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Medical and welfare workers across Japan breathed a sigh of relief after a court overturned a conviction in the case of a nursing home resident who choked to death on a doughnut.

The Tokyo High Court on July 28 acquitted an assistant nurse, 60, who had been found guilty of professional negligence resulting in death for providing the doughnut to the 85-year-old woman at a special care home in Azumino, Nagano Prefecture.

"The victim's risk of choking on a doughnut and the accused's chances of anticipating the possible death from eating it were both extremely low," Presiding Judge Kazuyuki Okuma said. "The nurse did not breach her care duties under the Criminal Law."

The high court decision annulled the ruling by a branch of the Nagano District Court in March 2019 that convicted the nurse and ordered her to pay 200,000 yen ($1,890) in fines.

Kazuhiko Katakura, a doctor at a clinic in Okutama on the outskirts of Tokyo, welcomed the high court decision, saying it would lessen unease in the health care industry.

Katakura, who also works at a nursing home, said care providers had "felt abandoned" by the district court's ruling.

The assistant nurse gave the resident a doughnut at the dining hall of the Azumino home after care workers asked for her help in feeding the woman in December 2013.

The resident temporarily suffered from cardio-respiratory arrest after eating the doughnut. She died about a month later from brain damage caused by a lack of oxygen.

The care home and the bereaved family of the resident reached a private settlement over the death.

But prosecutors indicted the nurse without arrest in December 2014 on charges of professional negligence resulting in death, stunning those in the medical and welfare sectors.

Problems during meals, such as accidental swallowing, are not rare at care homes for elderly residents.

Plagued by chronic labor shortages, individuals working at nursing homes have regularly faced close calls in the line of duty.

A survey in fiscal 2018 by the public-interest incorporated Care Work Foundation found that 74 percent of workers at special nursing homes, like the one in Nagano Prefecture, had experienced incidents that could have resulted in accidents over the past year.

The guilty verdict raised concerns among care providers that they would be held criminally responsible for accidents that occur when a resident eats or drinks.

A petition signed by around 730,000 people seeking the nurse's acquittal was sent to the Nagoya District Court and Tokyo High Court.

After the high court decision, the assistant nurse expressed gratitude to her supporters in the capital.

"I appreciate you for supporting me over these six and a half long years," she said in tears.

She also said she fought the legal battle under the belief that "care givers should not be intimidated by the indictment."

Hideo Kijima, a lawyer who heads her defense team, hailed the "landmark ruling."

"The court's recognition of facts and its judgment were appropriate," he said.

Kijima called on prosecutors to swiftly decide against appealing the case to the Supreme Court.

The Tokyo High Public Prosecutors Office said in a statement that it will "carefully examine the content of the ruling and take appropriate steps."

The district court had ruled that the woman's death resulted from the nurse's failure to check a document that stated the resident's snacks were changed to a jellylike food from solid food six days before the accident.

The high court, however, pointed out that "the document was produced to share information about residents among care workers" and that "the nurse did not need to grasp all the content in it."

The high court acknowledged that the nurse was not notified by a care worker about the change in snack items for the resident. It also recognized that the resident had experienced no trouble eating doughnuts or bean-jam buns until a week before the choking accident.

Under these circumstances, it was difficult for the nurse to foresee that the resident could die from eating a doughnut, the court concluded.

"Giving food is important in terms of not only sustaining residents' health and physical activities but also their mental satisfaction and comfort," the ruling said.

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Nurse's acquittal in doughnut death eases fears in care industry | The Asahi Shimbun: Breaking News, Japan News and Analysis

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Medical and welfare workers across Japan breathed a sigh of relief after a court overturned a conviction in the case of a nursing home resident who choked to death on a doughnut.

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OSAKA--The mysterious contents of a sealed glass bottle used by a noted feudal-era doctor of Western medicine have been identified through muonic X-ray analysis.

With age, the medicine bottle that Ogata Koan (1810-1863) is thought to have used for his house calls and other purposes has become impossible to open.

But by using muons, a type of elementary particle that can pass through glass and other materials, researchers "saw through" the 3-millimeter-thick glass and confirmed that the white power inside the bottle is mercuric chloride.

