Vaccinations in Japan are different than in the West - there are important points that you should know, because your Japanese doctor may not.

There are two very important things to know about new born vaccinations in Japan:

1. Japan doesn’t immunise for as many diseases as is standard in the West.
2. Japan has developed its own domestic vaccines for most diseases which means that they are not compatible with vaccinations taken for the same disease in other countries.

At the time of writing, the recommended injections for newborns in Japan (i.e. those that are provided free of charge to residents) are as follows:

The yobosesshu brand - Japanese babies will wear this mark with them until adulthood and beyond

• BCG (結核予防法) → at birth
• Diphtheria(ジフテリア) → 2, 4 and 6 months
• Pertussis(百日咳) → 2, 4 and 6 months
• Tetanus (破傷風) → 2, 4 and 6 months
• Polio (ポリオ) → 2, 4 and 6 months

In addition to these diseases, Hong Kong, for example, also recommends (and provides free of charge) vaccinations for the following diseases:

• Hepatitis B (Ｂ型肝炎) → 2, 4 and 6 months
• HiB (ヘモフィラス・インフルエンザ菌タイプB) → 2, 4 and 6 months
• Pneumococcal conjugate (PCV) (肺炎球菌結合ワクチン) → 2, 4 and 6 months
• Rota Virus (ロタウィルス) → 2, 4 and sometimes also 6 months

According to our paediatrician who was educated in London and Australia, both Australia and most of Europe vaccinate for the same diseases as Hong Kong. I’m assuming that they are all copy cats of the UK standard. Furthermore, each of these countries uses the same brand of vaccinations so your child isn’t going to have any problems if you travel between those countries. On the other hand, when we found ourselves in Japan 4 months after my son’s birth we realised that we’d created two problems for ourselves: (1) we were half way through vaccinations for diseases that Japanese paediatricians hadn’t even heard about (e.g. rota virus) and (2) we couldn’t even complete the four diseases that Japan also immunises for, as Japanese hospitals use domestically developed brands that aren’t compatible with the first two rounds that we’d taken overseas. Don’t let a Japanese doctor fool you on this point. They are not compatible.

This is an interesting chart (source) that makes a comparison of the standard Japanese vaccination schedule with that of the United States. Could be a good one to take with you when you visit your Japanese GP, to spur discussion about how he/she needs to help you:

It is actually possible to receive a hepatitis B vaccination in Japan if you pay for it yourself so I guess it is unfair to include it in the second list although it is not standard and most children don’t receive it. I’ve also heard that the HiB vaccine is very close to approval in Japan as well. Even if it is improved, it is unlikely that it will be included on the free list of vaccinations for several years so will probably be in the same basket as the hepatitis B vaccination.

It might seem like a lot of injections for your baby to receive but in actual fact almost all of these injections are administered at the same time. If you find a friendly paediatrician in Japan then you will probably get diphtheria, pertussis and tetanus together in one injection called a DPT (三種混合, sanshu kongo) which reduces some of the shock to the poor little kid. If you’re unlucky, your paediatrician might

Some clinics in Japan will give vaccinations the Western way - at 2 months the baby receives all of them at the same time with simultaneous jabs in both legs

It only took a few phone calls to leading hospitals in Osaka and Tokyo to realise that no public hospitals were able to administer any vaccinations other than those officially recommended by the Japanese government. They recommended me to try and find a small private hospital that might be importing the drugs on a proprietary basis. After smiling and dialling every international sounding private hospital I could think of in Osaka, Kobe and Tokyo, I was proudly offered various combinations of DPT and a bunch of branded vaccines that I’d never heard of. I thought I’d almost struck gold with a small practice in Hiro (広尾), until the senior doctor (院長先生, inchosensei) – who will remain unnamed – started trying to convince me that both brands of the rota virus vaccination were interchangeable. It scares me to think how many unsuspecting parents take their children to that guy and get the wrong vaccination!

Anyway to cut a long story short, I was only able to find one hospital that was able to administer each of the injections for us. Here are their details:

Tokyo Medical and Surgical Clinic
Address: 32 Shiba koen Building 2F,
3-4-30 Shiba-koen, Minato-ku, Tokyo 105-0011
Telephone: 03-3436-3028 (24 hours)
Fax: 03-3436-5024

Unfortunately for families coming from Australia, they only had Rotarix (and not Rotateq which is standard in Australia) for the rota virus at that time but that might change in the future. I highly recommend them for the other vaccinations and their professionalism. At the time of writing these vaccinations cost a hefty 80,000 yen for one round of all 8. For obvious reasons, it is nice to have an insurance policy that covers these payments – but it will have to be private as the clinic is not recognised by the Japanese health insurance system. While my focus has been on newborns, parents of children who are either 12 months or 4 years old will probably want to know what the story is with chicken pox, mumps, measles and rubella. All of these injections are available in Japan, but only measles and rubella are provided free to residents. Whereas the west generally administers measles, mumps and rubella together in a 3-in-one injection called MMR, for some reason Japan doesn’t include mumps and just gives an “MR”. It’s worth confirming the brand that you used for the first round at 12 months if you are giving the 4 year booster to your child for the same reason as mentioned above.

Lets us know about your yobosesshu experiences in Japan, or for that matter, anywhere else. It’s a fascinating topic, but sometimes a scary one, especially when it involves your own little one.

The New Keisei Skyliner Express - Tokyo to Narita Airport in just 36 minutes - but what's the catch?

Seems too good to be true.

So what’s catch? Well the first, and rather predictable, piece of fine print is how they measure the travel time. 36 minutes is the time needed to travel from Nippori （日暮里駅）to Narita’s Terminal 2 Station (空港第2ビル駅). Presumably if you get on at Ueno （上野駅）and have to use Terminal 1 （成田空港）then it will take closer to 40 minutes. That itself is not a deal breaker. Perhaps the bigger problem for most of us is the location of Keisei’s existing stations in Nippori and Ueno. Unless you live on the Yamanote Line (山手線) or in one of the many cardboard boxes in Ueno Park, neither are really that benri (便利, convenient.) It doesn’t help that JR’s Nippori Station is one of the only JR stations in the capital to have neither an escalator nor an elevator. Even if the new Keisei Nippori Station will be completely barrier free like they are promising, it is of little consolation to those of us who have to lug our family’s heavy suitcases up the stairs on the JR side in order to get there.

Here is the detailed PR video (in Japanese) that will give you a run-down of more details:

Click here to view the embedded video.

Narita Sky Access – 36 minutes/2400 yen/62.0km Between Nippori and Narita:
The new train will be known officially as: “Narita Sky Access” (成田スカイアクセス), and the fare from Nippori to Narita Airport will be consistent with the current Keisei offering of 2400 yen. This makes it not only faster than JRs N’EX (Narita Express) offering, but also cheaper.

The next best news – apart from cutting off 15 minutes from the existing travel time – is that trains will be really frequent. In addition to the 3 express trains (特急) that will continue to run the existing (51 minute) route to the airport from Ueno, there will be 3 Sky Liners and 3 express trains running every hour on the new route. That’s 9 trains an hour to Narita from Ueno. That’s even better than Hong Kong’s Airport Express (機場快綫, 5 trains per hour) which anyone who has used will agree is a very efficient system. How will the Narita Express (N’EX) be able to compete with its frustrating 2 trains per hour timetable? (Currently Keisei has 55% of the market for train passengers to Narita but this is bound to increase post 2010.)

Inside the new Keisei Skyliner

Apparently the government isn’t too happy about this as the Transport Ministry (国道交通省, kokudokotsusho) want to cut the travel time between Narita and Haneda dramatically before the runway expansions planned at each airport are completed in 2012. Fat chance of that. Keisei’s management have made it clear that it would be impossible without more tunnel space at some key stations on the subway line that would enable an express train to overtake the normal slower trains. But hold on a second, the government is talking about shaving off over 40 minutes from the current travel time (106 min à 65 min). That’s going to take more than just a bit of improvising underground near Asakusabashi (浅草橋駅).

So I can hear you thinking it over. What if they did get their act together and link Narita and Haneda with a high-speed express train? Would I use it? Is the Asakusa Line really that much more helpful compared to say catching a bus from Narita to a more convenient location? This is the icing on the cake for those of you who plan to be in Tokyo long term. Unless Hatoyama scraps it, the government will start including funds in their budget from this year enough to build a new station on the Asakusa Line that links it directly to Tokyo Station (東京駅) by 2015. Nice. I’m not quite sure how it would work exactly. It’s supposed to be somewhere between Takaramachi (宝町駅 ) and Nihonbashi (日本橋駅) but that smells to me of another long, sweaty underground walk like they have at the existing Nihonbashi station for the Asakusa Line. It all sounds a little too aggressive to me. I don’t think I would bank on it being completed on time especially since Ishihara wasn’t successful with his bid for the 2016 Olympics. Fat chance.

