Great sadness and great beauty

I spent last weekend in Fukuoka, a small city in the southwest of Japan. While I was there, I did a big day trip to Hiroshima and Miyajima, two relatively nearby destinations via the shinkansen bullet train. I didn’t think I would be able to go to Hiroshima while in Japan, but as the end of my time here got closer, the more ridiculous it seemed that I would miss it – I think its importance demands making the effort to go there. As I planned the day, reading online about day trips to Hiroshima, I decided it would be possible to spend the morning in the city and then take a ferry in the afternoon to the nearby island of Miyajima – the site of the Itsukushima shrine and famous floating torii. It was a packed day, but I am so glad I did it.

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The Atomic Bomb Dome building with a plaque depicting the hall as it was before the bombing.
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On the way to the Peace Memorial Park.

After arriving in Hiroshima, I went straight to the Peace Memorial Park, which is exactly where the atomic bomb was dropped – in the center of the city – on August 6th, 1945. The Peace Memorial Park has the Hiroshima Peace Memorial Museum on one end and the Atomic Bomb Dome on the other. I started at the Atomic Bomb Dome, the only ruin left from the war. The bomb exploded almost directly over this structure, which actually minimized its impact – as you can see, the frame of what was a dome in the center of the building was left standing. The building is preserved exactly as it was after the bomb hit. But as for the rest of the city’s buildings, Hiroshima is completely rebuilt and thriving with no evidence of the bomb.

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The Atomic Bomb Dome.
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The Flame of Peace, burning since its completion in August 1964. The flame’s large stone pedestal is supposed to be “an abstract rendering of two hands opening upward.” Beyond the flame, the long rectangular building is the museum.

On my way to the museum from the Dome, I saw this flame. My mom, who has been to Hiroshima before, told me to “look out for the eternal flame.” As I spotted it and walked towards it, my eyes teared up at the idea of a flame that’s been burning since it was placed there to honor the victims of Hiroshima. How much work to keep the flame burning for so long! As I read the plaque, I realized that the idea of the flame wasn’t exactly to be eternal. It reads: “Symbolizing the universal desire for a world free from nuclear weapons, the flame will burn until the day when all such weapons shall have disappeared from the earth.” A beautiful sentiment. Thus the idea of it being eternal – burning forever because we will never rid this planet of nuclear weapons – is all the more depressing.

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The red ball hovering directly over the center of Hiroshima represents the fireball created by the bomb immediately after it detonated. As you can see here, most of the city has already been reduced to rubble at this point.

I arrived at museum, which was already packed with tourists at 9am, and I spent 2 long hours there reading every detail. It was difficult and depressing, but its focus was peace. The museum was all about the horrors of the bomb itself, sadness about war and destruction, and the desire to rid the world of nuclear weapons. There was very little anger against America or the other countries involved in the war.

The Hiroshima Peace Memorial Museum taught me details of the war that made it even more depressing than I had realized. (Stop reading here if you don’t want to delve into these tragedies with me – but do keep scrolling for the photos). The first detail that struck me was about the demolition crews. These were groups of people who worked to safely demolish various buildings in Hiroshima’s more concentrated areas in order to minimize the effects of fires that might result from air raids during the war. That is, if there were fewer buildings all stacked up against each other, one catching fire from an air raid would not cause so much damage to the rest of them. I’d never heard of this tactic, but that’s what they were doing in Hiroshima. Most of these crews included young schoolchildren; innocent civilians as young as 8 years old. Maybe they lived far from the center of the city or came from surrounding neighborhoods, but they came to work in the center of the city where the buildings were densely packed. That means that when the bomb exploded that Monday morning, there were far more young children in the center of the city – right where the bomb hit – than there should have been. That was heartbreaking.

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Because dark colors absorb more heat than lighter colors, the heat from the bomb burned out dark fabric (including any black pattern in the clothing people were wearing that day) while leaving the lighter fabric.

The museum displayed many pieces of clothing of the children who died as a result of the bomb while working in those demolition crews. Their parents had to search for them, and they were lucky if they found any clothes or belongings (bodies were far rarer). I find it much sadder that parents had to look for their children rather than the other way around, though of course both are horrible. With each item or clothing scrap, the museum included as much detail (including a name) about the previous owner as possible to give you a full picture of the people that died in the bombing. This went on and on. But in one glass box, the museum had put clothing from 3 different children onto one mannequin. It was as though all these individual scraps of things and clothing, all with unique identities attached to them, had fused into one image: the child who died because of the bomb.

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This tricycle belonged to a 3-year-old and was buried along with him by his father. Forty years later, the father dug up the tricycle and helmet to donate them to the museum.

Another fact I learned was that there were American prisoners of war in Hiroshima when we dropped the bomb. I can’t imagine there were that many, but it still surprised me. I never knew that. Also, there was a replica of the bomb in the museum. It was called “Little Boy” due to its fairly small, lanky shape. It was smaller than I imagined compared to the amount of damage it was able to inflict – 10 feet long. Of course, it only takes a tiny bit of uranium to cause mass destruction, but it was still unnerving to see a full-sized replica of the bomb, just sitting there like something harmless.

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Lastly, it was stunning to realize just how much damage the bomb had done, and in which various indirect ways. Of course, I knew that the force of the bomb itself leveled the city and that the resulting radiation affected people for many years later. But there were other things, too. For example, the intense heat of the bomb burned people to death. Some people who weren’t killed by the bomb’s force, or heat, or radiation, were injured instead by glass – the bomb exploded so many glass objects and surfaces that it sent shards flying all over, into buildings and people’s clothes and into the people themselves. Some survivors had pieces of glass surgically removed from their bodies 20, 30, and even 40 years after the bomb. There were so many ways that the bomb hurt people.

