This blog chronicles my travels as a 2016-2017 Thomas J. Watson Fellow exploring cultural attitudes towards health technology around the world. Starting from and returning to New York City, USA, I am traveling to Sweden, Qatar, India, Singapore, Japan, and Botswana over the course of one year.
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.
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.
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.
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.
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.
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!
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.
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!
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.
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.
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.
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!
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).
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.
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?
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).
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.
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.
Early yesterday morning I said goodbye to the friends who came to visit me, and tomorrow morning I fly to Okinawa, Japan’s southernmost island, with my new host family. These are certainly busy times, and I’m glad to be seeing more of the country than just Tokyo.
I’m incredibly lucky that two of my best friends in the world were able to come visit me in Japan, all the way from NYC, while I’m on the Watson (as I was when my parents came to India for Christmas – though this is the end of visits for me!). I showed them around Tokyo for a few days, which was a blast since I’ve been here for a month now, and then we went to Kyoto with a half day trip to Osaka. We saw a ton and took literally thousands of photos and videos, so what I’m sharing now is only a quick summary of the highlights, but it’s something.
Kyoto and Osaka were not as different from Tokyo as any of us were expecting. We were all picturing these non-Tokyo cities as far smaller and less urban than they were, and we expected Kyoto to be mostly old architecture, shrines, and populated by far more kimono-clad women. Well, Osaka is Japan’s 3rd-largest city and Kyoto its 7th-largest, so we had the wrong idea!
As for Osaka, we only spent an afternoon there, but we had dinner on the Dotonbori “food street” – and it was hilarious. This area of Osaka has packed pedestrian streets, huge funky illuminated signs, loads of casinos, and cigarette butts lining the sidewalk gutters (a very unusual sight in Tokyo and Kyoto, where smoking on the street is generally prohibited and the sidewalks are impeccably clean).
It wasn’t until that evening in Dotonbori that I finally saw what I had imagined of Tokyo. My image of Japan was always two-faced: I would think of tradition, politeness, and organization, but also of bright lights, dark urban underbellies, and various futuristic sci-fi movies. More than Shinjuku or Akihabara in Tokyo – the typical ‘bright lights’ areas – Dotonbori in Osaka fit that latter idea.
You may be wondering: what about that core part of the Watson, the project? I’ve been in Japan for over a month now and written only one project post, though there are a few meetings and events I haven’t written about. It’s tough to do my project with so much group travel, constantly moving around (that is, more than I already do solo on the Watson), and getting wrapped up in the family scheduling and “cultural immersion” that naturally accompanies homestay life. Luckily, I was able to have a project interview last week while my friends were here in Tokyo. Though I was bummed that the timing meant that I had to leave them for an afternoon, I was ultimately very glad to have a chance to interview someone (especially after 2 weeks of staying busy with my Japanese class rather than project) while giving my friends a chance to explore Tokyo themselves.
In other news, I feel like I’ve been talking with a twinge of sadness lately – in Skype calls to my parents, letters to my friends, and certainly my last blog post – and I wanted to address that briefly. Of course, it was sad to say goodbye to my host family last week, and I think the reason that blog post came out in such a sad tone was because the difficulty of leaving them surprised me. Even now, I’m at my new homestay, typing in a house in the same neighborhood I left a week ago.
But overall, I think it’s just that I’m a bit tired. There’s been a lot going on, and in the past week and a half, I’ve finished Japanese class, traveled around with friends I hadn’t seen in a long time, moved to a new homestay, and started packing for another weeklong trip. I had an amazing time last week, and I’ve been excited about Okinawa since I picked Japan as a project country, but it still gets tiring sometimes. It’s also a lot of traveling with people, and while I enjoy that immensely, I’ve gotten used to solo travel on the Watson, and I think there’s something very refreshing about it. Also, like I’ve mentioned, the solo nature of the Watson makes it sound like you won’t be saying goodbye to people, and as I’ve said, goodbyes are hard and exhausting – but I would always rather have the goodbyes along with everything else, the hellos and the being together, than no goodbyes at all.
I suppose what I’m saying is yes, the Watson is tiring, perhaps especially once it’s been going on for 8 months. But that’s okay, and that’s expected, and I love it. I’m so happy to be able to do these things, to have my best friends visit and to travel with a Japanese family (and it’ll be interesting to experience those juxtapositions). I really wouldn’t have it any other way.