Ueto Aya at the kick-off press conference of the New Skyliner

But doesn’t that just strike you as poor planning? Why on earth wouldn’t JR have extended the shinkansen to reach Narita? They could have at least built their existing line on a wider gauge size so that they could potentially upgrade it one day. Funny you should ask. I’d always blamed this gross inefficiency on the ex-bureaucrats at JR but it turns out we have the selfless Japanese people to blame for that hour of pain we experience every time we travel out to Narita. Yep, the bureaucrats had it right. The national government actually approved the construction of a Narita Shinkansen (成田新幹線) and even purchased acres of land in Tokyo and Chiba before the idea was scrapped. At the time, the politically powerful residents of East Tokyo, Chiba and also the left-wing were up in arms at the idea of building a noisy train through their backyards that wouldn’t even stop near their houses. Sounds like that old lady who refused to sell her house to the Narita Airport and now lives right under the flight path of the second runway. Edogawa Ward (江戸川区) actually took the Minister for Transport (運輸大臣) to the Supreme Court in order to stop the construction!!

If you’ve ever gone to Disneyland then I’m sure you’ve wondered why the underground station for the Keiyo line (京葉線) at Tokyo Station is in such an inconvenient place? Well that “hole in the ground” was originally planed for the shinkansen station (as they were going to continue it through to Shinjuku). After canceling the shinkansen the government had to come up with an excuse to “use” the hole and hence we have the Keiyo Line. They also spent 90 billion yen building a meaningless piece of track from Narita to Tsuchiya (土屋) called the Narita Airport High Speed Rail. Oh, and you guessed it. It was completed 15 years behind schedule AND wasn’t even high speed! Because they built it on small 1067mm tracks, Keisei has had to build another wider line right next to it in order to complete their real “High Speed” railway! Gotta love JR.

I wonder how much the new train will cost passengers to use. The Hokuso Line that it will be an extension of is pretty expensive at the moment (It currently costs 1070 yen just to get from Nippori to Imba Nippon Medical School (印旛日本医大駅, Imbanipponidai) which is about the price you pay to get all the way to Narita on the existing Keisei line if you don’t use the Sky Liner. But hey, even if it costs 3,000 yen like the Narita Express it is still probably worth it for returning that extra 15 minutes of your life that JR robs from us each time. And I’m sure that the regular express will be cheaper for the day before pay day.

Here is the plan, for where the new track will run. It really seems to cut a beeline for the airport:

So back to my original worry: Where should I live? Well, if I could bare living out in the boondocks, I guess the obvious places where land prices are likely to rise are where the new express (特急) is scheduled to stop: Takasago (高砂駅), Shin-Kamagaya (新鎌ヶ谷駅), Chiba New Town Central (千葉ニュータウン中央駅), Imba Nippn Medical School and Narita New Town North (成田ニュータウン北駅). Hmmm. That’s a tough call. Nothing against those of you living in Chiba but it just feels soooo far away from it all!

I feel like I’m back at square one. What’s it like living in Takasgo? Where do you think I should live? I look forward to your comments below.

Official site for more information: www.new-skyliner.jp

Cabin Attendant with Baby - Travelling with bubs is not as much of a hassle as everyone makes it out to be - especially in Japan. You just have to know the tricks!

I figured that this is particularly relevant to other gaijin daddies out there who either want to take their child “home” to see their half of the family, or, if the child was born and lives outside of Japan, probably have a wife hoping to do the same. When is “too soon” to take your baby on a plane? It seems as though the current consensus is about six weeks but it’s not obvious that there is a lot of medical proof behind this. The six week period also happens to be a defining period in the recuperation of the maternal body and so it seems to me (as a total ignoramus when it comes to medicine) that perhaps the six week start-line is just as much for the mother as it is for the baby. At any rate we jumped on a plane (and a boat!) about two days after my son reached six weeks. No problemo.

The main thing that parents of little children (and other passengers) complain about on planes is crying due to ear pain. While you probably shouldn’t fly when your child has a middle ear infection, if your child is healthy then all you need to do is think of a practical way to encourage him to swallow continuously at the time of decent (contrary to popular belief the change in pressure in your middle ear at take-off isn’t a cause of discomfort, it’s the increase in pressure on descent that can hurt). Feeding is the easiest method. You probably want to start about half an hour before landing as the descent often begins before the fasten-your-seatbelt sign lights up. If you’re breast feeding this is pretty simple. If it’s a short-haul flight you might want to get a window seat for your wife so her oppai (breasts) aren’t seen by too many ero-oyajis. If you’re on the bottle then just make sure you don’t run out at the wrong time. Other things we’ve tried (and succeeded with) include thumbs (both his and mine), stuffed toys with mouth size feet, or some gauze. When they are over six months (not four or five like most Japanese books tell you) and are onto solids we’ve tried rusks and dried apple as well. Not having to think at all about food is the biggest advantage of travelling with a baby under six months, especially a breastfed one. If you’re child is asleep, for some reason unknown to me, there is no need to wake him up on decent. What other things do you need to consider when taking your baby on a plane?

Babies crying in planes annoy everyone - most of all the parents!

• Sleep: babies under three months or so sleep so much of the day there is a good chance they’ll sleep most of the plane trip. This is even more likely if your child goes to sleep easily in your car because he’ll also find the vibration of the plane’s engines very soothing.
• Movement: once your child starts to walk, catching a plane will take on a whole new meaning and you’ll spend your entire flight either entertaining your child or trying to restrain him. Conversely, in their first year of life, babies won’t be moving an inch so that makes them very obedient travellers. In fact, contrary to popular wives tale, a very young baby on a plane is much easier than a baby between one and three years old for exactly this reason.
• Cost: babies under two years of age are free on most airlines although sometimes you might be forced into paying a fuel surcharge for your child regardless of how young they are (with ANA you can avoid paying the fuel surcharge as well – at least for your baby – by using mileage to book your ticket). In order to get your child’s ticket for free, they have to travel on your lap. On long-haul flights you’ll be able to put them in a bassinet if they weigh less than 12kg (i.e. Up until about twelve months) or so and you’re lucky enough to get one (so book it early with the airline). Otherwise they’ll be sitting on your lap.
• Safety: If you’re very safety conscious, you won’t be over the moon to hear that the Japanese carriers don’t provide infant seatbelts (that attach to the one on your lap) on domestic routes. When you consider that the vast majority of in-flight injuries are due to sudden turbulence, I think this is pretty poor and am very close to writing an official complaint to both JAL and ANA. If this worries you too, or you don’t like the idea of your 12kg+ baby sitting on your lap for the whole flight, then it might just be easier to get a separate seat. Unfortunately the discount for children on a seat is minimal so assume you’re paying close to full fare. The other advantage to getting a seat is that it does guarantee your child a pop-down air mask in the case of an accident. Maybe the extra money is worth it for the peace of mind.

Travelling on a plane is nowhere near as bad as people will lead you to think and neither is travelling by boat, bus, or most other forms of transport. Just remember – don’t be discouraged to travel just because you have a small baby – especially in Japan. Travelling in this country revolves around eating tasty (and healthy) food, being treated like a King and relaxing in a hot tub. Especially if you’re wife is having trouble breast feeding, you might be pleasantly surprised: The warm, therapeutic waters of an onsen (温泉、hot springs) , and even your own bath at home to be honest, are known to stimulate milk production. My wife claims that her best milk producing days ever (in terms of quantity) were in the few days we stayed at Beppu Onsen (別府温泉) six weeks after our son was born. Although I’ve searched quite a bit on the web, I’m not quite sure of the minimum age for putting a child in an onsen itself but unless it is a tanjunsen (単純泉, spring containing less than 1000 ppm of dissolved minerals), I wouldn’t try it for at least 12 months (especially if your child has bladder/bowel control problems). It’s worth asking about the yushitsu (湯質, qualities of the spring water) directly with the ryokan as often the shower/bath uses the same gensen (源泉, source) as the onsen itself which could mean you’re inadvertently bathing your child in sulphuric water even if you use the bath in your private room.

Japanese ryokan and hotels are also pretty well set up for a family with a little baby, although it’s often worth checking with the manager first to make sure they don’t mind you bringing a little child. It’s also worth confirming that they have a kettle in each room as you can use that to sterilise things or boil water for formula etc. A typical mahobin (魔法瓶, flask) is fine as you don’t want to use very hot boiling water in your baby’s bottles anyway (for fear of BPA poisoning) I personally recommend finding a ryokan that offers heyashoku (部屋食, the option of eating your dinner in your room). Even if you have to go to the restaurant for breakfast, you’ll find your dinner much less stressful if your crying baby is rolling around the tatami next to you in the privacy of your own room.