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The center of the Peace Memorial Museum is lined up perfectly with the Cenotaph for A-Bomb Victims (the arch), the Peace Flame, and the Atomic Bomb Dome at the end of the park.

One way that was particularly depressing was that some of the people who died as a result of the bomb were those who came to the city the next day as rescue. No one in Hiroshima was capable of leading or organizing a rescue effort, so any help had to come from outside the city, and it did. But the radiation levels were still so high the day after the bomb exploded that many of the people that came to help suffered as a result.

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A close-up of the cenotaph. The small chest under the arch contains all the names of the known victims.

Okay – that is all I will say about the Peace Memorial Museum and the bombing. That museum is now a small part of the big, lively, healthy city that Hiroshima is known for today. After I left the museum, I had Hiroshima’s local specialty for lunch (a type of okonomi-yaki made with noodles) and visited a beautiful garden – though of course what I saw at the museum stayed with me.

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Itsukushima shrine and its torii from the ferry.

On the island of Miyajima that afternoon, I saw just as much beauty as the sadness I had seen in Hiroshima. The famous “floating torii” is the torii gate of the island’s Itsukushima shrine. Built on a beach, it stands in the sand at low tide, and it appears to “float” on the water in high tide, when the water submerges its base. Of course, all the pictures I had seen of the torii were taken at high tide in perfect lighting, so it looked magical. When I was on the ferry approaching the island, not only was it evident that the tide was low, but also the torii looked tiny from the boat! I prepared myself to be disappointed by a small, non-floating sight.

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Walking through the shrine, I was still mesmerized by the torii even though it wasn’t at all “floating.”
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These little hanging lanterns were very cool.

Luckily there is more to do on Miyajima island than see this torii, and first I explored the rest of Itsukushima shrine. It was enormous and beautiful, and I couldn’t get enough of the bright red vermillion structure, all built on stilts over the sand. On the rest of the island, there are hikes to do, Buddhist temples to visit, village shops to see, and a surprising amount of deer to avoid.

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With the water at low tide, I walked right up to the base of the torii like the people in the background here. It loomed above me once I was close.
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Many of the shrine’s ema (wish tablets) depicted the floating torii, of course.
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The looming torii up close! Despite looking small from the ferry, it definitely felt big here.

I spent about three hours on the island, and as the day inched closer to sunset, the tide started coming in. The island’s visitors that day started to gather at a stone wall facing the torii, many of them sitting in silence sipping beers. I quietly joined them, and as we watched the sun disappear into the clouds behind the torii, the water level rose enough to truly make the torii appear to float. I have to say that it was one of the most magical moments I’ve experienced so far on the Watson, and the sight was extraordinary.

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I’m thrilled that I was able to see the torii at both tides – I had the opportunity to walk up to it and touch it, and I also got to see it “float.” And that was really something.

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Health post: Japanese care robots

Last week, I visited Panasonic’s headquarters in Osaka. Back in the US, I knew Panasonic mostly as a television company. But here in the company’s home country, they make all sorts of products including audio-visual equipment, home appliances, IT solutions, smart home and home security technology, and robots – specifically care robots. I was there to meet an engineer, Mr. Ando, who has worked on Panasonic’s hospital delivery robot HOSPI, among others.

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Mr. Ando with the HOSPI robot.

Panasonic is working on care robots that work in pharmacies, hospitals, and personal homes. One splits in half to transform from a bed into a wheelchair (not your typical “robot,” but still an autonomous machine). This eliminates the possibility of injury to the patient during transference as well as injury to the nurse moving them from their bed to a wheelchair.

Panasonic has also built care robots that focus on improving the patient’s happiness. Ando showed me a video of a hair-washing robot: a station where immobile patients can have their hair sink-washed by robot “hands” that massage the scalp and do the washing and rinsing. It looked very relaxing. Ando said that this was in response to patients who were unhappy that they only had showers about twice a week. The nurses were simply too busy to spend more time manually washing patients’ hair, even if more frequent washing does contribute to the patients’ happiness. If a hospital installs a few hair-washing robots, however, patients can get their hair washed more frequently while the nurses focus on more pressing tasks. While this robot may not have a direct impact on their health, I think the impact on their feelings of dignity, independence, and happiness is important.

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One of Panasonic’s numerous buildings in Osaka – when I got here I thought I had arrived at the location for the interview, but I was still 10 minutes away from the right building. Ando told me this area is called “Panasonic Village” since the company’s headquarters comprise so many buildings.

Ando described Panasonic’s robots as contributors to “assisted care” and “assisted independence.” I got the sense that he used these terms to give dignity to the patient and put the user’s needs first rather than focus on the robot’s capabilities. That is, there is a thin line between “assisted care” and “assistive technology,” but the former focuses on the patient while the latter focuses on the technology.

In our talk, Ando and I mostly discussed HOSPI – a waist-high robot that talks, listens, and transports items such as blood samples or medications throughout a hospital. One special version of the robot, the HOSPI Rimo, also has a communication feature that can be used for telemedicine. I asked about how Panasonic came up with all these robots, and Ando told me that when Panasonic develops new products, the most important step in that process, at least for hospitals, is task analysis.

