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Discussion 1: with Dr. Tsuda and Ms. Long
Moderator
Today, we have Ms. Long leaving immediately after this discussion because she has to go back to Tinian to resume her job shift. She has a flight to catch. She has to leave us at 3:30pm. So, we want to keep ourselves to the clock. So, being limited on time, we want to move right along. If you have any question, please raise your hand and ask the question.
Audience 1
You talked about the different activities that are offered, and I am very interested in those activities. In Okinawa, we also have obesity, hypertension and diabetes. Those are common issues in Okinawa. How did your activity start? How did people become aware that these activities are needed, and how did they kickoff? What were some of the methods you utilized, and what are the difficulties you may have had?
Ms. Aurelia Long
The way our activity started; I can remember 15 years back. You would not see anybody washing cars. You would not see anybody walking outside. It was not cool. It was not part of the culture because if you do your own washing, your own car washing, you are not considered very rich. So, the less you do, the more you look like you are higher class. And because they are so dependent on outside workers from different places, it is so easy to just say, “Wash my car”, “Wash my clothes”, “Do this, do that”, “Take care of my children.” As the years progressed, although they felt this was a good thing because they felt rested, they were very sedentary.
When public health from Saipan started to do a little bit more digging and little bit more research, as trying to get more grants, because they started to notice that people were experiencing health issues just like the United States, just like other countries. They began getting grants to fund for these activities, and some of the activities started with the small children first. They would have field trips. They would have dance classes. They would hire the local girls to do more teaching of the dance. They had more walks, like health walks. They had extra curriculum in the school, PE class. They spent a little longer in PE. The difficulties that we find in the public health to try and get these activities is more consistency with people to help put these activities together, because the funding is so limited that you really need outside community volunteers to chaperone.
If we want to start a walk in the park at 7 o’clock at night, who is going to be the in-charge? Who is going to be in-charge? People have worked all day. They are tired. And it’s always the same groups of women and men who help. So, how many times can you stretch their arms to help? Because it becomes almost a burden, because now they’re been asked, “Oh, can you help here?” “Oh, can you help there?” “Oh, can you start this program?” Those are probably the challenges we faced to get these activities going, that is, a limited resources we have with people that can actually do these programs. The way we got the programs is through grant funding, the teachers instituted certain programs at the schools, and then also for the teachers’ afterschool. They started aerobics classes, volleyball teams. At the health center, we meet at the track. It just depends on every institution; what activities they started for their own groups. But the challenges still are the lack of interest for people to help to bring these activities for public awareness. Did I answer it good for you?
Audience1
Okay. Thank you very much.
Moderator
Thank you very much. Anybody else with a question?
Audience 2
Dr. Sally, I have a question for you. In Japan, we do have shortage of nurses. We are trying to recruit more from other countries, and you discussed that that is also occurring in the Pacific Island areas such as Guam. You also said that there is diversity of cultures. Do you also try to recruit nurses from other parts of the world?
Dr. Sally Tsuda
Thank you very much for your question. That is a very good question. Let’s see. I’m trying to think of which islands do not recruit. Everybody recruits because of the nursing shortage. If you decide to recruit, you need to understand that there will be some cultural barriers. There will be some language barriers. Generally speaking, in Micronesia, people love Japanese – Japanese nurses. They love Japanese nurses because Japanese nurses are “chang… zang… zang…” walk fast, whereas, local nurses take their time. The doctors tell me, “Oh, we love Japanese nurses.” So, generally speaking, you’ll be welcomed. However, I am not sure if the pay is equitable. The one nurse we've met in Palau pretty looks like she is so tired – Japanese, from Mainland Japan. Again, if you recruit from another country, they are short term. They do not understand the philosophy or the ways of that particular institution. They come and go. It could be very frustrating. If you do recruit from other country, don’t do one person alone, because it is very stressful. You need to have somebody else with you so you can discuss.
In the United States, in Hawaii, my sister had surgery 2 months ago for aortic aneurysm. The unit she was recovering on had one American nurse, one Japanese nurse, everybody else were Filipino nurse. My son is cardiologist in Las Vegas. He says that he has never seen so many Filipino nurses in his life. It is like he was in Manila. Foreign nurses are providing the services for the nursing profession in the United States. So, you need to know for Okinawa – yes, you do have a nursing shortage. Do you want to rely on outsiders? Would you people accept that? And please understand, I have a daughter-in-law who is Filipino, so it’s not that I am anti. There are problems or barriers when you bring in outsiders.
On Guam, when the nurses first started coming in, local people, the Chamorros were upset because they spoke Tagalog. And if you are the patient and you are most vulnerable because you’re sick, you're lying in the bed, and you have nurses who are speaking a foreign language while taking care of you, can you imagine how patient will feel? So, these are little things that you need to be aware of. If you do recruit, you need to have a very good program for orientation as to what is expected, how you want the behavior to be, it’s easy to rely on somebody else. But if possible, if you can train enough of your own people to take care of, then I would strongly encourage that, and I hope you’re a nursing student, yes?
Audience 2
Yes.
Dr. Sally Tsuda
Very good, okay. You get all your friends or your neighbors to come join the nursing program.
Audience 2
Okay.
Dr. Sally Tsuda
Okay?
Audience 2
All right. Thank you very much.
Moderator
Thank you very much, Dr. Tsuda. Any other question from the floor?
Audience3
I have a question for Sally. You say that some of the nurses could not come to work because her husband did not bring her to work by car. Is it male centered?
Dr. Sally Tsuda
How can I describe this nicely? One of the big problems that was mentioned over and over again is that women depend on the men to drive them to work. If the man used all the money for alcohol the night before, there is no money for gasoline, so he cannot drive his car and take wife to work. Or, if he’s drunk and he cannot wake up, then he does not want wife to bother him, so she cannot come to work. What was the other excuse? She did not provide him with the breakfast that he wanted, so he might hit her, and then she couldn’t come to work; many, many kinds of excuses or events that happen at home. So, is that culture or is that man-and-wife relationship, I am not sure. But there are problems with work ethics. You know Japanese work ethics is so-so, yes? If you have a job, you come to work and you come on time, but it’s not true in Micronesia. Some families have problems. Other families are very good with the work ethics. So, you need to know not only culture, but you need to know the society and how they function. And I told the class - when they're telling me all these stories, I told the class, “All you women, you learn karate,” but of course…
Moderator
Yes, thank you so much. I think time is up now. We are going to wrap up the question-and-answer session. Thank you so much and thank you the lecturers. Please give them a big applause.