What about when Nature calls? If you need to change nappies while you’re touring go to a shopping centre. While there aren’t that many in central Tokyo/Osaka, American style malls are all over the countryside. Most of them have a babies’ corner with plenty of space to breast feed, change nappies, and some even have a baby food “snack” （スナック, a colloquial term for a tiny bar where a mama-san usually serves sake to lonely salary-men but in this case sell food and drink that are suitable for a baby – together with it’s biological “mama” of course). If you’re wife is breastfeeding but still wants a coffee, go to Starbucks as they are the only coffee store that I’ve found in Japan to offer decaf coffee. Once again, you’re likely to find them in any major shopping centre.

If you’re breast feeding but want to take a small amount of formula with you while you’re travelling “just in case” then I recommend “Hohoemi rakuraku cubes”. They sell boxes of their milk subdivided into handy travel packs so you don’t have to worry about using more than you need at any one time. Within each travel packs there are five hard blocks of formula (each the equivalent of 50ml of formula if my memory serves me correctly) to save you having to measure out messy formula as well.

Finally a word on train travel. If you don’t have a car then you and your partner are going to be battling the railway system on a pretty regular basis with your baby. Good news is that you don’t have to pay for your child until they reach primary school age and as long as they are sitting in a buggy then you will probably never be questioned. That said, my best advice for short trips is “to do as the locals do” and hang your baby in a sling across your chest. While many stations in the large cities have elevators and escalators, you’ll be surprised how many don’t (and never will due to architectural restrictions!). My local station infamously has two flights of escalators, followed by one flight of stairs to get out of the station! When I do take my son on the train in our buggy, I always use “rakuraku odekake net” which tells you what norikae train route to take you to your location while avoiding stations that don’t have elevators and escalators. It’s great. Unfortunately there isn’t an English page at the moment so I’ve been pestering the owner of trains.jp to create one. He is a gaijin in Tokyo, and is using trains.jp make the best norikae annai experience for foreigners. Fingers crossed.

If you’ve got any other Japan specific tips on travelling with babies, please share them with us in the comments section below. Better yet, I’d love to hear some of the horror stories of taking infants travelling to prepare me for what is yet to come!

Semblance of our resident crazy Japanese neighbour.. Do you have one of these?

The perpetrator – my neighbour of five years – completely freaked me out a few years back by coming to my door and letting rip on me about my toddlers (they were 3 and 1 at the time) and the incessant noise they made. I was in the doorway and it was a very very intense moment as the guys mother (with whom he lives) came to the door to calm him down. The guy is in his mid-late 30′s and clearly something was not right – especially as on this occasion the kids had only been home a few minutes before he was dinging on the intercom. To my recollection we came in (after shopping for dinner), they washed their hands and went to the lounge to play. I was making dinner not far away and the noise was fine. The neighbour complained to the Kanrinin-san (caretaker) and he passed it on to the landlord (or at least to the agency that looks after the property). They came to us and dealt with the situation. The flooring was regulation thickness, we even had a thick carpet on top of most of it. We are not a loud family, and the whole situation did not make much sense. They went down to see the neighbour and came back to report that he suffers from some ailment of some kind. We were not sure but it started to sound like schizophrenia or something kind of “scary” to the uninformed (like us).

We agreed that should there be problems in the future we and he would go through the agent to communicate the issue. Of course we would try our best to keep our children quiet. This failed when on the next occasion the neighbour complained that it was me who was at fault for stomping around the house. As the father of two and wife of one, I had been at particular pains to keep quiet yet somehow my walking around in socks was noisy? Again, it did not make sense.

This type of thing carried on for years, with the occasional outburst from the man downstairs. We would get the call, “byonin ga imasu” (there is a sick person down here) every few months and we would be on high alert for a while to keep the noise down. It was not as if we were even all that noisy but with two small kids playing I can not guarantee that there were not at least some “bangs” and “thuds”. We have the same noise issues with the folks upstairs but we tend to understand, and get over it pretty easily. We have foot steps, knife on cutting boards and early morning alarm clocks but we don’t make any fuss. The noise is so slight that it really would be lame (or weird) to make a fuss.

Cue July 2009 – I was at the office and my wife was at home with our youngest son and three of his girlfriends (and their mummies) from kindergarten. Lucky little tyke, you may think but on this occasion – a warm, humid day – the window was opened and whatever noise those naughty little kids were making travelled south to the byonin downstairs. With no warning the ladies in the living room – three in all – heard an extremely loud and scary “Korosuzou! Kono Osutoraria-jin yarou!” (Going to kill you! F*ckin Aussie!). Needless to say the other ladies and their kids all left in a rush, probably thinking WTF is it with this wacko woman and her Aussie husband? What do they do to make their neighbours so angry? Well, as a matter of fact, ah… nothing, as far as we can tell. A week or so before this particular incident the byounin called the O-ya-son (landlord) and they sent a team around to investigate. They got to the door to find a very quiet household – the kids were playing Wii after all. Generally they are just glued to the TV when doing that. But it was clear that the byonin underneath us was reaching a peak.

He went nuts again just last week during the typhoon. For some reason he was paranoid that my home office (corner room) windows being open would cause major damage to his apartment. He asked the kanrinin-san to visit us, and make us close the windows. My wife explained (as I was on a call) that I had no air-conditioning in the room and there was no water coming in, other than the odd droplet that landed on my desk (with a newspaper strategically placed). The kanrinin understood and didn’t really see the issue.

Next thing – as I had not closed the windows – we had more of the yelling from downstairs. One of the neighbours and friends from upstairs called us to see if everything was okay (as this guy was now legendary in his own right). Being on the council (or whatever you call it) for our mansion they suggested that we call the cops. My wife was quite freaked out at this stage and duly did so.

Within minutes we had a copper asking about the trouble and also the real estate agent. We got some handy advice from the young policeman who was concerned about the potential for this issue to worsen and he went down stairs to talk with our byonin neighbour. He came back later to say that he gave the guy a warning to keep the noise down. Surely the man downstairs felt the irony in this, but we are already looking to move and buy our own place! The guy’s a psycho.

So. What would you do in this situation? We are thinking that after having “I will kill you Aussie!” yelled at our family, our chances at an amicable resolution are pretty low. Especially when you consider that I am not a bloody Australian but a Kiwi. (What an arsehole!) But we think that we need to vacate the premises and make the landlord pay for our new key money and gift money, seeing as we have paid that up so cheerily every 2 years.

Feel free to share your advice, or even better, your “crazy Japanese neighbour” story below in the coments.

Triumphant lawyers outside the court advocating mansion renewal fees in a similar case some years ago in Kyoto - This time they were not so lucky

The regular guy in Kyoto was living in a typical apartment room paying 55,000 yen a month rent. His rental contract reached maturity in April of 2006 and was automatically rolled over to a new contract when he agreed to pay two months of rent (110,000 yen) as a one off renewal fee ( 更新料 ) to the landlord. Nothing unusual there and I’m assuming that the guy himself didn’t think twice when he paid it. However, it’s funny how stupid some decisions look retrospectively. Due to various reasons the guy had to leave his apartment in the following month (May ’06) and decided that he would ask his landlord to refund the renewal fee and 100% of his deposit. When the landlord said no he took him to court arguing that it was in breach of the 消費者契約法 (shohishakeiyakuho, consumer contract law) and requested a full refund of both. Incidentally, his deposit was more than a whopping 350,000 yen (more than 6 months rent!) and that is probably the real reason why he took his landlord to court but for you and I the more relevant issue is what happened to his renewal fee.

To cut a long story short the Kyoto regional court ruled in his favour and argued that the concept of a renewal fee had no benefit whatsoever to the consumer and was completely in favour of the owner and hence in breach of the consumer contract law. While there have been various one off court cases concerning particular cases of a renewal fee, this is the first in which the entire concept was deemed to be against the spirit of the law. One of the specific reasons that the judge raised was that at the time of paying it was unclear what period of time a renewal fee was to cover and hence it was impossible to include in the definition of rent. I wonder what the same judge would say about reikin (礼金, the not very voluntary act of paying 1 or 2 months of rent to your landlord at the time of signing your rental contract).

The consumer contract law was passed in April 2001 in order to protect consumers from abuse in contracts that they have signed. It’s open to very broad interpretation and measures all contracts in terms of quantity and quality of information provided to consumers and ideally protects them from being abused, especially when they are not in a strong negotiating position.