The Panasonic team observes the staff performing various tasks at a hospital to see where the inefficiencies are – gaps that can be hard to notice when you’re in the middle of the workflow, but which become more evident from an outsider’s viewpoint. Based on this task analysis, Ando told me, Panasonic decides what type of product to develop in response to the observed problems.

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HOSPI hangs out in Panasonic’s lobby. She gives tours to guests and shares information about the company’s history.

In most cases, apparently, some type of robot is the best solution. The nurses don’t have enough time to wash patients’ hair? Let’s build a hair washing robot. There are issues associated with transferring a patient from their bed to a wheelchair? Let’s make the process robotic. And, of course, HOSPI, to make transport more efficient. I asked Ando for more details about the design process that led to the HOSPI robot.

He told me that, after Panasonic observed inefficiencies in the hospital, they discussed which solution would be best for the user. (I was glad to hear that – I’ve realized that, since going to Sweden as my first project country, the idea of a user-centered design process being a key factor of success has become really ingrained in my mind). Ando said that Panasonic quickly developed a prototype robot to solve the hospital delivery problem and then showed the prototype to the potential end users, nurses and doctors. The Panasonic team and potential users had a collaborative meeting about once a month, and after each meeting, Panasonic adjusted the robot in response to the users’ feedback.

“So when is that adjusting process finished?” I asked. “When the user says they’ll buy it!” said Ando, laughing.

I asked him if, with this user-focused design process, there are ever negative reactions to new products. His response surprised me: “All people react negatively to new products,” he said. “Especially in Japan.” Ando explained that certain particularities about Japanese ideas towards healthcare complicate the introduction of healthcare technology here.

He told me that the idea of healthcare in Japan is “humans supporting humans;” so robots as helpers for the nurses, then, are not part of the “philosophy” of healthcare. I asked him what he meant by the “philosophy.” Ando gave me the example of the kanji for “nursing care.” (Kanji is the Japanese character-based writing system – one of the language’s three alphabets). Ando reached for a nearby sheet of paper and quickly sketched it out. These characters often incorporate and combine pieces from more basic kanji that represent simpler ideas; so the characters can build on each other, becoming more complicated while representing more and more complex ideas. Ando pointed towards the kanji for “nursing care” and told me that it incorporated the kanji for “human hand” and “human eyes.” Thus the way that “nursing care” is written in Japanese necessarily focuses on the idea of human involvement – excluding the work of any automatic product from being part of the idea of nursing care. I absolutely loved this moment of learning how Japan’s ancient writing system influences reactions to medical devices today. That’s what this project is all about.

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It might be really cheesy that I kept this piece of paper and photographed it, but here you go.

But for the most part, it seems that nurses are grateful for the help that HOSPI offers. Ando stressed that HOSPI has separate tasks from the humans, which is a key factor of its success – it does the grunt, time-consuming work of sorting and delivering medications, allowing the nurses to focus on doing actual nursing work that only humans can do.

“What about the patients?” I asked. “Are they comfortable with the idea of robot care?” Ando said that, based on a survey done by Japan’s National Institute, 85% of people don’t hesitate at all with care robots. Ando said this is mostly due to positive representations of robots in Japanese media such as anime, but that when it comes to care robots, people want robots that are less human-like. He said that people have the impression that anthropomorphic or humanoid robotics are meant to be friends, and when they are in hospitals, they don’t want their friends taking care of them – they want the support and precision of tools. They respond better to simple-looking, machine-esque robots. HOSPI could have been designed to look like a human, but instead she looks like a clean, classic robot – well-suited to the hospital environment. I wonder, too, if patients would have a negative reaction to human-looking robot because of the uncanny valley phenomenon (which, by the way, was first tested by a Japanese roboticist in the 1970s).

Finally, I asked Ando what makes Japan so healthy and what that has to do with technology, if anything. He made a distinction here: the older, super-ageing generation is healthy, while the younger generations are less so. He said that the elderly are healthy simply due to their lifestyle of eating well and exercising enough. But in his opinion, the younger generations eat less healthy food and spend less time exercising – mainly because of the negative effects of technology, especially television and the internet and smartphones.

“So do you think technology helps people be healthy or not?” I asked – after all, Ando does work in the field of healthcare technology. He said that while the prevalence and popularity of technology has a negative effect on peoples’ health and fitness in Japan, it can have a positive effect on peoples’ illnesses. Once people are already sick and in the hospital, said Ando, technology can begin to have a positive effect, such as the effect of robots like HOSPI.

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I really had a blast talking to Ando and meeting HOSPI in person.

Getting my alone time in Osaka

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A bridge at the Sumiyoshi-taisha Shinto Shrine.

I arrived in Osaka on Easter Sunday, though of course no one celebrates it here. Wandering around Osaka that evening was my first time really being alone in Japan, and I wasn’t used to that, so it felt a bit odd and lonely. But soon I relaxed into the feeling, and enjoyed it. I remembered how it felt when I arrived in Sweden by myself so many months ago, or when I was off on my own in Kerala.

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I’ve talked about Osaka once before, when I traveled here for just a few hours with my friends on a day trip from Kyoto. It’s Japan’s second-largest city, and fairly dirtier and funkier compared to Tokyo.
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Osaka street art.

I was reminded that the only thing that connects all these random places, besides my project, is myself. I like being off on my own, and in those moments, sometimes I think I could quietly disappear into the Watson. I don’t know how else to describe that feeling, except maybe that’s my way of keeping this going forever.

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It was when I saw this scene that I first thought of Sweden.
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More from Sumiyoshi-taisha Shrine.

