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Two prominent environmental public health crises that occurred in Japan was the tragic Itai-Itai disease and Minamata disease. The former was due to industrial waste dumped in the Jinzu River, and chronic cadmium poisoning afflicted the residents from ingestion of the contaminated water. The most significant symptom was osteomalacia, which is the softening of bones from rapid loss of Calcium and excruciating bone pain. The government placed economic growth post World War II as a priority over the health of the public and the residents suffered for decades even after the source of the illness was identified. This was one of the first epidemiological studies conducted traced the environmental point source contaminant.

Minamata disease is caused by methylmercury poisoning and the route was ingestion of contaminated fish. The Chisso Cooperation produced chemicals and dumped the excess materials into the Minamata Bay which is what the local fisherman relied on for their livelihood. The disease manifests with neurological symptoms, numbness in extremities, general muscle weakness and is fatal. Minamata Disease was termed “dancing cat fever” as the cats lost coordination, walked erratically, and subsequently drowned in the Bay and at this time the citizens did not know the cause for this disease that plagued them. We had to opportunity to hear from a speaker who was born with fetal Minamata disease.  Nagamoto-san was a kind man, and shared his experiences while growing up such as bullying in school, and he was ostracized by peers. He told us about his work today as an advocate for equal treatment of those born with disabilities and people in society with rare diseases. There was a negative stigma surrounding Minamata disease because originally it was thought to be contagious, but the negative stereotypes continue to haunt the city. For example, people fear moving into the region or others fear marrying native Minamata residents.

The objective of this program is to understand how Japanese society, culture, history, and environmental influence human health issues. Public Health is a relatively new field (gained popularity due to the pandemic) and was established when urbanization occurred around the world in order to take care of health on a population level. Through the tours of the museums and storytellers, I was able to gain a deeper understanding of the complex interplay between the environment, anthropogenic stressors, and burden of disease on a population through an international lens. This trip strengthened my decision to pursue my master’s in public health.

The takeaway from these key public health events is to take preventative measures to protect population health. With the technology and knowledge, we have today it is crucial to protect the public’s health and have environmental control legislation in place to prevent such tragic incident from ever occurring. The Japanese government has since implemented stringent environmental controls to protect the public’s health. This is picture of us outside the Itai-Itai disease museum.

Visiting Miyajima Island was one of the most enjoyable experiences throughout my travels in Japan. It was about an hour away from Hiroshima, so we spent the afternoon exploring. We got to board a ferry which I’ve never done before, and it was quite refreshing and exciting. The ride offered stunning views of the Seto Inland Sea, and the anticipation built as we neared the island. Upon arrival, we were surrounded by a bunch of deer. We were advised not to touch them due to any illnesses they might have, but they were quite rowdy and would follow us, adding a playful part to our visit.

We took a short walk down to see the floating Torii gate. It was quite breathtaking. The background water was so scenic and the bright red corridors were beautiful. We also visited Itsukushima Shrine. We walked through it and also bought a few good luck charms. It was a blend of natural beauty and rich culture. I could feel the deep-rooted history and spirit. We walked a bit further close to the water just to see what could be laying on shore and saw many little creatures.

After the walk, we began to explore the island streets. We were surrounded by traditional shops and refreshments. We indulged in the best shaved ice I’ve ever had, which was a perfect way to cool down. A friend of mine also tried oysters. I’m not really a fan of seafood and was quite afraid to try it, but it looked great. I did buy a bunch of handmade crafts as gifts to bring back home. One specific souvenir that I bought was a stuffed animal of a deer. It was a cute reminder of the friendly deer we encountered and my little sister loves stuffed animals. I showed her all the pictures and she even named one.

We took a seat looking towards the water and indulged in matcha ice cream as well. Japan had the best sweets, so we had to keep indulging in them and couldn’t get enough. The combination of natural beauty, rich cultural experiences, and delicious treats made the day unforgettable. We had to be very cautious of the time and make sure to make it back on time. The ferry ride back was peaceful and full of laughter. Spending the afternoon in Miyajima Island is a day I will never forget. Nothing can top it!

