September 2, 2011 Leave a comment
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.