I’ve been listening to the podcast S-Town as I travel around (it’s currently #1 on iTunes and I highly recommend it!). The podcast centers around the life of an “antiquarian horologist,” a restorer of antique clocks, and, appropriately, one of the podcast’s themes is time. The profession of antiquarian horology, as I’ve learned from S-Town, is dying because time is so accessible now on smartphones and watches.

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Osaka’s “Tsūtenkaku” tower.
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It was raining when I visited Osaka Castle on my sightseeing day (my other days in Osaka were filled with project meetings). See the castle in the background?

It got me thinking – what does that say about the relationship between humans and time? Now that it is so easy to check, at any moment, what the exact time is down to the nanosecond, do we relate to time differently then we did before? Does this hyper-awareness of the passage of time at all affect the way we approach life? I realize these are ridiculous exaggerated questions, certainly the product of traveling solo and having too much time to think (heh). But what I’m saying is that what’s important here (to me, anyway) is not the measurement of time itself but the way people relate to it.

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This is the Osaka I saw when I was there the first time – neon lights in the Namba / Dotonbori district!
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Dotonbori again.

I don’t think it’s enough just to talk about medical devices, or embedded systems, or the topics of space and time; what’s interesting is how do people relate to these things, and why, and how can we make them in a way so that people have the most positive reaction? How is a medical device interesting if you’re not thinking about how people will use it and how it will impact their health? None of these things matter without that framing (and of course none of it would exist without the people to make it; even time would be a moot point without people to experience it, frame it, and measure it). I’m sure this all sounds obvious – my project has been about the “human response to medical technology” since I designed it over a year ago – but it’s still fun to think about, especially extending that thinking to other disciplines.

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One of Osaka’s specialty regional foods is takoyaki, grilled balls of battered octopus (this octopus is holding one in its tentacle).
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A street vendor making takoyaki.

Anyway, that’s all, and if you celebrate Easter, I hope you had a lovely weekend!

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Hōzen-ji Buddhist Temple, Osaka.

That time of year again…

Yesterday I submitted my report for the third quarter of the Watson: 9 months in, 3 to go. This is what I wrote (warning – it’s long!).

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Tokyo’s Midtown area.

I’m writing this from a park in Kichijoji, a small trendy neighborhood on the outskirts of Tokyo, and it’s the calmest I’ve felt in a while. The cherry blossoms here have been in full bloom all week, and now their short period is ending – the trees are turning from pink into green, scattering their petals all over the ground. When I submitted my last quarterly report in January, I was still in India. Since then, I’ve participated in a health camp in rural India, closed the chapter on my long and demanding visit there, spent a quick two weeks in Singapore, and traveled to Japan. I’ve been in Japan now for nearly 8 weeks now, and I have another month to go.

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Sakura petals have been blanketing everything lately.

One of my last weeks in India, I traveled with a company I had interviewed in Bangalore to the tier-two city of Bhopal up north. For five days, we joined a group of volunteer doctors who had traveled there to do “health camps,” one-day pop-up clinics in rural villages around the city. Each morning we got up early to pack a bus with basic medical equipment and travel the 1-2 hours to a predetermined rural village, where we registered villagers and gave them basic care based on their complaints. I was one of the few non-Indian and non-Hindi-speaking attendees, and along with my complete lack of medical training, it all made the event a hugely humbling one. My job was to administer blood tests using a small device, and it was my only time on the Watson actually operating a medical device rather than interviewing someone about one. I saw firsthand the fear that comes with a lack of awareness – adults scrunching up their faces in anxiety and pain in response to a little finger prick, the same way kids do with pediatricians. As many interviewees had told me, lack of awareness is one of the biggest barriers to acceptance of medical technology in India.

By the time I left India, I was exhausted. I had done everything I wanted to do, and I was ready to leave – or so I thought. It’s still hard to say goodbye, and I struggled with that my last day there, especially leaving Mumbai. I had left and returned to Mumbai so many times by that point that it was starting to feel like some kind of home. The further along the Watson gets, the more people I meet and the more friends I say goodbye to. I thought my presence in these places would be too transient to make real friends, and I’m thrilled that hasn’t been the case, but it certainly doesn’t make it easier.

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Art at Nittele Tower, Tokyo.

Then I arrived in Singapore, a late addition to my project. I decided to go while I was in Qatar because I learned there that Singapore was ranked by The Lancet as the second-healthiest country in the world, and by the WEF as the world’s most “technology-ready nation,” and I wanted to know why. I allocated only two weeks there because Singapore is small and because I wanted to stick closely to my original Watson itinerary.

I was amazed by the nation-state when I arrived and a bit disillusioned with it when I left. First of all, I realized that two weeks is not long enough to spend in a country for my project (the four weeks I spent in Qatar were a good minimum). It takes time to grow these “connection webs” – the networks that form when you embark on interviews, when you finally meet the right person who connects you to an opportunity somewhere else, or links you to another person to interview, and so on. The opportunity to do the health camp in Bhopal, for example, was several months in the making. It was frustrating in Singapore to learn that two weeks simply isn’t enough. At the same time, Singapore is tiny, and I was fairly ready to leave after two weeks. I didn’t get a great sense of attitudes towards medical technology there, but I did learn some things through my few interviews. It seems that Singapore’s high health ranking is mostly due to the tight control of the government over its small population and the fact that Singapore’s nationals form an even smaller, high-income group that can afford good healthcare. I actually started to notice a lot of parallels between Singapore and Qatar, as both countries have many expats and migrant workers, as well as highly involved governments. Though Singapore is certainly “technology-ready” and a tech-enhanced city, most medtech companies there are using the city as a Southeast Asian hub, with large manufacturing facilities taking advantage of the low taxes. There are very few start-ups or products tailored specifically to Singaporeans.

