Botswana: First impressions

The Batswana – the people of Botswana – refer to the country as “Bots,” and I love that. Gaborone is pronounced Ha-borone-y, but this city has a nickname too: Gabs. I’ve already been here for ten days, and I can’t believe it. Time flies by faster as the Watson goes on, I’m sure.

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I flew from Tokyo to Doha (back to Qatar!), then from Doha to Johannesburg, and finally from Johannesburg to Gaborone on this little plane.

Botswana is a huge change from Japan. The population here is about 2 million people; 10% of them, 200,000, live in Gabs. Japan has 127 million people with 13 million living in Tokyo alone. I knew that Gabs wouldn’t be nearly as urban or pedestrian-friendly as Tokyo, nor as safe. I even read a mildly alarming email from the US Government suggesting that visitors avoid walking around solo at all.

Luckily that email was over-cautionary (though I still won’t be walking around in the nighttime), and after a couple days in Botswana, I started to feel at home. The transition from Japan was quicker and easier than I expected. I don’t know if that’s because I’m used to transitions now, and better at adapting quickly to new and foreign places, or because the people here are so friendly and easy to talk to in English – probably both!

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Botswana is quite sparsely populated.

The surrealism of the Watson is often lost on me these days, though I frequently marveled at the lovely strangeness of it all in my first few months. It’s become an odd routine – of traveling, landing someplace new, figuring out how to get a local number, taking a couple days to figure things out and feel safe – that I’ve learned to repeat in each new country or even city. Each new destination gets easier to manage, and each unexpected interaction or step along the way seems less like a snag. That in itself is exciting and surreal, though, knowing that I now feel comfortable walking into pretty much any situation and making it feel like home.

Of course, this is the end of the proverbial road, and I won’t be traveling to another new country after Botswana. But that’s not to say the U.S. will feel exactly like the place I left, and maybe this new-country-routine is something I can apply, on a much smaller scale, to my return back home and whatever “reverse culture shock” awaits me there.

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Cracking up in this teacup at an empty amusement park here called “Lion Park.”

Speaking of home, I just extended my stay at an Airbnb here by an additional 7 weeks – the remainder of my time in Botswana. Though I might travel out of Gaborone over the next couple months (in fact, I just did yesterday), it’s always nice to have a home base. I can leave for a night or a few and come back while leaving some of my stuff in a place that I know is safe.

Anyway, this is a big milestone for me because it means that I’ve figured out a place to stay for every single night of the Watson year. Just before I left for Sweden, I only had a few weeks of housing figured out, and it scared me. I had to set up all my own accommodation for 365 distinct nights, and I didn’t know where I was going to be – and at the same time, my friends were moving into apartments with yearlong leases. I knew that I would be okay figuring things out day-to-day on the Watson year once I got over the hurdle of where to stay night-to-night. Now that I’ve booked these last 7 weeks, that’s it. I’ve done it – I found a safe place to stay every night of the Watson and stayed in budget while doing so. I’m tempted to say that it was easier than I expected, but maybe that’s just in hindsight.

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The Central Business District of Gaborone. It’s really mostly buildings under construction.

Finally, the stars here are just beautiful – Gaborone must have the least light pollution of any city or town I’ve been in this year. (If I could capture them on my camera, I would certainly post a photo). I keep getting distracted by them at night. I don’t think most of the Batswana notice.

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The 10 Shrines of Tokyo (A goodbye to Japan)

A friend of mine in Japan told me about the Tokyo Jissha, the ten shrines of Tokyo, a couple weeks before I left. In 1868, at the time of the Meiji Restoration when Tokyo became Japan’s capital, Emperor Meiji chose ten Shinto shrines scattered throughout the city to be the sanctuaries for the new capital. Every shrine and temple has a unique stamp (goshuin) that can be written in a special stamp book (a goshuin-cho), and my friend had decided collect the stamps of the Tokyo Jissha in her goshuin-cho. I decided to get a book of my own, and traveling to these 10 shrines during my last days in Japan to collect goshuin felt like a pilgrimage to say goodbye.