The researchers from Osaka University and other institutions scanned the bottle with muons at the Japan Proton Accelerator Research Complex (J-Parc), a high-intensity proton accelerator facility in Tokai, Ibaraki Prefecture.

During the closing days of the Edo Period (1603-1867), Ogata established Tekijuku, an academy for Rangaku (Western technology and medicine), said to be the origin of Osaka University's Faculty of Medicine, and made contributions in medicine and education.

Two medicine chests that he used are housed at Osaka University. One, which he used during his later years, contains 22 glass bottles and six wooden cylinders.

About half of the containers had become locked tight, so no one knew for sure what they held.

The top of the lid of a medicine bottle believed to have been used by Ogata Koan is marked with a kanji character for "kan." (Provided by Kyoko Takahashi)

But one bottle held a hint as its lid was marked with a kanji character for "kan," the first of two characters that stand for "kanko," or mercuric chloride.

When muons strike a substance, the impact generates light with different characteristics depending on the substance. A close analysis of the light can reveal the nature of the substance.

When muons passed through the glass bottle, the researchers detected light energies from its contents that were typical of mercury and chlorine.

In Ogata's days, mercuric chloride was used as a laxative and for other purposes. The substance is no longer used because it is highly toxic.

"It is thought that kanko was not used by itself, but was blended with other medicinal substances to treat patients suffering from strokes and rheumatism-like symptoms," Kyoko Takahashi, a guest professor at the Museum of Osaka University specializing in pharmacognosy, said, citing an analysis of letters in which Ogata provided treatment instructions.

The team's research, published in the international professional journal, the Journal of Natural Medicines, can be viewed at: ( https://link.springer.com/article/10.1007/s11418-021-01487-0 ).

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Muonic X-ray IDs contents of medicine bottle from feudal era | The Asahi Shimbun: Breaking News, Japan News and Analysis

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OSAKA--The mysterious contents of a sealed glass bottle used by a noted feudal-era doctor of Western medicine have been identified through muonic X-ray analysis. With age, the medicine bottle that Ogata Koan (1810-1863) is thought to have used for his house calls and other purposes has become impossible to open.

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Yamasaki R; Yamasaki M.; Morisada; Murakami

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Yamasaki R; Yamasaki M.; Morisada; Murakami

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NAHA--It is hard to imagine the horrors that Nobu Madanbashi faced as she toiled in a rough-hewn dugout treating injured Japanese soldiers during the ferocious Battle of Okinawa in 1945.

In the words of her adopted daughter, Kanako, "It must be beyond imagination."

For the rest of her life, Madanbashi, who died in 2004 aged 85, devoted herself to the development of nursing care.

For her efforts, she was named in 1985 as the recipient of the Florence Nightingale Medal awarded by the International Committee of the Red Cross.

Madanbashi often found herself compared with Nightingale, a heroine of Victorian England who transformed nursing care for soldiers injured in the Crimean War of 1853 to 1856. Nightingale, who died in London in 1910, earned the monicker "The Lady with the Lamp" because she would visit the wounded men at night with a small lantern in her hand.

As memories of the war and the Battle of Okinawa fade, kin of the nurse have gone to great pains to make some sense of the fierce ground battle and pass down Madanbashi's legacy to future generations.
HEAD NURSE AT ARMY HOSPITAL
On June 11, two relatives clasped their hands in prayer in front of a cave where the Imperial Japanese Army's No. 2 Surgery unit was located.

Yukako Matsuoka, 46, a granddaughter of Madanbashi's younger sister, and Yukako's younger sister Kanako Madanbashi, 44, said they tried to imagine what it must have been like with lights flickering amid all the shelling and screaming of wounded men.

Kanako is also Madanbashi's adopted daughter.

The cave site is about 1.7 kilometers northwest of Himeyuri no To (Himeyuri Monument) in Itoman, Okinawa Prefecture, which commemorates a unit of female students mobilized by the Japanese army to provide nursing care to wounded soldiers and bury the dead. They were known as Himeyuri Gakutotai, or Star Lily Corps.

They suffered terrible losses as U.S. forces started gaining the upper hand, forcing the Japanese army to retreat.

It was there that Madanbashi worked as a nurse 74 years ago. It is said that she served as head nurse at an army hospital and nursed soldiers with limited medical equipment.