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Not what I expected to find in Tokyo! An American apple pie restaurant appropriately named “Granny Smith.”

By the time I came to Japan, I was excited to do something different. My time here has been characterized by homestays, far more so than in any other country. Nine of my twelve weeks in Japan are spent living in Tokyo with two Japanese host families that I found via a Swarthmore alum. My nightly fee includes both breakfast and dinner, and this complete immersion into family life (especially with families that speak minimal English) has been new and wonderful. I spend less time writing on the blog or setting up project meetings, but it certainly seems worth it for the way I’ve gotten swept up in day-to-day life here.

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I went on a nighttime boat tour of Sumida River with my host family. This is the Tokyo Skytree building disappearing into the fog!

I’ve loved jumping into life here as though I’ve always been in Tokyo. I took a full-time Japanese class for two weeks, which was a great way to have structure outside of the project and feel like a Tokyoite commuting in the city. Those two weeks constitute my only language study on the Watson, so I’m happy that I was able to do that here. The week after my class ended, two of my best friends from home came to visit me in Japan and we had an amazing time traveling together – in addition to the week around Christmas when my parents were in India, that’s the end of visits for me. Immediately after they left, I traveled with my second host family to Okinawa.

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A beautiful green walkway that stretches for many blocks – very close to where my homestay is.

With all this going on, and group travel unlike what I’m used to on the Watson, I’ve had fewer project meetings than in other countries so far. But since Japan is so different from anywhere else I’ve been, I think it has been helpful to go slow in terms of seeing my surroundings and setting up meetings (even though I wondered at first if it was too slow). Also, now that I’ve done so many interviews in general through the year, I feel like I know how they go. It’s been tough feeling like I don’t have as many revelatory ‘wow’ moments as I used to, either with myself or the project, but I suppose that’s natural. I’m getting answers to my questions that surprise me less and less frequently.

So at this point in the Watson, now that I have many meetings and travels under my belt, I rely less on one-on-one interviews than I used to and more on myself and my observations, trying to pick up on relevant nuances and how they compare to what I’ve seen. I’ve enjoyed this slow absorption of Japan, joining the population by being packed into a rush-hour metro train or making the pilgrimage to one of the many parks ripe with blooming cherry blossoms. I like living this way, spending time with my host family, learning the seemingly irrelevant attitudes – the very safe, low-risk style of life; the strong sense of a common collective; the appreciation for anything cute (kawaii!); the intense corporate culture – that do indirectly affect the way people respond to medical devices and the field of medical technology as a whole.

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Shinjuku

Now that I’ve done my project in four countries, I’m quicker at understanding how cultural trends complicate attitudes towards medical technology, which is good even if it makes interview experiences less novel for me. That’s why I like mixing up “project events” so that it’s not always the same interview after interview by going to trade fairs or even touring the showrooms of big tech companies. Although, one thing that’s nice about interviewing people in this stage of the Watson is that I can add something to the conversation, too. People are curious to know what I’ve learned so far, and now that I’m in my fifth country, it turns out that I have a lot to say! I definitely prefer having an exchange of information rather than a one-sided interview – I feel like I’m giving something back.

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Speaking of Japanese culture…See the young woman he’s holding in his hand?

In summarizing my experience so far to my interviewees, I’ve realized that I’m so impressed with Sweden. It may be order bias with Sweden as my first country, but as a main point of comparison, few countries measure up to it. I thought Japan would blow me away in every project-relevant department – health, technology, quality of life, innovation – but Sweden is doing just as well in those areas, if not better. Japan does have a lot of fun technology, but I don’t think it’s very well integrated with healthcare. Traditional corporate culture and social hierarchies still reign in Japan, and combined with a risk-averse business mindset, that means that the cute robots here aren’t always being used for health applications, and those that are cannot prove that they are making a positive impact on the population. It’s definitely complicated, and it’s been fascinating to see all these contradictions in Japan that I wasn’t expecting – I feel like I’m really getting to know the place.

All that said, the pace of meetings here in Japan is finally picking up. I’ve done three interviews since returning from Okinawa, and I just planned two weeks of solo travel to meet with researchers in Osaka and Nagoya. It’s odd to me that I haven’t done any solo travel in Japan since arriving here – that’s the Watson bug! – so I’m looking forward to going off on my own again.

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Mt. Fuji as seen from the window of the shinkansen bullet train. It took two months of being in Japan for me to see it, and then I whizzed past it at 160 mph!

One thing that’s really hard about being at this point in the Watson is that it is hard to stay unaware of the end. I don’t want to think about going home, but it’s an unavoidable fact that this is the last quarterly report I will write while on the Watson. If I let myself go there, I worry about coming home, getting a job, and adapting to a non-Watson lifestyle. But that’s distracting, so I try not to think about it, and instead focus on how happy I am that it’s turned out so great so far. I have to say that I’m still stunned by how kind everyone is. People, even people I barely know, continue to be unendingly and exceedingly kind to me. That’s one thing I never want to get used to (or worse, come to expect). It’s all too wonderful and strange.