I’ve been in Tokyo for over 3 weeks now, and there’s still so much of the city I haven’t seen. But as I mentioned in my last post, I’ve been happy taking this Japanese class every day. Though the routine has put a pause on my city-wide exploring, it’s allowed me to explore in a different way – getting to know the surrounding neighborhood in depth, talking to my classmates, nailing down my commute through the crazy underground complex that is Shinjuku Station, and learning about the culture through language. Returning home to dinner with my host family every evening completes this sense of ‘normal day-to-day life’ that I’ve rarely encountered on the first 8 months of the Watson.
I would love to take the class for more than 2 weeks, which is the school’s minimum, but it’s expensive – and as I mentioned, it does take time away from researching project connections and trying to set up meetings. For that reason, I couldn’t justify spending much more of the Watson grant on the class than I already am, though Watson fellows are allowed to take language classes while abroad. I figured that I should try language study in at least one of my six Watson countries, and Japanese was a good fit since I’ve always been intrigued by the language and the culture, and I’ve wanted to study a language with a different alphabet (or 3, in the case of Japanese), and finally, I think English has the least amount of mileage here compared to the other countries on my list.
Anyhoo, before my class today, I was on a mission to get business cards. Yep, business cards, or “meishi” in Japan (often translated to “name cards”). I’m going to a trade show tomorrow here in Tokyo that will showcase various nursing products, including the healthcare robots that inspired me to name my Watson project “Robots & Gizmos: Interfaces of Health.” Though the expo is free admittance, I have to show up with proof of my pre-registration (a printed email) and two business cards. I’m not sure why – I suppose I’ll find out tomorrow – but of course my first thought was, well, I don’t have any business cards.
A while ago, someone told me about a meishi-making machine in Shinjuku Station, the station I now travel to every day for class. A machine just for making business cards – could I be that lucky? I searched online and found a video from a few years ago of an American using such a machine. I watched the video, which printed 30 business cards for 1000 yen (just under $10), and memorized the look of the machine. Once I arrived at Shinjuku station, I looked around at all the machines. I was surrounded by metro-pass machines, ATMs, and even coin lockers, but Shinjuku Station is big and confusing; it took a good five or ten minutes of scoping out the scene to find the meishi machine, nestled in next to a photobooth machine (for passport or school photos) in a quiet spot. I was thrilled to find the machine exactly as it was in the video I had watched. Of course, being designed for Japanese business men, the whole interface was in Japanese. The first button I hit caused the machine to immediately spit out my 1000 yen bill, and I tried that a couple times before realizing it was the ‘cancel’ button.
There were about 20 one-sided black-and-white designs to choose from, none of them very thrilling or aesthetically pleasing, and I picked one but couldn’t figure out how to add my email address. Eventually I navigated back to the first screen, picked a less interesting but less confusing design, and I managed to figure the rest out. Basically, I pushed a lot of buttons until it made sense. Luckily no one else was waiting to use the machine! Once I was done, the machine started sputtering out the 30 cards one by one. One little plastic flap was all that stopped them from flying out of the machine, which looked fairly old. At this point, bending down to peek at the growing stack of cards, I was cracking up. Then finally I had all my cards! I was surprised at the quality of the cards – obviously not cardstock, but thicker than regular paper.
According to the internet, meishi are a big deal in Japan, and there are all sorts of rules about how to use them in the most polite and formal way: say “はじめまして” (“hajimemashite”, or “nice to meet you”) when giving your card, never give a wrinkled card, always accept someone else’s card with two hands and a bow, etc. Well, my meishi certainly lack any interesting designs or features, but I’m interested to see how this all comes into play.
Later in the day, feeling bolstered by the success of my business card printing, I went to a 7-11 over my lunch break to print the aforementioned pre-registration email. The 7-11 stores here have a system called “net print” that allows you to create a free online account, upload various documents and/or photos from your computer at home, and print them at any store. 7-11 stores are all over Tokyo (along with the other brands of konbini, or convenience store), and most of them have a big Kinko’s-esque printer. I uploaded my pre-registration email in the morning, and in the afternoon, I typed the ‘reservation code’ corresponding to my document on 7-11’s printer screen. I put in my 30 yen (about a quarter’s worth of cash), and voila, it started printing…a photograph. The long, type-heavy email I needed as a printout for the expo was coming to me in 4×6 glossy form. I’m not sure what button I mistakenly pressed to have that happen, but I needed to get back to school for my next class, so here’s hoping it works! Well, you win some, you lose some.
