Many of us have had reason to complain about our job at some point or another, but the next time you feel like handing in your resignation and storming out of the office in a huff, spare a thought for the subject of this recent news story:
Death by overwork: only three days off in thirteen months - charges filed against presidents of confectionery company
The supervisory office for labour standards in Mito City and the Mito City public prosecutor's office have filed charges against the 69-year-old male director and 54-year-old female president of Japanese confectionery manufacturing company Hagiwara, which is based in Kasama City, Ibaraki Prefecture.
The suspects are being prosecuted for contravening a labour and management agreement by granting one of their male employees - a resident of Kasama City - just three days off in the thirteen-month period between 1st August 2010 and 31st August 2011, and for making him work on his days off a total of fifty-three times during the same period. They also failed to notify the labour standards office of the contents of the employee's contract.
According to the labour standards office, the member of staff, who was working as 'general director of manufacturing' and in control of shipping at the company, collapsed after arriving home on August 30th last year and died two days later. He was thirty years old and died as a result of ventricular fibrillation, although in February of this year, his death was officially recognised as being due to overwork.
It was recorded on the man's time card that he did more than one hundred hours' overtime per month for every month of the thirteen-month period, although the company could not confirm this, and said, 'the employee in question was taking breaks'.
Citing the man's status within the company, the suspects are refuting the allegations, saying that 'sections of the rules regarding labour standards law are not applicable to such a supervisory position'. The labour standards office, however, ruled that 'the employee was responsible for shipping, and as such, his role did not constitute a management position'.
(Various sources, including the Mainichi Newspaper, 1st October 2012. Oh, and in case you hadn't already cottoned on, karoh-shi / 過労死 is the Japanese word for 'death by overwork'.)
When you have a baby, all of a sudden poo takes on a much bigger role in your life than it used to. In the days following M Jr’s birth, her nappy filled with a black, tar-like substance, the technical term for which is meconium, and which contains a mixture of (and I quote) ‘intestinal epithelial cells, lanugo, mucus, amniotic fluid, bile and water'. This eventually settled down into something less sticky and with more of a green tinge to it, and while Mrs M and I both wondered aloud how M Jr’s digestive system contrived to turn milk green, according to a kind of colour swatch given to us at the hospital, white poo is actually a bad thing, and a sign that your baby could be suffering from a medical condition called tan-doh-heisa-shoh
(胆道閉鎖症 / biliary atresia).A
fter this initial period of plentiful poo-ing, however, M Jr was soon exhibiting signs of the dreaded benpi
(便秘 / constipation). Many more Japanese are cursed with this condition than the rest of us, and as a consequence, the relative ease and frequency of one’s bowel movements is considered a perfectly respectable topic for dinner party conversation. S
ome say the epidemic came about after meat and / or dairy products were introduced into the Asian diet, and others that after centuries of eating rice, the Japanese intestine has evolved to be slightly longer than average, and thus more easily blocked. When Mrs M – who is, as the saying goes, benpi-kei
(便秘系 / a member of the constipation club) – first moved to London, like most of her fellow countrymen and women, she still ate sticky, white, low-in-fibre rice with every meal including breakfast. But despite experimenting with supposedly bowel-friendly brown rice, wholemeal bread, dried fruit, orange-flavoured fibre drinks and even linseed, it soon became clear that what we were dealing with was a full-blown genetic predisposition.A
t just over a week old, and while she and Mrs M were still staying with the in-laws, M Jr went poo-free for over forty-eight hours. I had read online that breast milk contains an ingredient that naturally guards against constipation, and at the time, M Jr was drinking a mixture of breast milk and formula, so we immediately cut out the latter. With the temperature in the thirties, dehydration was another possible factor, and at least once a day we gave her a baby bottle of warm water. In accordance with an NHS Direct-style website I had found, we also massaged her stomach and moved her legs around as if she was jogging or riding a bicycle, but to no avail.T
hen one evening I sat in front of the TV with M Jr on my lap, and in her usual fashion, she wriggled about and pulled an array of funny faces. She also farted a couple of times, and I soon became aware of an odd – although not necessarily offensive – smell. Upon investigating further, I was confronted with a veritable number twos tsunami, and before long, the entire family had gathered round to congratulate M Jr on her achievement. More to the point, f
rom that day onwards, sitting on my lap had a kind of laxative effect on M Jr, so that every time I put her there, she would screw up her face until it turned red, wave her arms and legs like a beetle on its back, and endeavour to grant me the gift of poo.
