DOTS of Light in the Nishinari Dark



                                                    Nurses Hashikawa (right) and Yoshida.  Illustration: Ross Siu


Keiko Hashikawa’s hands are steady as she finishes arranging a jumble of technicolour pills and capsules, her calm a contrast to the patient who hurries in, wheezing as he slumps in the chair.

Shakily thumbing his cap and mumbling greetings in earthy Kansai dialect, he washes the medicine down, has his card stamped, and is gone. The treatment room is still again, beams of watery light falling on the recently vacated chair.

Hashikawa, 71, treats tuberculosis patients in Nishinari, a rundown area in south Osaka synonymous with crime, homelessness and unemployment.

The ill health rampant here comes as no surprise to anyone familiar with the district’s grinding poverty. Yet that Nishinari has one of the highest concentrations by population of tubercular cases in the world goes shockingly unreported and unnoticed.

A response to the epidemic is at hand, its backdrop the sprawling 1970s complex that forms Nishinari’s centre of gravity. Here, a handful of public health workers like Hashikawa work with TB patients.

Part-shelter, part labour agency, Airin Chiki Labour Centre is a miserable place full of men killing time on shabby futons, drinking one-cups or looking disinterestedly at creased pornos. Pigeon turds pile up of the windowsills. The stench of urine hits the back of the throat.

In a light-bathed room on the seventh floor of the centre’s health clinic the upbeat demeanours of Hashikawa and her colleague Hatsue Yoshida are a welcome contrast to the squalid conditions below.

Short, amiable and possessed by an infectious enthusiasm, Hashikawa moves with an irrepressible energy, speaking rapidly about her work as she pops pills from their plastic in preparation for her next patient.

In charge of the DOTS (Directly Observed Treatment Short-Course) programme, the nurses have overseen the treatment of over 400 TB patients in eleven years.

Originally introduced to Osaka as a pilot programme, DOTS treatment is based on close supervision of patients, who are interviewed, tested, and given tailored treatment courses based on the severity of their illness. Those signed up must attend daily sessions to receive drugs, free of charge, even for the overwhelming majority in Nishinari without health insurance.

The success of the programme in encouraging patients to return daily is founded on the rapport developed by the nurses with their charges, done so in spite of the sociology of the area.

In contrast to the camaraderie characteristic of western homeless communities, most in Nishinari eschew companionship and live solitary lives. And if contact among the homeless is rare, developing relationships with working Japanese shakai-jin such as the nurses is even more unusual.

Hashikawa and Yoshida have countered this obstacle by creating an environment where the patients feel secure enough to return with the regularity required by the programme.

This is the key to the success of DOTS, says Yoshida, who in her sixties is the younger of the couple.

“They are all single men, who live independently,” she says, smiling reassuringly. “They find it hard to properly live and take care of themselves. We feel a duty of care towards them, and that’s why they come back.”

The nurses are non-judgmental towards the troubled lives of the DOTS patients. Solace is often found in alcohol-induced anesthesia or the fleeting thrill of street gambling, while taking adequate care of personal health is of little urgency for those on the street.

“Daily chores are banalities for these people. Any spare money they have is spent on alcohol,” says Hashikawa, as if chiding an errant child. The nurses’ daily contact with the down-and-outs in Nishinari leads to sympathy with their charges.

Such close contact will soon be over: retirement day for Hashikawa is just two months away. Yet even after a long career she is loath to leave her post.

“I’m not thinking about that yet. For the time being, my work is here, looking after these people.”

Hashikawa’s reluctance to abandon her post is understandable. DOTS is understaffed and underfunded, a situation unlikely to be redeemed given the scant political will for the extensive funding necessary for a widening of the programme. New staff will come but it is doubtful that the relationships so painstakingly developed with the unwell will be quickly replaced.

Although not family, Hashikawa is for her patients the closest to kin they have. With her departure a light in the Nishinari dark will fade; a residual glow, one expects, will remain.


Analogue Archives No.1

A few 35mm flicks from winter.

The Japanese Mecca

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Ise Jingu is one of Shinto’s holiest shrines and probably the most important site for Japan’s indigenous religion.
Spread over a sprawling, leafy area in Mie Prefecture, Ise is entwined with the very fabric of Japan. The offices of high priest or priestess are filled by members of Imperial Family, with the current high priest the great-grandson of the Meiji Emperor.