On the last day of the program Thursday, May 30th, we first visited the Nisseki Ishinomaki Hospital after traveling from Sendai to Ishinomaki. When we got to the hospital we first received a lecture on the Tohoku Earthquake and the hospital’s response to the disaster. They walked through every decision that was made with timestamps. It was incredible to see how prepared the hospital was for the disaster and how fast they were able to begin treating patients after the emergency triage. There was also a resident surgeon who went over a number of common health issues that they saw during and after the disaster. Once we finished the lecture section they had a number of exhibits set up to show how they stocked the emergency shelters. For example, they had a sleeping tent with cardboard beds which could hold a whole family. There were also bathroom tents on display with special toilets that bagged the excrements for easy disposal without running water. After we finished rotating through the exhibits we boarded the bus and stopped for lunch at a mall nearby. Once we ate we started our drive towards the site of the Okawa Elementary School. When we arrived the first thing that we saw was the shell of the former building. Concrete walls had been knocked down and reduced to rubble and there was twisted rebar hanging all over. When the wave came it destroyed almost everything in its path. It struck the building with incredible force, there was nothing left unscathed. As we continued our tour our guide continued to share the story of the disaster and the actions that the children were taking to try and save themselves before being called back by their teachers. We were shown the spot where the tsunami caught up with the evacuating students and teachers and our guide told us about how after the tsunami parents went to the school and had to pull their kids’ bodies out of the ground. He then showed us a path that was used by the school to get to an outdoor learning area up on the mountain that a handful of students attempted to use. It was here that he showed us how high the water rose and how far students would’ve needed to go to reach safety. The distance to safety was much closer to the school than the route that the students and teachers finally took and if they had decided to go up chances are every one of them would’ve survived. It was a horrifying disaster and the whole situation left a sick feeling in our stomachs. For the entire drive to the train station I don’t think any of us said a word. This was truly something that I will never forget.

On Sunday, May 26th, we first went back to the Hiroshima Peace Memorial Museum to receive a tour of the Peace Memorial Park the Atomic Bomb Dome from a group of local highschool students. We broke up into groups of about four and began walking around the park. One thing in particular that I found incredibly cool was the cases of paper cranes that people made and brought in. In Japan it is said that if you fold one thousand paper cranes it will bring you good luck and many people string up their paper cranes onto a chain and then hang them all up. After we saw that we walked across the Aioi Bridge around the Atomic Bomb Dome and the students talked to us about the history of the building and how orphaned children lived in it in the aftermath of the disaster. It was truly indescribable to be standing in the exact spot where the bomb went off. After visiting the Peace Memorial Park and Atomic Bomb Dome we boarded the train towards Miyajima where we spent the rest of the day. After we took the ferry to the island we began walking towards the shrine along the shore. There were a bunch of deer that had been effectively domesticated wandering around town and messing with the tourists. We then made our way through the shrine and into a small area of shops where myself along with a handful of other participants picked out souvenirs. After walking back to the main tourist area we got soft serve coffee ice cream and ate it on the beach. We also walked up to the part of the shrine that was further out towards the water, but was exposed due to low tide. Once we finished exploring we made our way back to the ferry dock to meet up with the rest of the group and made our way back to the mainland and soon after made our way back to our hotel in Hiroshima. That night we also got Okonomiyaki for dinner, which was fantastic. This was my favorite day of the whole program. We had so much free time to explore not only the shrine but the other interesting architecture around the island. It was by far some of the most beautiful buildings and views that we experienced on the trip. It was also a fantastic dinner with the professors that I highly recommend all participants take advantage of.

On Monday, May 20th, we woke up early to visit the Fukushima Daiichi Nuclear Power Plant. After getting a quick breakfast from 711 we boarded a bus bound for Fukushima Prefecture. Once we arrived we stopped for a quick lunch and then participated in a lecture at the TEPCO archive center and had a brief tour of their exhibits on the disaster. Some of the displays contained the gear that workers used to protect themselves from the radiation that was being released along with videos explaining the disaster and dioramas of the site. Shortly after we left for the actual site of the power plant. Once there we received our radiation detection gear and brief explanation of the route we would be taking through the power plant. First, they were going to take us to a platform that overlooked the first, second, third, and fourth reactors. After that they were going to take us to a second area that overlooked the fifth and sixth reactor, along with the pump that carried the treated water out into the ocean for dilution. Once we arrived at the first platform I was immediately surprised by the size of all four reactors. They were absolutely massive compared to all other buildings around. The second thing that surprised me was the level of destruction still visible thirteen years after the disaster. The ground around the reactors was overgrown and strewn with rubble and twisted metal, and the reactors themselves were burnt and blown out. However, what was most interesting was the work being done to retire the reactors entirely. Around some of the reactors you could see large covers being built to protect the environment and nearby residents from the radioactivity that could be released with the removal of the radioactive material. On the drive to the second lookout we drove past an incredible number of tanks filled with radioactively contaminated water and a water treatment plant. It was at the second lookout that we were able to see the pump that moved this treated water back out into the ocean along with a cross section of the massive pipe that they used. Reactors 5 and 6 were also visible from this location, however they were shut down when the Tsunami struck the location. Due to this they did not experience any meltdown. I think the most surprising part of our visit was still how prevalent the damage from the Tsunami was. It is very hard to gauge how bad a disaster truly is without viewing the aftermath yourself, and I recommend anyone who has the opportunity visits.