I suppose this debate in this case probably boils down the question of whether or not you would be willing to pay a higher monthly rent for the pleasure of abolishing the renewal fee. At the end of the day most landlords include this in their budgeting and without it would almost prefer you to leave so they can sign on a new tenant for their reikin. But, given the considerable oversupply of rental properties at the moment it might not be that practical for landlords to raise their rent. That would mean rents on long-term properties would fall by 8% (assuming 2 months renewal for a 2 year contract). Bad for inflation but good for renters like you and I.

Breastfeeding: Baby formula product marketing and your doctor may make you blind to the benefits

It really frustrates me the number of heart-ache stories that I hear from friends who’ve been totally convinced by the Japanese mass media that their breasts aren’t good enough for their babies. Just as depressing are the number of stories that I’ve heard where mothers in Japan who had previously believed that breast is best, have been convinced by their doctors (after only a few weeks of trying) that they’re not making enough milk and switched to formula or a mix of formula and breast milk. Whereas 90% of Japanese mothers when surveyed before giving birth suggest that they want to raise their child on breast-milk, only 3~40% of them are still exclusively feeding their babies breast milk by their three month check up. That is lower than most countries in Asia, and is extremely low when compared even with developing countries – what makes Japanese mums feel so unhealthy/unqualified that they can’t breastfeed properly? It’s not because they are rushing back to the work force, the vast majority are dedicated (and motivated) stay-at-home mothers. It’s because a combination of dated medical practices and an advertising dollar focused publishing industry has lead Japanese mothers to believe that there is a good chance that their breasts won’t be making enough milk. If you introduce me to another Japanese mum who cries to me that her breasts are 出が悪い (degawarui, don’t make enough milk) then I think I will take to her doctor with a knife! While I profess to have no official medical background, I’m hoping that my views as a novice Daddy-san in Japan will be able to save a few couples from resorting to an unnecessary evil. (This is the second article in this “Daddy-san” series. Make sure to also read part one).

To be very clear, I have absolutely no qualms with mothers using formula for lifestyle reasons: because they want to go back to work, because they want more freedom or because their husband wants to be a stay-at-home Dad, etc. I know many people who were raised exclusively on formula and they have been able to function as normal human beings. I’m angry because there is a significantly large number of mothers out there who want to feed their babies breast milk but are actively discouraged by (a) their pediatrician, (b) mass market literature claiming to offer information on bringing up babies, (c) stealth marketing by infant formula companies and (d) their parents (who grew up in a time where formula was erroneously thought to be better than breast milk.) Let’s be very clear about this. There is absolutely no doubt that breast milk is the best thing that your baby should be drinking. Your baby can and should be fed exclusively with breast milk (that also means no water) for approx. 6 months. Even after you gradually introduce real foods from 5~6 months onwards, your baby is best drinking breast milk at least until 12 months of age if not longer. The list of the benefits of breast milk over formula is very long and growing. My favorite is that despite it being totally free, it also provides higher immunity and hence lower medical expenses for the child’s entire life. You can find a long list of the benefits all over the web and in most English books on child rearing.

The Japanese deception starts the moment your wife begins reading the pregnancy magazines by Benesse and the like. Have you ever wondered why these publishers can afford to publish so many magazines on pregnancy so regularly despite Japanese mothers giving birth to less and less children every year? A healthy advertising budget from the infant formula companies help. Whereas English books often focus on the potential difficulty of breast-feeding and the need for support from the father, Japanese magazines seem to paint the world as if it is totally normal for a mother not to be able to make enough breast milk and that to top-up with formula is the norm. This is called kongo (混合, mixed) and refers to feeding your baby part breast milk and part formula.) Perhaps it works because of the perennial Japanese complex of having small breasts (which is known to be totally irrelevant) or perhaps it is just because first time mothers are lacking in confidence and hence willing to believe what they read in a magazine written by a company that runs English language schools (Benesse owns Berlitz remember!). Someone please explain to me – If the human race has survived for so many thousands of years, why on earth would breast milk not be enough to raise your child? Needless to say, I’m yet to see a Japanese book written by an academic that doesn’t paint the picture accurately. For some reason, it’s the colourful magazines written by editors – not academics – that survive on advertising and sales of other products to their readers, that have become the trusted source of information for Japanese mothers. If you are a new gaijin Daddy, I definitely recommend that you come to your own conclusions about breast feeding after reading a book or two written by an academic. Here are some great ones:
The New Father: A Dad’s Guide to the First Year by Armin Brott or
Baby Love: Everything You Need to Know About Your Baby’s First Year by Robin Barker

Unfortunately, “information” magazines are only the tip of the stealth marketing iceberg when it comes to Japanese formula companies. Most of the professionals that you have trusted (yes, your sanfujinka too) are probably on their pay-rolls. One of the key conditions for becoming a baby friendly hospital (BFH) is not to accept free samples or other forms of financial assistance from infant formula companies. Given that 70% of Japanese public hospitals are loss making, I guess you can’t blame them for seeking out private sector subsidies like this but is it fair to sacrifice the health and well being of our children while doing so? (See our article on BFHs in Japan for where to find one – they’re few and far between).

Take a look at these pictures taken in our nearby hospital (you can click to see a large version of them).

I guarantee you that there is not a single mother (or father, or grand mother or 3rd cousin twice removed) who doesn’t check out the photo of their loving little baby who’s just been born into this world. Better yet, this sign is right near the front entrance so even patients coming for other illnesses are likely to have a peek. What better subliminal messaging could you hope for than a rather unsubtle add from Meiji for their infant formula called hohoemi (ほほえみ) when you first see the face of the newest member of your clan? This hospital is known in our area to be highly respected for its sanfujinka (産婦人科, Ob/Gyn). With a reputation like this, why does it have to stoop to paid advertisements from one of Japan’s major formula manufacturers? Or is this hospital just like many other hospitals in Japan where the male Ob/Gyn’s claim that they can stimulate breast milk production through special Zen breast massages before resorting to formula when they proclaim that it is the mother’s fault as her breasts don’t produce enough milk. Rather than focusing on the joys of breast massaging, we need Japanese doctors to spend more time explaining how difficult breast feeding can be. Let’s face it, it’s not easy and it doesn’t come naturally to the baby or the mother.

Historically mankind have had grandmothers around to teach breastfeeding to the rookie Mums. But because the baby boomer generation decided that formula was “better” than natural breast milk, we can’t necessarily rely on the elder generation anymore. While America was just as guilty of throwing out the breast in the 70s, they’ve also come to the rescue of the younger generation with lactation consultants to take their place. We had a lot of trouble with breast feeding. My baby refused to grow in line with the pediatricians expectations for most of the first month of his life which was very stressful. Ironically, this is not that uncommon. It takes different babies (and mothers) different lengths of times to get into the swing of breast feeding – very few people get it right in the first week or so. We were lucky enough to have the support of two lactation consultants who helped my son and wife latch better. There is a vast shortage of internationally accredited lactation consultants in Japan so if you’re expecting or have just given birth you should book one ASAP (see the link below).

I’ve heard of some very unsettling stories in Japanese hospitals that have even resorted to giving formula to babies within the first few days of their lives. Even perfect breasts do not manufacture milk for 2~3 days after the baby has started suckling. You’re lucky if you get more than a teaspoon of a liquid called colostrum during that time. That is totally natural and your baby can survive for a few days on the fat stores that he built up in the womb. More to the point, the colostrum has vital nutrients to boost your babies immunity that are sacrificed if the Mother gives up breast feeding from day one (reference). While none of this is obvious, it only takes some caring advice from a responsible midwife to calm the first-time mother who is worried that it’s taking “too long” for her milk to come in. Then, except for a very small percentage of women, the amount of breast milk slowly increases as your child suckles on the breast, creating oxytocin. Oxytocin not only stimulates breast milk production but it also speeds up the recovery of the Mother’s body which is why mothers of formula fed babies are less likely to have a smooth and quick physical recovery.

