Anjo Kosei Hospital was instituted in March 1935. In those days many people in rural areas of our country were suffering from poverty and illness. Of the numerous agricultural cooperative hospitals and clinics that were established across the nation in the 1930s with the spirit of cooperation, many were inaugurated with a heroic resolve. However, the Kosei Hospital in Anjo founded by the Maruheki Association was fraught with optimism and great promise. The reason for this was that the county of Hekikai-gun was, at the time, called the “Denmark of Japan” and boasted the largest business expenses among all the counties in the nation. In order to return the surplus to group members, a plan to build a hospital was drafted with the advice of Nobukichi Yamazaki, the first principal of Anjo Norin (Agricultural and Forestry) Senior High School. He used to say, “The greatest threats to a farmer's livelihood are accidents and sicknesses. There can be no happiness without good health. We should build an agricultural cooperative hospital to provide its members with modern health care.” Initially, the hospital had 34 beds, eight medical departments, and 40 staff members, including seven physicians. Control over the hospital was transferred to Aichi Koseiren (the Aichi Prefectural Federation of Agricultural Cooperatives for Health and Welfare) in 1948, after having tided over a shortage of labor prior to World War II and during the chaotic postwar period. The hospital began togrow rapidly, measuring up to the expectations and trust placed by local residents. Through enrichment of functions and expansion of the wards, the institution went on to become what could be called a citizens' hospital of Anjo and in fact, the largest hospital in the Nishi-Mikawa area. With the passage of time, the hospital got cramped for space and the buildings decrepit, adversely affecting not only the care environment but also disaster prevention measures. To maintain medical standards, hospital relocation was a must. In May 2002, the hospital moved to the present site, thanks in part to the support of the City of Anjo. After relocation, the hospital decided to give priority to treatment of acute diseases. Now, the number of hospital employees has been increased to 1,205, including 128 physicians and 676 nurses. In addition, there are 40 interns. Designated as an emergency medical care center, the hospital is the nucleus medical institution in the southern part of the Nishi-Mikawa area. However, due to the excessive concentration of patients in this hospital, it has come to pass that all the 692 beds are almost always occupied. This has inevitably made it difficult for the hospital to accept emergency patients. Measures to combat the situation, such as bed control, shortening the length of hospital stay and referring patients to other facilities have reached their limit. Therefore, further effort must be put into the division of hospital functions in the community. The required number of personnel such as physicians and nurses currently reaches the full quota, though only barely. Nonetheless, it would become more difficult even to maintain the present level. The 71-year history of Anjo Kosei Hospital reminds us of our predecessors' will and wishes to work hand in hand with the community to promote the health andwell-being of the people. We would like to continue to be a hospital that appeals not only to local residents but also to physicians and nurses by upholding the following basic principles: 1. To contribute to the health and happiness of local residents through health care. 2. To place patient care at the center of all the activities of the hospital. 3. To create a work environment which the staff can be proud of and feel happy with.
The author founded the “Society of the New Elderly” in 2000 and launched a campaign to redefine old age. It was some 50 years back that the elderly were defined as those people over the age of 65 in industrially advanced countries. However, with the average life expectancy of Japanese at birth topping 82, the author suggested five years ago that the elderly should refer to those people 70 and over. The Society adopted the following four slogans:(1) to love, (2) to initiate, (3) to endure, and (4) to promote world peace by letting school children learn how peace could be realized through the stories of the horrors of war told by the aged who experienced them during World War II. It was emphasized that good models of the elderly should be shown to the young generation through hearty communication at their homes or at public places. The author recently visited Dr. Schweitzer's hospital at Lambarene in Gabon and learned how the Alsatian medical missionary had dedicated himself to the people there to let them know how precious the life of humans and all other living things, because they were created by God. Finally, the author mentioned the latest research we had been conducting with the participation of volunteers among the memebers of the Society. Through the cohort study, it is to investigate how their genus are influenced by their lifestyle. The author has been trying to persuade health professionals in different disciplines into working together more closely in order to improve the quality of health care.
Corresponding to the international trend toward a reform of higher educational institutions and a structural reform of universities of Japan, a tota 89 national universities were incorporated in 2004. Each university is making its way in accordance with the 6-year interim plan. Analyses were made of the background and framework of university incorporation, its effect on community medicine, the international trend of agricultural medicine and problems to be addressed by the JARM from the viewpoint of reconstruction of community care in rural areas, especially in out-of-the-way villages and on solitary islands throughout this country. University reform is aimed at separation of education from management, clarification of the responsibility for students, independence from the educational administration, and guarantee of higher education. Behind the incentive of the reform is internationally common recognition that the society in the 21st century will be “knowledge-based society.” The surge of high education reform kicked off in the U.S. and Britain in the 1980s was closely related to their intention to continue economic and cultural development steadily, a market mechanism, intensified competition, and the grouping for the best way to create a new social system. In order to create and maintain healthy rural community, the JAPM has to grapple with various tasks strategically. They include:a comprehensive approach to health care, welfare and higher education; collaboration of rural residents and related governmental agencies with the former acting on their own initiatives; combination of health promotion and other local policies in remote rural areas; participation in agricultural policy making with international cooperation taken into consideration.
The first theme set on me is “Was there any necessity that a cooperative society had to take it upon itself to provide community medicine?” The second is “its present meaning.” About the first theme, I think we need to look into the historical factors behind the start of community medicine by the cooperative -- especially the free medical practitioner system and community movement. Regarding the second theme, we have to ponder over why community medicine must be provided by the cooperative at the present. In my opinion, what is of paramount importance is that every person, as a human being who lives an ordinary life as a citizen think about these issues. I prefer not to stand on the medical donor side but on the side of medical care recipients when considering these themes. It is we that decide on tomorrow. People who are members of the community living there have the right to determine their future as the independent persons. You would learn from the history of the cooperative movement that the “spirit of cooperation” protects your health and well-being.
In 2001, the Ministry of Health, Labor and Welfare called upon nursing and welfare homes to take measures to reduce the use of physical restraints. However, depending on circumstances, nurses find it, necessary to restrain patients to prevent accidents and for treatment purposes, which makes them face a dilemma over ethical problems and suffer great stress in a clinical setting. We received a lot of advice as to how to think about and use physical restraints in acutecare and chroniccare, and from legal, safety and ethical points of view. Doctors claimed that they are also caught in the ethical dilemma, and tend to stay away from any risks that they might have. Then, we discussed how to solve any ethical problems. It was clarified that we should get rid of worry by establishing mutual understanding. Therefore, it is necessary to set up a relief organization in case of medical dispute, hold problem-solving conferences and risk preventive meetings. Through thses occasion, we have noticed how to cope with ethical problems of the use of physical restraints on the job.