After she retreated to the cave, she was caught on June 21, 1945, two days before organized fighting by the Japanese Imperial Army ended.

Madanbashi worked at a medical facility in a prison camp immediately after the war and also at an orphanage. She went on to become head nurse at a hospital in Naha and later served as an instructor at a nursing school.

In accepting the Florence Nightingale Medal, she said it was on behalf of the Himeyuri students and nurses working in Okinawa Prefecture.

Yukako and Kanako had lived with Madanbashi as children. They always remember her as their "grandmother."

Yukako described her as "always cheerful" and Kanako recalled that she "rubbed my feet until I fell asleep."
WHAT WAS THE BATTLE LIKE?
The sisters decided four years ago to dig into Madanbashi's life. Yukako was watching the Okinawa Memorial Day Ceremony on TV on June 23 that year with her family when her eldest son, who was then at elementary school, asked her: "What was the Battle of Okinawa like?"

She found herself stumped for an answer.

The sisters started combing through all sorts of materials to gain a better understanding of Madanbashi's life.

They deepened their knowledge of the Battle of Okinawa as well as Madanbashi's feelings toward nursing care.

Madanbashi wanted "to serve her country" and felt she could best do that by devoting herself to nursing care after the war.

The sisters concluded that Madanbashi had an unwavering commitment to help those in need based on her selfless consideration and compassion for others.

In 2017, the sisters founded the Madanbashi Nobu Institute in the prefectural capital, which has the express purpose of studying the Battle of Okinawa and the history of nursing through Madanbashi's life and achievements. In May this year, they set up a website (https://mothernurse.jp/) to explain her life and introduce sites related to the Battle of Okinawa.

In addition to preparing a picture book, they also plan to set up a scholarship program to nurture nursing talent in the future.

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Quest to keep memories alive of Okinawa's 'Nurse Nightingale' | The Asahi Shimbun: Breaking News, Japan News and Analysis

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NAHA--It is hard to imagine the horrors that Nobu Madanbashi faced as she toiled in a rough-hewn dugout treating injured Japanese soldiers during the ferocious Battle of Okinawa in 1945. In the words of her adopted daughter, Kanako, "It must be beyond imagination."

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Empress Masako attended the Japanese Red Cross Society's national convention in Tokyo on May 19 for the first time in three years.

This was the empress's first solo official duty outside of the Imperial Palace since the 47th Florence Nightingale Medal awards ceremony in August 2019.

The annual convention of the Japanese Red Cross Society had been canceled in 2020 and 2021 due to the COVID-19 pandemic.

The empress, who serves as its honorary president, gave medals of merit to 10 individuals and representatives of three organizations for their continuous support and volunteer activities for the JRC.

She also listened to a report from the director of the Japanese Red Cross Musashino Hospital with Crown Princess Kiko and other participants. The hospital has accepted many patients infected with the novel coronavirus.

"I am certain you have gone through many difficulties," Masako told the director of the hospital after the convention.

This is the second time the empress has attended the convention since taking over as the honorary president from Empress Emerita Michiko.

Including Kiko, three princesses who are honorary vice presidents of the society also attended the assembly held at the Meiji Jingu Kaikan in Tokyo's Shibuya Ward.

The annual convention brings JRC members from all over the country and representatives of its volunteers together. The event was scaled back, however, to prevent the spread of the novel coronavirus, with about 600 people participating.

The emperor and empress took a video tour of the JRC Medical Center in November 2020 in Tokyo's Shibuya Ward and Red Cross hospitals in Hokkaido, Fukushima and Okinawa prefectures. They expressed their gratitude to the doctors and nurses working at the sites.

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Empress attends convention for Japanese Red Cross Society | The Asahi Shimbun: Breaking News, Japan News and Analysis

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Empress Masako attended the Japanese Red Cross Society's national convention in Tokyo on May 19 for the first time in three years. This was the empress's first solo official duty outside of the Imperial Palace since the 47th Florence Nightingale Medal awards ceremony in August 2019.

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Yumiko Nobue's childhood dream was to work as a veterinarian in Africa treating exotic animals.