It wasn't long before she had clammed up again, and this time we were in for the long haul. After three defecation-free days, Mrs M took her to the maternity clinic, where I-sensei said that M Jr was too young to take any medicine or have an enema (rather than a rubber hose and warm water, My First Enema involves sticking a glycerine capsule up your baby’s backside, upon which the capsule dissolves and magically opens the floodgates). The only thing he could suggest instead was the Cotton Bud Method, which I can’t imagine anyone resorts to in the UK, but which is tried and tested over here. For this you dip a cotton bud in baby oil or vaseline, insert it to a depth of about a centimetre (and when I say insert it, I don't mean into your baby’s ear), and gently move it around in a circular motion, supposedly to stimulate the evacuation response. Even this didn’t work, though, and on Day Six, Mrs M called A-san, who as well as being the mother of one of my students, does home visits as a qualified midwife.B
y the time A-san turned up, it had been a full week since M Jr last needed her bottom wiped, and while we weren’t exactly panicking – I had read that a week between poos is nothing out of the ordinary for a newborn – it was disheartening to watch her gurning away of an evening, only to find that no solids were being emitted, just gases.T
his time, on the second or third attempt, the Cotton Bud Method worked, and again, the result bore an uncanny resemblance to the contents of a jar of Patak’s
. If someone is benpi-kei, one always assumes that their poo has congealed to a diamond-like hardness and would therefore be painful to pass, but this carrot-and-coriander-soup-like mixture looked as if it ought to come out of its own accord, or at least without the sufferer having to pull any funny faces.A
nd perhaps that was M Jr’s problem all along, in that she hadn’t yet worked out how to push, as it were, in the correct fashion. A few nights ago I was awoken by the sound of another Niagara Falls of faeces, which had burst forth at the exact moment Mrs M was changing M Jr’s nappy. Like me, Mrs M had assumed that it would be a couple more days before the next installment in this scatological saga, but after a few seconds of grunting like a pensioner with a prostate problem, M Jr let rip, and Mrs M almost ran out of baby wipes trying to stem the tide.W
hat the future holds is anyone’s guess, although I suspect that no matter how much fibre we force her to eat when she moves on to solid food, M Jr’s digestive fate is already sealed, and she is doomed to spend the rest of her life worrying about where the next poo is coming from. Still, at least she’ll have a hundred million fellow Japanese with whom to talk about it over dinner.(If you fancy reading another poo-related blog post, please make your way to this page at More Things Japanese.)
A few weeks ago something strange started happening with my hearing. Particularly when I had been sleeping on my right side, when I woke up in the morning my right ear would be blocked – as if I had been swimming and it was still filled with water, or as if I was on a plane after take off and it hadn’t ‘popped’ (my ear, that is, not the plane). This normally cleared up after a couple of hours, but depending on which side of the blackboard I stood, large parts of the morning’s English lessons were passing me by.
At first I put the problem down to hay fever, which always plays havoc with my sinuses and was still going strong even at the beginning of July (I had been under the impression that grass pollen is practically non-existent in Japan, but no such luck – another foreigner working in Ibaraki recently posted on Facebook about how his grass pollen hay fever has been almost untreatably bad). It soon got to the point where the offending ear would remain blocked until after lunch, and then to the point where it was still the same when I went to bed. After two or three days of listening to the world in mono, and having to either lean in towards people to hear what they were saying or turn around so that my left ear was facing them, I realised that it was time to go to the doctor.
At the height of the cedar pollen season in the spring, Mrs M’s uncle recommended a jibika
(耳鼻科 / ear, nose and throat specialist) who had been a contemporary of his when they were at school, and whose surgery is just up the road from our new apartment. As is the case whenever one falls ill in Japan, I didn’t have to be referred to S-sensei by a GP, nor did I have to make an appointment to see him: his clinic is open until 6.30 on weekdays, and in the four or five times I have been there, it has never taken more than a twenty-minute wait before I am ushered into his office and asked to sit down.
Rather than an ordinary chair, however, as the patient, one is directed to a kind of high-backed examination seat equipped with various attachments, head- and arm-rests, and which reminds me of a Frankenstein-style electric chair whenever I sit in it. S-sensei himself is a chubby fellow in a white coat and spectacles, and while a normal doctor (well, the kind of doctor I’m used to seeing on ER
, anyway) will have a stethoscope draped around their neck, S-sensei has a CD-shaped mirror strapped to his forehead at all times. He is more nutty professor than friendly doctor, has a habit of licking his bottom lip when he speaks, and when he does speak, it is faster than possibly any other Japanese person I have ever met.