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goshuin stamp I got at this golden temple in Nikko, a town close to Tokyo.

Just because I keep leaving doesn’t mean that it gets easier to let go. I left Japan a few days ago and I’m still wrapping it up, cleaning it away. I feel like I have to do this spring cleaning every time I leave – change my number, close the tabs of “medtech companies in Japan,” tell my friends I arrived safely, and then drift out of regular contact with them. Is it easier to leave, or to stay? I’ve become someone who leaves and I don’t know how I feel about that.

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“The 10 Jinga of Tokyo.” This was at Hikawa Jinga, the first shrine I visited out of the 10 and where I got my goshuin-cho book).
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Hie Shrine.
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Up the stairs of Hie Shrine.

The thing is, as much as I live in these places and learn to love them and get to know their people, I don’t really belong. I’ve become increasingly aware of the fact that no matter how long I spend abroad, I won’t become Indian or Japanese or Singaporean. I need to take all that I’ve done this year and bring it back with me to places I do belong. I want to know what my project would be like in the US – what impact I could have on medical technology there, where I can invest the time.

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This is my goshuin-cho. Each stamp in the book is unique – it has the name of the shrine and the current date. It takes a few minutes to get a stamp because you have to wait for the shrine attendant to paint it in.
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A bridge in Nikko.
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Kanda Shrine, probably the most popular shrine of the ten.

But I’ve gotten used to leaving everything behind every few months, and I wonder how that will manifest when I’m back home and trying to build something more permanent. Perhaps I’ll find that it’s easier to keep seeing new things, rather than to try finding new aspects of old things.

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The Kameido Jinja is very serene, and the Tokyo Skytree building is visible in the back.
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My favorite of the ten was the Nezu Shrine, with all these torii gates.

I was worried that my fleeting presence in various places this year would make people feel distant, but it hasn’t. Especially in Japan, where I was worried about the formality of the polite language, I learned that so much warmth can be imbued between the words of formal speech. It’s still hard to know, without speaking the language, if you’re doing things right or just the recipient of excessive politeness, but I’ve gotten closer to people than I expected to.

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I also traveled to Kamakura, a town very close to Tokyo, right before leaving. This is the country’s second-largest Buddha.
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The Buddha is hollow, and it’s cool to go inside and see how the different pieces were fused together.

Still, I’m getting tired of saying goodbye. I’ve arrived in Botswana now – my last project country – and that feels right. I’m used to leaving places, but I don’t want to be; it’s actually comforting to know that this cycle of coming and going, goodbyes every few months, is ending soon. I’m excited to spend two months here and explore one more new place. Also, on a lighter note, it’s lovely to be in a country with fluent English speakers!

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At the entrance to the big Buddha temple: “Stranger whosoever thou art and whatsoever be thy creed, when thou enterest this sanctuary remember thou treadest upon ground hallowed by the worship of ages.”

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A few days before I left, I finally found the prototypical Japanese garden scene in Kamakura. I really had a wonderful time in Japan and learned a lot about the culture there, and I’m also happy to keep moving forward.

Health post: Tying the threads together

In Japan, any time you walk into or even near the door of a shop, you’re guaranteed to hear “Irasshaimase!” It essentially means “welcome to the store and come on in.” I’ve heard it in so many iterations by now: the full, exuberant call to any visitors; the periodic, slightly robotic “irasshaimase” called out by shop workers to no one in particular; and the occasional, tired, not-quite-there “…shaimase.” Sometimes, the call of “Irasshaimase!” is so happy and charming that you can’t help but smile in return. Other times, I walk past a store and ignore the dully repetitive “irasshaimase” calls along with other Japanese passers-by.

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This is Hakone Jinja. Over the weekend, I went to the nearby town of Hakone with my host family.

