Annual Physical Examination

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APANESE CASE STUDY #1
This case study is a composite of actual situ
ations. Marianne, who is American, and Ken
Shimizu, who is Japanese, have worked
in Tokyo for over 30 years as Methodist
missionaries. They have annual furloughs and
occasional sabbaticals, during which they
visit relatives and sponsoring
organizations and engage in
continuing education in the
United States. They met as college students
in the United States, and their three grown
children have established their ow
n careers in the United States.
Ken’s 98-year-old mother resides with
Marianne and Ken. She is not Christian
but has always been extremely supportive of
Ken and Marianne’s work. Ken teaches at
a large Christian university, whereas Marian
ne has served in various church-related
positions over the years. As missionaries, they live in subsidized post–World War II
housing near Ken’s university. Marianne has
been a frugal housewife, preparing local
foods in the Japanese style for her family.
Ken, who is nearly 60, recently learned
that he has glaucoma. By the time it
was discovered, he had lost a signific
ant amount of peripheral vision. Although
Marianne delivered all three
children at a Christian hos
pital in Tokyo, she gets her
annual physical examination when visiting rela
tives in the United States. She has never
believed that the Japanese health system is
as proactive as that in the United States.
On her most recent visit to the United
States, Marianne learned that she has
hypertension. Her physician prescribed a medica
tion that is readily available in Japan,
but the physician was concerned about the leve
l of stress in Marianne’s life. Mother
Shimizu is quite confused and requires considerable care, but it is unthinkable for Ken,
the only child, to put his mother in a long-
term-care facility. Even if he would, the
quality of facilities in Japan l
eaves much to be desired. Most of the responsibility for
Mother Shimizu falls on Marianne, in addi
tion to her work. Marianne’s relatives are
urging her to consider placing Mother Shimiz
u in a church-related life-care community
near Marianne’s family in the United Stat
es, where Marianne and Ken would like to
retire. Marianne’s own parents
lived in this facility at the end of their lives. She is
considering these issues
as she returns to Tokyo.
Study Questions
1. Identify some of the cultural issues that
may lead to conflict in this international
family.
2. What are the family resources for this international family?
3. What factors within the Ja
panese health system may account for the late diagnosis of
Ken’s glaucoma?
4. What practical issues might arise for th
e Shimizus if Mother Shimizu were placed in
a long-term-care facility in the United States?
5. What dietary factors may cont
ribute to Marianne’s hypertension?
6. In what ways might you consider Ken to
be countercultural as a Japanese man?
7. What social pressures might Marianne ha
ve faced, given some of her choices, as a
housewife in Japan?
8. What pressures will Ken likely experience
as he considers how to meet the needs of
both his mother and his wife?
10. compare and contrast the fertility and mortility rates of japan and the united state.t
11. To which drugs might Japanese people have greater sensitivity than that of white
ethnic populations?
12. How do most Japanese people meet their need for calcium?

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