‘What seems to be the problem?’ he asked the first time I met him.
‘My hay fever is really bad and I’ve run out of medicine,’ I said. ‘I’ve tried the over-the-counter stuff but it doesn’t work, so I was wondering if you could prescribe something stronger – I was taking cetirizine hydrochloride back in the UK’
‘Actually that's quite weak. Hay fever drugs are classified in three levels, and cetirizine is a level three.’
‘Really? That’s all I’ve ever been offered. I didn’t realise there was anything stronger.’
‘Obviously the stronger medicines may make you drowsy, so we’ll monitor your condition through the season and give you a prescription based on that. If you take a look at this chart, you’ll see that the pollen in Ibaraki is particularly bad – the worst in the country, in fact – and next year it’s going to be even worse. Do you take any other kinds of medicine?’
‘I use a nasal spray sometimes.’
‘You need to be careful not to become too dependent on nasal sprays. Can you read Japanese?’
‘So long as it’s not too technical, yes.’
‘Have a look at this – or your wife can read it for you.’
He handed me a photocopy of an article from a medical journal about the perils of steroid-based nasal sprays, and carried on talking for several more minutes. The more he spoke, the faster his voice became, and rather than interrupt his flow, I asked Mrs M to go over the salient points as we drove home.
When we went to see S-sensei last week, he peered into my right ear using one of those instruments with a little conical whatsit on the end containing a magnifying glass and a light.
‘It’s just full of earwax,’ he declared. ‘Let’s check the other one. Yes, that’s almost as bad.’ He called Mrs M over to see for herself. ‘See? Completely blocked. There may be another problem, but until we get these cleaned out I won’t be able to tell.’
A couple of years ago I had an attack of tinnitus, which I eventually decided had been caused by my rather over-zealous use of cotton buds. I have been trying to wean myself off them ever since, to the point where for the past few months, I have only been cleaning my ears once a week. As a result, instead of having tinnitus I was now partially deaf, so S-sensei prescribed some ear drops and asked me to come back in three days’ time, when he would clear the blockage.
‘Do you mind me asking how you’ll do that?’ I said. ‘It’s just that a couple of friends of mine suffered hearing damage after having their ears syringed.’ I wasn’t sure how to translate this into Japanese, so described the kind of syringe you would use to receive an injection or give a blood sample.
‘Don’t worry,’ said S-sensei. ‘We don’t do any alternative therapies here. A few years ago there was a treatment going round that involved putting a lit candle in your ear. It was ridiculous, and I was the one having to clear up the mess.’
Three times a day for the next three days, Mrs M put three magic ear drops into each ear and left me lying on my side for three minutes at a time, and by the third day – as S-sensei had warned me – the gunk had softened up and then re-congealed to make me deaf in the left ear too. Monday was my first day working at the board of education since the beginning of April, but I could do little more than sit at my desk and ignore everybody. If someone spoke very clearly and I listened very carefully then I could just about hold a conversation, but it was like spending all day stuck at the bottom of a swimming pool, and I left early in order to get to the clinic before it closed.
The first time I thought the nurse had called my name it turned out to be somebody else’s, and when she did call my name I didn’t hear it at all, but before long I was back in the Frankenstein Chair and S-sensei was sticking a long, thin metal tube into my ear. This worked a little like one of those small-scale computer keyboard vacuum cleaners that you used to be able to buy from the Innovations
catalogue, and Mrs M and I also found out what that mysterious CD-like mirror was for: S-sensei positioned it over his eye so that it reflected light into my ear, and looked through the hole in the middle.
‘Try not to move,’ he said. ‘This may hurt a little.’ And indeed it did, although the pain was nowhere near as disconcerting as the noise, which was a combination of hoover-like suction and what sounded like extreme radio interference: crackling, squealing and the occasional firework-like explosion.
‘You see that?’ said S-sensei, holding up a chunk of earwax that rather than the usual orange-y colour was a kind of dark, reddish brown. ‘That’s what happens when you don’t clean your ears properly.’
