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.
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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.

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. 

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?

Health post: Medtech Expo 1

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Tokyo Big Sight, a bit removed from Tokyo’s main neighborhoods, hosts all the big conventions and expos in the city.
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It’s definitely equivalent to the Jacob Javits Convention Center in New York. (I can’t help but compare every aspect of Tokyo to its equivalent in NYC!).

I like mixing up my project meetings so that I’m not always interviewing people in offices, and one fun way to do that is to go to expos (trade shows) to get a broad sense of what companies are currently doing in the field and what’s popular. My time in Tokyo has luckily coincided with two healthcare expos at the big exhibition hall Tokyo Big Sight, and I was able to attend both for free by pre-registering online (and, for the second one, by getting those business cards). There was a lot of technology for healthcare at these events – I was happy to see loads of “care robots”! – so I wanted to post about my experience.

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Nescafé was at the expo advertising its new, helmet-shaped espresso machine. At this expo, all new technology was welcome. I was just happy to get some free coffee while wandering around the booths.

I’ll use two posts to share some thoughts and photos from these expos. This post is about the first trade show I attended, which focused mainly on “retail technology” and technology design in general. Along with retail, this expo had subsections such as health, transportation, and home living.

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These people are discussing a set of exercise equipment for children.
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Lots of companies had booths where their products were set up for testing. These “medical chairs” look super comfy, and based on some browsing of their website in Google Translate, they use artificial intelligence and vital sign monitoring to help people with muscular issues via personalized massages. Their website mentions ‘shiatsu,’ which is apparently a Japanese preventive care method focused on applying ‘finger pressure’ to key points on the body.

Appropriately, then, I stumbled upon the “Good Design Award” area, which showcased various winners of the 2016 Good Design Award in Japan. There were nine award categories, each of which had a few winning products. The competition committee had outlined these “essential Good Design Award perspectives on design trends” to demonstrate that the winning products were not only well-designed, but also that they addressed a relevant social concern. The nine “focused issues” were: the environment, urban infrastructure, community, medicine and health, security, education, business models, culture, and technology (IT). Of course, I was on the lookout for well-designed technology in medicine and health, so I made a beeline for that part of the room.

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Perhaps another ‘shiatsu’ product? I loved to see that this elderly man was trying out the product.

In the Medicine & Health area, there was a big block of Japanese text printed on the wall. Luckily I found a small booklet with an English translation, and I read this text, which was an introduction to the topic and a discussion of the winning products by a man named Takahiro Uchida. I learned that he is a cardiologist who has consulted for medical device startups in Silicon Valley, and now he is the CEO of a Tokyo-based incubator for medical innovations.

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I tried out a product too: NTT Docomo’s fat-burning analyzer, intended for doctors’ offices. Though it looks like a regular scale, it doesn’t measure your weight – it senses the acetone emitted by your skin when you step on it while barefoot. Based on the amount of acetone detected, a number which is sent to the accompanying tablet over Bluetooth, the software can determine how well your metabolism is working. I got a terrible rating! The NTT Docomo employee who helped me try it out explained that it’s normal to get a low rating in the morning before any exercise and that the rating changes over the course of the day. All I had done that morning was take the train to the exhibition center, so hopefully he’s right! It’s definitely motivating for exercise, though.

A lot of what he wrote really resonated with me; Uchida stated that, when it comes to well-designed medical products, simply adding bells and whistles isn’t enough and can even undermine the goal. Health should be a basic right for all people. “Safe, effective diagnosis and treatment remains the goal of medical care, yet superficial design such as appealing drug packaging increases development costs and makes drugs or devices more expensive,” he wrote. “This undermines the social mission to expand medical care.” (Full text here).

But, of course, it is important to consider what will be most satisfying and comfortable for the patient, even if that means making cosmetic changes (though ideally without raising the cost). This is where I think co-design is most important – if you start by designing with the user, and generally making the design choices that will make them happy, you won’t lose money changing those choices down the road.

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Being a trade show intended for Japanese businesses, almost all the information was in Japanese. There were loads of questions I wanted to ask various companies, but I couldn’t because they had no English information and no English-speaking representatives (which is how it should be, so I have no problem with that!). Oddly, there was often one phrase written in English that would catch my eye, such as the poster pictured here titled “Health IoT – Clinical IoT”. I would think great, that’s my project! and peer closer only to realize that the rest of the information was all in Japanese. Why write the title in English, then?

