Wakatsuki, Toshikazu

Japan today is thought of as a giant among industrialized states with an avid commitment to everything new. Yet, despite price supports for some produce, toward farmers and fishermen attitudes persist reminiscent of the feudal view—“neither let the peasant live nor die.” Farmers, in turn, continuing to believe it is their lot to suffer, encourage their children to leave the land. An offshoot of this belief is that farmers often seek medical assistance too late for effective treatment; they are further deterred by fear of the profit motivation of many city doctors and hospitals.

TOSHIKAZU WAKATSUKI is that rare kind of person for whom backwardness offers opportunity. A graduate of Tokyo Imperial University, he was drafted into the Army in 1937 and assigned to Manchuria. Invalided out for tuberculosis after two years, he was later jailed for his socialist anti-war activities. Upon his release in early 1945 his revered professor Dr. Kikuo Otsuki found constructive obscurity for him as one of two doctors at a small clinic supported by a farmers’ cooperative at Usuda, in the mountainous rice and fruit growing country of Nagano Prefecture northwest of Tokyo.

At this remote, very simply equipped clinic, WAKATSUKI, in 1946, performed the first surgical operation in Japan for tubercular spinal caries and organized the first blood bank. His goal became total health care to farmer families on a 5-3-2 formula: “five parts of our ability are devoted to care of inpatients, three parts to outpatients and two parts to outside-the-hospital medical care and public health and hygiene service.” In over 150 papers for national and international medical journals and conferences he has shared his trials and errors in rural doctoring and his central finding: farmers’ support can be gained by educating them to an awareness of their needs and by offering them high-level medical practice. In a popular play he elaborated his philosophy that a physician’s true professional satisfaction comes only through honest and devoted service to patients.

In 30 years Dr. WAKATSUKI’s enterprise has become the 937-bed Saku Central Hospital in Usuda, with 60 full-time physicians, 300 nurses and an equal number of other staff. Clinic and hospital branches are located in Komoro and Koumi. A new National Training Center for Rural Health–for doctors, nurses and dietitians–will complement the School of Nursing, the Institute of Rural Medicine–researching the environmental hazards of farmers, the Rural Health Study Center, and the headquarters of the Japanese Association of Rural Medicine.

More significant than these splendid facilities–sponsored by the Welfare Federation of Agricultural Cooperatives of Nagano Prefecture– is their pervading spirit. Visitors remark upon the easy camaraderie between staff and patients, credited by associates to 65-year-old Dr. WAKATSUKI’s conviction that “rural medicine should be social medicine.” Increasingly, the movement emphasizes preventive medicine and “well aging.” Indicative of community response is the Hospital Festival celebrated every spring by the 15,000 citizens of Usuda and their prefectural neighbors. Morning, noon and evening chiming of bells, and the organ of Saku Central Hospital playing the melodious “Together with Farmers,” elicit lifted heads and smiling countenances from the country people.

In electing TOSHIKAZU WAKATSUKI to receive the 1976 Ramon Magsaysay Award for Community Leadership, the Board of Trustees recognizes his bringing to his country’s most depressed citizens the highest type of technically competent and humanely inspired health care, thus creating a model for rural medicine.

I am greatly honored to have been designated recipient of the 1976 Ramon Magsaysay Award for Community Leadership. Attending this presentation ceremony, I must frankly confess that my conscience still asks me whether my past achievements really deserve this recognition. But please be assured, Trustees of the Foundation, that I will share it with my rural medicine colleagues who recognize the categorical imperative of delivering increased and sophisticated health care to millions of medically underprivileged people in Asia.

My selection newly awakes me to our grave task, particularly when I give thought to the late President Magsaysay’s devotion to rural reconstruction. When your government hosted the U.N. Community Development Conference for South and Southeast Asia in 1954, he said: “The spirit of self-help is sweeping our rural communities . . . the role of the government is simply to tap the creative energies of our people and to provide the means by which their desire for improvement can be translated into permanent benefit. It is for this purpose that our health, education and social welfare programs are being reoriented with emphasis on self-help.”

Serving as director of a general hospital in the middle of the Japanese equivalent of the Alps, I was deeply impressed by these sagacious words as I was keenly aware of the necessity of awakening people to the protection of their health on their own initiative.

It has already been 31 years since I left the hospital of Imperial Tokyo University and began working as a surgeon in the present hospital. My dearest hope was to protect the health of medically underprivileged rural people, but again I must confess that I have not fully realized this ideal of mine. I am aware that the road along which I am trodding is thorny, and God knows whether I shall be able to arrive at the destination in my lifetime. If there were anything good about myself at all, it would be my determination to spend my lifetime deep in the mountains for the sake of rural people.

In recent years, the technological developments in every field of medicine have been spectacular. On the other hand, one is compelled to note that many problems have yet to be solved in respect of the delivery of medical and health care to outlying areas. Gravest of these is the formulation of measures to cope with the so-called doctorless villages. Rural people are not blessed with sophisticated medical care. To make the matter worse, their communities are fraught with hazardous environmental conditions, and when their economy is developed at a rapid pace, new problems developing from urbanization also endanger their health.

The staff of our rural hospital has been striving to provide sustained community medicine for the benefit of local people with their cooperation. No rural hospitals could fulfill their mission simply by taking care of patients. Considerable energy must be devoted to outpatient services, to be sure, but there is need to evolve what we call “village health care,” in which physicians are sent out to engage in public health work, go round doctorless villages and provide mass health screening. These activities must be preventive in nature, rather than being satisfied with the early detection of diseases. To evolve such care there is need for deep understanding about and sympathy for rural people. In this context, health education to rural people turns out to be self-education in humanism to us medical care workers. It is with this philosophy in mind that we are striving to develop movements for the protection of rural peoples’ health through the mass media, based on our past advances, and also to reorient physicians, public health nurses and livelihood guidance workers in rural medicine. Folk legend says genesis here in the Philippines was by Divine Wind. The bamboo was split, and there was a man called malakas, for strong, and a woman called maganda, for beautiful. Each had a role to play. In rural medical and health care, too, medical care workers and inhabitants have mutual roles to play.

Once again, I must express my most sincere appreciation for being invited to Manila for the presentation of the Magsaysay Award. Nothing will give me greater pleasure than if the achievements of the Japanese Association of Rural Medicine prove to be of use in protection of rural health in your country during the course of our future interchanges. We are in full sympathy with the devotion of Filipinos to the construction of a peaceful country since your independence from long years of colonial rules. I, as a Japanese citizen, must deeply apologize for all the atrocities committed by the Japanese military in your country during World War II. When Japan’s reparations to the Philippines were completed last month, President Marcos generously stated that it is time people stopped talking about the dreadful war. We, the Japanese, must admonish ourselves not to presume upon his generosity.

Last but not least, I wish to express my deepest sympathy to the earthquake and tidal wave victims in Mindanao. I have asked the Ramon Magsaysay Award Foundation to set aside half of my prize as a donation for their relief.