Once the ordeal was over, he told me that I should use a cotton bud every day and come to the clinic once a month for the mini-vacuum cleaner treatment. Despite his assertions to the contrary, however, I realised that the procedure I had just undergone was to all intents and purposes the same as having one’s ears syringed, and not an experience I had any intention of repeating.
Still, the original problem had certainly gone away, to the extent that my hearing was now almost too good: every shuffling footstep, every humming machine, every tinkling metallic medical instrument, every chattering voice in the clinic sounded inordinately loud, as if someone had turned up the volume on my internal amplifier. The sensation reminded me of a story from Oliver Sacks’ The Man Who Mistook His Wife For A Hat, in which a patient’s sense of smell becomes hyper-sensitive after a drug overdose, and popping into the supermarket on the way home was like being immersed in the kind of interactive sound sculpture installation you sometimes find at the Tate Modern. It seems likely that my ears had been at least partially blocked for some time, and that instead of this over-sensitivity being due to the shock of regaining my hearing, I was simply experiencing the world as it really sounds; whether or not this will help me keep up with S-sensei’s high-speed Japanese, though, is another matter.
Mrs M is pregnant!
Actually she's been pregnant since late last year, but I've waited until well past the antei-ki (安定期 / literally 'stability time' - ie. the point at which it's OK to tell your friends, relatives and readers) before writing a blog post about it.
Surprisingly enough - and in the first of what will no doubt be numerous differences between the British and Japanese experience of child rearing - while I would describe Mrs M as beings six months pregnant, she would describe herself as being seven months. When I first found out that Japanese babies wait for ten months before entering the world, I thought that I was dealing with a fundamental biological discrepancy, but no, when it comes to measuring one's term, the Japanese use lunar months of 28 days, as opposed to calendar months of between 28 and 31. Confusing, yes, but logical too when you consider body clocks, menstrual cycles and so on.
By the time our little one is born, I will have fulfilled my ambition to delay becoming a father until my fifth decade, and the first time we went to our GP for advice was more than two years ago, in early 2010.
'You're both fit and healthy,' he said, 'so there's no need to start running tests. Think of it this way: you've got twelve goes between now and next spring, so I'm sure you'll come back to me with good news before then.'
Twelve goes later nothing had happened, although the GP in question was none the wiser, as by that point we had moved to Japan. Rather than a GP, when you need medical treatment here you go straight to a specialist, so once we had settled in, we registered with the nearest sanfujinka (産婦人科 / maternity-gynaecology clinic). All four doctors at the clinic - mum, dad and their two daughters - are members of the same family, and dad - let's call him I-sensei - was the first one we met.
'Do you understand Japanese?' he asked me.
'By and large,' I said, 'although I'm not very good when it comes to accents and dialects. I prefer "NHK Japanese", if you see what I mean.'
'Did you hear that?' said I-sensei to one of the nurses as he went through to the next room. 'I speak standard Japanese!'
One Saturday last summer he gave a lecture at the clinic about the science-y side of conception and pregnancy, and the various treatments on offer should they be necessary. The most reassuring fact of the day was that the average man is capable of fathering a child until he is seventy-five years old (I almost punched the air and shouted 'Get in!' when I heard this), but according to I-sensei, while my tadpoles were both energetic and longevitous, they were emerging in comparatively small numbers - the average school, so to speak, has 50 million members, whereas mine were in the 10 million range. In order to counteract this shortfall, he suggested that we move on to The Next Stage: jinko-jusei (人工授精 / artificial insemination, which for the sake of brevity I'll refer to as AI). This meant a lot more trips to the clinic for Mrs M, as there were injections to receive, prescriptions to pick up, and the AI process itself, which without going into too much detail, involved my tadpoles getting some assistance on their journey to meet Mrs M's egg - a bit like being given a lift to work rather than having to walk all the way there, if you see what I mean.
After two months of AI and still no result, I-sensei said that it might be time for The Next Next Stage, so as well as my tadpoles getting a lift to work, Mrs M underwent an additional series of injections - one a day for ten days, to be exact, and a process that was, quite literally, a pain in the backside - to enable her to produce multiple eggs simultaneously (this is standard practice with fertility treatment, and increases your chances of having twins to one in five, as opposed to the usual one in a hundred or so). He also referred me to a nearby hinyoh-ka (泌尿科 / urology clinic) for a more thorough check on my tadpoles.