Cultural humility is an ability I strive to embody in my daily life. The world has many different ethnicities, religious background, languages and food (and other factors) that contribute to identity.  It is important to be accepting and open minded of cultural differences.  Whether you are traveling or just to school or work (etc.), we are all individuals with different experiences, thoughts and emotions that create the beauty we see in the world. The insights gained from interacting with people different from myself are important because there is a lesson or new perspective to learn from. It was so fun to meet with Azabu University and University of Tokyo students and I appreciate their openness and inviting nature. I attached a picture of one night when we got dinner in Tokyo. Everyone was kind and we were all excited to share and learn things about each other’s culture. In my opinion, life is about making bonds and from this study abroad experience I created memories and connections I will treasure forever.

Although people may have different physical features, eat different food, or speak different languages as humans we have language to communicate our experiences.  Communication one of the most important skills because it is essential to build relations and connections with others. At the beginning of the trip there were cross-cultural communication difficulties with the university students, but with patience, persistence, and (sometimes) google translate we were able to convey what we wanted, and we all got along so well.

Traveling, especially internationally, provides so many opportunities to adjust your mindset, and gain new perspectives if you try everything with an open mind. One of my favorite things about this trip (there were so many favorites) was observing the daily routine and local’s life. During our stay in Tokyo, we would religiously go to the 7/11 konbini to get breakfast or snacks. It was interesting to see people of all ages doing their daily routine, from young kids going to school, adults getting on the metro going to work, and elderly doing errands to start their day. There was a sense of peacefulness and I enjoyed staying in the Yoyogi area during our time in Tokyo. I also appreciated the time and effort all the restaurants would put into our food and it was all so delicious. It is a Japanese custom that no tips are allowed because workers take pride in their products and their professionalism and work provide high quality food and service.

This study abroad program is unique due to the nature of the program itinerary where we had the chance to travel to multiple regions of the country. Unlike other programs that focus the time within a city or one region, in our case, we saw the suburban and more rural areas while traveling via the Shinkansen. This journey was unforgettable. I am beyond grateful to experience so many aspects of Japanese culture, made amazing friends, and blessed to have had such hard goodbyes..

One of our first program activities was visiting Azabu University. Here, we met with faculty and students to present our projects and learn about Japanese student culture, lifestyle, cuisine, and public health issues. Our trip to Azabu University began with meeting Dr. Oui and other faculty such as the chairman and English teacher. The staff at Azabu University were all so welcoming and kind, it seemed like they were very excited to have us students from OSU visit their university. 

After the introduction of the university from the faculty, it was our turn to present our projects on different Japanese topics. My group presented about earthquakes in Japan and preparedness strategies. Other groups included topics like water quality and the aging population of Japan. We used this as a practice to share our work and receive feedback before being evaluated on the actual presentation a few days later. After the OSU students presented, we listened to the Japanese student’s poster presentations. At this time, we met students in smaller groups and I listened to many presentations from students such as Ann, Rui, and Shinosuke, who became great friends! Some of the Azabu student’s topics included “foods you may find weird but should try,” “daily life of a Japanese college student,” “Oendan; the samurai cheer boys,” and, “Japanese pets.” The students did an incredible job presenting their posters in English and it was fun to learn more about the culture through a personal connection.