Ironically, when your baby isn’t growing “fast enough” in the first few weeks of his life, your pediatrician is not necessarily the best person to rely on for information. He is there to ensure that your baby meets certain growth targets which are deemed to be “normal.” He’s not a lactation consultant and he hasn’t studied very much about the female body. It’s no surprise that he’s going to be quick to suggest a “boost” of formula to help your baby hit his growth targets. When we were in that situation, our lactation consultant kindly explained to us that we could sakunyuu (搾乳, express) milk from my wife’s breasts and feed it to him via a bottle or syringe (we actually elected for a blunt syringe as we didn’t want to promote nipple confusion). Unfortunately, in the vast majority of cases in Japan, the doctor is more likely to portray a “now or never” need of urgency and bully mothers into adding formula to boost their babies weight. Sure that is the easy option but it is rarely the only option. Less than 2% of the population actually have breasts that cannot produce “enough milk”. Make sure that you’re wife is seeing a lactation consultant from day one so you have the option to express before you’re forced into using formula. While it is a tiring process, expressing gives your baby a few more weeks to learn how to suckle independently. Better yet, you don’t have to worry about your babies weight-gain in the interim. If you are going to try it out, make life easy and go straight for the automatic ‘milking’ machine (for want of a better term). We rented ours from Medela after battling with a manual pump for way too long (you can find your closest rental agent on their homepage). I can’t stress enough, you should be able to supplement your babies milk intake with expressed breast-milk before you have to resort to formula top-ups. You’re wife is only going to have the confidence to do so if she’s been talking to a lactation consultant from day one.

The stealth marketing of the formula companies does not end there. One of my friend’s mother works at the local shopping center. She visits the baby section once a week or so to hold sessions for mothers on baby nutrition. If you’ve ever been to a Jusco or a big shopping center, you’ll know what I mean. In the area where they have the nappy changing tables and the baby scales, they often have a room which is used for these nutrition seminars. Sometimes it is once a week, sometimes once a month but local mothers come to get a free checkup on their baby’s health and to “learn” about how they should be feeding their child. What a great idea, huh? Apparently the advice that my friend’s mother give ranges from how many mls of miruku to feed your child each day and how to prepare solids for slightly older babies. Hold on a second. Did you say miruku? Yes, and that is specifically miruku (ie. formula milk) and not the natural stuff (母乳, bonyu). On further questioning, it turns out that my friend’s mother is not even employed by the local supermarket, she is employed (and trained!) by Otsuka Pharmaceutical Co. (大塚製薬). Yes, the company that makes the biggest selling brand of formula in Japan, Beanstalk (for some reason pronounced beanstark (ビーンスターク) but don’t get me started on that). How stealth is that? I guarantee you that every week, huge numbers of innocent, unsuspecting mothers around the country are being fooled into believing by their local “baby nutritionist” that they should be substituting their own breast milk for formula. Not only are the hospitals and the publishers working against us, but the supermarkets are, too. I guess it makes sense. The supermarkets get a free “entertainment act” that not only attracts shoppers but also promotes shopping, not to mention that this likely boosts formula sales right after the deed. Who can we trust?

Good book for your Japanese partner: 「母乳の方が楽だった？！おっぱいでらくらくすくすく育児」

So as a new-chum gaijin parent in Japan, what should you do? The simple answer is education. Read up a lot in English yourself and do your best to subtly pass on the more important messages to your Japanese partner. Try to find a lactation consultant and better yet find some decent literature in Japanese written by a medical professional. If you’re wife is struggling with breast feeding or not totally on board with the idea, I personally recommend this book (cover pictured here):
母乳の方が楽だった？！おっぱいでらくらくすくすく育児
(Bonyuu nohoga raku data? Oppai de rakuraku sukusuku ikuji, “Breast feeding is easier?! Raising your healthy child on the breast with a minimum of effort”)

It’s written by an internationally accredited lactation consultant (Kitano Sumiyo, 北野寿美代) who realized one day after retiring as an official 助産婦 (josampu, midwife) that she’d spent her entire life focusing on babies and how the baby could get more nutrition while ignoring the mother completely. She then decided that there must be an easier way of breast feeding that was enjoyable and rewarding from the Mother’s perspective. That lead her to studying more about international standards of lactation and her ultimately coming up with this book which mixes the best of both Japanese and Western methods.

Finally, let me leave you with a list of the ingredients of Meiji’s Hohoemi formula – yes the one that advertises in my local hospital (See baby pics, with ads above). This is just taken from the back of the pack, I’m not sure if it includes the 30 different additives that the Japanese government approves for including in infant formula. (source: オーガニック食品最前線) or not. While I know that thousands of Japanese babies drink this every day and still grow up to be strong and healthy adults, I ask you – do you really think that this could be better than breast milk? Ironically, hohoemi means smile. I wonder who it is that is smiling.

Hohoemi Milk Formula Ingredients: Lactose (乳糖)、adjusted edible oils (調整食用油脂)、refined soy bean oil (大豆白絞油)、palm kernel oil (パーム核油)、fractionated pig fat (yummo!) oil (豚脂分別油)、refined fish oil (精製魚油)、milk serum protein (乳清たんぱく質)、butter milk(バターミルク)、casein (カゼイン)、fructooligosaccharide (フラクトオリゴ糖)、dextrin (デキストリン)、salt (食塩)、milk phosphatide extract (乳リン脂質抽出物)、yeast (酵母)、iron pyrophosphate (ピロリン酸鉄)、calcium phosphate (リン酸Ca).

If you have any stories about breast feeding in Japan, either happy or sad ones, we’d love it if you could share it with us in the comment section below so that hopefully the broader community of gaijin Dads (and Mums) can benefit.

Here are some more handy links and contacts that might help your breastfeeding challenge:
• La Leche League Japan (English), ラ・レーチェ・リーグ日本 (Japanese)
• Japanese Association of Lactation Consultants (NPO法人日本ラクテーション・コンサルタント協会)
• Japan Breast Feeding Association (日本母乳の会)
• Japanese Midwives’ Association (日本助産師会)
• Unicef: Ten Steps to Successful Breastfeeding (English), ユニセフ:母乳育児成功のための１０カ条 (Japanese)

Bringing up a bi-cultural kid - it can be confusing

It turns out that while the world knows a lot about bringing up babies, maybe there aren’t as many universally agreed upon facts as I’d thought. Almost one year down the track from becoming a Dad, I’m wondering if there is any topic that isn’t disputed from one culture to the next. But I guess that is one of the things that makes bringing up a baby – your baby – so eye opening when your partner is from another culture. Generally what we believe is best for our children is a concentrated version of the kool-aid that we drunk as a child, or at the very least, what the society that we were brought up in led us to believe. I can tell you now, you will learn more about Japanese culture by having a baby than you ever will by taking the class of the similar name in first year University!

Maybe you didn’t fall into the same trap as me, but I never got around to reading the 9th chapter of any of the “month by month” books on pregnancy. In fact, I didn’t even bother buying any books on bringing up an infant. I was too focused on the pregnancy and on how big my baby was after X number of weeks. I wish someone had have sat me down and just said: “Stop reading the pregnancy books. The baby will pop out regardless of what you do! Start reading up on what you’re gonna do after the big day now because as a sleep deprived Dad you won’t have the time or the energy to be reading anything for months after your baby arrives!” In fact, just like most of the stuff that I wrote in the pregnancy series is most relevant to Dads who aren’t pregnant yet, I have a funny feeling that a lot of this series will be most relevant to Dads who aren’t Dads just yet.

Even mono-cultural Dads don’t have an awful lot of time to recover after the birth before the reality of your new life sets in, but you, the newly Knighted bi-cultural Dad, are in for twice the onslaught. The differences will start to slap you in the face from the first few days in the Hospital. Whereas most English (language) academics are now recommending a more natural environment for your newborn, Japan interestingly chooses to focus on cleanliness and often puts this before many other considerations when it comes to your baby’s health. Take your baby’s belly button stub for example. Whereas you’d probably be encouraged to ensure it was clean with warm water back home, the standard in Japan is to regularly sterilize it with alcoholic swabs. (This used to be the norm in the West, too, but recently Doctor’s are discouraging it as they don’t understand the potential side-effects for the baby from the alcohol). The desire for sterilization doesn’t stop there, most nursing Mums are encouraged to rub their nipples with alcohol before breast feeding. I guess they deem a little grog to be better for the baby than what other potential germs could be on its Mummy’s breast. Clearly babies have been breast feeding without sterilizing breasts for thousands of years so I’m not sure why we’d want to start now. I’m guessing that this must stem from the poor hygienic conditions in war-time Japan but I’m not sure. (If anyone knows the real reason, I’d love to hear about it in the comments section below.)

If you’re lucky enough to learn how to bathe your babe at the hospital, you’re probably wondering why you can’t let water in your baby’s ears or whether you really do need that gauze on his/her stomach at all times. Then there is the perpetual desire to feed him/her mugicha (麦茶, wheat tea) from 2 months onward or the Japanese book that insisted that if your baby doesn’t eat rice regularly during infancy then they won’t grow up to be a real Japanese person. (Yes I really read that in a book about rinyushoku (離乳食, solids)! The list goes on…

Believe it or not, we’re not much better. Have you ever tried explaining the nursery rhymes that you sing to your child to your Japanese spouse? How do you go about explaining why you dance to and laugh about a song about Tuberculosis? And what about rationalizing poor Georgie Porgie’s pedophilic tenancies? Even better, why on earth a dead man in a ditch and the flaws of the judiciary system shows it’s face I don’t know. Don’t get me started on teapots or people with four names. (Sorry for the Windows media stuff, couldn’t find mp3s..)