This was, it has to be said, one of the less dignified episodes in my life so far, and took place on the eighth floor of a rather run-down office building (the clinic was on the verge of moving to new, purpose-built premises nearby). After taking my blood pressure, the head nurse - a middle-aged woman with a tobacco-tinged voice and a no-nonsense manner, no doubt developed over many years of dealing with sheepishly embarrassed men like me - said that she needed a sample of my shoh-sui.
'Shoh-sui?' I said.
'She means pee,' explained Mrs M (a polite euphemism, the literal translation of shoh-sui / 小水 is 'small water').
This required filling a paper cup to about the halfway mark, in a toilet that was directly off the reception-area-stroke-waiting-room, and which had a door that was rather tricky to lock: although it didn't happen while we were there, countless patients must have suffered the misfortune of having someone walk in on them in mid-small water.
Once the nurse had taken some blood to be sent away for analysis, it was time for the most important sample of the three. For this I was given another paper cup, and led downstairs to a little room with a sofa, a TV and a selection of magazines and DVDs (thankfully, the door lock here was more secure and easier to operate than the one on the toilet).
In yet another room - this time with a bed and some machines that looked very much as if they might go 'ping' if you pressed the right button - the nurse taped two sensors to what are referred to in Japanese as one's kintama (金玉 / golden balls). This was to make sure they were functioning at the appropriate temperature, so I lay down for a few minutes watching the figures on a digital readout waver by fractions of a degree, and then stood by the bed for a few more minutes doing the same thing. The tricky part came when the test was over, and I was left in the room to remove the sensors: particularly when it's adhered to one's nether regions, surgical tape isn't ripped off in a single swift and momentarily uncomfortable motion, but rather in a series of protracted and agonisingly painful ones.
Mrs M and I were then admitted to the urologist K-sensei's office, where he produced a garland-like string of different sized yellow plastic eggs. These are for assessing the relative dimensions of a patient's kintama, and reminded me of the set of different sized rings Mrs M used in her previous job at a jewellery shop.
'This may feel a little cold,' said the nurse as she then applied some gel to my lower abdomen and kintama, in readiness for an ultrasound scan. For minimum patient discomfort, the gel had been warmed up in advance, although the unexpectedness of this was probably more disconcerting than if it had been cold in the first place.
Once the tests were over and I was finally able to put my trousers back on, K-sensei said that my tadpoles were fine - their image through a microscope was on a TV screen in the corner of the room, and apparently, if a certain number are active within a certain area of the screen, you're in the clear. Where I-sensei was a kindly, professor-like man who wore John Lennon spectacles and used standard Japanese, K-sensei was shambling, eccentric and spoke in a kind of incoherent mumble, as if his voice were a poorly tuned radio, and had a habit of propping his trendy, rectangular specs on his forehead, from where they would promptly fall back down onto the bridge of his nose.
'The results of your blood test will be back in three weeks,' he said. 'But that's just a formality, really - there's a condition called koh-seishi koh-tai (抗精子抗体 / anti-sperm antibodies) that we have to check for. I'm sure that if you keep trying you'll get pregnant before long.'
'This may sound like a strange question,' I said, 'but do you think I should stop riding my bicycle?' (Along with wearing loose-fitting underwear, the standard advice in the UK is to lay off the cycling if you're trying for kids.)
'No effect at all,' he said. 'Some professionals suffer from ED, of course, but that's only if they're cycling for very long distances.'
'ED? What's that?'
'Ah, I see.'
Three weeks later we went back to the urology clinic, where I donated another blood sample, another half-full paper cup of small water and another school of tadpoles.
'Your tadpoles are fine,' said K-sensei - they were darting around on the same TV screen in the corner of the room - 'I'd be perfectly happy if these were mine. But...' He let out a long sigh as his spectacles plonked back down from his forehead to his nose. 'You can't get pregnant naturally. The test came back positive for anti-sperm antibodies. We'll run another one to make sure, but your only option now is taigai-jusei (体外受精 / IVF).'
While we were both practically speechless with shock, it was quite a relief to know exactly what we were dealing with. Plenty of people who have nothing to physically prevent them from having children take a lot longer than two years before they manage to conceive, but Mrs M had suspected from the start that something was amiss. As anyone who's ever tried it will tell you, IVF involves large amounts of time, money and stress, coupled with a comparatively slim chance of success, but at least we could now entrust ourselves to medical science, rather than having to cross our fingers every month and hope the stars of fertility would somehow align in our favour.