Uchida was thus impressed by the devices that walked the line of satisfying users’ wants and needs while not getting bogged down by expensive or excessive additions. 2016 seemed to be a good year for well-designed patient monitoring systems and digital imaging systems, the latter of which Uchida said respond “to patient needs for smaller, quieter, and more visually appealing devices.” Also, any products submitted to the Medicine & Health category needed to be medically approved – Uchida wrote that there were many medical- or health-related devices that were designed very well, but which were removed from consideration for the award because they did not pass the stringent regulations necessary to qualify as a “medical device” in Japan (for a general example, the Fitbit is a type of health/fitness technology that cannot legally be called a medical device).

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The expo was well laid-out, with the red stripe indicating the section of “good design” in general and the blue stripe indicating the healthcare technology section.

Other winners of the Good Design Award 2016 for Medicine & Health included a wheelchair and an assistive device. There was the COGY wheelchair, which can be pedaled forward with minimal effort so that the user feels more self-sufficient and independent. It adds haptic feedback to the wheelchair experience, enhancing the limited pedaling power of the users so that they can engage with the wheelchair and have the sense of mobility, as though they are pedaling a bike.

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Different iterations of the COGY wheelchair.
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I’m not entirely sure what this poster was saying, but it seems to be promoting acceptance of wheelchair users and fun wheelchair racing events.

There was also the Ontenna, a bone-conduction device for people with hearing impairments or full hearing loss. According to Uchida, the Ontenna follows a general trend of new medical devices products that support minority and disabled populations to help change perceptions surrounding disabilities. As described by IT entrepreneur Dominique Chen in the IT section, the Ontenna is “worn like a hairpin…[and] conveys ambient sound in the form of vibration and light to hearing-impaired users. The thinking behind this product turns the tables on an unfair but common bias that those with disabilities trail healthy people in perception and cognition.”

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The Ontenna.

I noticed that many of these products (as well as health-oriented devices that didn’t go through the extensive regulation process) were also mentioned in the introduction text for the Information Technology section of the Good Design Award. In the intro text for IT, written by the previously-mentioned Dominique Chen, both the Ontenna and COGY come up again. Chen writes about them in the context of human-centric IT with glowing reviews. He seems to be hugely optimistic about the power of such products to change perception of bias towards disabled people: “It seems inevitable that, as some have already discussed in the context of sporting events, disabled individuals will be the first to venture into the realm of cybernetic existence as cyborgs, or cybernetic organisms. As the reality of physical and mental issues faced routinely by many with disabilities becomes more openly revealed, as shared knowledge in society, it will be easier to dismantle the binary division between healthy and disabled. Such openness shows the possibility of a middle ground in a dichotomy that has remained unequal, encouraging us to redefine the social image of reality and join a social movement not yet seen.”

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There was a lot going on at this expo that had nothing to do with health and medicine but that still revealed a lot about popular technology in Japan. That is, there were robots! This pair is part of an IoT security system.
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The biggest section of the expo was centered around technology used in retail. These blue robots wander around a retail space (in this example, a grocery store), and they scan the shelves to detect the quantity and price of various items in the store. They can alert the owner or a shop employee when a product’s stock needs to be refilled. I think they can help patrons shop, too.

I suppose it’s already telling that the Medicine & Health entry overlapped with the Information Technology entry. So many of the best, new medical devices designs are in fact technology designs. Still, it’s clear that there is an issue with stigma against disabilities in Japan. Both Chen and Uchida mentioned it, and the success of the Ontenna is a sign – it is designed to disguise the disability and the need for assistive technology (though pretty much everyone around the world seems to appreciate small, subtle devices).

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More from the health section: “bio-surfactant through fermentation” products such as laundry powder and dishwashing liquid. Though not quite related, my host mom was telling me that fermented foods are considered to be an important part of a healthy diet in Japan: fermented tofu, fermented soy beans (natto), yogurt, and so on. Of course, in the US we consider yogurt, kombucha, and other ‘fermented foods’ to be healthy as well, but we rarely use the word ‘fermentation’ to describe them.
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Of course, Japanese toilets are infamous, so I was amused but not surprised to see a toilet brand on display in the health section (this is apparently another winner of the Good Design Award 2016, though I’m not sure if there is technology involved here).