But most of these differences are just cosmetic. The last thing your baby wants is a tense house because of small difference in opinions and most of these you just have to wash under the bridge as being interesting and educational. My intention is for this series to focus on areas that I found either confusing, frustrating or educational while bringing up my son in our bi-cultural household. For most gaijin like me, living in a foreign country, it can be difficult to get balanced information with your family living in another country and the local medical staff speaking another language (in more ways than one). Hopefully this series will serve to be a bit of a resource for foreign parents in Japan who are keen to share their questions, worries and advice with out parents. I’ll be writing from a Dad’s perspective but there is no reason to limit it to just men. In fact, I have a funny feeling that there should be a whole separate series for Gaijin Mum’s in Japan married to Japanese guys and their experiences. In the meantime, this will be the story of how I endeavored to become a balanced Daddy-san. If you have any requests or worries to begin with- don’t hold back – share them with us in the comments section below.

Breast feeding at a Baby-Friendly Hospital in Japan

Has your wife already chosen her Obstetrics & Gynecology (Ob/Gy) Doctor in Japan? Have you met him? (I use “him” as unfortunately the vast majority of Ob/Gy’s in Japan are males) Did you go along to help scrutinize him? Call me paranoid but we went and interviewed 4 different doctors before we decided on who we wanted to deliver our baby. It’s astounding how different one Doc’s perspective can be to the next.

This is the sixth installment in a series about my personal experience of being pregnant in Japan (or perhaps I should say, of my Japanese wife being pregnant). I decided to start writing this series when I realized that there must be a significantly large population of gaijin dad’s out there who are making all of the mistakes that I have and wished there was a bank of information somewhere to save them some of the pain. In that respect, this installment might be most relevant to Dad’s who haven’t even gotten pregnant yet or are in the early stages. If you’re too far along in the pregnancy, it’s likely that your wife has already decided on which hospital she wants to use. That could be fine, but I don’t want you to overlook how important such a choice can be. With a bit of balanced information from an international perspective you might want to rethink your priorities. There doesn’t seem to be very many independent, balanced sources of information for Japanese people, let alone gaijin parents so hopefully I can shed a little more light on the Japanese hospital situation here. If you haven’t already, you might like to catch up on the first, second, third, fourth and fifth installments of the series before reading on.

Although it might seem painfully obvious, choosing the right hospital is a very important decision in your wife’s pregnancy. Most people just focus on the size of the room, the kind of food that is served and the price but there are a whole lot of other things that you need to take into consideration when choosing a hospital for delivery. Although the private health system is almost non-existent in Japan, Ob/Gy is one of the few areas where you have a pretty wide choice and certainly don’t have to rely on the large scale 総合病院 (general hospitals / Sogo Byoin) if you don’t want to. There are thousands of tiny Obstetrics & Gynecology clinics (called 産婦人科 / sanfujinka) dotted around the country which specialize in nothing but pregnant mothers. Many of them have a limit on the number of patients (often a single digit one) and so can provide a very personal service compared to what you might have expected if you have ever needed emergency treatment at a regular hospital in Japan.

Although you often have to pay up front in cash for Ob/Gy services in Japan (remember, credit cards generally aren’t accepted in Japanese hospitals at all), the Japanese government will give you a cash payment of 350,000 yen per child as long as either you or your partner are working in Japan and paying some sort of government insurance. (While it’s nothing to celebrate, you are actually even eligible for the cash in the case of a miscarriage as long as the fetus reaches 85 days or more!). While most clinics structure their fees so that you are charged spank bang 350,000 yen, some in remote areas with aging populations are proactively charging less (so that you can profit from the birth) in order to attract young couples from the cities. By the way, if you’ve recently had a baby and you haven’t applied for the government subsidy, it’s called “出産育児一時金” (Shussan Ikuji Ichijikin) and you can apply for it up until 2 years after the date of birth of your child.

Check out the price. Check out the size of the steaks they serve you to celebrate the birth of your child, but more importantly check out the philosophy and policies of the doctors, nurses and midwives. And this doesn’t just refer to being organic or having/not having an epidural. If you need a list of questions to ask, there is a great template in the book, “The Expectant Father” that I introduced in part two of this series (it is still my favorite book on this subject matter by the way). But if you’re hoping to breast-feed your baby exclusively, I recommend that you add the following few questions for Japan:

• What percentage of children born in your hospital last year drank formula at least once?
• Under what circumstances will a baby be fed formula? (especially focusing on if nurses ever feed babies formula without consulting the parents)
• Do you have, or can you recommend a lactation consultant?
• If the mother is deemed to have a low supply of milk or the infant is not putting on weight fast enough, what countermeasures do you recommend and after how many weeks?

One of the big problems is that although many hospitals claim that they are all natural/back to basics, or that they encourage breast feeding, this often means little more than them giving private breast massages to your wife for the few days after her delivery. The reality is that many of these doctors were educated a long time ago and aren’t up to date with the most recent academic thought and they are more likely to trust what they hear from the visiting salesmen from the major pharmaceutical companies (who also, strangely enough, leave plenty of samples of their products). Hell, it is so hard to keep a hospital profitable in Japan that you don’t have time to do your own extra research.

So, I ask you this question? Who do you trust more? The quack down the road from you who operates a small scale clinic that is only viable because of government subsidies and strategic bribes from pharmaceutical companies? Or the World Health Organization (WHO) and UNICEF? Yes, there is a better way of judging how reliable your Ob/Gy really is.

It turns out that WHO and UNICEF have developed a global criteria for what they consider to be a Baby-Friendly Hospital (BFH), under the BFHI (Baby-Friedly Hosptal Initiative), which encourages and recognizes hospitals and maternity centers that offer an optimal level of care for breastfeeding babies, which includes protecting, promoting and supporting breastfeeding.

The BFHI Ten Commandments
of Breastfeeding

The concept stemmed from the fact that (almost) all Mothers use a hospital when giving birth to their baby and almost all of those Mothers are heavily influenced by the practices of that hospital and the teachings of their Ob/Gy and/or midwife that delivers their baby. If the hospital is so focused on the bottom line that they skimp and cut corners when it comes to education or even worse give misinformation to their customers due to a lack of continual independent education then there can be serious repercussions for the long-term health and welfare of the babies born there. Pretty simple, eh. Well WHO and UNICEF have now designated over 20,000 hospitals in 152 countries as being Baby Friendly Hospitals. How many do you think exist in Japan? 48. Yep. Japan has less than one quarter of one percent of all of the BFH’s in the World. What are the criteria that the WHO and UNICEF use to judge hospitals? It turns out that they have 10 simple rules for becoming a BFH and they center on making your birth natural and giving your baby the best chance it can have for a healthy birth and to reduce the probability of allergies and other medical risks developing in later life. They cover everything from giving the child a chance to bond with it’s mother on the breast immediately after the birth to not accepting free or low-cost substitutes for breast milk (ie. Powdered milk). You can read the details for yourself on their official website entitled, “The Baby-Friendly Hospital Initiative” which also has a link to all of the 10 commandments of breastfeeding. Perhaps most interestingly, it gives you an insight into what so many of the world’s hospitals are messing up.

Perhaps you might think that BFHs aren’t for you, but please let me try one more time to convince you. We were lucky enough to find a BFH that also met our other needs (including geographical) and I’m convinced that it made a huge difference in terms of emotional support and acceptance (from the midwives to my wife and I) and was key to a flawless entry to the world for my child. Before you finalize your hospital, please see if there are any Baby Friendly Hospitals near your home. If there is one, give them a visit and find out how they’re different to your current hospital. You might be pleasantly surprised.

Below is a list of all of the BFHs in Japan (as at July 2008). As far as I know, this is the only English language list of Japanese BFHs. As you’ll notice, the biggest problem is that there just aren’t that many BFHs to choose from (Damn, even Burma has more!) but by spreading the word to your local Ob/Gy you might be able to help change that. If there are any readers out there who have actually been to one of these BFHs, we’d love to hear your thoughts in the comments section (at the very bottom) so other gaijin parents can benefit, too.

List of Baby-Friendly Hospitals (BFH) in Japan:

(Click on the Japanese name to jump to the homepage of each one):

The “Mercury Food Chain” – From the ocean to your baby

Everyone knows that pregnant women should avoid fish and definitely shouldn’t eat raw fish… right? Or at least I thought that was “a given” until I started discussing what my wife and I might eat on our next date in the big smoke. Well, it turned out that we were to have sushi and that I had no say in the matter.