After our presentations, we took a lunch break. Many of us decided to take a trip to the grocery store down the street. At this grocery store, I had Shinosuke show me around, translate, and give recommendations on foods I should try. It was amazing to go to the grocery store, pick up microwaveable meals, and warm them up in the store. One of my favorite aspects of Japan was the price and quality of food. The food was affordable, fresh, and delicious. Once we made it back from the grocery trip, we ate lunch as a large group with more Azabu students. At this time, we met Takuya, and he became a close friend with our group. He was so friendly, outgoing, and easy to talk to. He met with us many times outside of program activities to hang out with us.

During our lunch, Dr. Oui held a presentation about the aftereffects of earthquakes and how besides the immediate dangers of shaking from quakes, they can have huge public health implications. He discussed the struggles that Japanese people faced after the 2011 Tohoku earthquake, such as rotting fish, building damage, and resource scarcity. Following lunch, we toured the Life Museum which held many skeletons of various animals like anteater, dog, fish, sloth, elephant, snake, etc. At the museum, I met Yosuke and we immediately became great friends. I talked to him about biology and his life in Japan, and I asked him any questions I had. He even went to Tokyo University with us that evening. Yosuke met with our group many times and even surprised us on our visit to Hiroshima.

After we toured the museum we headed to Tokyo University to see the students we met there the previous day. Azabu University had an incredible campus and a lovely atmosphere. Our first day of visiting Azabu had me extremely excited to go back the next day. 

During the second leg of the study abroad, we visited the Tokyo Fire Department Hongo Citizen Disaster Prevention Center, where we engaged in four simulations related to an earthquake, a flood, a fire, and a typhoon. These simulations, focusing on disaster response and survival techniques, ended up being one of my most memorable experiences of the trip.

The first simulation was the earthquake one, where we entered a room with six mats in them, with a backdrop depicting a typical living room and kitchen. The mats were rigged to shake in accordance to various earthquakes that had happened in the past, including the 2011 Tohoku Earthquake. The mats would not necessarily recreate the magnitude of the earthquake, but it would slowly increase in intensity, which is a scale of how rattled the human body feels after an earthquake. During my simulation, we slowly increased the intensity from 1-6. On the mats, we would sit on our calves. When the earthquake tremors started, we were to bend over, covering our heads with our hands, as we were supposed to do in an actual earthquake. I went in the second group, and I was surprised to find myself struggling to not fall over. Behind me in the backdrop, dishes and cabinets fell over, and it became incredibly clear why drills like this were needed—even if I had known the protocol for earthquakes beforehand, it was difficult in practice to stay in position. If it was a real earthquake, the dishes and furniture falling would have panicked me, and might have exacerbated an already dangerous situation.

The second simulation was related to flooding, where we learned that even a few inches of water build up could make it challenging to open doors. We were shown a front door and car door to open as practice with different water levels as difficulty settings. I hadn’t realized prior to the simulation how strong just a little water could be—I struggled opening just the first settings. This also gave me a newfound appreciation for flood prevention systems, especially near houses.

The third simulation was a smoke simulation, related to fire. First, we watched a projection of fire over a created bedroom, where an outlet plugged in for too long sparked and set fire to the curtains. Within minutes, the room was clouded with smoke and the window was blocked by the fire, leaving the resident no option but to leave through the door, through all the smoke. We were told to cover our nose and mouth with whatever cloth was accessible, and to crouch down for mobility rather than crawl. We were to use our right hand to feel the wall in front of us and feel our way through a mini smoke-filled maze set up for us. Since my prior knowledge about navigating a fire consisted of “stop, drop, and roll,” I thought this simulation was also very insightful and useful.

The last simulation was a typhoon one, where we wore raincoats, pants, and boots that were so thick and covering that only our faces were exposed. We went into a room with handlebars, that we were to hold onto and lean against, as heavy winds and rains artificially whirled around us. My bangs were soaked, but overall, I thought that this was the easiest simulation. It might have been because we were from Columbus, but I thought the winds were nothing compared to pre-tornado winds in Ohio. Still, the winds were very strong, and I did appreciate the value of the demonstration.

Disaster preparation is easily overlooked, even in the public health sphere, because of the lack of frequency of such events. However, the simulations at the Disaster Prevention Center helped me appreciate how important practicing for natural disasters is.

As an environmental public health major, I am highly interested in water quality and how water impacts health. Exploring the underground regulating reservoir in Tokyo was highly interesting and introduced me to new ideas about floodwater management. Tokyo Metropolitan Government implemented the Kanda River/ Loop Road No. 7 Underground Regulating Reservoir to protect against flood waters that the Kanda River and Zenpukuji Rivers cannot handle during flooding events. 

