Our home for the 5 days was turned over to the Japanese by the US government a number of years ago. Despite the downsize, the US military still maintains a substantial presence here including the remainder of the base across the road from where we are teaching. We heard reveille, the US national anthem and artillery practice from there, daily.

The Japanese government turned this parcel into a conference center. It is not typical of most US conference centers. The class rooms are large and spacious with comfortable seating and good technical support. The living accommodations are much more basic. Although I had a bed in a small room, many rooms are large open spaces where participants slept on futons piled on tatami floors (woven, mat-like). Dharmasuri and I had similar accommodations when we were here last January. We shared the center while with a number of groups with a broad spectrum of interests from adults to kids as young as 5 – 6 years old. Our meals are buffet-style, with some greens and sprouts, dishes with fish or pork and noodles. There is always enough vegetarian fair, and of course white rice with every meal. There was as a relative paucity of fruit and no dessert to speak of.

Each morning at 0600 we are greeted by announcements. At 0700 we have a community assembly complete with a flag raising, a speech or 2, and stretching. Everyone knows the drill. From childhood most people go through the same exact stretching routine called “radio stretching” accompanied by the same tune. When there are children here they raise the flag and stand out in front leading the stretches to music and narration. The other morning 4 kids raised the flag. It was hilarious. The point is to raise the Japanese and center flag in unison to the national anthem, reaching the top just at the end. The kids struggled with the process, getting the halyard twisted in the pulleys and either getting the flag to the top too soon or in a mad rush after the anthem was completed. They were kids being kids. Not once did any of the adults seem angry or frustrated. In fact everyone got a good laugh with their efforts. In addition, the kids had daily clean-up chores around the facility including their rooms.

I continue to be impressed with how well Isamu and Tak (our 2 Japanese instructors) translate for me. This is not as easy as our usual courses because of the amount of technical language used in the Wilderness Advanced Life Support course (WALS). Neither of them have a strong clinical background. It is an ongoing challenge but one we are all meeting. The feedback from our students bear this out.

Tak was worried on the last day because several students complained to him about the course the night before. He wasn’t sure if he should tell me. Because of the varied backgrounds of the students and the instructors I work with on this course, each course has a different feel and emphasis. I think the people he spoke with were expecting more practical skills and less medicine. Although we cover a lot of skills (and this one had more than most), the focus really is on how to use medicine in a remote environment. I sometimes joke that this course is a bait and switch. We entice people in with the word “advanced” but then downplay the value of technology. The advanced part has more to do with knowledge and its application than it does with tools and medication. And when it comes to patient care, basic skills may be even more important. True to form, the most experienced are the most restlessness about having to sit through the basics. They are also the ones who come up short when it is time to perform. My job is to offer opportunities. There are lessons to learn; some students are more open to learn them than others. The beauty here is that it is up to each individual. You can’t possibly meet all of their needs but we do try.

In the end the course turned out okay. The critics were quite happy and the vast majority of the students were thrilled. I have learned to temper my emotions and expectations about each one of these.




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