Reflections on WONCA Asia Pacific, Kyoto Japan

What a week!

I’m currently writing this on my way back from Kyoto (published on the day that I fly back to the UK) although admittedly I’m also slipping in and out of snooze mode whilst on the bullet train. I attended the WONCA Asia Pacific Region (APR) conference (15th to 18th May), not as the Chair of the JIC but as someone who works for the Vice-Chair of the Japanese Host Organising Committee.

The WONCA Kyoto journey began two years ago when we were discussing the poster that would be used for advertising. Kyoto is a historical city in Japan, having been the capital from 794AD to 1868. It is home to 17 World heritage sites and history oozes from every alleyway and every doorway; so much so that even Japanese people flock to Kyoto for the chance to see the sights and sounds.

Planning a conference for the Asia Pacific Region would always have its challenges. As a region, it is diverse: there is diversity of language, from the native English speakers of Australia and New Zealand to countries like Japan where not many people speak a second language; there is diversity in the definition of family practice and how long it has been established; and there is diversity in culture, food, religion and political ideation. Having one event to meet all these needs was going to be challenging.

Hanging out with the celebrities of the international primary care network at Kiyomizudera: Robin Ramsay (L) and Greg Irving (middle) 

My week was kicked off with meeting Greg Irving (ex VdGM rep) and Robin Ramsay (ex Chair of the JIC) after their breakfast and going on a whirlwind tour of Kiyomizudera, Ginkakuji and the Philosopher’s walk. I then met up with my boss and his friends from WONCA including Chris from the Netherlands, Jill from Australia and Chris Dowrick from the UK. They were running a workshop on mental health at which I would be assisting so it was great to sit down and have a little chit chat with them. The workshop itself was very interesting and we had an opportunity to learn about anxiety and depression through role-play. The lectures were given in English but the groups were split so that some of the role-plays could be conducted in Japanese with an opportunity to feedback within the group. I’ve also managed to get my mitts on Professor Chris Dowrick (Chair of WONCA’s mental health working group)’s business card as he’s agreed to be interviewed for this blog – watch this space!

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Giving my grown-up talk about why we should be part of a Young Doctors Movement

Second up was my lecture on “cultural considerations in communication” with Maham, a UK GP now living in Japan, and Daisuke and Kentaro, two Japanese GPs working in Japan. This was followed up by a workshop on “continuity of care” with David from the JIC who is a massive Japan-o-phile and speaks Japanese. The highlight of my week was giving a plenary speech at the conference on the Young Doctors Movement which is probably the most grown-up thing I’ve ever done. I’m not going to lie but I think was sweating through the soles of my feet!

It’s a bit too late for the next WONCA Europe but it did make me think that I better stop submitting workshops as I felt a bit rushed off my feet this time round. I only had time to make it to one workshop and I’m glad I made it to the one about Japanese philosophy and primary care where we discussed two philosophical concepts of “Ichigo, ichiae” and “shuwari” and how they can be intertwined with family medicine. What impressed me most is how most of my closest Japanese friends were masters in some sort of Japanese art – whether that was shodo (Japanese calligraphy), chado (Japanese tea-making), judo (Japanese martial art) or kendo (Japanese fencing).

The Buddhist concept of “ichi-go, ichi-e” (一期一会)is a famous one that all Japanese will know – the direct translation being “one time, one meeting”. It suggests that every moment is a once-in-a-lifetime moment, however, familiar and mundane it is and therefore should be cherished. Even if you are making tea for an old friend or jumping onto public transport to get to work, the subtle circumstances will differ every time and we should savour these understated differences. I guess it’s not far from the concept of mindfulness and we know that presence is good for mental health. What is the significance within primary care? I’m sure there can be loads. Every 10 minute consultation is a different experience; every time you meet the same patient, it’s a different dynamic; every walk to work brings new smells; every new trainee brings different learning points. Making the familiar unfamiliar will let us have a true appreciation of the passage of time.

Shuwari (守破離)applies to learning and reminds me somewhat of Luke Skywalker’s training with Yoda.

  • Shu  (守)- learning through following and obedience
  • Wa (破)- breaking these rules and discovering your own style
  • Ri (離)- departure and becoming a master

The difference between Eastern and Western learning was highlighted by my Italian friend who said during group discussion that he felt that shu and wa were the same stage as you ask your “master” (clinical supervisor) questions as you develop your own style. My personal thoughts on this is that this is a reflection of the Western Socratic method of learning through debate and critical thinking which is different to the Eastern Confucian learning style which can be feel more didactic from a Western perspective. Do we see training in the UK as “shu”, and First5 as “wa”? Do we ever reach “ri” as GPs?

Our UK ambassadors: From L to R: Becky, Lola, Professor Kusaba (President of JPCA), Josie, and mystery photo-bomber.

Throughout the four days, I was trying to (unsuccessfully) keep an eye on the three British doctors who were on our exchange programme with Japan. Sorry guys, I’m normally a bit better than this! We had Lola (trainee from the Lewisham VTS), Becky (academic GP trainee from Oxford) and Josie (trainee from Coventry). Due to my hectic timetable, I wasn’t able to attend their poster presentation which I was gutted about but I did have some time to talk to them at the JPCA dinner and was mightily impressed by these ladies.

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I managed to not smile for about 15 seconds to partake in this recreation of Charlie’s angels at Inari-jinja with Erfen, Chair of the Rajakumar Movement. NB I don’t usually wear a suit to go hiking but I didn’t have time to get changed!

And then I finished my crazy week climbing the stairs at Inari-jinja with the executive members of the Rajakumar Movement where I was able to finally have a one-to-one discussion with their Chair, Erfen. The Rajakumar Movement is the Asia Pacific version of the European Vasco da Gama Movement and with the first Chair, Naomi, being from Australia. Shin, a GP from Japan, was next and now this baton was passed to Erfen from Indonesia. We talked about the challenges that he faces – the fact that family medicine is relatively new in some countries but established in others; the varying levels of English spoken; and the fact that there are some deep-rooted governmental politics and divisions that need to be navigated diplomatically. I was also introduced to the idea that making it feel inclusive for our Chinese young doctor colleagues is difficult due to the restrictions at national level on social media. We also touched on the issues faced by Indonesian family doctors with the high levels of litigation and general feeling of discontent. I am grateful not to be in his shoes at the moment!! Having this opportunity to talk to Erfen, Loretta (from Hong Kong), Mel (from Philippines) and Wee-Sian (from Australia) made me realise that I love my Young Doctors Movement family and I could spend hours with them putting the world to rights even though we are from very different countries. Everyone has the same vision and that is we feel stronger together and more empowered together and I love feeding from this energy. The next WONCA Asia Pacific is in New Zealand and I might forego WONCA WORLD in Abu Dhabi for a bit of Kiwi antics…

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Some of the awesome guys from the Rajakumar Movement. From L to R: Wee-Sian (Australia), Erfen (Indonesia), Mel (Philippines), Loretta (HK) and your truly

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