For the most part, this welcome call is polite and lovely, and I see it as indicative of many trends I’ve noticed here: the feeling of a common collective, a strong work culture, perfectionism, and a charming consideration of the feelings of others. The way that every single shop and restaurant worker says it – whether they sound happy about it or not – means that every shopping experience starts with a welcome, and I feel like that fits in well with the strong collective culture I’ve felt here. Generally, once you figure out how these interactions go in Japan, they will always go the same way.

There’s also a surprising amount of talking that, in the shop example, might start with “irasshaimase” and continue at the register with far more Japanese than you’d expect when buying a pack of gum, as the shop employee hurries through a certain set of phrases (I wish I knew what they all meant). There’s an idea that someone is much more likely to carry out a task correctly – that is, perfectly – if they verbally reinforce each required action. This recent article perfectly describes this phenomenon as it applies to Japanese train workers, who call out what they’re doing even when no one is listening as a way to reinforce the performance of the required task. Of course, this is an example of the perfectionism and work culture.

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While in Hakone, my host family and I went to this great open-air museum. This photo of my host mom and me was taken by the dad of the family!

I’m soon leaving Japan, and I’ve had many meetings here for which I haven’t written individual posts. I wanted to share some highlights from those meetings and focus more on the themes I’ve noticed from them, such as the perfectionism and work culture as I’ve already mentioned. Based on what I’ve seen, and of course in terms of health and medical technology, I think the most significant cultural trends are respect of hierarchy, conformity, and risk avoidance.

Hierarchy

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Jizo statues, little protectors at many temples.

From what I’ve gathered, hierarchy is quite important in Japan, and hierarchy often correlates with age. I met with a Tokyo-based company called Allm (for “All Medical”) that offers a platform of multiple smartphone apps to increase efficiency in healthcare. Their main product, an app called Join, serves as a secure messaging service between doctors. Through Join, doctors in different areas can share ideas and expertise – for example, a doctor might send an X-ray through the private app to a more senior remote doctor, who can then give immediate feedback and advice about what to do next with the patient. The woman I was interviewing at Allm, Ms. Kudo, told me about the difficulties they’ve encountered when encouraging doctors to use the app.

When I asked her what specifically impacts the usage of the Allm app, she said “In Japan, we really care about hierarchy.” The younger doctors always follow the elder doctors, she explained. If the more senior doctors say no to something – such as the usage of a new app – “that’s it,” she said. Allm company members often travel to expos to promote the app, and if older doctors say it’s too difficult, they have a very hard time selling it. Adoption and acceptance of new medical devices can hinge on an influential decision maker – I’ve learned that medical technology companies often try to find these “ambassadors,” perhaps an influential doctor who is excited about the new technology and can convince their hospital to purchase it. Ms. Kudo told me that, for Allm in Japan, those ambassadors always have to be the most senior doctors (the highest in the hierarchy, who also often happen to be the oldest as well).

This respect for the hierarchy also complicates the group-chat aspect of the app, where doctors can discuss cases and share knowledge and advice. Ms. Kudo told me that the younger doctors become shy in the group, not wanting to ask questions, because they don’t want to seem foolish or ignorant in the presence of more senior doctors – their bosses – who are also on the chat. They’re very worried about screwing up, said Ms. Kudo, even if the senior doctors would have the answers they seek. I was sad to hear this since, of course, I would much rather have a younger doctor ask a somewhat silly question than never learn a crucial tactic; I feel like asking questions is seen as a necessary part of the education process in the US.

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A band of robots at the Toyota Museum in Nagoya.

Someone in Sweden once told me that, with technology being so pervasive, even grandparents were considered uncool or out of the loop if they didn’t have cellphones or use computers. In fact, the word they used was “hermit.” I expected the same in Japan – if Japan is known for being a technologically innovative country, with so much exciting technology everywhere (such as the robots in stores), why doesn’t that extend to, or influence, the older generations? (I asked Ms. Kudo this question, and she was decidedly stumped).