But Nobue's life took a different course after she worked as a volunteer in India under Mother Teresa, a missionary who won the Nobel Peace Prize in 1979 and was feted across the world as "the saint of the Calcutta slums," during her spring vacation before moving on to graduate school.

Nobue eventually embarked on a career as a nurse.

Now aged 58, she has been working in India as the only Japanese member of the Medical Mission Sisters (MMS), a monastic order of about 450 Catholic women providing humanitarian aid around the world.

She attended a girls' school in Tokyo, but feeling she was missing something in her life went on to study in the United States.

But even then, she still held back and was unable to build a close relationship with her host family.

A Christian host family that took her in next patiently talked to her until Nobue began to open up about her true feelings.

Nobue was baptized after she returned to Japan.

The MMS was founded in 1925 by Austrian native Anna Dengel to provide poor people with better access to health care. Dengel raised donations in the United States after seeing women dying because they couldn't receive proper medical care from male doctors for religious reasons in what was then northern India, present-day Pakistan.

Members of the MMS live with local communities and share their everyday lives in the hope of building a better world where all living creatures can enjoy a richer life.

Nobue usually rides a bicycle to get around and takes a small camera with her. She has snapped photos of children's smiling faces, landscapes and other aspects of life that catch her eye.

She published a photo book titled "Weaving of Spirit: A Journey into North East India" late last year.

Her intention was to remind Japanese that the region is where the disastrous Battle of Imphal was waged between Japanese troops and British forces during World War II.

It distresses her that conflict remains a constant in the world when each region has its own rich culture.

She chose a recent photo of herself riding a bicycle with a smile on her face for the book, hoping that the peaceful day on which the image was taken would prevail across the world.

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Africa beckoned, but nurse devoted her life to the poor in India | The Asahi Shimbun: Breaking News, Japan News and Analysis

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Yumiko Nobue's childhood dream was to work as a veterinarian in Africa treating exotic animals. But Nobue's life took a different course after she worked as a volunteer in India under Mother Teresa, a missionary who won the Nobel Peace Prize in 1979 and was feted across the world as "the saint of the Calcutta slums," during her spring vacation before moving on to graduate school.

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TANABE, Wakayama Prefecture--During a four-hour delivery at a two-story maternity clinic here on Oct. 14, midwife Fujie Sakamoto continued encouraging the mother, saying, "The pain is caused by labor contractions, so there is no problem."

"Her helping me intimately made me relaxed," said the 38-year-old mother.

When the 95-year-old Sakamoto assisted in delivering her last baby on Oct. 20 after 70 years, she quietly but emotionally described it as "nice and peaceful."

"I feel a slight sense of regret but I am rather surprised that I could continue working until I became so old," said Sakamoto.

Sakamoto started working as a midwife around Japan's defeat in World War II.

She has since assisted in 5,000 births, until the oldest active birthing nurse in Japan retired in October this year.

"Babies receive affection from people around them and represent divinity," said Sakamoto, looking back on her 70-year career. "I am happy that I could help in the childbearing of all of them."
MIDWIFE AT 21
Born in Minabe next to Tanabe, Sakamoto moved to Osaka in her teens to enroll in a nursing and obstetrics school while working at a dental clinic. When the war ended in 1945, she returned to her hometown.

At 21, Sakamoto began her career as a midwife in Kamihaya (present-day Tanabe). As mothers more frequently gave birth at home around that time, Sakamoto then had to rush to pregnant women's houses by bicycle even late at night.

Sakamoto was so busy within 10 years following the end of the war that she once assisted in deliveries for five days in a row.

She opened a maternity clinic in 1976 as fewer people decided to give birth at home. It was relocated in 1997 to a residential area near the central part of Tanabe, 500 meters east of JR Kii-Tanabe Station.

The two-story maternity clinic had a sign saying "open throughout the year."

On its first floor are a childbearing chamber and a Japanese-style room where the mother and child stay following birth.

According to Sakamoto, what is important in childbearing is to bring babies into the world in "a natural fashion." In line with the philosophy, Sakamoto patiently waits for newborns to come out of the wombs spontaneously, no matter how long it takes.

"Babies go out when they like to do so," Sakamoto said. "I leave it to the natural way of things just as tides naturally become high and low."