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Speaking of wonderful and strange, this enormous clock was designed by director Hayao Miyazaki (and it definitely looks like something from his films). Four times a day, it grinds, whirrs, and clanks to life on the hour, and it’s so much fun to watch all the little pieces move – like the people in the bottom right tending to the mini fire.

 

Sakura Time

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Sakura at the grounds of Tokyo’s Imperial Palace.
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Minato, Tokyo.
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A guard at the Imperial Palace.

Every spring, the Japanese celebrate hanami, which is sakura (cherry blossom) viewing. I was told that Japan’s famous trees bloom only for a week out of the year, and I was determined not to miss them. In fact, I mostly based the timing of my three months in Japan on sakura. It sounds crazy, but they bloom at a different time every year and only for a week, and I wanted to make sure that week fell during my visit! So when my host mom casually told me a few weeks ago that “oh, we might miss the cherry blossoms in Tokyo while we’re in Okinawa, oops” – in Okinawa, full bloom comes and goes as early as January – I got a bit nervous. Could it really be that quick?

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In some areas, the blossoms are surprisingly dense.
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This is in the neighborhood of Naka-Meguro. Everyone takes loads of pictures – and all the same one – but I couldn’t resist joining in!
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This is what they were photographing, by the way.
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See the green pushing through these rain-heavy blossoms? It’s evidence of what is soon to replace these beautiful flowers. I actually like them better with some green mixed in.

Well, the answer is yes, it’s very quick, but we didn’t miss them! We came back to a Tokyo in the midst of full bloom and covered in little pink petals. Over the course of 4 days, I took nearly 100 pictures of cherry blossom trees. I definitely went overboard (and I certainly won’t share all of them here). I’m not much of a flower person, or a nature person for that matter, but these trees are beautiful. It’s also hilarious to see the massive groups of people walking through the trees, taking photos, and having hanami parties (essentially, alcoholic picnics under the trees).

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Hanami in Shinjuku.
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Evidence of hanami – the most trash I’ve seen at once out in Tokyo!
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This guy keeps the crowds under control.
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In the Shinjuku Gyoen National Garden. The best time to see sakura is on a rainy and foggy day like this one, when fewer people are out! 

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The cherry blossom season is often used to illustrate a Japanese fascination with fragile and delicate beauty, especially beauty so fleeting. I definitely agree that there’s an appreciation here for the delicate, whether that’s the cherry blossoms, or tiny pastries, or food flavors in general, or tiny exquisite designs on manicured nails. I suppose it even manifests in the traditional gender roles here – it’s definitely a thing for women to be ultra-delicate and feminine.

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Well, the cherry blossoms are certainly fragile. It makes for a beautiful scene: as you walk under the cherry blossom trees, the slightest breeze sends individual petals off the branches and swirling around you, ultimately blanketing the ground you’re walking on. But it also makes it evident that the cherry blossoms are soon to fade, even though the way in which they settle down on all of Tokyo makes them seem more durable.

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Check out how many petals have already fallen to the floor! The rain accelerates the process and thus shortens the period of full bloom.
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The Chidori-ga-fuchi Moat, surrounding the Imperial Palace, is lined with sakura.
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This is in Naka-Meguro. It was hard not to smile on such a lovely day! (Photo credit to my friend Soichi).
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Last shot from Shinjuku Gyoen. 

Okinawa

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I don’t think I’ve ever seen quite so many shades of blue in such a concentrated area of ocean – the water in Okinawa was beautiful.

Okinawa, Japan’s southernmost prefecture, has always been at the top of my Watson to-do list. Comprised of one main island and many smaller islands, it’s considered one of the healthiest places in the world – even healthier than the rest of Japan. It’s called a “Blue Zone” for being one of six regions in the world where people have extra-high life expectancies (https://www.bluezones.com/2016/11/power-9/). Japan’s overall life expectancy is 80/87 male/female, already quite high, but in Okinawa those numbers reportedly stretch to 84/90. Of course, I’ve been curious for months to go there and see what, if anything, makes it feel remarkably healthy.

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With my host family, I spent 3 nights on the main island and 3 nights on a smaller island, Ishigaki. This is the lush greenery of Ishigaki, which I found to be incredibly stunning.

Also, as an American, I felt that it was important to go to Okinawa due to its complicated history with the US. For the 27 years following the end of World War II, Okinawa was under the occupation and rule of the US Military Government. Even though the US “returned” Okinawa to Japan in 1972, there are still many bases in the prefecture and thousands of US military personnel stationed there. When our plane landed in Naha, Okinawa’s capital, this became an immediate reality – though the little oval window, I saw military aircraft using the same airport as the commercial planes like ours.

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The water was many beautiful shades of blue but also incredibly clear.

So, when my host mom suggested a trip to Okinawa in the spring, of course I said yes! She said that she likes to go there for vacation. It was reassuring that Okinawa was her choice of destination – it confirmed the idea that this place is considered a rejuvenating, or even particularly healthy, area in Japan. I was thrilled to be able to tag along with my host family on their vacation to a spot I had learned about because of my project – and hopefully see it through that lens while I was there.

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As it turns out, I’m a bit taller than my host mom and her 9-year-old son! This is the Shurijo Castle, the historic site of Okinawa’s old kingdom. It was first built in the 15th century and has been rebuilt a few times since (most recently post-1945).
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Detail at Shurijo Castle.
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More from Shurijo Castle, which is on the main island.

