Dr. Maki Kano is the current JMSA Vice President and a Pediatrician and Internist who practices in Westchester, NY. She sat down for an interview with Riku Moriguchi, a fourth year medical student at Albert Einstein, to discuss her career as a Japanese-speaking physician in the US. Below is the transcript of the interview, where she speaks about her upbringing, her current practice, both the joys and challenges of being a working mother, and her experiences in JMSA.

Please tell us about your background and how you came to choose a career in medicine.

I was born in Japan and I came to the U.S. when I was three years old because my father was transferred to work in New York as the General Manager for Daimaru. Back then, there were not as many Japanese families in the area as there are now. My older sister and I were born in Japan and my younger sister was born in Bronxville, NY. I finished elementary school through high school in Chappaqua, a town in Northern Westchester. I actually live there right now, so my daughter who is 15 and my son who is 12 go to the same schools that I graduated from.

Especially in the first few years of life in NY, my mother spoke very little English and therefore the primary language in our home was Japanese. I remember my mother taking us to a local pediatrician who did not speak Japanese and struggling to get the symptoms across. I can vividly remember being about 9 or 10 years old and translating for my mother. I think that seeing my mother struggle to communicate in English left a really big impact on me during my childhood.

I am the first medical doctor in my family. I have participated in panel discussions about becoming a doctor and often most of the other doctors on the panel come from generations of physicians and they often mention that they grew up with the assumption that they would become doctors like their family. I was attracted to the medical profession because you can help people and work with people directly and make significant impact on their lives.

Growing up in New York, how did you develop and maintain your ability to provide medical care in Japanese?

I went to the Hoshuko from “yo-chi-en” all the way to “ko-ichi”, and I remember dreading it because I couldn’t read the kanji and my Japanese reading and writing skills were so behind others who had just come from Japan. I remember on Friday nights, my mom would write the hiragana next to the kanji in my textbook, and during class I’d be so nervous that the teacher would ask me to read from the textbook. I am happy that I have still kept in touch with some friends that I made from Hoshuko. Some of them actually went back to Japan as kids, but came back here as wives of expats, and it’s been interesting to see them here again. I have very fond memories of Hoshuko because it was one of the only times I was within a predominantly Japanese community, because the school district I was in didn’t have many Japanese students. Although my parents did always say, “you have to speak Japanese”, my siblings and I always spoke in English to each other. Especially during my years at Cornell Undergraduate and Mount Sinai medical school when I didn’t see my parents as often, my skills in reading and speaking in Japanese declined.

Thanks to working at the Japanese Medical Practice since 2000, my ability to speak Japanese has increased steadily. Now I’m at the point where I may catch myself thinking in Japanese instead of English. I’ll come home and it hits me that I speak more Japanese in the day than I do English, because I speak to the patients and the staff in Japanese. So through my practice, it’s been wonderful that my Japanese language skills have improved so much as well as a deeper understanding of Japanese culture and ways of thinking.

In the past almost 20 years, I have steadily built up my medical vocabulary in Japanese. One encounter I’ll always remember is one of the first patients I saw in my practice. He had impetigo, or “tobihi”, and the mother kept saying “tobihi, tobihi” and I said, “What is that?” She then looked at me like, “you’re a pediatrician and you don’t know what tobihi is?” I think it was many things like that (that helped me learn the vocabulary). When you use something regularly, you improve it, and lose it if you don’t.

How have you managed to maintain a good work-life balance throughout your career?

I think certain medical fields are more challenging than others in striking a balance. My practice has pretty regular hours and I don’t work on weekends. My day starts at 9am and I’m generally home by 6pm. Surgery and Ob-GYN are much more likely to have emergencies and a more intense overnight call schedule so I think that people need to think about what type of life style they want because it will be very different based on the field they chose.

I’m very thankful to my husband. He is very busy too as a real-estate developer but his hours are somewhat flexible. We’re both the type of people that want to be there for our kids as much as we can. Over the years, I have appreciated him because he respects my career and will do anything to support me. In addition, I am very fortunate that my parents live about 20 minutes away. I am very lucky that I get to see them almost every week and they are willing to do anything they can to help me. I feel that my career is possible because I have an amazingly supportive family. It is a team effort.

What was it like to have children while you were working?

I was home for 3 months for maternity leave. When I came back to work, I felt so disorganized and anxious and not myself. Soon after returning to work, I recognized that I was suffering from post partum depression. I couldn’t multi-task or think clearly and I remember actually wondering if I would be able to return to my old self again.

Looking back, I have gained such important insights from that experience. I know what it feels like to be anxious, and not yourself and dysfunctional. I remember I couldn’t sleep even when I was so exhausted. Now when patients tell me they “have trouble sleeping…” I can relate to it and understand it.

That’s also when I started an organization called New York Sukusuku-kai with Kumiko Seki who is a nurse and a midwife who used to work as a nurse and office manager for my practice. She then worked as the nurse at the Consulate General of Japan in New York for many years. One of the seminars we developed is called Primama, which is for the first time parents giving birth in the US. We started our programs in 2014 after I recovered from the post partum depression and I realized that being a new mother has many challenges and I wanted to spread awareness about the realities of life after having a baby. Seki san and I thought that especially for Japanese women giving birth for the first time in a foreign country, we wanted to develop a program that discussed expectations for pregnant woman, what they should buy and prepare, and how the birthing experience is different from Japan. We just gave our 36th seminar in the spring and we hope to keep going. New York Sukusuku-kai is an organization that supports health and wellness amongst the children and families of Japanese expats in the area.

