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Keywords:

  • culture;
  • ethics;
  • Japan;
  • premature infant;
  • health care;
  • universal health insurance

Abstract

  1. Top of page
  2. Abstract
  3. Experience of Midnight
  4. Disclosures

This essay is a story about a cultural interaction between a Japanese mother and a Chinese young mother whose baby was premature. When I was staying in a hospital in Japan to deliver my second son, I shared a room with this mother. She delivered her baby very early—at 25 weeks of pregnancy. Her baby received extensive medical treatment in the neonatal intensive care unit. However, this Chinese young mother appeared bewildered about the communication from the Japanese hospital staff because Japanese hospital's communication about the medical care of premature infants was very different from China. One day at midnight, she spoke with me about having deep uneasiness about the situation and having many unanswered questions. After this cultural experience, I began to think more deeply about cultural differences in terms of health and illness and the influence of universal health insurance on the lives of the families of premature infants. I also recognized that the value of life is not calculated in the same fashion globally.


Experience of Midnight

  1. Top of page
  2. Abstract
  3. Experience of Midnight
  4. Disclosures

Nine years ago, in the last trimester of my pregnancy, I began to have placenta problems. Subsequently, I delivered my second son early at 35 weeks gestation. He entered into the neonatal intensive care unit (NICU) immediately and I was permitted to remain in the hospital with him for 10 days afterward. During my stay, I shared a room with a Chinese woman who also had a baby boy. She delivered her baby very early—at 25 weeks of pregnancy. When I met her the first time, I got the impression that she was very shy and that she did not speak Japanese.

Several times a day, the doctor or the primary nurse came to talk to her about her very sick baby. They tried to communicate with her, but each time she remained silent. Yet when her husband or relatives came to the hospital almost every day, she spoke to them in Chinese. In particular, she talked to her husband until midnight nearly every night.

After sharing a room with her for several days, I was certain that she could not speak any Japanese. One night, I could not sleep well and kept turning from side to side trying to get comfortable. Around one o'clock in the morning, suddenly my Chinese roommate spoke to me in Japanese. She said, ‘How is your baby?’ I was very surprised. Then I answered, ‘Oh, my son is getting better, little by little. Maybe he is going to stay in the hospital for 2 more months. How about your son?’ She responded, ‘I don't want a sick baby. If this baby were born in China, he wouldn't receive any medical treatment.’ I was very shocked and I could only say, ‘Oh, you think so?’ I knew that her son was very serious because my son's incubator was nearby her baby. She continued, ‘In China, medical care is very expensive for such early babies; there isn't any public health insurance system to help parents. Most parents do not place their baby in intensive care for economical reasons.’ I didn't know what to say after that, so our late night conversation ended there.

Now in retrospect, I have a better understanding what she was trying to tell me that night. In Japan, premature or low birth weight (less than 2500 g) babies are automatically admitted to NICU. Japanese parents can rely upon the public medical insurance system and also receive other benefits for the premature baby. In my son's case, I think the cost of his care totalled about 2 million yen. It never occurred to me that his care might be an economic burden for us. I always expected that he would have the best medical treatment available. Likewise, the NICU staff would naturally assume that all mothers would want whatever medical care necessary to save their child's life. Based on this common assumption, they met with this Chinese mother daily to talk to her about her baby's care and how he was doing. This partly explains why she never talked to the doctors or nurses when they came to see her. I think that she must have been feeling a deep uneasiness about the situation and had many questions. Why is this hospital staff saving my son's life? What if he has some handicaps? Do we have resources and ability to bring him up—economically, mentally and physically? Should my baby have been born early in China and not in Japan?

I didn't know whether she ever told any of the hospital staff about her feelings or concerns. During the rest of my stay, I never shared her fears or reveal that she spoke Japanese after all. Ten months later, I met this family again at the paediatrics outpatient clinic when I took my son for a routine health checkup. The Chinese mother held her son softly. He had grown into a very lovely and handsome child. The parents and the child were like a happy portrait.

After this experience, I began to think more deeply about cultural differences in terms of health and illness. I also recognized that the value of life is not calculated in the same fashion everywhere. In many cultures children are valued above all else, even in the face of poverty and illness. In other cultures people are too plentiful and money is scarce; families are permitted to have only one child. Thus, a healthy male child might be highly preferred because families are given only one chance. In any case, meeting this Chinese mother again and seeing how sweetly she held her baby erased any anxiety I still held about our late night conversation. Perhaps motherhood finally triumphed over the cultural worries that engulfed her that night.

Disclosures

  1. Top of page
  2. Abstract
  3. Experience of Midnight
  4. Disclosures

The author declares no conflict of interest.