Anyway, all of this – the business card machine in the busy station, the net-print system in the convenience stores – is obviously for the large ‘businessperson’ culture here. In a city like Tokyo that is so focused on work, famous for its insanely crowded rush-hour trains, it makes sense that there would be such conveniences for the city’s career-focused individuals. But I also feel like this is a uniquely Japan thing, and I wonder why. I can’t imagine a business card machine in New York’s Financial District. Wouldn’t you just go to a Staples or a Kinko’s and get your cards made there? Even if you needed them day-of, as I did, I’m sure you could find an express service at these places.
I think these conveniences exist here not only to be extremely practical for the average Tokyoite businessperson, but also to save customers the trouble of needing to talk to someone in person. Maybe it’s time consuming to have a conversation with someone, and it can be a bit awkward as well. Japanese has multiple layers of formality, and when a customer and a shopkeeper interact using the language, they will use many polite words that complicate and lengthen the conversation. I’m not saying this is a bad thing at all – I think it’s lovely, and it’s nice to know exactly what’s appropriate to say in such situations – but I can imagine that it gets a bit tiring. So maybe if you’ve just had a packed commute, and you’re rushing off to a business meeting where you will be using a ton of formal language, you want to get your business cards without having any extra interactions. That would also explain why the trains, where most people are on their phones wearing earbuds, and restaurants, where many customers eating alone at lunchtime and may have ordered by pushing a button, are so quiet – small moments of peace and minimal interaction and no need to worry about word choice in a city as busy as Tokyo.
Many people in Singapore were surprised when I mentioned its new ranking as the world’s second-healthiest country (according to The Lancet). I’m still not sure why. One person scoffed and said “Oh, it’s because they don’t let anyone into the country who isn’t wealthy.” This actually makes sense, as the government-mandated “insurance” program Medisave operates like taxes; 13% of your income automatically funds an account locked away for medical costs, so the higher your income, the more hospital visits you can afford. What about people with little to no income, then? Someone at the Singapore National University Hospital told me that Singaporeans with incomes that fall below certain tiered levels can get additional need-based funding, though she acknowledged that those that just miss the cutoff – with incomes only slightly above the mark – struggle the most.
Much of Singapore is new – the expats, the skyscrapers, the governmental influence. I felt that the government is making a big effort to create a sense of shared culture and history, which is great but also means that Singapore seems to be lacking some of the tradition that roots other nations (this is not to say that Singapore hasn’t had inhabitants for centuries, but rather that Singapore has changed a lot over the past few decades and become a melting pot for many different cultures).
One expat in Singapore said to me, “You know it’s a bad sign when the older generations are cooler than the younger generations.” In her experience, older Singaporeans have some interesting “back in my day…” stories to share, while the younger Singaporeans tend to be more law-abiding and well-behaved. As an expat in the creative field, she sees this as a less-than-inspiring trend. With life in Singapore being so easy, it makes sense that there would be few motives for revolution and innovation; I’m reminded of the adage that “necessity is the mother of invention.”
In terms of the implications on medtech development, then, that explains why there aren’t as many medical device start-ups in Singapore as one might expect. Though many international medical technology companies are coming to Singapore, it seems like the focus is more on business and marketing rather than research and development; more about good sales and less about inspired invention.
Despite the incentives for Singaporean start-ups put forth by the government agency A*STAR, as I mentioned a couple weeks ago, I only read about a couple local medtech start-ups. I asked someone about this at Abbott Laboratories, a global medical company with an office in Singapore (they do, in fact, have an R&D center in Singapore, but 95% of their focus in the country is manufacturing and marketing). “Is it because A*STAR is a relatively new organization, and they haven’t had time to fund start-ups yet?” I asked. “No, it’s not that new,” my interviewee replied. “Oh,” I said, frowning. “So it’s just…” I trailed off. “Not panning out,” I said eventually. He couldn’t explain it either. “Yeah,” he said, shrugging and laughing in return.
