Now I would like to talk about my experience in the concerted efforts among government, experts and community. It is an old story that offered me the opportunity to work in the field of public health as a researcher.

　

It goes back to the late 1950s to the early 1960s when I was a young medical student I was involved in a research for one month at Okino-Erabu Island of the Amami Islands as a member of the filarial control study group organised by Professor Manabu Sasa of the Institute of Infectious Diseases in Mejiro.

　

In the old days, 20 to 40 percent of the people living in islands south of Southern Kagoshima were infected by filaria. Filaria is a 10cm long and 1mm thick parasite that lives in people's lymph vessel and causes elephantiasis by blocking the lymph vessel. It also causes fever and chylous urine, a disease in which absorbed nutrients drain into urine from intestinal tract. Treatment of people with this parasite and extermination of common house mosquitoes are the measures available for control. I went to the field with Professor Sasa to exterminate the mosquitoes. Dr. Takeshi Yoro, who is often on TV, and Dr. Hiroshi Yoshikura of Institute of Infectious Diseases were among the members. This experience was very valuable for me because it taught me how a well-trained team could work closely together to attain remarkable results.

　

Extermination of filaria requires extermination of mosquito which is an intermediary host for filaria. This requires steady efforts such as placing lids on crocks used for keeping domestic water, eliminating puddles and spraying insecticides. In addition, as filaria larvae only come out of lymph vessel into blood vessel at night, we had to collect blood from earlobes of the local resident after 8pm to check if they had any filaria larvae.

　

Then we had to administer drugs to filarial carriers. A specific medicine against filaria named "supatonin" became available at that time. However, it cost 500 yen per person which was a lot of money then. Moreover, the local people with filaria were not aware of the fact that they were ill. There was a famous story about Takamori Saigo's hydrocele testicle, but he did not take it seriously. It therefore took much convincing to have the people receive treatment. It was only possible through the effort of the study group over the 5 year period as well as the efforts of the Ministry of Health and Welfare, local government and all the residents.

　

To tell you another story from the same period, I stayed in Sarufutsu Village in Wakkanai, Hokkaido for a month as a member of visiting medical team for medically underserved areas. The leader of the visiting medical team was a health nurse named Ms. Wakana Ohnishi, a member of National Health Insurance Association who was in charge of the vast wilderness of Hokkaido. I worked with her and heard stories about her decade-long activities in the field of maternal health including family planning and movement for the improvement of living conditions. It was way back in 1960 when Japan had already entered the stage of demographic transition.

　

This will get things out of sequence, but before that in 1955, an international conference named International Conference of Planned Parenthood was held in Tokyo. According to a record of this conference, Chairman Shimojo talked about the status of population in Japan and Japan's approach towards family planning. The conference was held in Japan because of the extraordinary interest among the participants in how Japan, a developing country at the time, succeeded in birth control. In response, Chairman Shimojo made the point that family planning was a movement for liberating Japanese women who were suffering from poverty and high rates of birth and infant mortality. Meanwhile, Ms. Shizue Kato reported as an important conclusion of the discussion reached at this meeting that people were able to confirm the effectiveness of family planning proved only after fully mastering the contraceptive measures as an alternative to artificial abortion that had been widely practiced in Japan.

　

Ms. Ohnishi was a midwife in addition to being a health nurse. She was also a passionate person who worked as an actress in Tokyo in her younger days. She was working as a midwife in addition to offering guidance on planning and operation of collective cooking, nutritional improvement with emphasis on conception control and health management for prevention of parasites and adult diseases for the housewives who were busy from early in the morning till late at night working in the field and taking care of housework in the reclaimed land amidst the wilderness of Sarufutsu. I remember her saying that it started as a meeting of housewives but their husbands also started taking part in the conception control guidance and the meeting turned into a family planning movement for the entire village filled with jokes and laughter. Although her commitment partly contributed to this, she seemed to have an inborn gift of solving many problems that lied ahead of her.

　

What she was practicing at that time with the villagers was "reproductive health and rights" which is now a much-talked subject. At the time, I interpreted the work she was doing in the field of maternal and child health and daily activities to be more of "a movement based on her own creativity and ingenuity" than "frontline activities of administrative authorities. However, I started realising recently that today's Japan was built by many people like Ms. Ohnishi who were working in the field of government, community and business.

　

At the beginning, I mentioned that population problem is an issue about how to make available the means and resources for guaranteeing survival and livelihood to each and every person comprising the population. The people of Indonesia are seeking life of affluence with the rapid advancement of industrialisation and urbanisation. As I mentioned earlier, the country has now reached the level of Japan in 1950 as far as population structure and disease structure are concerned. Her ratio of dependent population is declining and is predicted to reach the bottom in 20 years. JICA launched a family planning project in 1969 and has been implementing a project on maternal and child health handbook. I am sure that Japan's experience in family planning and maternal and child health is being utilised in such project. I would very much like to know its outcome.

　

As for the path towards affluence for the people of Indonesia, I assume that their situation is quite different from that of Japan back in 1950. Aspects such as standard of living and education, values including religion, international situation and information environment should be completely different from those in 1950. The Japanese experience and wisdom shall be utilised along the direction of development, economic growth and QOL that they themselves are thinking about and are seeking.

　

With regard to the most underdeveloped sub-Saharan countries, demands are being made to build the system itself by relying entirely on Japan to solve all the problems. However, it is basically necessary for the people of those countries to think about how to obtain their own happiness. The goal, at least for the time being, is to attain the level of health, social welfare, social security and public health enjoyed by the developed countries that they see in front of their eyes. No one should be able to deny their rights to enjoy them. In reality, however. the gap between the rich and the poor is expanding. On the other hand, increasing number of regions are succeeding in demographic transition, as can be seen in the countries of East Asia including Japan, and are striving towards their economic independence.

　

Developed countries need to be more active in offering funds and wisdom to the most destitute countries suffering from high rates of birth and infant mortality. The world population is estimated to reach 9.1 billion in 50 years. While I am doubtful whether we would be able to secure sustainable resources to support such population, we do need to think more seriously about the population issues in other countries.