Hikikomori...

If ill health does not happen by chance or through bad luck. Must it has relationship with biological factors, lifestyle factors, environmental factors? Of course, not forgetting the extent and nature of health service.

In most cases, the formal three are not hard to recognize. As for the latter, it takes more to explore the reality of it. Ill health that is caused by the extent and nature of health service can happened in the cities as well as the rural. One normally is hard to identify it when one was not exposed.

Poverty, social injustice, social stratification etc., are easily contribute to this factor.

Does Hikikomori fit into any of these? Can I identify the factors influencing the development of Hikikomori, thus identify the 'fields' in which 'health' can be promoted?

Think......

Harajuku teens
- the aggressive teens that dressed out to express themselves.


Pachinko Housewives
- the housewives who neglected their children, so much immerse into Pachinko, and had let to several cases of death of their children because of their neglegiance.


Hikikomori People
- the people who shut themselvs in, withdraw from social communication, for six months and above.




What are the main differences? What are the similarities?

Questions for non-Hikikomori

Questions: (based on the literature readings, and first 3 interviews)

1. Have you heard about Hikikomori?
2. Do you know anyone who is/was a Hikikomori? (if no, go to Q.4)
3. What is your relationship with him/her?
4. How do you feel about Hikikomori?
5. How do you think they come about?

Analyse the questions and answers, suggesting keywords: school bullying, school failure, job failure, death.

6. Do you see any different in their circumstances at this time, compare to the circumstances at your time? If it is different, how does it differ? If it is not different, how had you cope with it?

7. How do you look at this phenomenon in relation to the society?

Does knowledge help in promotion of Blue Sky Campaign?

Copyright South China Morning Post Ltd. Mar 22, 2007: A study by the Environmental Protection Department released in 2002 found that more than 80 per cent of polluting emissions came from the region.

In contrast, university scientists used air quality monitors in Hong Kong and the Pearl River Delta, wind data from the Observatory and satellite pictures to confirm the sources of air pollution. They also found that local sources played the biggest role in pollution from April to August, whereas regional sources affected air quality mainly in winter, from November to March.


Does knowledge help in promotion of BLUE SKY?

Who shall we target the promotion program to? How should we propose it? In the sight of the Expatriates, Government, People? Which group will serve to be more effective in this communication?

The government had been reserve in concluding the problem,what had been troubling their mind?

All these things would need to be considered and addressed, before we can run a effective program. Knowing who to target, what kind of strategy that we should approach, and time for pushing and holding back, would be a key to more likely to success with reduced wasted efforts and manpower.

The Poor

POVERTY , you need to treat them first!

Poverty is the greatest Disease!

In the story of "Akahige", a Japanese story directed by Akira Kurosawa in 1965 featured a charitable hospital and the various kinds of patients whether they falls into  charity welfare or damyo (landlord). In the movie, dr. Niite was angry, he said, "Poverty is the disease!" "What is the government doing about poverty? Nothing! They were doing nothing!" Forceful remarks, yet so much truth, more than we can withhold.

Isn't that what happens now? In various country, in various government. Regardless how steep the GDP grows, how stable the GDP takes it foot on, there are always disparity between rich and poor.

Blame it on poverty, mental illness or physical illness, all are about poverty!

I remember that was once we had a discussion on a similar issue with a Chinese friend, casually taking the disparity in China as an example, when we talked about Mercury poisoning, environmental pollution... she became defensive.  "It is not our fault!" But the fact was no one was pointing the finger on anyone in that conversation. Nothing really solid was being mentioned.

There is a certain pain in her, just as an innocent child who had been exposed to many unaccepted truth,  or ugliness in her search of life, the face that she had never had a chance to see, or she had immune herself to think about, in this process, formed into such vivid images, that she had no way to hide. She could not deny it, or ignore it, so she became defensive whenever people started to talk about the issue. She became sensitive and protective.

"Why do you accused us for having a better opportunity?"
"You cannot blame us for us having a better opportunity than others! Have you thought about we also have our own problems?"
"We just cannot afford to care so much of all people!"
"These are natural selection, that some will loose and some will gain! That is the only way!"


She is a public health student.

She is not wrong either.

But yet, how should we promote public health? Who should promote public health? Does an attitude of the person who sit on this seat count?

The principles of Health Economy do not work in place of extreme poverty with stiff competitions to grow and getting out from it.

The rich and the poor; power and money, these will birth forth a new set of rules and principles. And these principles will rule, and be accepted by its own nation, social norm takes place.

When power and wealth are goals, when people became fearless, when the love in men begin to fade......

After all, health is not so important when one is in extreme poverty. Just like a believe system does not hold, when one is hungry. BUT then, we standing outside the circle, we know that is a complete lie. Without health, there is nothing that we can achieve. There might be different standards in health in various situations. Nevertheless, health is the essential thing to hold our breath together. Without health, is DEATH.

"We use health to buy wealth when we are young;
We use wealth to buy health when we are old."

This is a cycle that we need to break!