The tranquility I had expected during my visit a few weeks ago was conspicuous by its absence, shattered by busloads of tourists wearing garish jackets and chattering noisily as they followed the tour leader’s flag.

Nearly all the day-trippers were elderly, beaming huge grins of satisfaction. I was perplexed: where were all the youngsters?

Slowly the penny dropped.

Just as devout Muslims must complete the Hajj at least once in their life, so must true Shintoists make the pilgrimage to Ise while still on this earth. For the ecstatic pilgrims on that wintry morning, it was mission accomplished: they beaten had the clock, and made it to the shrine before old father time taps.

Foreign Correspondents’ Club of Japan

Back from Tokyo today. ただいま〜  Time for a rare update!  The new season has some new projects in the pipeline – stay tuned – but for now, something I’ve been sitting on a for a while.

I won the 2010-11 FCCJ  Swadesh DeRoy scholarship. Many thanks to the FCCJ for this wonderful award! Here’s the article.  

Whither the Buraku Liberation League?  Japan’s Human Rights at the Crossroads

Grey clouds in the winter sky, black soil in the bare flowerbeds, peeling white paint on the cold concrete walls: melancholy hangs heavily over the Aramoto Human Rights Centre, a monochrome milieu lightened only by the thick green ivy that colonises the squat building.
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Burakumin in the 1960s

Michael Rogge, a Dutchman, has a wealth of fascinating 16mm clips of Showa-era Japan and the Far East, including this one of those left behind by Japan’s speedy post-war economic development.  Interesting to see Burakumin acting as street bookies for bicycle races – along with leather tannery and undertaking, another example of Buraku involvement in jobs deemed taboo.

Some of the shots of the destitute don’t look so different to the less salubrious parts of Osaka today.

Zainichi Koreans II

While Osaka has the highest concentration of Zainichi Koreans in Japan, the influence of the Dear Leader reaches the most unlikely of places.

Thanks to Mike @ FCI London for the heads-up!

Zainichi Koreans: Foreign in Japan?

Yeong Jin speaks in the same staccato Kansai-ben as the other three ossans at the small izakaya table in the bowels of an Umeda hotel.

He sups his draught beer and chews his kushiage skewers with the same satisfaction as Messrs Tanikawa, Nishiguchi and Tsunoda, and  (as he admits) has the same love for the Hanshin Tigers as any self-respecting Osakan.

Yet despite being the archetypical Kansai man, Jin is certainly not the same as other Japanese.  Despite being born and bred in Amagasaki, west Osaka, he doesn’t have the right to vote, and must carry a registration card whenever he leaves his house.  He is a Zainichi Korean, one of the 515,000 who cannot take the citizenship of the country of their birth.

In Japan, where nationality is determined by blood, the lottery of one’s ancestry still determines much.

Jin’s parents were brought to Osaka during the war to work in the factories of Kansai, and, like many, did not return to the Korean peninsula on its independence.

“I can’t hide who I am,” he says “I am Korean by blood but Japanese by breeding.”

Such confused identity – and the discrimination which accompanied it – was borne with dignity and stoicism by Jin’s generation.   From the 1960s to 1980s Zainichi Korean groups gradually secured basic rights to social welfare and pensions, and exemption from fingerprinting on re-entry to Japan.

Director of the Osaka Zainichi Foreigner Association, Jin has been involved for over thirty years in the struggle for Zainichi Korean rights. But as he approaches retirement, the battle for equal rights has still not yet been won.  He worries that his children – like he unable to participate in political life – will still face the same feeling of exclusion as him.

“There is a problem inherent in Japan that leads to foreigners being treated as they are.  The attitude of law and politics must change.”

Yet here is the rub: for the necessary legislative and political change to come the Zainichi Korean movement, as a voice for all foreign residents in Japan, must remain strong and continue to lobby the government.  Yet despite being “motivated by their experiences of discrimination” its leaders are ageing.  It is unclear how regeneration will occur, and seems certain that as the ancestral identity of the third and fourth Zainchi Korean generation fades, youth participation in groups such as the Mintōren and Mindan will decline.

The movement is weakening, and with it hopes for the securing of the most basic of human rights: suffrage.  Jin’s good mood darkens slightly at the thought.  “The Zainichi problem won’t be solved in my time.”

Names changed at request of interviewees