For my children, although they have been some sacrifices since I was often not present after school, I think they have also gained a lot from seeing me work and have a career. I think in a lot of ways, going to daycare at a young age and having a full time working mother has made them more independent and resilient. Of course, it wouldn’t have been possible without my husband who has relatively flexible hours and my parents who live near by. Whenever I am home, I try to be present with the children as much as possible both physically and mentally. Whenever I can, I love being able to pick them up from activities or after school because I cannot always do so.

What is your current practice like?

I joined the Japanese Medical Practice right after I graduated from my residency. When I was a medical student, I received very fortunate to receive a couple of medical student scholarships from JMSA, and through this, I met some of doctors that were part of the Japanese community. I was very lucky to have met Dr. Robert Newman who first told me about the Japanese Medical Practice. Dr. Newman encouraged me to work in my current office and I have stayed at this practice for almost 20 years.

That was my first job out of residency, and it’s been so satisfying. First of all I get to practice both medicine and pediatrics, so I am really practicing Med-Peds the way it was meant to be. For many years, I was really the only Japanese-speaking pediatrician in the tri-state area. I have been very fortunate to have patients from the tri-state area. These patients are willing to travel a long distance because they really want to receive their healthcare in Japanese, and there’s a big cultural component when working with the patients. I’d say 80-90% of my patients are Japanese families who have come from Japan recently. The office is set up so the nurses, the staff, the brochures are all bilingual. Every day I feel so lucky working here because I just enjoy it. It is very satisfying to be in a role where I can reassure people, and to educate people. This practice is based on the needs of the Japanese community and as a physician working with this population, it feels great to be able to go the extra mile and to feel really happy to do that.

What is the community of Japanese physicians like? What are some other experiences you’ve heard of with practicing medicine in Japanese?

I feel that physicians in the Japanese community have 2 different perspectives about Japanese patients who do not feel comfortable in English and I think both are valid. Some doctors feel that the Japanese people here need to realize that they’re not in Japan and not expect to get all of their care in Japanese because it’s not realistic, we’re not in Japan. On the other hand, other practitioners want to try to do as much as they can to support and provide care for the Japanese patient in their language and culture.

My practice is comprised mostly of Japanese patients and set up for the Japanese patient to be able to receive their care in Japanese from the minute they call the office to make an appointment. I think if you have a special skill or background such as being able to speak a language or have cultural sensitivity, patients will seek your care. Most of the JMSA physicians do not work for a practice that is dedicated to treating Japanese patients so most of my colleagues see a more diverse group. For example, Dr. Kichemon Asoma is an ophthalmologist and many Japanese people will travel from Westchester to NYC to see him because they want to be able to get care in Japanese. Through JMSA, I have been fortunate to develop a network of wonderful Japanese speaking specialists who I can refer patients to.

Medicine in the US is also very different from medicine in Japan, so there are patients who need a lot of explaining. On a weekly basis, I have patients who have just arrived from Japan. Before their jet lag wears off, they are in my office getting check ups because the children can’t start school without having their forms filled and updating their vaccinations. The vaccination system here is very different than it is in Japan. In Japan, vaccines are highly recommended but not mandatory. Unvaccinated kids in Japan may get measles or mumps.

Also, they’re more concerned about taking certain medications together, and used to only getting one shot at a time. So when a child shows up and you tell them they need 4 shots before they start school, they’re like “4? Is that okay?” So I explain to them that whether it’s 1 or 4 it is safe. There’s also a belief amongst Japanese people that they require a smaller dosage. They may feel that American doses are too much for Japanese patients.

What has your experience in JMSA been like?

What makes JMSA special for me is the other members. I enjoy meeting and working with the new younger generation. In addition, I treasure my relationships with the senior members. They were my mentors when I was a medical student and starting to practice. I appreciate all the friendships I have made within the JMSA community. JMSA physicians are caring, dedicated physicians. I’m currently the head of the community outreach program, which supports the community by giving small grants to community groups. Our former president, Dr. Shunichi Homma developed JCOP or the JMSA community outreach program over 10 years ago. I am grateful that he appointed me to run the program when it first started. I want to be in the position as a senior member of JMSA to give similar opportunities for leadership to the younger generation of JMSA.

Is there any advice that you would give any young person pursuing a career in medicine now?

I think medicine is truly a wonderful field because you get to work directly with people and you can make a huge impact on their lives. It can be really hard and intense at times, but there’s really nothing more satisfying. For the people who are really getting into the field, I would get a lot of exposure and explore the different fields. Each field has different cultures, different pros and cons, so talk to a lot of people and get experiences. It’s a long haul but it’s so worth it because you end up gaining amazing skills. For people who want to have families, it’s certainly possible. You just have to find your own balance and figure out what you want and what’s important to you.

For high school, college, or medical students, what are some ways they can be involved in JMSA?

We’re always looking for volunteers at various events like the annual life science forum and holiday party. There’s also a summer party that students are welcome to attend and it’s a great chance for students to see what JMSA is like. JMSA and its members and board of directors are a very approachable group overall and we’re excited about young people getting involved.

We also have the JMSA scholarship program that we give out annually to medical students, and of course we are interested in students who seem genuinely interested in JMSA and who seem to want to get involved with JMSA in the future. Overall, I think JMSA is a great community and we would love to have more young people to get involved with us early in their careers.

For students who are interested in volunteering at future events, please fill out this google form below.

https://goo.gl/forms/Pg7IiFy5NlOv69B13

If you have any questions, please direct them to Riku Moriguchi (rmoriguc@mail.einstein.yu.edu)