When the mother is suffering from terrible labor pains, Sakamoto continuously rubs her lower back while reassuring her, "It's OK, OK," to help ease the pain.
BUILT BUSINESS BY WORD OF MOUTH
At her clinic, the mother and child are allowed to spend time in the same room for five days after the birth, because Sakamoto believes that infants' minds become filled with love when they are repeatedly held and breastfed by their mothers.

"Babies can read mothers' feelings through the warmth of their skin," said Sakamoto.

Her accumulated experience, skills and cheerful personality spread through word of mouth, attracting many pregnant women around Tanabe. One of babies whom she helped deliver has turned 70, while Sakamoto assisted in childbearing of a family over four generations.

Sakamoto has also helped deliver all her six grandchildren and eight great-grandchildren.

After her husband, who was a former bank employee, died when she was 87, Sakamoto lived in her clinic alone to manage it.

With fewer people having children in Tanabe and elsewhere across the country, only two to three deliveries are made a month at Sakamoto's maternity clinic, around half that of 10 years ago.
DECLINING CHILDBIRTHS ACROSS JAPAN
According to the health ministry, the number of children born at maternity clinics fell to 5,410 in 2017 from 10,610 in 2007. Whereas there are 366 such facilities across the nation at the end of fiscal 2017, the figure is 100 lower than that for the end of fiscal 2011.

Under such circumstances, Sakamoto decided to end her business after holding talks with an assistant midwife and other staff members, although she still feels healthy enough to continue working.

Kazuyo Kamiya, 61, chairperson of the Wakayama prefectural midwife association, said she is sorry about Sakamoto's retirement.

"Sakamoto is a landmark midwife who has been active since the era when birthing nurses still went by the traditional name of 'sanba,' " said Kamiya. "One of our challenges is preserving maternity clinics as their numbers shrink."

Sakamoto said she will continue offering advice on health and child care following her retirement as a midwife.

"They (mothers today) appear to try hastily to make children stand on their own for no reason," Sakamoto noted. "They should do things slower. Each child has his or her own exceptional personality, so mothers just need to respect it."

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95-year-old midwife calls it a career after 5,000 deliveries | The Asahi Shimbun: Breaking News, Japan News and Analysis

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TANABE, Wakayama Prefecture--During a four-hour delivery at a two-story maternity clinic here on Oct. 14, midwife Fujie Sakamoto continued encouraging the mother, saying, "The pain is caused by labor contractions, so there is no problem." "Her helping me intimately made me relaxed," said the 38-year-old mother.

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Dogs are often called man's best friend.

Now, a study covering more than 10,000 elderly Tokyo residents found that owning a dog lowers the risk of loss of independence--requiring nursing care or dying--by about half.

The study by the National Institute for Environmental Studies and the Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology indicates that people walking with their dog and interacting with other dog owners are beneficial to maintaining good health.

"Our next step is to examine the economic impact of dog ownership, such as whether it can contribute to reining in social security costs," said Yu Taniguchi, chief researcher at the National Institute for Environmental Studies in Tsukuba, Ibaraki Prefecture.

The research team asked more than 10,000 Tokyo residents ranging in age between 65 and 84 if they owned dogs or cats and whether they used nursing care services covered by a public insurance program.

The survey respondents were randomly selected from basic resident registers kept by local authorities.

Analyzing data on 11,233 individuals who did not require nursing care at the start of the study, the researchers found that the risk of loss of independence for dog owners was 0.54 times that of those who never kept a dog.

The risk for people who used to own a dog was also about 20 percent lower compared with those who never kept one.

The low risk for dog owners was statistically confirmed after adjustment for other risk factors, such as age, gender, chronic illness, drinking and smoking habits, income and number of people in each household.

The team's findings were published in the Plos One scientific journal.

It was unclear whether owning a cat reduces the risk of an elderly owner's loss of independence. But the researchers said cat ownership may also have health benefits, citing separate studies that indicate felines have a positive mental effect on owners.

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Owning a dog best prescription for good health in old age | The Asahi Shimbun: Breaking News, Japan News and Analysis

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Dogs are often called man's best friend. Now, a study covering more than 10,000 elderly Tokyo residents found that owning a dog lowers the risk of loss of independence--requiring nursing care or dying--by about half.