Shoh-shi koh-reika (少子高齢化) describes the modern Japanese phenomenon of a declining birth rate and an ageing population, and because of the former, the government is desperate for its citizens to procreate. Up until a few years ago, and even if you were paying your national health insurance every month, having a baby would cost you somewhere in the region of £1000, and even more than that if you needed a caesarian, an epidural or an extra few nights in hospital to recover from the birth. Nowadays, though, most local councils will foot the bill for everything, including part or all of the cost of at least a couple of tries at IVF. So while Mrs M and I would still have to deal with the time and the stress, at least we wouldn't have to shell out too much cash for the privilege.
A few days later - partly out of habit and partly because she had a couple left over from her last trip to the chemist - Mrs M took a pregnancy test.
'I'm not sure if this is right,' she said, 'but there's a line.'
'It's a bit faint, though.'
'It must be faulty.'
'There's one more left in the box. I'll try again later in the week.'
At the second attempt the line was more distinct, and when we went to see I-sensei to make absolutely sure, he confirmed the good news.
'But K-sensei said it would be impossible for us to get pregnant without IVF,' said Mrs M.
'It does happen sometimes,' said I-sensei.
'Perhaps Caucasians are biologically different...' mused K-sensei after giving us the result of the second blood test, which confirmed the positive result.
If you have anti-sperm antibodies - which as K-sensei explained are normally caused by trauma to the kintama, although in my case the origin was unclear - even if your tadpoles manage to swim all the way to their destination, the antibody stops them from fertilising the egg: like a kind of kamikazé tadpole, they effectively self-destruct. But - and this is the important part - the anbtibody isn't present in the tadpole himself but in the liquid he swims in, from which he is removed in preparation for both AI and IVF. Even so, while K-sensei was (probably) wrong and I-sensei was (probably) right, Mrs M getting pregnant was still mathematically unlikely and spiritually miraculous, albeit in an athiest, secular kind of way.
(Oh, and in case you were wondering, it's not twins.)
It may seem a little strange given the fact that it was snowing the other day, but a lot of people are already suffering from hay fever, a condition that until a few decades ago was practically unheard of in Japan. Rather than summer grass pollen - which turns my nose into the physical equivalent of a bath tap with a broken washer when I'm in the UK - the problem here is spring tree pollen, specifically sugi (杉 / cedar) and hinoki (檜 / cypress), although until I read this centre-page spread from the Tokyo Newspaper, I hadn't realised exactly why.
Thanks to an abundance of diagrams, graphs, pie charts and so on, and a writing style that is more Newsround than Newsnight, these encyclopaedia-like articles - which appear ever Sunday, and cover such esoteric topics as the history of coal mining and the Japanese space programme - have become essential reading, and okah-san makes a point of saving them for me. I haven't bothered to translate the entire hay fever piece (published on 5th February), but hopefully those sufferers amongst you will find some of the information useful and / or interesting, and those non-sufferers amongst you will be able to sit back and relax, safe in the knowledge that the next few months of your life will be both sneeze- and snot-free:The number of people concerned about hay fever is on the increase. The season for hay fever caused by cedar pollen - a condition that is often referred to as the "citizens' illness" - is drawing near. Here we describe the hay fever mechanism and how to deal with it - measures which may be difficult to find out about at crowded ear, nose and throat clinics.The reasons for hay fever manifesting itself are threefold: 'genetic predisposition', 'environmental factors' and 'pollen'. Most hay fever sufferers are sensitive to cedar pollen and the number of those sufferers is on the increase. Cedar was planted all over the country as a national policy in the years after WWII, and once a cedar tree exceeds 30 years of age, it is likely to produce large amounts of pollen.