Allowing flood waters to collect in an underground reservoir like this reduces damage to downstream basins. Water is collected via the intake facilities which receive the water and guide it to the underground tunnel. Connecting ducts, discharge pumps, and shafts lead the water underground to be held in the reservoir tunnel. The total storage volume of both stages of the regulating reservoir project is 540,000 m^3. The 4.5 km tunnel has three intake facilities located at the Kanda, Zenpukuji, and Myoshoji Rivers.

While we explored the underground tunnel it was impressive to see the massive diameter. The inner diameter of the tunnel was 12.5 meters. It was mind-blowing to realize we were 57 meters below ground in a massive tunnel. The tunnel needed to be placed so deep within the Earth to avoid subway lines and plumbing, while also being deep enough to sit below the flow of the rivers. 

During our tour of the regulating reservoir, we got to visit the control room where the control boards and monitors are located. This control center operates and monitors water inflow from the rivers and handles discharge pumping. The control facility can raise and lower the gates of intake spots to control when and how much water flows into the tunnel. 

The intake facilities are equipped to handle the mass flow of water in a way that redirects the water and reduces noise. If water is allowed to freely flow into the reservoir, there are loud noises, vibrations, and other disturbances. By forcing the water to instead spiral down the drop shaft, it gets quieter and flows faster.

Walking around the facility and seeing the control room with the models of the reservoir was very impressive but it still didn’t prepare me for seeing the real thing. After going down 11 flights of stairs, I was amazed at the size of the tunnel. I can’t even begin to comprehend the amount of water that would fill a tunnel that big. I think reservoir tunnels such as this one are a great way to protect the community from massive amounts of rainfall that can cause flooding. 

A major difference from American and Japan early schooling, is the focus on proper waste methods, and recycling. On May 23^rd, we visited the Hikarigaoka incineration plant which is 1 of the 23 plants that takes manages waste in the city of Tokyo. Japan’s limited land area means they cannot rely on landfills for waste disposal; thus incineration is the main waste disposal method. We learned about the various steps of the process. For example, the removal of harmful substances from the fumes created while burning trash, and the ashes from incineration are repurposed for other uses such as incorporation into industrial materials. This application aligns with reuse aspect (Reduce, Reuse, Recycle) and illustrates the deeply-rooted commitment in Japanese society to reduce wasteful practices, and protect the environment.

Furthermore, the lack of trash cans in public spaces is an interesting concept because it can be attributed largely to cultural norms and the efficient, albeit, complex waste management methods (and other factors but these two are most relevant). First, Japanese culture and norms place a strong emphasis on cleanliness, and personal responsibility. So to throw away trash in public spaces is not encouraged because the government wants citizens to be mindful of waste. Everywhere we traveled, starting Tokyo and ending in Sendai, it was prevalent across the prefectures that the locals take care of public spaces to promote a clean environment. Next, the recycle and waste sorting practices are strict and highly organized so public trash cans would need to align with this system, so cities reduce the number of public trash cans to encourage citizens to sort waste in their homes.

I have never considered the implications of having trash cans so readily available in society. An example that we as students at The Ohio State University can relate to is Thompson Library. Every floor has multiple trash cans and one thing I thought after traveling to Japan is how wasteful this is and what does this imply about values on a societal level regarding trash/waste. Single use plastics is harmful to the environment, but the ease of these plastics mean they are used very frequently. Their prevalence creates an enormous amount of waste, and some countries have taken initiatives to reduce such waste. But a key difference is the mentality and cultural norms surrounding waste. The capitalistic nature of America contributes to constant consumption, which leads to overconsumption of goods and subsequently wasteful practices. Whereas in Japan, reducing waste and utilizing resources as needed are both emphasized during early education in schools. In sum, both countries are developed, but differences in values between United States and Japan are: convenience versus efficiency (many public trash cans, and less prevalent public trash cans), environmental awareness on a societal level, and community responsibility to take care of public spaces (individualistic, versus community based society). On a side note, I did not know Tokyo was the number one most populous city in the world at 37 million, followed by New Dehli India at 32 million (World Population Review). After I learned this fact, it is even more amazing how clean the streets are of the most populous city in the world! This is a picture of when we were walking in Shibuya, Tokyo and one I like the green spaces in the city and two, the streets are clean!