It was when I was a high school student that I first came to want to be involved in health issues of the developing world. Though born in Japan, which has become one of the richest countries in the world, and growing up surrounded by overflowing material, I realized that there were many people in the world who cannot afford even the minimum required nourishment. I thought I should not let this situation pass, and wanted to do something to improve the situation.

　

The problem, however, was that I had never experienced poverty or hunger and this lack of real experience made it difficult for me to have a clear idea on how to tackle this inequity. The reason I became determined to be a medical doctor was because I thought that with such special knowledge and skills, I could be useful for the people in the developing world. Participation in this fieldwork fellowship program, together with experiences in several other countries I visited during my university life, gave me a chance to rethink the true meaning of tackling this current global situation, as a medical doctor.

　

During the five years of university life, I visited countries in Asia and the Middle East, and spent good time with the local people. These experiences made me realize that I had seen only a small part of this world, and that it was only an illusion that I knew the whole world. I know now that I was mistaken. For some people. God was the center of their daily life. Having a homeland, which I had taken for granted, was a biggest dream for some other people. There were starved and skinny children smiling happily only because they were able to be with their mother. There was a poor but united family trying to give the sick elderly mother the best medical care they can afford.

　

I learned mainly two things from these experiences. First, that health is deeply related to the economics, politics, human relations and social backgrounds of all dimensions. Second, that what I can do is not to give something from "the richer to the poorer" stance. Instead, I need to learn from the local people and assist them with the viewpoint as an "outsider". That is, an outsider may be able to realize a factor needing assistance, which is difficult for the local people to notice since they are used to that factor. Perhaps I may be able to give them an opportunity to start programs to better their situation themselves. This fellowship program made me certain of that. Botika Binhi is a good example. It is not a program of "giving" people medicine but "thinking together" with them of a system in which they can obtain drugs themselves. I think everything starts from asking the local people what they want, what they can do and how I can help them. In the future, I want to work with the local people, making use of what I have learned here.

　

Yet, there are times when health situations, which are deeply related to economics or politics of the country, cannot be improved only by community-based activities alone and international assistance is needed. This fellowship program enabled me to meet many people who are dealing with international activities from various backgrounds, such as the staffs of WHO, JICA and NCOs. Each organization has its own means and range of activities, and I realized each one had its own advantages as well as limitations. But what I have learned here is that every person and every organization is an irreplaceable part of society working together to improve a situation. No one should think that he/she can do something all by him/herself, nor that someone else would do it for them. In cooperation with others, to keep on looking for what each individual can do and carrying it out is the responsibility of every one of us living in this world. This program gave me several visions on my future and it taught me the importance of "taking my own responsibility" whatever and wherever my position would be.

　

I think the principle role of a medical doctor is "to think with the people and help them to live healthy lives". This is the case for any doctor either working in hospitals, in communities or in international organizations. I was wrong in that I thought, "I would be able to give special knowledge or skills to the people when I become a doctor", but I am very happy about my future role. I think it wonderful and I am willing to take the responsibility.

　

There is another important thing-considering carefully what "a desirable society" we are working hand in hand to achieve is. Many people assume that they are sure about the answer to this question, but most of them do not actually know nor have considered it seriously. No one can do anything right without knowing exactly what he/she wants to achieve is. Conversely, if they know where they want to go, there are many ways to reach there, and what appears to be a failure in one way may encourage them in another way, as a precious experience.

　

It was very lucky of me that I could talk and talk with the members of this program formally as well as informally. We had talks about what true happiness means, what we hope for the society... By discussing these issues with them repeatedly, I was able to develop the ability to think deeply and to listen carefully to various opinions of others. I strongly hope to keep seeking the answers to these questions with my 13 friends. I also have kept in touch with the students we met at the University of Philippines. We did not have enough time to talk on complicated issues during our short stay, but I would like to talk about these various issues with them, my precious friends in making a better world together.

　

At last, I wish to express my deep gratitude to all the people who gave me this great chance and helped me learn a lot. Also, I would like to promise to do for others what they did for me someday.

　

I was a junior high school student when I started to wish to take on a worldwide profession, which could contribute to a lot of people. I decided to become a doctor. During this fellowship program, we had opportunities to meet doctors taking an active part in WHO and JICA. These opportunities enhanced my vision of what my career opportunities could be. We were able to experience with our five senses. I would like to share my thoughts enriched through this experience.