(The fact that there was an enormous increase in the number of cedar trees being planted after the war - the original intention was to use the timber to help rebuild Japan's devastated urban areas - is common knowledge, but the 'thirty-year rule' explains why the hay fever epidemic occurred more recently.)If genetic predisposition and environmental factors are both present, symptoms become apparent in the sufferer once a certain amount of pollen is released. Not only do environmental factors make it more likely for the allergy to occur, they also exacerbate it. For example:Eating habits - high-protein and high-fat dietLiving environment - airtight living spacesMovement towards urban living - asphalt roads and pavements (pollen tends not to settle on road surfaces and is re-dispersed)Atmospheric pollution - exhaust fumesIn this sense, hay fever is also called an 'illness of civillisation'. The first public warning about pollen levels - relating to ragweed - was issued in 1961, and changes in the environment brought about by modernisation cannot be overlooked as a reason for this.Pie chart - proportion of natural to man-made forestation in Japan:Total forested area - 25,100,000 hectaresNatural forestation - 53% (13,380,000 hectares)Man-made forestation - 41% (10,350,000 hectares)Of which: 18% cedar (4,500,000 hectares), 10% cypress (2,600,000 hectares) and 13% other tree varieties (3,250,000 hectares)Others - 6% (1,370,000 hectares)The area covered by artificial cedar and cypress forests takes up around 19% of the total Japanese land mass - approximately 7,100,000 hectares. Six prefectures in Kanto (Tokyo, Saitama, Kanagawa, Chiba, Gunma, Tochigi and Ibaraki) and four prefectures in central Japan (Aichi, Gifu, Shizuoka and Nagano) have particularly extensive cedar and cypress forestation.
(Japan's population is highly concentrated in urban areas, and it's estimated that between 80 and 90% of the total land mass is mountainous, with most of that being forested. That more than 40% of that area was replaced with man-made forestation in the space of a few decades is an extraordinary statistic.)Graph - Age of trees in artificial forestsBetween 700,000 and 800,000 hectares of man-made forests are occupied by cedar between 41 and 45 years old, while fewer than 100,000 hectares of cedar are between 76 and 80 years old, and fewer than 50,000 hectares of cedar are between 1 and 5 years old.Between 3 and 400,000 hectares of cypress are between 36 and 40 years old, with similar proportions to cedar for 76-80 and 1-to-5-year-old cypress.(In other words, there's a big spike in the graph for trees that hit their pollen-releasing prime in the past couple of decades.
)Over the past fifteen years, there has been a large increase in cedar pollen in years when the previous summer was extremely hot. In metropolitan Tokyo, the longest sunshine hours during that period - 300-plus in 2004 - were followed by the highest pollen count - 10,000 parts per cm² in 2005. Because of this, indications show that global warming is also influencing pollen levels, and therefore hay fever.
(These are statistics that I can vouch for through personal experience - ie. summer 2004 in Tokyo was stiflingly hot, and my hay fever in the spring of 2005 was even worse than usual.)According to the results of a survey carried out with patients at ear, nose and throat clinics, the estimated number of sufferers countrywide stood at 29.8% in 2008. Of those, 26.5% were allergic to cedar pollen - around one in four people. The estimated number of hay fever sufferers among Tokyo residents is currently at 28.2%, or around one in every 3.5 people. This is about three times greater than it was 20 years ago, and 1.5 times greater than it was 10 years agoDepending on the influence of wind direction and topography, in areas where pollen is easily dispersed there is a tendency for the number of suffers to increase.The rate is highest in Kanto (Tokyo, Kanagawa, Chiba, Saitama, Ibaraki, Tochigi and Gunma prefectures) and Tokai (Aichi, Gifu, Mie and Shizuoka prefectures)Highest percentage of sufferers - Yamanashi 48.7%Lowest percentage of sufferers - Kagoshima 12.7%Percentage of sufferers in Ibaraki - 28.2%Spreading from east to west, the hay fever season starts at the beginning of February in the west of Kyushu, in the middle of February in Tokyo, and at the end of March in Hokkaido.It is currently popular to go on 'pollen avoidance tours' to places like Hokkaido and Okinawa.
(This isn't as ludicrous an idea as it might sound - when my hay fever was at its worst in my mid-twenties, I spent a couple of summers in North America for the same reason.)Regarding radioactive cesium in cedar pollen after the nuclear accident in Fukushima, in January this year, university researchers began a factual investigation at 11 locations in Kanto and Tohoku, and the Forestry Agency has said, 'there is no effect on the human body'. (In Ibaraki at least, fallen leaves have registered the highest levels of radioactivity, although as yet I haven't seen any statistics for radiation levels in pollen - presumably because the season has only just started. Make of the Agency's statement what you will!)Cedar registers the largest amounts of pollen, from mid-February until mid-April, with the cedar pollen season in Hokkaido having the shortest duration.Cypress has a shorter season with smaller amounts of pollen - mostly between mid-March and the end of April.Pollen from alder, hazelnut and birch trees is negligible by comparison.Grass pollen is prevalent from the beginning of April until the beginning of September, mainly in Kanto, although in comparatively small amounts.