Refining research question (1)

While I do a search for the definition of Hikikomori through Oxford Online Premium, it was stated that:

1. hikikomori n.A culture-bound syndrome found almost exclusively in Japan, most com-monly among male teenagers and young adults, especially eldest sons, although about a quarter of cases are female. It is character-ized by extreme social withdrawal and near-total ...
(From A Dictionary of Psychology in Politics & Social Sciences)

In South China Morning Post Ltd. Jan 15, 2007 was reported that the number of young people who spend their lives locked in their bedrooms has tripled in the past two years to as many as 18,500 according to the estimation of a welfare group.
Of these young hermits, some had isolated themselves for as long as six years, with the youngest being just 12.

These lock up young people were reported that they would kill time surfing the internet or playing computer games, or watch television or idle away the hours in a dark corner at home. It had been also suggested that the phenomenon partly to the increasing competition at school and pressure to succeed within the community.

"Many of them become evasive and eventually choose to lock themselves up in their bedrooms during the day and only came out to have food or take a shower,"

Is Hikikomori still, a culture-bound syndrome found almost exclusively in Japan? Or is it a epidemic in Mega cities? Does Hikikomori happen in Hong Kong? Or had the term had been loosely used? If it was loosely used, why? What is the attraction of this term, or phenomena? When the term was loosely used, was it suggesting or predicting something? What are the psychologist and sociologist have to say?



I think those are the questions that I would like to find out at this moment.

Indian's youth reflect Disparity

CNN reported on the "Indian Youth reflect Disparities" today. It was a series of interviews and video taping in different areas in Calcutta in contrast of city and the rural. The program exposed the contrast in thier living circumstances, conditions, opportunities and expectations in life.

In every 2 minutes, a chld is borned in India. The fertility rate is high. GDP is fast growing, and same as China, the disparty in this nation is huge.

In the city, the youth are sitting in starbucks, shopping thier clothes in one of the most branded shop in town, chatting about their dreams in making a difference in the business sector. The country itself is heading for a good future. A female college student said, " I don't think I need to go any where else, India is having plenty of golden opportunities these days."



The rural, a boy who hold a rope that ties on a cow in his hand, "I am to take over my father's job in next few years. I am to take over the responsibility of being the head of family."

In the villages, the villagers are still struggling with poor sanitation, unclean water, no electricity supply, average income less than 2 U.s. a day. By contrast, in the cities, teenage girls sitting in the coffee longue, shopping in the branded boutique shops, having educations in comfortable highly equipped institutions. Both, were aware of the existence of one another.

What kind of health promotion is needed here? I wonder?
Which is the greatest need of India today?
How shall the money of the government to b e spent in health?
Building more maternity ward in the city, bringing more qualified highly professionals. sufficient ultrasound machines and operation theaters?
OR to improve water sanitation, building electric and water supply system in the rural? Sending doctors and nurses in to the rural, setting up clinics and hospitals in a futile land?

Education is nontheless important! Again, how do we make the villagers to understand this and allow their children to got o school? We can have schools in the rural, in the village, but are they being empowered to pursue dreams by having education? In the rural, children are needed to take care of the younger ones at home. Older children are needed to be on the paddy field, or shepherding, or take over the jobs of their parents when their parents or grandparents are sick! How do we help them to pursue education? How could equity be set into this place? The school or education might exist, however the feasibility of them, or the ability to choose education over bread on the table might just not there.

First RCT in Bible

RCT in Bible

In the class of Evidence-based Epidemiology, Prof. Gabriel challenged us to think about at least one biblical reference of randomized controlled trial. I thought for a long time, no trials registered.

Which verse? Which chapter? Which incident in the bible was actually:
First, it must be an intervention;
Second, the allocation of the intervention group and control group were randomised; the allocation concealment was achieved. No one knows what was going to happen next, not even the researcher. Everyone had a fair chance to participate in the game.
Which means no bias, no preference, no favoritism was involved.
Third, there were a proper time of follow up of both groups.

Incidence of Babel Tower: Random allocation, but no intervention involved.
Noah's ark: The Flood was an intervention, but the participants were not randomized, or at least no proof of randomization.

This is really hard, isn't it? Even as I claim that I am trying hard to study bible and public health side by side. I couldn't do this just on the spot either. But then, this is really a good lesson to me!

Think hard, analyze and map what I read with what I know and what I anticipate. So that I know what I am off to :-)

Shalom! May Peace be unto you!

When Rabbies Attack

Rabies deah toll promts warning of new dog cull. Hunan-Deputy Hunan governor Gan Lin has announced plans to kill all dogs hat have not been vaccinated against rabies. Sixty-one people in the province died from the disease in the first two months of this year, Xinhua reports.

An announcement of "Killing all dogs that have not been vaccinated against rabies" would be an effective healh education from the local official.

First of all, there are as much as 61 victims that died from the disease in the first 2 months of this year, certainly this is an public health issue, and clearly something that has to be done!

Taking action on the unvaccinated dogs, will result increase of awareness of the public against rabies.
The act/ annoucement would result a several attitude and responses of the public:
1) The dog owners will make sure if their dogs were vaccinated.
2) Strangers will stay away from the stray dogs, or any dogs which they are not familiar with.
3) People will start taking precautions when they see dogs.
4) People will be aware that what going on was serious enough for such action to be taken.
5) People will be alarmed to take immediate action once bitten by dog.


I think that is a good step of public health promotion and intervention.

Perhpas one thing that I would suggest to this, is set up poles in different areas, with a sign, "Beware of dogs! Beware of Rabies!". :-)