Table Speech

Japanese Healthcare Facilities in the Post COVID-19 Society

November 25, 2020

Dr. Yasushi Nagasawa
Professor Emeritus of Tokyo University and Kogakuin University
Director General of Gerontechnology Research Center

 I studied the history of healthcare facilities as a visiting scholar in the U.K. in the 1970s. Let me walk you through the five waves that surged from ancient times to the 20th century and examine the future role of healthcare facilities in the post COVID-19 society.

 The first wave was initiated by Asclepeions (healing temples) located in ancient Greece, dedicated to Asclepius, the god of medicine in Greek mythology. Patients received therapy to cure their psychological and emotional states through a holistic approach including dream therapy, cleansing baths and purgation. The second wave surged in medieval Europe where religion interfered with medical treatment. Christian churches and monasteries played a major role in patient care which focused more on meeting people’s psychological aspects rather than physical needs. Patients were put into cubicles separated by curtains to provide a private enclosure and monks and nuns cared for the sick. The third wave unfolded after the Renaissance when infectious diseases ran rampant and makeshift medical facilities appeared to separate between healthy and infected persons and limit the spread of diseases. Black Death spread throughout Europe in the 14th century, killing almost one-third of the population in the continent. In acute circumstances, palaces and prisons were converted into hospitals or large-scale makeshift camps were established in rural areas to protect society from diseases when infection control medical care was still lacking. As we entered the 19th century, Florence Nightingale revolutionized the fourth wave and clarified the functions of medical facilities in her publication “Notes on Hospitals.” It emphasized the importance of ensuring patient safety and sanitation and stated “the first requirement in a hospital is that it should do the sick no harm.” Based on her experience as a nurse, she proposed to provide each patient greater bed space (2.4m wide x 3.6m long x 4.8m high), ample natural sunlight, fresh air and appropriate room temperature.

 The remarkable development of science such as X-rays for medical diagnosis, introduction of anesthesia, discoveries of various infectious bacteria and viruses, antibiotics to control tuberculosis and other diseases as well as sterilization techniques all promoted the development of sophisticated western medical sciences and technologies by the 20th century. After WWII, hospitals experienced the fifth wave where specialized departments with new architectural requirements emerged to improve the economic efficiency and functional utility. Hospitals took the administrative policy of “centralization” that made patients walk long distances to visit relevant departments for diagnosis and/or therapies and wait for long hours. The establishment of public health and effective and advanced medical care provided at high-performance hospitals throughout the 20th century made us somewhat overconfident about pandemic control measures. Ironically enough, the heavy toll the COVID-19 outbreak has taken in the 21st century serves as a wakeup call to shift our focus away from the traditional sites of care and departments onto more integrated care settings that address the needs of communities and patients.

 It is helpful to look back on history as we look ahead to the post COVID-19 society. In older days, our everyday life events happened in and around our dwellings. Even funeral and wedding ceremonies were held in our own home. As our country underwent modernization, the emergence of urban lifestyle pursued economic and functional efficiency. Various facilities were built for specific purposes such as schools for education, hospitals for medical treatment and amusement parks for recreation. The contemporary urban environment makes people gather at these specialized facilities, resulting in 3Cs (closed spaces, crowded places and close-contact settings) that create an ideal environment for infectious diseases to spread, exposing massive urban populations to higher risk. The outbreak of COVID-19 highlighted shortages of single-bed private rooms in hospitals across Japan that could heighten the risk of nosocomial cross infection. I believe hospital functions in the 21st century will focus on providing intensive care and life support for acutely ill and injured patients in single-bed rooms. We can learn from AAR (Acuity Adaptable Rooms) already common in the U.S.A. that allows almost all medical examinations and treatment carried out in a private room through all stages of patient care. Thanks to the advancement of ICT and IoT, patients with non-acute conditions or older adults will be able to receive a variety of medical treatment and services at home and will result in decreased hospital visits as outpatients. Home care and community care will come to play an instrumental role, as rightfully predicted by Florence Nightingale in the mid-19th century.

 The rapid global spread of COVID-19 is the result of effective traffic and transportation systems of people and goods that we have developed over the past 100 years. When the 9.11 tragedy occurred in 2001, a renowned architect the late Mr. Shoji Hayashi warned that “the incident should be remembered as a starting point to divert from the 20th century civilization and reorient ourselves to a new direction.” After two decades, we are yet to come to terms with a new lifestyle and set of values. I sincerely hope we can turn the COVID-19 crisis to our advantage and take due measures based on a long-term perspective towards the 22ndcentury.