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Friday, May 4, 2001

MATTER OF COURSE

HEALTHY SCHOOLS

Reading, writing and pinworm tests


When I moved to Japan intending to enroll my children in public school, I had no idea what kind of health records we'd need.

Based on my experience in the United States, where children must be examined by private physicians before they can enter school, I carried over a suitcase full of health records, vaccination certificates and letters from our doctor.

As it turned out, no one in Japan was the least bit interested in my stacks of papers. Like all public school students, my children would get the necessary exams at school -- free of charge.

By law, local school boards must conduct a battery of health exams on all students. Most of these are conducted in April and May, at the beginning of the school year.

I quickly came to appreciate the convenience of not having to take my children to the doctor for annual school check-ups, as I did in the U.S. But wouldn't it make more sense to have parents take care of the exams after school so teachers can use school time to teach (particularly since class hours will be reduced starting next April, when students will no longer attend school every other Saturday)?

A health official to whom I posed this question allowed that it does take up a lot of school time to do health exams at school. But the thinking in Japan, he said, is that health exams at school are the best way to provide children with basic health care. It helps ensure the health of the group, he said, and is equitable because all students receive the same quality of care.

At the beginning of every school year, each child in the school receives a comprehensive health exam. Doctors visit the school to check students' hearing, vision and heart and lung function. A dentist checks for tooth decay and other dental problems. Urine samples are collected and tested for diabetes and urinary-tract infections.

I was a little alarmed when I learned that one of my children would be given an EKG at school, but I was assured that heart monitors are used routinely in Japanese schools.

At the beginning of every school year, parents fill out a detailed questionnaire that probes for potential heart problems. Any child suspected of having heart trouble, and all first graders, have an EKG test. A child with an undetected heart problem could collapse or even drop dead during vigorous exercise, a school official explained to me -- and there is plenty of vigorous exercise at Japanese schools.

Spring is also the time for the annual gyochu kensa (pinworm exam). My children refer to this, quite aptly, as "The Dreaded Scotch Tape Test."

Pinworms are tiny parasites that cause rectal itching and other health problems. In Japan, prevalence varies by region, but at a school with a relatively high rate of infection 4 or 5 percent of the students -- one or two per class -- will have pinworms.

The best way to detect pinworms is to look for evidence of eggs. The female pinworm dwells in the appendix of an infected host, but comes out of the body at night to lay microscopic eggs.

I don't want to get too graphic here, but let's just say mama pinworm lays her eggs in a place where the sun doesn't shine.

So once a year the school sends home a cellophane square with a special adhesive on each side. First thing each morning for two days, we parents apply one of the sticky sides to our student's backside.

The school collects the cellophanes, called pin teepu in Japanese, and sends them to a lab where they are examined under a microscope. Any child who tests positive must take deworming medicine and be retested. Schools strongly recommend that everyone in the family take the pills, which are sold over the counter at pharmacies.

Overall, the quality of school health exams seems good. When I took my 6-year-old to a group exam for all incoming first graders, I was impressed that the eye doctor noticed that my son has a minor vision problem that had not previously been detected.

Schools also take a role in teaching children how to prevent illness and care for their own bodies and health. Every public elementary school in Japan, no matter how small, has one teacher who is responsible for health care and education.

These teachers have special qualifications,including training in first aid. The health teacher, whom the children call hoken no sensei, supervises the medical exams and conducts bimonthly height and weight checks.

Although not a nurse, the health teacher handles minor injuries and illnesses that occur at school.

Health teachers also conduct lessons, and have the freedom to teach what they consider most important for their students.

At the school my children attend, for example, the health teacher noticed that many students seemed tired. A relatively high percentage of students at this school attend juku, after-school classes to prepare for middle-school entrance exams.

By the time these children get home, eat dinner and do homework, it's late. In an effort to get students to bed earlier, she conducted lessons on the importance of a good night's sleep.

The year before, noticing that more children are overweight, she focused on nutrition. Because she supervises the medical exams at school, she has a good idea of the general health of the student body, she told me.

Perhaps linking medical care and health education by conducting both at school is, after all, a healthy idea.



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