(Not only is there less grass - and therefore less grass pollen - in Japan than there is in the UK, but according to the article, 'the scope of grass pollen is much narrower' - ie. it isn't carried as far on the wind as tree pollen.)Hay fever occurs when the immune system tries to eliminate germs or viruses from the body. Essentially, the body recognises harmless pollen for an allergen and tries to expel it.1 - Pollen enters the body2 - Pollen allergen dissolves and attaches itself to the membrane of the nose and eyes3 - Allergen is recognised as a 'foreign body' and antibodies are produced4 - Antibodies merge with mast cells (sensitisation)(NB: for some reason the Japanese word for 'mast cells' is himan-saiboh
- 肥満細胞 / obese cells - and there is a note in the article explaining that there 'is no
connection between mast cells and bodily obsesity'.)5 - When pollen is inhaled again, chemicals are emitted to combat the allergen6 - When sensory nerves stimulate sensory nerves and blood vessels, symptoms appear: itchy nose and eyes, runny nose, teary eyes, sneezing, blocked nose, bloodshot eyesBy sneezing and therefore cleaning out the nose, the body expels the allergen, and by blocking the nose, it makes it difficult for the allergen to enter the body.The middle of the day and early evening are the peak times for dispersal of pollen. Wear a surgical mask when you go out. It is important to find a mask that feels comfortable and matches the size of our face.(As the nice people at Quirky Japan pointed out in
out this blog post
, surgical masks have been popular here for the best part of a century, although frankly, I'm dubious as to their effectiveness in keeping out pollen. Blowing your nose is considered to be bad manners in Japan, and if you absolutely have to, it's customary to use a paper hankie and dispose of it straight away. As I discovered from years of trial and error, however, paper hankies make your hay fever worse, as their abrasiveness irritates the skin and the fibres act like sneezing powder, thus making your nose even runnier. So while it may not do a lot for me in terms of cultural integration, I stick to cotton hankies and try to blow my nose as discreetly as possible.) The most important thing is to prevent pollen from entering the body. Understand the dispersal pattern and the pollen count information, and as much as possible refrain from going outside.On average, pollen levels peak at over 80 parts per cm² at midday, with a second peak at over 60 parts per cm² at 6pm.The symptoms begin directly after waking up, a phenomenon that is known as 'morning attack'. When the temperature drops in the evening, pollen which has been suspended in the air descends.The most appropriate treatment differs depending on one's lifestyle and the severity of the condition. You should choose a treatment that fits you after discussing the matter with your doctor.Medicine - Preventative treatment is effective. If you begin taking medicine before symptoms appear, they can be reduced
.Operation - An operation to scorch the nasal membrane can be completed as an out-patient. But its effectiveness is limited and symptoms may reappear. Recommended for pregnant women and students taking exams.Immunotherapy - A treatment by which an antigen extract is injected into the body at fixed intervals. Injections take place over the course of about 3 years, and in 70 to 80% of cases are effective on sufferers. Medicine that can be taken orally is currently being clinically tested.It is hoped that [allergen immunotherapy] could provide a complete cure. Symptoms can be abated by repeatedly injecting pollen extract in gradually increasing doses. The treatment requires patience but symptoms are fundamentally reduced, and to a great extent the use of medicine becomes unnecessary. However, as very rare side effects include breathing difficulties and low blood pressure leading to anaphylactic shock, caution is necessary.At present, instead of being administered hypodermically, a new technique of administering immunotherapy as a medicine is under scrutiny. Since 2000, at the Japan University Of Medicine, with clinical research as a starting point, more than 400 cases have already been investigated, and serious side effects have not arisen. Apart from going to hospital about once a month, the medicine method can for the most part be carried out at home.
(An even newer treatment - called phototherapy - made an appearance on a recent TV show, and involves shining ultraviolet light into the nose. The machine that administers this is currently prohibitively expensive, but the boffin who introduced it said that a cheaper and more portable version should be available soon. Another TV programme introduced the fascinating possibility that asthma triggered by allergies - and presumably allergies of all kinds - can be cured by spending time 250m below ground in a salt mine: a quick Google search unearthed these two articles from The Telegraph - http://www.telegraph.co.uk/expat/expatnews/7527907/Asthma-treatment-in-Pakistani-salt-mine.html
- and The Guardian - http://www.guardian.co.uk/world/2005/dec/03/ukraine.tomparfitt
. For the moment, though, it looks as if I'll have to stick to anti-histamines, nasal spray and my trusty cotton hankies...)