That’s all for now. I’ll cover the next week’s expo in a follow-up post. (Edit: part 2 is here).

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In the living section, this colorful “donut” furniture for kids speaks to Japan’s kawaii (super-cute) culture.

Lovely visit with lovely people

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.

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The 3 of us at Kyoto’s Fushimi Inari shrine.
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Of course, we took loads of trains this trip, but this was the first time I had ended up in the first car!
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I like these streets in Tokyo that show small, old-fashioned houses nestled in among the more modern buildings.

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.

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On their first day in Tokyo, we walked into a retail store that had this robot helping people find the bathroom and access the store wifi. Though the robot was fun and eye-catching, we all found its help to be completely superfluous. What a great intro to the complexities of Japanese culture! (This is the ‘Pepper’ bot, by the way, and many different companies were using it for health applications at the expos I attended).
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Incense at the Senso-ji shrine of Asakusa, Tokyo.
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On this rainy day we visited Odaiba, a bizarrely artificial island of Tokyo devoted to companies, museums, a ferris wheel, and the like (I don’t think anyone can live there). For some reason they also have a replica of the Statue of Liberty!
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Pepper wasn’t the only robot we saw – this is a statue of the iconic robot from the Miyazaki film Castle in the Sky at Tokyo’s Studio Ghibli museum.

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!

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Dragon moulding on a building in Kyoto.
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Kyoto’s Nijo castle at night.
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The Fushimi Inari shrine has to be Kyoto’s largest attraction. It’s packed with tourists and Japanese women in tradition dress, and it’s a huge complex of shrine buildings and the vermilion gates (torii) for which it is famous.
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Though it was hard to escape the throngs of people, the torii were truly beautiful. My favorite part was how the light filtered down through them. Made of wood, they seemed so fragile and so embedded in nature – though they appear to form a tunnel, walking through the torii still leaves you completely susceptible to the outdoor elements.
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We saw thousands of paper cranes next to a wall of these wooden wish tablets.

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).

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Underneath Osaka’s Umeda Sky Building. The architect described this circular opening between as a ‘crater’ left by a UFO-style spaceship that once departed from the building. I liked that idea.
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My favorite sign in Dotonbori was this giant hanging blowfish.
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One of the casinos in Osaka.

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.

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What I wanted to see most in Kyoto: the Arashiyama bamboo grove. Another packed-with-tourists attraction, but we managed to find more secluded spots in the neighborhood to get away from the crowds.
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Part of Arashiyama’s immense forest. I loved seeing this traditional boat on the water. Two men used long sticks of bamboo to steer it. Where did it come from?
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Is it just me, or does the dragon presiding over Kyoto’s Nishiki food market look…drunk?
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Maybe he’s modeled after this dragon, who presides over the purification fountain at a nearby shrine.
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My favorite person at Nishiki market: this elderly woman handing out samples at the sake shop. (My gleeful friend in the back is on his way to purchase the sake we tried!).

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.

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While I’m thinking about my project and health attitudes, check out these stairs in the metro station. They clearly aim to motivate people to exercise by displaying how many calories you burn walking up each step. I’m not sure how motivating ‘0.1 calories’ is (apparently the whole flight adds up to 6 calories burned), or how many people would notice these faint engravings, but I thought it was fascinating! I’ve never seen anything like it.
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And in a similar vein of fascinating culture, this is “eyetape for men” at a cosmetics store (next to “eyebrow pencils for men”). As you may be able to tell from the photo, eyetape is a thin layer of tape that you’re supposed to put just above your eyelid to achieve the double-eyelid look of Western eyes. I’ve seen eyetape for women in a few stores and even women around Japan that have definitely altered their eyes with tape or perhaps even surgery. I have no idea why double eyelids are considered so attractive or why standards of beauty here are so based on Western looks, but it bothers me immensely.

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.

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We took the shinkansen (bullet train) between Kyoto and Tokyo. It travels at 160mph, probably due to its aerodynamic shape!

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.

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A hilariously Japanese menu.

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.

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Kyoto sunset.