Many people, when answering my question of what makes Japan so healthy, say that it’s the diet. Okinawan food is Japanese food with an even healthier spin. At meals, my host mom pointed out “no calorie” and “no sugar” foods every so often. The food in Okinawa is all about fresh vegetables and fruits from the area, as well as seaweed and particularly protein-heavy tofu. In Tokyo, the fruit is imported and crazy expensive; the colder climate leads to a heavier reliance on meat, fish, rice, and potatoes.

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The main attraction of Okinawa’s main island is the aquarium. 
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This octopus would instantly freckle all over if you got too close to the glass! Luckily he wasn’t angry when I took this picture.

My host mom described Okinawa as “practically a different country from Japan,” and it’s easy to see why – Okinawa is geographically distant from the rest of Japan and has also been politically separate from the country for most of its history. There’s even an Okinawan language (in addition to, and different from, the “Okinawan Japanese” dialect spoken in the prefecture).

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My host family and I took this driverless golf cart up to a lookout tower. Talk about fun tech – though you can’t tell in the photo, the golf cart was definitely moving at this moment!
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I found Ishigaki to be far more beautiful than the more highway-heavy main island. Every corner of Ishigaki has green.
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We also went to a stalactite cave in Ishigaki. I had never been to one before, but I loved it! It took a full 30 minutes to walk through the section of the cave that was open to the public.
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Being in the caves felt super sci-fi, as though we were walking on the set of an alien spaceship.

In addition to the food, I’m sure that the relaxing lifestyle in Okinawa contributes to its health standard. In terms of what makes Japan unhealthy, I often hear people speak negatively about the work culture. Especially in Tokyo, people tend to work very long hours, and it seems like their main source of exercise is going up and down the metro stairs (which, to be fair, often involve multiple flights both ways). In Okinawa, and especially in Ishigaki, I saw none of that stressful urban work culture.

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A juice stand in Ishigaki. This lovely woman made us fresh juices from lime, pineapple, and sugarcane. (“No added sugar!” my host mom pointed out). 
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Something that’s come up a few times since I arrived in Japan is that the Japanese people are apparently risk-averse. I don’t know if that’s true in every sense, but I have never seen a playground map with 30 different explanatory labels on it! (I don’t know if I’ve ever seen a playground map, period).

Okinawa seemed to have a lot in common with Hawaii, being the geographically distant island paradise state of its country (of course, there’s also the WWII connection). But Okinawa is supposed to be the epitome of health, whereas I never thought of Hawaii as being so healthy. I decided to check out where Hawaii falls on a list of all 50 states ranked by health. To my surprise, Hawaii wasn’t only in the top ten, but it was ranked #1! It’s held that ranking for the past 5 consecutive years, apparently the healthiest state in the US due to a number of different factors (with MA and CT following as 2nd and 3rd in 2016; from America’s Health Rankings 2016 report). So maybe there is something to island life in the Pacific. Certainly this longevity is not due to medical technology.

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My favorite photo from the trip. This is at the lookout by Ishigaki’s northernmost point.

Health post: Medtech Expo 2

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I ended up with a lot of stuff from this expo – mostly handouts advertising the participating companies (99% in Japanese, of course). Here you can see my business card, stapled onto my admission tag for the expo!

The second expo I went to at Tokyo Big Sight was called CareTEX, and it was all about health technology for the nursing industry. I saw a much wider range of health technology there than I had seen before, since CareTEX was specifically focused on technology for health and medical purposes (unlike the first expo I attended, which had many categories under the umbrella of tech and design). CareTEX even had a “special exhibit counter” with booths for all the companies making nursing care robots! I saw multiple different robots, wearable devices and patient monitoring solutions; hearing aids, sanitizing equipment for hospitals and clinics, special gloves for arthritic patients, and more. I also saw some of the same devices and equipment I had seen at the last expo, such as wheelchairs (although more varieties) and massaging machines.

(Note: This post is a follow-up to my most recent post, here, about the first expo I went to).

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Patient lifting systems for hospitals and home care.
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More patient lifting systems by another company for bathroom use.

I also saw some health products that were not so obviously related to technology, such as different brands of face masks, workout clothing with special fabric blends, underwear for incontinence patients, and even food. I was a bit confused by the food – there seemed to be a few stalls promoting healthy meals and giving out samples – and my guess is that they are food suppliers for hospitals. Another company was giving out mini paper cups filled with treated water (which was intriguing to me, as the tap water is drinkable all over Japan. That said, my host families here have both used water filters, so I suppose there’s something to being extra cautious).

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One of the food booths displaying set meals.

As at the first expo, much of the information was in Japanese. But still, since it was an expo showcasing Japanese companies for Japanese customers, I’m almost glad that it was difficult to navigate using only English. I wish I could have fully participated by asking people questions in Japanese, but the extent of my usage of the language at the expo was to say things like “Hello! Do you have any information in English?” Usually the answer was no, but I still tried out a few products and spoke to the English speakers I did come upon.

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This is an assistive glove for people with arthritis or other problems causing weak grip. I tested the glove by putting it on and picking up a water bottle (pictured at the far end of the table here). Once the finger pads came in contact with the bottle, they gradually applied pressure to it until I was gripping the bottle and able to pick it up without any of my own effort. While this is cool and works well, the glove is very obvious when worn. I can’t imagine any arthritic person wearing it outside, and I think it would be a tough sell for anyone with a stigma against assistive devices.
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More on the glove and its potential uses.
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This is the Sanbot, a Chinese-made robot that is used in home and office settings in Japan. The team representing Sanbot at this expo was promoting its applications in health, such as Sanbot’s ability to detect someone falling at home and alert the appropriate resources. According to the website, Sanbot has the “power of cloud-enabled robotics and AI for Retail, Education, Healthcare, Hospitality,” and more. Also – this seemed very Japanese to me – the Sanbot has multiple LED “eyes” that are designed to show a range of oddly specific emotions such as “shy,” “wronged,” “dizzy,” and “sleep.”