There is no better topic than pregnancy for old wives tales to prevail and the list of different foods that you can and can’t eat seems to be not only the longest, but the most contentious when it comes to the cross-border battle of who’s “common sense” was to prevail. While it is hard to prove most wives tales either right or wrong, but I assumed that something as important as food must have a “right” answer.

This is the fifth installment in a series about my personal experience of being pregnant in Japan. Although I hope that the observations have value for gaijin of both sexes, I’m intentionally writing this series from my own perspective – a Gaijin Father / Japanese Mother. (You might like to read the first, second, third, and fourth installments before reading on. And sorry to those expecting Father’s who were wondering what had happened to the series – you’ll know what caused the sudden blackout for me, right after your child is born!)

As I mentioned in part part two, my wife and I have tried to do our research about pregnancy in both English and Japanese in order to avoid bias toward one culture versus the other. Perhaps the biggest contradiction I noticed between the two banks of knowledge was how fish is treated. While every English book (and website) has numerous warnings peppered across at least 2-3 different chapters of the book telling you that you must reduce your intake of oily fish (example), Japanese books as a rule actively encourage pregnant Mum’s to eat as much fish as they can. To make matters worse, neither side of the debate writes anything that isn’t true. It’s just that the rationale employed by each culture is so different, that a Martian would be forgiven for thinking that perhaps they were referring to entirely different species.

So how can there not be misinformation if both sides are arguing opposing points, you ask? Rather than lying, it seems that most authors take the approach that “simple is best” and (almost always) fails to mention some key facts about fish/seafood when describing what it’s readers should unilaterally do. The typical English book talks about the high mercury levels found in many fish, especially tuna, which can affect the neural development of your fetus severely if ingested in excess. On the other hand, Japanese books focus on the healthy properties of fish, especially blue fish and recommend that you should eat fish regularly in order to increase your intake of DHA and other Omega 3 & 6 fatty acids. In reality – although contradictory – they are both correct.

So that brings me to my next question. Why don’t we ever hear both sides of the story? I guess in the English books, authors are just leaning on the conservative side and recommending against something that isn’t easy to measure. Who wants to take the risk of being sued by a pregnant Mother who misinterpreted your recommendations? Surely there is a limit to how far they should be allowed to play on our fear though? On the other hand, it’s no surprise that the Japanese, who are amongst the longest living, biggest consumers of fish in the world aren’t too worried about the side-effects of over consumption of fish. Or are they? Well it turns out that the Japanese government is (good on ‘em!). Even though it is rarely mentioned in Japanese books about pregnancy, the MHLW (厚生労働省) actually announced recommendations for pregnant women to reduce their intake of various types fish for fear of mercury poisoning. How many times have you been shocked to hear from well educated Japanese friends that they had no idea that tuna consumption could be unsafe for their unborn baby?

It boils down to the fact that too many books on pregnancy in Japanese are designed to sell. They are supposed to be fun, easy to read and almost always “edited” by a magazine publisher as opposed to being “authored” by a medical professional. Given that being a pregnant mother in Japan is stressful enough with your hubby doing overtime until the middle of the night, the last thing a pregnant Mum wants is to read that she can’t even eat fish. Half of the mags out there will focus pages upon pages on fish recipes.

It’s worth showing your Japanese spouse the MHLW’s “水銀を含有する魚介類等の摂食に関する注意事項” (Translation: Warning on Intake of Seafood Containing Mercury) as she probably won’t discover it herself unless she is reading a University level textbook on nutrition. It was announced first in 2003 and updated again at the end of 2005 to double the number of fish that could potentially have high levels of ethyl-mercury. The ministry regularly updates their official site and has a pretty good FAQ about the guidelines titled:魚介類等に含まれる水銀について (Translation: Memo on Mercury Levels in Seafood). Their most recent effort in publicizing the guidelines is in this PDF called 「これからママになるあなたへ　お魚について知っておいてほしいこと」 (Translation: A message for all expectant mothers – A few things you must know about fish (found on MHLW’s page here).

Before I go into the details, you’ve got to forgive me for reproducing the first paragraph here:

魚介類（クジラ、イルカを含む）は、良質なたんぱく質や、血管障害の予防やアレルギー反応を抑制する作用があるDHA(ドコサヘキサエン酸)、EPA(エイコサペンタエン酸)を多く含み、またカルシウムなど栄養素の摂取源で、健康的な食生活を営む上で重要な食材です。
Translation: Seafood (including whales and dolphins) is a good source of good protein, DHA (which is known to reduce allergies and vascular damage) and EPA. It is rich in calcium and other nutrients and so is an essential item of any healthy lifestyle.

Sure. I hear you. What is written is totally correct and English books should remind their readers about it more often. But did they really have to make that reference to whales and dolphins in the very first sentence? Anyway, after that strong fish advocating opening, the document goes on to recommend a reduced intake of various fish during pregnancy. It’s worth scanning the list below as the kind of fish you see in a Japanese supermarket are totally different to what you’ll see in other parts of the world. The biggest drawback of ordering an English book on amazon.com is that all of its examples will be about fish that you find in US supermarkets. I’m pretty sure you’ll agree that there are at least a few items on the Japanese list that aren’t on the US list and vice-versa:

The bigger the Tuna are, the more likely they are to have high mercury
levels in their fat (Photo: Tsukiji Fish Market, Tokyo Japan)

Not more than two 80g servings per week:

• キダイ (Yellowback Sea Bream)
• マカジキ (Striped Marlin)
• ユメカサゴ (Rockfish)
• ミナミマグロ（インドマグロ） (Southern Bluefin Tuna)
• ヨシキリザメ (Blue Shark)
• イシイルカ (Dall’s Porpoise)

Not more than one 80g serving per week while pregnant:

• キンメダイ (Splendid Alfonsino)
• ツチクジラ (Baird’s Beaked Whale)
• メカジキ (Swordfish)
• クロマグロ(本マグロ） (Bluefin Tuna)
• メバチ（メバチマグロ） (Bigeye Tuna)
• エッチュウバイガイ (Finely-striate Buccinum) – better known as 白梅貝（シロバイガイ)
• マッコウクジラ (Sperm Whale)

Not more than one 80g serving per fortnight:

• コビレゴンドウ (Short Finned Pilot Whale)

Not more than one 80g serving every two months:

• バンドウイルカ (Bottlenose Dolphin)

Large side of Tuna showing the oily toro underbelly
(lighter colour, on right) – Tuna was not included
in the original guidelines for pregnant women, but
was added later on

Interestingly, when the first version of these guidelines were released back in 2003, the list was only half as long and didn’t refer to any kinds of Tuna. As the general rule of thumb, in the West people are encouraged not to eat large pelagic fish like tuna, shark and swordfish. I guess the new Japanese list is matches reasonably well with Western recommendations, but I would love to hear the real story as to why tuna wasn’t in the original version, and how it came to be included). As the focus on this article is on health and pregnancy in Japan, please direct any comments about Whale and Dolphin eating to our dedicated thread here. For or against whaling, the Japanese guidelines are a fascinating look into Japanese society when you consider that the MHLW have actually gone out of their way to point out that Minke Whales (the ones that the Japanese do the most “research” on) are safe to eat during pregnancy as they have low ethyl-mercury levels. (You can see the government list of official mercury levels by fish here for more details).

While I’m at it, let me briefly list the other risks that most tin foil hat wearing English books (and no Japanese books) will have you worrying about every time you see fish on your wife’s plate. Most of the references to poisoning will at the very least lead to gastroenteritis which is dangerous as it can cause dehydration from vomiting and diarrhea (Source: “What to Eat When You’re Expecting”).

● Some fish caught in lakes and rivers are high in Dioxins and PCBs (e.g. blue fish, lake trout). This, once again, seems to be a US-specific issue based on research into US lakes and rivers. I don’t know enough about Japanese estuaries, but if you happen to live near either Yokkaichi (四日市) or Minamata (水俣), I’d probably avoid as much of the local catch as possible as a precaution.

● Raw shellfish (if contaminated) can cause hepatitis-A, cholera or gastroenteritis.

● Some fish found in warm tropical waters (eg. Sea Bass, Grouper (yum!) and Red Snapper) can be a cause of Ciguatera poisoning. The risk is particularly high when there is a “red tide” (a rapid increase in the amount of blooming algae in the Ocean). (more details). Don’t think that just because you live in Japan that this isn’t related. Because Japan imports a lot of its fish, it’s worth trying to find out where your fish was caught.

● If you don’t refrigerate (or freeze) your fish immediately after catching it, normal bacteria can create large amounts of a toxin that will cause Scombroid poisoning. Tuna and Mahi-Mahi are two examples of common culprits.