Now, I think it is because of this respect of hierarchies and the elderly in Japan – the younger people would not ask the elderly to keep up with all the new technology, as they are expected to in Sweden. There very well might be Japanese nurses and doctors that are eager and excited to use an app in their work, but if their older and higher-up bosses disagree, their voices might go unheard because the respect of the hierarchy is so strong. In Sweden, however, I noticed that there was little respect for hierarchy and more of an effort to treat everyone as a peer. One Swedish doctor who had been practicing for decades told me that, when a patient mentions something they read on the internet about their condition, he’s not going to tell them they’re wrong – he’ll sit down with them and have a conversation about it, and maybe learn something new himself. I don’t think that would happen here.

A subtler issue here is that, if you’re trying to sell medical technology to someone who has been doing their job well for the past 40 or 50 years, they might have a harder time seeing the use of an additional tool (or worse, be insulted by the implicit suggestion that a medical device would improve their work).

Since younger generations are typically more interested in using new technology than older generations, having the senior people be the decision makers with regard to medical technology probably means that adoption will be slower here than it could be. I thought the mere ubiquity of technology in Japan would lead to high acceptance of medical technology, but I was wrong. There might be cute robots in stores (which are very technologically advanced), but that doesn’t mean that all the less-advanced tech (like smartphone health apps) will be as popular. Using a cute robot at a store is a very different interaction from using a smartphone app every day, and maybe the culture here is more excited about the former rather than the latter. I was expecting some “trickle-down technology acceptance” – that because of the appreciation of robots here, people would want all areas of life to be technology enhanced. But that’s not how it works. Technology is not everywhere here, and there’s still a lot of value placed in tradition and ancient culture (for example, I see many young people visiting and praying at the many shrines and temples Japan).

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Taking the escalator up to the huge Hie Shrine in the middle of high-rise Tokyo.

Conformity and Work Culture

The collective sensibility is something I’ve noticed in many aspects of Japan, even walking the streets of Tokyo. For example, street fashion in New York City is all about standing out – doing something completely unique and bold and different. In Tokyo, I’ll see friends meet up with each other, and they’ll all be wearing iterations of the same outfit (really, it’s crazy how often I see this). Japan is not a particularly diverse place, and I get the sense here that fitting in – conforming to certain looks and roles – is highly valued.

It’s hard to know exactly how the sensibilities of a corporate culture and common collective impact reactions to medical devices; perhaps it’s simply that there are fewer individualist and innovative start-ups here adding many devices to the market. With a strong corporate culture, doing one’s job well in the same company for many years is rewarded. In the US, however, we reward individual success and the ability to quickly commercialize a new innovation.

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Dr. Mukai of Meijo University and his ROBEAR, a healthcare patient-lifting robot that is used purely for research and will most likely never work in a hospital.

In one meeting, I spoke with an American named Marty who has a start-up here in Tokyo called enTouch KK. He talked about how there might be fantastic research happening at universities, but that the results are not commercialized. The job of the professor is not to commercialize research ideas and move into business, but rather to write as many papers as possible and start working on the next research project. Marty said that since the professors are proud in what they do, they don’t feel the need (or want) to commercialize it. Their success is already measured by the research itself, and with that aspect of professorial work perfected, there’s no need to bring ideas beyond the university. (This is not to say that there aren’t professors trying to commercialize ideas and collaborate with businesses; I met a few professors in Osaka who are trying to do just that. They did, however, discuss the difficulty of being surrounded by professors who have no interest in business).

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This is Professor Nakane of Osaka University, who is trying to commercialize his idea of applying the mathematic theory of homology to the medical problem of tumor detection.

In the US, however, we’re trained to take any idea farther and think: how can I commercialize this? How can I monetize it? Marty taught me an old saying from Japan: “The nail that sticks out gets hammered down.” I was so stunned, I started laughing at how absurdly dramatic the saying is. It describes an attitude that I see as a stereotype about Japan that may have been true a few decades ago, so I was surprised to hear that sentiment echoed in Tokyo in 2017. Marty did not mean that it applies to all scenarios, of course, and he did say that it was an old saying – but it’s still a sad one.

