Cross-cultural communication （60）　

60）Communication is important after all!
It was in the autumn of 2014. During a consultation on a Saturday, the nurse told me that I had an English-language phone call, and when I answered it, it was from a French male tourist. He seemed to be not very good at English, and from what I could understand from the mixture of English and French, he said that he had had a painful swelling above his right eye for three days, and that he had already visited three medical institutions, but that he needed help because he had not been given a diagnosis. When I asked him where he was, he said he was in front of the most famous university hospital in Osaka, which had been recommended to him by his hotel. It seems that he was turned away politely because it was just before lunchtime on a Saturday, he didn't speak any Japanese, and his English was poor. It was half an hour by taxi from that hospital, so I asked him to come to office by taxi.

He was a healthy-looking 30-year-old French man, but he had three red rashes above his right eye, which were quite painful but not itchy. He had also visited an ophthalmologist, but there were no lesions on the eye itself. When I asked him a few more questions, he said he also had pain in the scalp on the right side of his head. When I examined the scalp by brushing back the hair, I found the same red swelling. I was able to make a diagnosis within five minutes of examining the patient. It was shingles of the first branch of the trigeminal nerve. This is a disease in which painful blisters or red papules suddenly appear on one side of the body, including the face, and can be on either the left or right side. There are also antiviral drugs that are very effective, and significant improvement can be expected after taking them for one week.

Shingles is not an uncommon disease, and can be diagnosed with a simple medical interview and examination. This can be diagnosed in a dermatology, internal medicine, or even ophthalmology department. However, in cases such as this where the medical interview is difficult, diagnosis can be difficult. As it happened, I was able to diagnose the patient in five minutes because I could speak French and English. He is a layman in the field of medicine, so he seemed to have mistaken me for a great doctor.

When it came to paying, it turned out that he didn't have enough cash. I took him to the ATMs at two convenience stores near the clinic, but both of them said that they couldn't dispense money from cards issued overseas, so in the end I paid the bill myself, received some of the money back from him in euro notes, and he agreed to pay the rest later.

He was a patient who took a lot of time and effort, but in the end everything worked out and he was grateful to me, and I also felt a great sense of fulfillment. However, with the Tokyo Olympics coming up in 2020, this case highlights the poor state of primary care for foreigners and the inconvenience of using credit cards.

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