the early morning after the first day of my Nobivac Global vet Exchange Program at Dr. Koichi Fujii’s clinic in Shin Yokahama, Tokio, Japan. The advantage of my jet leg is that I woke  up early and have some time to work on blogs, social media and email 😉

Yesterday was my first full day at Dr Fujii’s clinic and it was great! The very nice and helpful staff made me feel ‘at home’ right away. Amazing, if you think about it. Our practices are more than 10000 kilometers apart and for the first 48 years of my life I’d never heard about Fujii-Vets, but only one day here and it feels like my own place.

What also struck me was the amazing openness and trust of all staff-members, from the moment I came in. I was allowed to see, ask and do everything from the first second. No reservations or ‘no-go-areas’ at all, which –at least in my mind- is quiet amazing.  And don’t get me wrong here, I really appreciate this collegial transparency. Great! It enables you being on the same, right level from the start and makes the communication more intensive, rewarding and sincere. Really a super experience!

Today the upcoming consultation hours are not fully booked (yet) so that probably gives us again some opportunity to share experiences and thoughts.Because that’s what this exchange program is all about. Pets are more or less the same world over…but are vets?

In the afternoon I’ll give a presentation of the book to the staff of Dr. Koichi Fujii and some members of the Merck Animal Health team in Japan. I’ll reveal them my ‘secret of (practice)flow’, although I have the impression they already know it, if I take the smooth working processes in consideration.

Keep you posted!

LEARNING CURVE ;-)

Got the different communication media for my trip to Japan. A well designed booklet (including paper diary) and an iPad with all kind of apps and functions pre-installed. Happy with that, since I’m learning “on the job” now to find out how all this Apple-stuff is working. Until now my “Windows” only we’re open for “HP” and my music was sung from a “Sam-sung”. Keep you posted on my learning-curve… Dr. Roeland Wessels, Nijmegen, The Netherlands