　

Inequity

Why do we often face the reality of inequity? My desire to alleviate inequity in health care leads me towards a career in International Health. For example in Japan, a vast amount of money is being spent to prolong the lives of terminally ill people while in some other countries, children are dying because of the lack of vaccinations which cost only a few hundred yen.

In the Philippines, the health care system is firmly structured from the central to rural areas as a pyramid shape, though there are some fundamental problems such as lack of doctors and shortage of medicine. This system enables people of low-level income to have access to health care and support. I was surprised to learn that people receive free medical examinations at public hospitals. This free access is good, but the problem is that people become unaware of the actual high cost of maintaining the health care system. The same can be said for the system in Japan, but I believe that to institutions or individual workers who provide better services, the more suitable remuneration should be provided for their services. There is a limit as to how much a system of any kind could function with reliance on only an individual worker's good conscious and sense of responsibility. Such system will not work properly and will not improve.

It is very difficult to differentiate between equity and inequity. It is not always right to use the standard of equity as a method of determination. I think an ideal system is a system which can be modified by social consensus, depending on the changes in societies and flow of time.

　

The meaning to go into other societies

One thing which left a strong impression on me is the Smoky Mountain area problem. We held hands with the children who live there and enjoyed listening to songs they sang. Such an experience allowed me to intimately feel their problems. I wondered how many of these children would make their dreams come true. Even given medical supports, there are still too many hardships for them to overcome. I think without a great improvement of the Philippine economy, no dramatic change will occur for them. I noticed my powerlessness as a medical student to deal with the situation there.

However, by looking at those children, I felt a power within them, which I do not feel in children of Japan. I think it is the power they receive from their family and community, acquired through the daily struggles for existence. They didn't seem to be unhappy. Is it better to try to make them happy by giving them what they don't have compared to us? Or is it better to leave them alone rather than give them improper help? This is the question every one of us asked. During this trip, we discussed "What is a happy life for you?" Each member had a different answer reflecting his or her sense of values. Even we, of the same generation and background of being brought up in Japan and studying medicine or co-medicine, all have different opinions. "Happiness" for each person on the face on this earth is far beyond description.

What is important for the international health cooperation is to make people happy by cooperating with each other. But 'happiness' is very difficult to define. I think it should be each citizen member of the society who should seek and also pursue a better health care system as well as further development of his or her own society. It is not only about politics at the national level, but small things such as starting health education among a gathering of mothers, is a good start on development. Dr. Barua gave us a poem which meant "When the project is completed, villagers say, 'It is we who established a better village.' This is the best assistance." I would like to give such assistance.

There are many reasons I would like to go into the societies of foreign countries in the field of international health. It is great work connected to the happiness of many people. I think it is a great and challenging work, one worth spending my life in. Possibly I will become a talented medical specialist, and also a human bridge between Japan and their society.

　

As a Japanese

The first step in achieving international cooperation in pursuit of international health is to know other countries. I noticed that it is also very important to know Japan and myself. When I was in the Philippines, I always compared things there with those in Japan. Generally speaking, people examine new experiences based on their common sense obtained through their personal experiences. I think of Japan as an ideal county in the sense of giving us equal chances, with only a small gap between the rich and the poor. That is why I feel uncomfortable when I go to countries with bigger disparities, and wish to change the situation.

Humans influence each other. Our visit to the Philippines was a very good study for us. I wonder what the people whom we met felt during our visit. Some may have ascertained their confidence in their projects by showing them to us; others may have thought that it is a waste of money to have young students with no power to solve problems to come to see them. I would like to be reminded to always look at myself through their eyes. I think it is also very important to know the history when visiting a country.

　

Conclusion

It was an honor to have had many guests attend our reception. Many of them gave us good advice for our future. I feel that we were very blessed and I will always be thankful. It is up to me to make the most out of these experiences. I have finished a quarter of my life. Of whatever time I have left of my life, I intend to seek opportunities to contribute to the people and society using what I gain through these valuable experiences.

In conclusion, I would like to say thank you to all the people who supported this program and my wonderful fellows. I hope that this excellent fellowship program will continue giving new experiences and chances to many students from now on.