I had heard about Japan’s corporate culture before I arrived, and I had this 1970s scene in my mind of men all wearing the same black suits, walking through Tokyo with the same black briefcases. It’s not quite that intense, but the idea of the “salaryman” persists well into 2017. If not directly related to medical technology, I do think the corporate culture has an impact on health – a few people have told me that if there is anything unhealthy about Japan, it’s the work culture, the long hours and commitment to doing your job perfectly (as opposed to trying to stand out and jump up the ranks). At the very least, I do think it’s connected to the lack of more health start-ups.

Risk Avoidance

The small number of medical start-ups here is also due to a fear of risk. The very first person I met in Japan, a doctor, told me that the most important cultural aspect of Japan with regards to medicine is that people are risk-averse. This manifests both in people, who take extra care to be safe in their everyday lives, and in companies, who seem hesitant to build invasive technologies (as most medical devices are).

The day to day risk aversion is evident in the stereotypes of Japan such as the wearing of face masks (which people do, but not everyone). People also avoid direct sunlight, and everywhere I’ve been has felt extremely safe. I honestly think that part of why people live so long here is because they avoid risky or dangerous activities, staying safe throughout their lives. (There are unhealthy habits as well, though, such as the prevalence of cigarette smoking; and yet Japan is not ranked as a country with high lung cancer rates, whereas the US is: source).

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At one of Hakone’s most sulphuric destinations, workers give you little cloths at the station: “To prevent accidents occurring due to volcanic gases, please be sure to cover your mouth and nose with the wet cloth.”

I interviewed someone at a big Japanese medical technology company that produces non-invasive equipment for hospitals and patients living at home – nothing invasive or implantable. He said that those types of devices are seen as too risky and that, for example, no Japanese company makes pacemakers – medical companies here want to avoid any potential of failure. Everyone he knows in Japan who uses a pacemaker, he said, has one from Medtronic (from Ireland) or some other globally recognized brand.

Professor Yoshizawa, of the bioethics department at Osaka University, told me the same thing – that while there are many robots in Japan, most of them are for communication and business because companies are reluctant to put a robot in a healthcare space where the risk and consequences of failure are much higher. He said that most medical devices in Japan (especially those that are implanted or provide treatment) are generally imported from the EU and US, while Japanese companies make non-invasive monitoring systems for diagnoses and check-ups because they’re safer. Professor Yoshizawa said that if one Japanese-made device causes any harm, the company will be attacked by the government, media, and general public and their whole image destroyed, so there’s no room for error – better to just avoid the risk altogether, and therefore Japanese medical companies focus on prevention and fitness. (Personally I find this a bit frustrating, because being at the forefront of medical technology does involve some trial-and-error. But it makes sense that a stereotypically perfectionist culture would want to avoid such errors – and perhaps this idea of only using extremely well-tested invasive technologies from abroad does make people healthier).

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Iridescent glass “leaves” at the Hakone Venetian Glass museum.

Risk avoidance also leads to fewer start-ups, which are inherently risky endeavors. Marty, of enTouch KK, said that start-ups are just beginning to become more popular in Japan (of course, they have been very important in the US for many years now). Investors in Japan are “very, very cautious,” he said. As opposed to the US, the idea of start-ups and angel investment is not normalized in Japan – though it’s starting to be – and there are not as many start-up success stories to inspire young entrepreneurs or give confidence to potential investors. Marty said that Japan’s most recent corporate success story was Sony (founded in the 1940s). Many of the small, innovative medical devices I’ve seen this year have come from smaller companies and local start-ups, so maybe in a few years, when start-ups are more common in Japan, there will be more medical devices in development – but for all that to be true, there would have to be more comfort with risk-taking.

Well, that’s that. It’s been fascinating seeing the interplay of these attitudes, and Japanese culture in general, and how some of it affects the way people approach medical devices.

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The Zōjō-ji temple near Tokyo Tower.

