Cross-cultural communication （４）　

４）Cultures of Asian compatriots vary.
　Our patient this time is Rachel, a 24-year-old Filipino woman. She is a talented young lady who graduated from the prestigious University of the Philippines and is studying at the graduate school of a national university in Osaka. She has been in Japan for more than a year at the time of her visit, but she came to Osaka National Hospital because of severe back pain that was interfering with her studies. In fact, Rachel had been visiting the orthopedic surgery department of the hospital affiliated with the medical school where she was studying for several months. However, there she had received only repeated prescriptions for painkillers with little explanation of her condition.

　At the first visit, Rachel looked worn out and said that if her back pain continued, she would have no choice but to return to Japan. On examination, there were no findings to suggest a herniated disc, and she gave the impression of normal back pain. Still, I was cautious and contacted a colleague, an orthopedic surgeon, who examined her. His examination also revealed no findings beyond usual low back pain.

　I explained the entire examination process to her in English and instructed her on back pain exercises, etc., and she visited my clinic several times. After a few visits, her back pain, which had been so stubborn, improved as if it were a lie. In Rachel's case, the bottleneck in the improvement of her symptoms was her distrust of the medical treatment she had been receiving.

　Now, I would like to tell you about the language situation in the Philippines. Language is closely related to culture, so you can call it a cultural situation. It is no exaggeration to say that most of the higher education in the Philippines beyond high school is conducted in English. When it comes to universities, all lectures and textbooks are in English. Therefore, in Rachel's case, English is almost her mother tongue. For Filipinos with higher education, medical care has historically been strongly influenced by American culture, and they are not satisfied without informed consent.

　In Japan, even doctors, who are considered intellectuals, seem to have a tendency to look down on their non-Japanese Asian counterparts. Being familiar with the American culture does not mean you have to respect it, but at least being aware of the cultural situation is necessary for medical care.

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