● If I haven’t written enough to make you totally paranoid… While we’re on the topic: raw meat (especially pork, lamb and venison) may contain “Toxoplasma Gondii” which can blind the fetus or damage its nervous system and may cause schizophrenia (more details). And soft cheeses may have Listeria and raw eggs might have salmonella. (This must be the record for the most Wikipedia links in one paragraph!)

A lot of these worries center around the consumption of raw seafood. Japanese pregnant women have been eating raw fish for centuries without any problems (Just like you’d never hear a Doctor in Thailand or India advising pregnant mothers not to eat spicy foods!). Why? I can think of at least two good reasons. (1) They’re used to it. Anything that you eat on a regular basis, is unlikely to be a shock to your system if you consume it while you’re pregnant. Perhaps more importantly, (2) the Japanese food distribution network is designed specifically to cater for raw fish. Because there isn’t that much consumption of raw fish in the West, fish are generally treated more roughly by supermarkets and distributors.

Whale on Sale – Most whale and dolphin meat contain high
levels of Mercury (Photo: Tsukiji Fish Market, Tokyo Japan
Note the “whales of the world” poster in the background)

At the end of the day, if the customer is going to deep fry the fish then who really cares how long it has been sitting out, thawing under the sun. You’d never get away with that at a supermarket in Japan. In fact eggs are a great example. Have you ever compared the length of egg used by dates in Japan with those in the West? Eggs in the West are generally “good for consumption” for at least one month longer than Japanese eggs. Why? Because a lot of Japanese eggs will be eaten raw and supermarkets can’t take the risk of salmonella and other creepies having their way. If you have any friends in the Japanese supermarket trade, it is a very interesting dinner conversation topic to ask them about how they treat their eggs (compared to say Walmart in the West).

To be very clear, if your wife is Japanese and living in the West, you should definitely discourage her from eating raw fish, eggs, meat etc while she is pregnant as the quality just isn’t the same as back home. But if you’re living in Japan, then you are probably doing your unborn baby a disservice by not eating fish. If you take the Western approach of not eating any fish because its all too complicated and overwhelming then you miss out on a valuable source of DHA which in recent studies has been linked with a lower rate of premature births (source: “Your Pregnancy Week by Week”). Common Japanese fish like Sardines (イワシ)、Mackerel (サバ)、Herring (ニシン)、Salmon (サケ)、Pacific Saury (サンマ) are all good sources. Omega-3 fatty acids are thought to promote neural development and so are particularly important in the 2nd and 3rd trimesters when the brain is growing at its fastest. (By the way, the best vegetarian source of Omega-3 fatty acids is from flax seed (linseed). We used flax seed oil in our cooking and ate eggs from hens which were fed flax seed. They’re pretty hard to find but available in some large International Supermarkets). Perhaps, even more important for Gaijin Daddy’s out there, recent research suggests that a high DHA intake can help reduce the chance of post-partum depression (reference) so make sure you keep eating fish after bubs joins you at thedinner table too!

Pregnant women (and their paranoid husbands) should be presented with both sides of the story and given enough information to chose themselves. Unfortunately there are very few books or websites that do so (in either language). The best that I have found so far is the Environmental Defense Fund. Make sure you download their pocket seafood selector (here) which has a brilliant chart that tells you which fish are high in fatty acids, which are likely to be high in mercury, and hence which are the most sensible items for your dinner table. Print out a copy and keep it in your wallet so you have it handy when you go shopping. Good luck!

HIV Awareness in Japan:
Has anything changed?

Thus far, we have two articles about HIV and AIDS in Japan on stippy.com (the first and the second). Another year has passed since we last touched on this issue, but a recent episode in my own life drove home that things still are really not changing fast enough with regard to the blurry awareness of HIV/AIDS in Japan, and the studied nonchalance of the Japanese people whenever the topic arises.

In Japan, everyone knows the word AIDS, but still very little is known *about* HIV or AIDS by the general public. This giant disparity of awareness was brought clearly to my attention one day after overhearing the following conversation between a physical education teacher and a young math teacher in her early twenties in my office (I work in a Japanese School):
Ms. Math: So wait, I don’t understand; what is the difference between HIV and AIDS?
Mr. PE: If you are infected with the HIV virus, it will eventually lead to AIDS and if you catch another less serious illness you can die because the virus weakens your body. If you have HIV, it doesn’t mean you have AIDS, but that you will eventually get AIDS. As long as you don’t catch the virus, you don’t need to worry.
Ms. Math: I don’t understand. What is HIV?
Mr. PE: It’s the virus that causes AIDS. If you have HIV, you will get AIDS.
Ms. Math: I still don’t understand.

The fact that this conversation could occur between two adults in a First World country nearly 12 years after I can recall asking the same questions of my teachers in America is absolutely baffling to me. Japan is slow to catch the news because the virus has only just recently started to increase within the population despite its low numbers; here is an article explaining the situation, including the country’s reaction to its .02% prevalence rate of the virus reported. However recent statistics are showing that the virus is on the rise in the country, due mainly to increased contact with foreigners abroad and within the country, and the government is scrambling to inform and educate the public about HIV.

This year my junior school has become one of presumably many which are currently including information about the disease in its annual curriculum. In early December 2007, they distributed red ribbons at the weekly student body meeting and included information about it both spoken and in print.

The following is a translation of a PTA Bulletin from November that is sent out to students of our school and their guardians each month:

December 1st is World AIDS Day. We ask for the student body cooperation in accepting a red ribbon. The red ribbon is a symbol of support and understanding for people who are suffering from AIDS. We are distributing the ribbons to promote the message that we will not discriminate against or have a narrow-minded view of AIDS.

AIDS is a sickness that leads to death. However, the infection rate is very low, and there are three main ways of contracting the virus:

1. Sexual transmission
2. Transmission during birth from mother to child
3. Shared intravenous needles

You cannot contract it from touching the body or sweat of an infected person. It is very important that each of you have understanding about this disease.

By the way, do you know the difference between AIDS and HIV? AIDS stands for “acquired immune deficiency syndrome” and HIV stands for “human immunodeficiency virus.” In other words, if you contract HIV, the resulting disease is called AIDS. We would like you to understand and have proper knowledge about the people in the world infected by this virus. Please wear these ribbons on your school uniform during this period of time.

This information is new for the children at my school, as well as for the adults who are teaching them. How it can be new so late in this age is an indicator of extreme isolation. I am always curious just how this isolation still exists.

Even when Japanese people enter into adulthood, awareness about AIDS and its prevention never seems to be high on anyone’s agenda. Women Japan is a popular site amongst “around 30″ girls in Japan. It features several 相談室 (consulting rooms) where girls can ask doctors, and several prominent personalities questions about almost anything they like. One of the rooms is a セックス相談室 (sex consultation room) where people can ask “Dr. Seiko先生” their deepest and darkest questions about their sex lives that they could never share with their friends or colleagues.

Dr. Seiko self-professes herself as, 性に関して日夜研究。研究結果をみなさんの悩み解決のために役立てたいと願っています。 (Translation: “I am researching sexuality day-and-night. I hope the fruit of my research can help you solve your sexual hang-ups and problems”). It is a semi-serious, “Ask the Doctor” type site, generally keeping a down-to earth approach on proposed solutions – except however for some of the condom usage advice given to the girls (who assuming from their questions, had the math teacher above for sex-ed class) where it is inappropriate and dangerous.

Here where a 22 year old girl asks for advice about her コンドームをつけてくれない彼 (Boyfriend who wont ever wear condoms), Dr. Seiko answers with three not very well thought out solutions. 1. Don’t have sex, 2. Get on the pill, and 3 Ask another guy to tell him to wear condoms. There is not one mention of STDs in her response, or any of the other reader’s comments. The Doc even goes so far as to say, 私の場合は医者にピルを処方してもらった (“One time when I had a boyfriend like yours, I just got my Doctor to give me the pill”). Hmmm.

As the answer to another 35 year old (!!) reader’s consultation entitled コンドームをつけるタイミングは？ (“At what stage should I put a condom on him?”, Dr. Seiko gives this advice:
1　口でフェラチオ
(First, give him fellatio)
2　一度挿入　※性病が怖い人は挿入する前から
(Put him into you without a condom first – unless you are afraid that he looks at risk of having an STD)
3　プレイとして、口で女性がつけてあげる。　※これはテクニックが必要となりますのでバナナで練習しましょう。
(Then before he comes, roll a condom onto him with your mouth – This takes technique, so practice with a banana first)

Well, advice for champions. This is the state of condom usage and STD prevention awareness in Japan.