Last week in Japan

A week from today, I will leave Tokyo and travel to Gaborone. I don’t exactly know what to say or how to express my feelings (I’m not sure I know what I’m feeling), but I did want to post and share some photos from Fukuoka. I visited Fukuoka between project meetings in Osaka and Nagoya, and Fukuoka is the city from which I visited Hiroshima and Miyajima as well.

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At the ruins of Fukuoka Castle in Maizuru Park.
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Lantern at the Sumiyoshi-jinja Shinto shrine, just across the street from my Airbnb.
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A surprisingly beachy area at the outskirts of Fukuoka.

Fukuoka is a friendly town and quite small compared to the other Japanese cities I’ve seen. It’s easy to explore most of the city center in one day on foot, which was a refreshing change from the immensity of Tokyo, where even after many weeks here there’s still so much to see. I’ve spent the majority of my time in Japan in Tokyo, but as I’ve described before, my time in the capital city has been spent with host families and really trying to blend in with daily life. As I’ve avoided trying to be a tourist, I almost feel like I’ve seen less here than in the other cities. But I think it’s simply that Tokyo is more of a mega-city-complex than one city, and seeing everything (including the many possible day trips from Tokyo) was never going to happen over the span of a couple months, not with project meetings and language classes and host families thrown in the mix. I’d still choose the project and host families, though – this “Watson style” travel – over seeing all of Tokyo in one go!

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Fukuoka had beautiful flowers all over the city – lovely city planning.
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It’s also a canal city with many bridges.
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Looking at this building, I didn’t feel like I was in Japan anymore.

It’s still hard feeling as though I’m leaving things unfinished, and I wonder if I could have made more of my first month here. That’s the Watson, though – you have to pack up and go, whether you’re ready or not. I’ve been quite ready to leave every country I’ve traveled to so far this year; I’m not sure I’m ready to leave Japan. Of course, I hope to come back, and I am beginning to get excited and curious about Botswana – a good sign that it is, in fact, time to move on.

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Fukuoka’s ACROS building.
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Sunset over Fukuoka’s river. Far off on the right are yatai, the canal-facing food stalls for which Fukuoka is famous.
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Each yatai has a simple Japanese menu and about 10 seats. The idea is that people will come here to eat and drink and mingle with the other diners. After waiting a while for a seat, I joined a stall full of Japanese customers and had a hilarious Japanese/English conversation with my nearby diners.

Thinking about the project meetings I’ve had here, I’m fairly happy with the range (professors, doctors, people at start-ups, and people at larger corporations), but I still had a much wider range in India over the same time span (all of the former, along with ashram gurus, visits to hospitals, NGO workers, and more). I’ve wondered many times this year about order bias – how the order in which I’m visiting these countries is impacting my experience in them. I think my expectations get more defined (and thus more critical) as time goes on. As the year progresses, the end of each country visit fills in another detailed segment of the once-blank canvas of “What could this year look like?”. It’ll be a strange feeling at the end of Botswana when that painting is well and truly done – when I no longer have any questions about a year that once loomed before me in its uncertainty.

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A short train ride from Fukuoka is Dazaifu, a city of mountains and temples that’s perfect for a day visit over the weekend.
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At Dazaifu’s main shrine.
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I had never seen a tree supported by wooden slats before.

Also, I think it’s been a bit challenging to “break in” in terms of my meetings in Japan because of the language difference, which has been more difficult here than anywhere else. There are also simply fewer medical technology start-ups than I expected due to the ever-strong corporate culture. Maybe there’s something else, too, something I can’t quite put my finger on – but there’s some distance I haven’t always been able to break through when trying to schedule meetings and so on. I often get the sense here that Japan has such a unique culture and has so much figured out that it doesn’t need the rest of the world.

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A quiet area in Dazaifu.
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I managed to find my way to the top of one of Dazaifu’s nearby mountains.
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Overlooking Dazaifu city.

Of course, my time here has also been complicated by the fact that I’ve wanted to come to Japan for so many years – I was always going to have high expectations for my time here, as well as feel slightly pulled between wanting to see as much as I could, making the most of my time here, and figuring how best to approach my project. I suppose no span of time, then, would ever be enough!