I found a rare English speaker at the booth for Sivantos, a large worldwide hearing-aid company. This man at Sivantos told me that 14% of the people in Japan with hearing impairments have hearing aids – compared to 50% of hearing-impaired people in the U.K. I asked why, and he said that hearing aids in Japan are very expensive, with the government barely covering the reimbursement cost. He also added that there is a stigma against revealing that you have a disability. (If there is a stigma in Japan against small hearing aids, which I thought were pretty normalized across the globe at this point, I really can’t imagine someone using that assistive glove here).

In response to this stigma, Sivantos has made a range of colorful hearing aids to get people excited about using them, especially children. This reminded me of Cochlear, who offers a similar set of brightly-colored and patterned cases for the external part of the cochlear implant. The man I was talking to also pointed out Sivanto’s advertising – he gestured to a long banner depicting an older man with Japanese text and asked me “Do you know who that is?” I didn’t, but he is apparently a famous Japanese skier who wears hearing aids, which were invisible in the photo. The Sivantos man said that more Japanese people will feel comfortable with hearing aids if they know that this celebrity wears one and is okay with promoting it. It was cool to see a company adapting and responding to its cultural environment – that’s really what I’m looking for when I survey these companies.

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Maybe these colorful wheelchairs were trying to combat stigma the same way as Sivantos.
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This is the Telenoid, a small baby-esque robot made to mimic human presence. I’m not sure what the health benefit of that is (perhaps companionship for mental health patients?), but this guy totally creeped me out.

One of the biggest devices I saw at this expo was a large dining room table with an oversized tablet built into the surface. Loaded onto the tablet is a basic swiping-on-the-touchscreen game that gets faster and more difficult with each level (I tried it out). The company told me that the goal of the game, and the tablet in general, was to engage elderly people living at home. They said that elderly people at home often have limited mobility, so they end up spending large amounts of time sitting at the dining table with nothing to do, which can be lonely and frustrating (and of course in Japan, there is an enormous elderly population). The aim of this table, with this game, is to give those people something to do and also help them keep up their motor function.

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The people I talked to about the tablet-table, pictured at the bottom of the shot.
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Advertising handout for the tablet-table, with a cartoon of elderly people happily sitting around the table and playing the game.

It was a big operation – the table and tablet both looked custom-made, which would make the whole device very expensive, and of course it was physically large. While I appreciated the sentiment behind the tablet-table, I had never heard of anything like it, and I thought to myself that maybe there was a cheaper or simpler way of addressing the problem at hand. The table hasn’t hit the market yet and will apparently be ready in July, so it’s impossible to say how it’s been received by real users or if it will face success or failure in the market. I asked the people at this company if they had done any user testing (to see how potential users might react to the table and if they feel as though they would benefit from having one). I’m not sure if my question really got across the language barrier, but the company people said that they would do user testing in July – the same time as the product’s release date. If that’s right, that means no, they don’t know how people will react until they start selling the table. That is a ton of development for a large table that is probably quite expensive…and no user testing to verify that this is a product needed or wanted by the elderly population.

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This was an automatic plastic-packer for trash at hospitals and clinics so that the germs and odors of items such as adult diapers could be fully sealed before being thrown out. I saw it in action and it worked very well. This company was one of many focusing on infection prevention at the expo, which is definitely a cultural thing here (with all the face masks and so on). The person manning the booth told me that the device is currently mostly in Japan, but that’s because “Japan probably has more nursing homes than anywhere in the world,” which wouldn’t surprise me.

I saw an overwhelming array of products that day, many of them cool and some of them crazy. But by the time I left the expo, I was starting to become disillusioned about the amount of fancy tech I was seeing. There are so many competing companies that are all doing cool and interesting things. Once I saw my seventh care robot, I started to wonder: when is the market saturated? At what point do you stop?

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This guy was super cute and spoke to me in Japanese, but I have no idea what his function is.

Most importantly: how do you actually ensure that you’re improving people’s health? As amazing as these devices are, I’m not always clear on how they actually help people. These ideas and products cost a lot of resources and money, and I’m not sure if all that expense is justified. I wonder if some of those resources could be spent on effecting more direct change, like increasing government subsidies for hearing aids or lowering hospital fees. I’m reminded of an early project conversation in Sweden, in which a wheelchair company recommended that I ask medical technology companies the following questions: a) how do you verify that there’s a real need for your product (that your idea is good, and original, and address a real problem), and b) once you’ve made the product, how do you validate it to make sure that it works well and fixes that problem? Ideally a company would have good answers for both questions. Their methods for verification and validation, or lack thereof, can be quite revealing. In Sweden, the discussion of human factors or ergonomics came up often, and most companies seemed to care about doing user-based testing to keep in touch with their users’ needs at every step in the design process (which would be the verification step – the answer to question a) above).

So, it’s clear that Japanese companies are into cool innovation. But are they into ergonomics? That doesn’t seem to be the case. Does that mean that the care robots, and all the other fancy health tech I was excited about seeing, doesn’t really have an impact on people’s health here? It’s hard to say.

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Lastly, there was a Birkenstock booth at this expo! Since when do Birkenstocks count as medical devices?