I’m still not sure what factors contribute to Singaporeans having a more positive or negative reaction to medical technology. I suppose the reaction is generally positive due to the country’s high standards of education and safety, as well as the familiarity with technology one develops simply by interacting with Singaporean infrastructure on a day to day basis. But Singapore has multiple different ethnic groups (mostly Chinese, Malay, and Indian) and lots of expats as well, so it’s challenging to make generalizations for “all Singaporeans.” Singapore has a lot of surprising commonalities with Qatar, actually – both are very small nations with a high proportion of expats; both have highly involved governments that drive healthcare agendas; and both are dealing with fairly recent booms in wealth (Singapore, perhaps, dealing with it better than Qatar is), leading towards similar health problems – increasing rates of diabetes and cardiovascular illnesses along with an increasing proportion of elderly citizens.
Of course, my main challenge with the project in Singapore was timing. I had 5 meetings in two weeks, a few of them with very similar companies, and that wasn’t enough to give me a broad picture of Singapore’s medical device space and what works in the country as opposed to what doesn’t. I realized that two weeks simply isn’t long enough to build the ‘network of understanding’ that I try to create in each country. In India, that building process was very slow, and it wasn’t until I had spent a few weeks in the country that I finally found the right opportunities, and met the right people who could connect me to other people, and so on.
Though my project would have benefited from more time in Singapore, it’s a small enough place that it wouldn’t have been thrilling to spend much longer than 2 weeks there. Either way, I’m glad I went, and now I know – I’m excited to have a full 3 months in Japan to take things slow, hopefully making those connections and growing that network.
Singapore lights up at night, sort of like Disneyland: strategically placed lights in neon colors illuminate every well-designed nook and cranny of the city. In a way, that makes the city at night feel more futuristic and less realistic than the city during the day.
Singapore is very much a transition point for me between India and Japan, which are my two biggest Watson countries in both size and importance. By devoting 3 full months to each, the plan has always been to make India and Japan the “cornerstones” of my Watson year. Singapore thus serves as a stepping-stone between these countries, not just geographically but emotionally and culturally as well.
Maybe for that reason, I’ve been thinking a lot lately about what it means to be in the second half of the Watson year. I’ve gotten very accustomed to Watson life, which is a bit sad; part of me misses the way I felt when I first arrived in Sweden, the mess of emotions that included how I felt about my college graduation, profound wonder at the nature of solo travel and my sudden freedom, and nervousness and excitement at the full year ahead, with zero expectations. Well, now I’m in my fourth country (and Singapore is certainly an easy one to be in), and I know how this goes. I suppose this is the kind of thing that you never want to get used to, and that’s why it’s so important to keep packing up your bags and moving on – but that also serves as an indicator that time is passing, and maybe I don’t want the time to pass so quickly, either.
Even the challenges of being by myself and setting up project meetings have quieted, either because I know what to expect now or because it’s gotten easier as my network grows (probably both). Friends I make in one country connect me to their friends in the next, and companies I’ve worked hard to meet in one country might have an office in a future country on my list and set up the contact. Since I’ve been more social as the year has progressed, I’ve spent less sustained time by myself – I feel like I’ve spent less time reflecting, arriving at fewer and fewer “grown-up” realizations. I don’t know if this means that I’m not growing as much on the Watson as I did at the beginning; I hope not, though the Watson definitely gets easier as it goes along. Maybe (hopefully) I’m simply growing in less obvious, immediately-out-of-college ways, learning things more subtle and nuanced as opposed to grand and profound.
Now that we’re in 2017, I can’t help but wonder where I’ll end up by the end of this year. I don’t want to think about post-Watson life yet, but it’s certainly on the horizon, and I have no idea what’s next. While that’s been true since I started the Watson in 2016, it’s merely been an exciting thing to think about – the future, that is – but once I start planning for it, which I should do within the next few months, I’ll be acknowledging the approaching end of the Watson. At this point halfway through the Watson, it’s difficult to disentangle myself from it and objectively assess what I’ve done so far, but I really hope that by the end of it all, I’m happy with all I’ve done and seen, with no regrets.
Anyway, there’s still a lot left to do, and I think Japan will certainly bring its set of new challenges. While I wish I could still say that I have no idea what to expect, and isn’t that thrilling (though quite honestly, that was something that terrified me just before starting the Watson), I do know what to expect now, and I’m looking forward to it.