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I loved the late-blooming pink-and-green sakura trees here (Dazaifu).
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Dazaifu had a lot of beautiful nature.

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On the way to RoboSquare, far from central Fukuoka.

While I was in Fukuoka, I made a point to visit the “RoboSquare,” a center showcasing various Japanese-made robots. I wanted to go because I had read that they had a Paro, a Japanese care robot made to look like a fluffy seal who has helped dementia patients worldwide. I contacted the government organization that made Paro a reality and was never able to get an interview, so I wanted to see it in person. (The agency is AIST: Advanced Industrial Science and Technology).

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Paro was “sleeping” when I first saw it, but after I petted its head (as the RoboSquare attendant instructed), it slowly lifted its head up and to the side, blinking its big eyes and making cute noises.

RoboSquare was a small room in a shopping complex, but it was still exciting to “meet” a robot I had read about months earlier. As far as robots go, it’s nice that Paro is soft and fluffy all over (though the big black eyes looked a bit creepy to me). There was an information card next to Paro that explained how the robot has been used in pediatric wards, nursing homes, and hospitals. AIST conducted studies that proved that both children and elderly patients had improved mental states and lower stress levels after interacting with Paro. The Paro robot has been around for over ten years now, so hopefully AIST can continue to sponsor more health technology projects in Japan.

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I also met this robot, which has nothing to do with healthcare but still caught my attention. This is the Japanese-made SR-01, a search-and-rescue robot that helped find missing people on 9/11 in NYC, over fifteen years ago.
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For some reason this was at the RoboSquare as well – a software platform that dresses you up in the outfit of your choice! I love space stuff, so I decided to be an astronaut.
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Last shot from the Fukuoka beach area. My guess is that this is a fancy resort, but I’m not sure.

Health post: Beautiful capillaries

In Osaka, I met with Dan Takeno of Kekkan Bijin, which means “vascular beauty.” His company’s device is essentially a microscope that observes peoples’ blood flow in a non-invasive 5-minute procedure. The scope focuses on the capillaries under the thin skin around people’s fingernails, and it displays the nature of the blood flowing through them in real time (while also digitizing the image to capture information in numerical form). The idea is that this procedure will indicate health; healthier people will have straight, clear capillaries through which blood flows easily, and less healthy people will have twisted, jagged and/or thick capillaries (perhaps indicating a blockage in a particularly thick spot).

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Mr. Takeno with the device, plugged into an LCD monitor.

Takeno’s father developed the device in 2001 after being diagnosed with cancer. He decided to supplement his cancer treatment with alternative healing, taking supplements, and drinking more water. Takeno’s father wanted to know if and how these alternative treatments were affecting his health but could find no quantitative measure. He became frustrated that there was no easy, trackable indicator of his general health – something he could have been watching even before his diagnosis. Doctors always check blood pressure and body temperature, said Takeno, but this doesn’t add up to a simple, one-stop “health index.” To get a full snapshot, his father would have to go to the health diagnosis center, spend $500 for a complete checkup, and lose half a day’s worth of time. How could this be simpler, cheaper, and faster?

Takeno’s father ultimately collaborated with a man named Dr. Ogawa, who started research 6 years ago on the potential of capillaries being an indicator for health. Takeno’s father read his book and decided to apply the idea to a machine. He was successful, selling 2,000 machines to Eastern medicine (EM) pharmacies and eventually to doctors. “Eastern medicine?” I asked. Well, Takeno replied, the device is still based on non-Western ideas. Sitting in an office in one of Japan’s busiest metropolises, meeting about a health device that looked like a scientific instrument, I was surprised that we were discussing non-traditional medicine.

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The nearby Sukunahikona Shrine, showcasing its health products for sale.

