How are you doing? I am doing great. It has been almost a week since I have been back in Hawaii and I already miss Saga. I am still a bit jet-lagged, but nevertheless started my primary care preceptorship today.

Thank you for allowing us to have the invaluable experience of visiting your clinic. The entire day was filled memorable moments.

The hardest part of my visit to Mitsuse Clinic was overcoming the unavoidable, yet understandable language barrier. I wished I understood more of the conversations you had with your patients. The interactions between the patients and doctors in America and in Japan are very different and being able to understand the dialogue between you and your patients would have allowed me to immerse myself in the culture of Japanese health care. Regardless of the language barrier, I was still able to understand quite a bit about your mission and purpose at Mitsuse clinic by the more important non-verbal cues between your patients and your staff.

I thoroughly enjoyed following you on your home visits. While rounding patients in the hospital takes time, your sincerity to make time and visit patients in their OWN homes was a heartwarming and unique experience for me. I could feel the gratitude that your patients and the patient's family had for you and your staff. I will never forget the lessons learned from the experiences I had doing home visits with you.

I also enjoyed riding the clinic's bus and touring the rural area of Mitsuse. By providing opportunities to go shopping and visit the clinic, the buses gives patients the added incentive to take ownership of their health. Please allow future exchange students to experience this asset of the clinic.

Lastly, on a personal note, thank you for the wonderful lunch and allowing us to experince the different elements of the clinic's spa. It was very relaxing and fun. Doomo arigatoo gozaimasu.

Dear Dr. Shirahama,

Thank you very much for accommodating us during our previous visit to Saga. I really liked the location of your clinic as it was my first time seeing the mountainside. The bus ride was enjoyable and we all thought highly of this service provided to your patients. I was very impressed with your clinic and how you address the health care needs of elderly patients who are unable to visit hospitals far from their homes.
Furthermore, the house visits we made were touching and gave me insight into the compassion that underlies Japanese medicine. We only wish that there were more clinics and health care provisions like this in Hawaii! Finally, thank you for allowing us to use your wonderful spa and massage chairs. The machines were outstanding and we all found the experience to be very relaxing. For future visiting students, perhaps allowing more interaction with patients would be beneficial.
Although we enjoyed watching you interview and examine each patient, we could have learned more if we were more involved. However, we really enjoyed visiting your clinic and meeting you. Thank you again for the experience!

Sincerely,
Darren Teshima