Takeno told me that Eastern medicine is quite popular in Japan and that many women he knows go to EM drugstores and healers (such as chiropractors). After our meeting, he showed me an Eastern medicine drugstore that was just a block away from the office, selling herbal ointments and the like. Across the street from the drugstore is the Sukunahikona Shrine, enshrining both a Japanese god of medicine and a Chinese god of medicine – the shrine also sells some of its own alternative treatments. I didn’t realize that alternative medicine was so popular in Japan, and it’s hard to find statistics about this. But I did learn that kampo is the name for Japan’s version of Chinese Traditional Medicine, and that a well-known university here in Tokyo – Keio University – has a center for kampo in its medical school.

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“Unhealthy” capillaries on the left and “healthy” ones on the right. (Source: Kekkan Bijin website).

For now, Takeno says, his device falls under the umbrella of alternative medicine. “Western medicine is science,” he said. “This machine is not science – yet.” But he expects that it will move into the realm of Western medicine, mentioning that the first researcher of capillary health was German – “and their history of building microscopes is good,” he adds (I couldn’t find any history of this type of capillary observation online, so I’m not sure). This reference to German medicine reminded me of my first meeting in India with the company that offers a homeopathy service. They also mentioned that the Germans invented homeopathy, which is true – a German scientist invented homeopathy in the 18th century, but the practice has long been written off as pseudoscience by Germany as well as many other nations. Still, based on some apparent global trust in German science, the homeopathy company used the German origins of their product as a way to legitimize it.

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The traditional medicine shop around the corner. The sign in the window advertises treatments for high blood pressure, diabetes, PMS, back pain, insomnia, and more. It also mentions the opportunity for an online consultation.

Next, we discussed Takeno’s ideal users for the device and the reactions he’s gotten so far. He said that he has received more enthusiastic responses to his product from women than from men. Based on his experience in Japan, men don’t want to hear bad news or learn about bad health, but many women do want to know. This is partially due to the media, he explained – many female-oriented magazines and TV shows in Japan advise women to get regular health checks. Some even specifically recommend getting arteries or capillaries observed (Takeno showed me a huge stack of these magazines in the office). These broadcasters and magazines, he explained, say that having a healthy blood flow is important for beauty and young-looking skin.

So Kekkan Bijin currently markets its device to women, but Takeno hopes that once many women start checking their capillaries, men will want to do it too. “I think people are comfortable” with the device, he says, and he’s gotten all positive responses so far. “People want less technology – this is easy to use and not expensive,” he said, almost as though he was distancing his device from the idea of technology (or at least from the idea of a complex medical machine, which would perhaps not fit so well with the Eastern medicine I mentioned earlier).

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Capillary length vs. age for men and women. (Source: Kekkan Bijin website).

Takeno told me that, due to the connection between healthy capillaries and younger skin, the device results can be used to predict someone’s age. The graph above shows the correlation between average capillary length in nanometers and age in years (the red line is for women and the blue line is for men). Takeno went on to explain the cultural consideration here, starting with the fact that age is very important in Japan. Since it culturally important to respect anyone older than you are, you should know the ages of the people with whom you interact. Takeno compared this to America, where age is less important – we care less about an age-based hierarchy, rather celebrating people based on merit, individualism, and innovation, especially if they’ve managed to accomplish a lot at a young age. However, in both countries, it’s rude to ask someone’s age. So in Japan, where knowing someone’s age relative to your own is important for navigating an interaction with them, what do you do? I had never thought about this being a potential issue in Japan!

Of course, it’s a very unlikely use case that you would have the opportunity to measure someone’s capillaries and use that result to determine their age – but it’s an interesting side benefit of the device.

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Here, Takeno is focusing the scope over my pinky finger.

Finally, of course, I had to test out this machine. Takeno adjusted the scope over the tip of my ring finger, but it wouldn’t focus (apparently because I had used hand lotion that morning). As he was focusing the device over my pinky finger instead, I began to get nervous. Well, as it turns out, my capillaries are definitely not perfectly straight, though they aren’t terrible either. I’ll have to ask my doctor about it when I get back to the U.S.!

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The strained smile here is a product of my uneasiness at seeing my own capillaries on display.