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COVER STORY: Life Innovation for the World

Mothering by the Book

Japan has one of the lowest infant and maternal mortality rates in the world, and one reason behind this is the introduction of the maternal and child health handbook system. In recent years, Japan has taken the initiative in advancing this handbook system in developing countries. Osamu Sawaji of the Japan Journal reports.

The maternal and child health handbook system in Japan started as a system for pregnant and parturient women in 1942. The introduction of the handbook system made it routine for women to have health checkups during their pregnancy, which contributed to reducing the maternal mortality rate. In later years, the handbook for pregnant and parturient women was transformed into the maternal and child health handbook, including mothers and their children. The handbook records the health status of pregnant women, as well as the baby's delivery date, height and weight, and vaccinations received. It also covers topics such as feeding infants, infant diseases, and childcare advice.

Japan is now working on disseminating the maternal and child health handbook system in developing countries.

In one such country, the Philippines, the Japan International Cooperation Agency (JICA) has since 2010 been working on the Project for Strengthening Maternal and Child Health Services in Eastern Visayas with the aim of reducing the infant and maternal mortality rates. As part of the activities, the project worker compiled a Philippine version of the handbook, translated the text into the local language and provided capacity-building assistance to Community Health Teams (CHT) to educate and support pregnant and parturient women using the maternal and child health handbook as a tool. In 2011–2012, about 55,000 copies of the handbook were printed and distributed to healthcare centers to ensure that all prospective pregnant and parturient women in the project's coverage area would receive one.

"The maternal and child health handbook develops an awareness among pregnant women that they themselves as mothers need to take responsibility in safely giving birth to their child," says Satoko Ishiga, chief adviser of the JICA project. "The handbook is also used to help plan and confirm the finances and goods which pregnant women must prepare, as well as to plan their health checkups."

Through JICA's assistance, use of the handbook is now spreading among many countries and regions, including Indonesia, China, Vietnam, Laos, Bangladesh, East Timor, the Dominican Republic and Palestine.

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Innovation Using Ancient Wisdom—Martial Care

As Japanese society ages, the physical burden placed on nursing caregivers has become evident. Many caregivers suffer strained backs and shoulders while trying to move elderly or disabled people or helping them to stand up at their home or in nursing care facilities.

Nursing care assisted by techniques from kobujutsu (ancient martial arts) has gained attention in recent years as a means of alleviating these burdens. Kobujutsu in this case are martial arts developed by samurai fighters during the Edo period (1603–1867). This form of nursing care incorporates the body movements and thinking of these martial arts for assistance.

"Common in the body movements of kobujutsu for attack and defense is that they do not rely on muscular strength and therefore have no physical burden," says Shinichiro Okada. "Kobujutsu nursing care makes care possible without exerting unnecessary force, because the care worker uses his or her body rationally."

For example, one of the basic body movements in this form of nursing care is turning the palms outwards when lifting. This technique can be applied in various situations, such as when a caregiver helps the care-receiver to lift his or her upper body, stand up, or sit down. The procedure is as follows. The caregiver embraces the upper body of the care-receiver using the back of the hands, imparting just the right amount of tension on the care-receiver's shoulders and back with the forearms. Maintaining this tension, the caregiver turns his or her palms inward and then flexes the forearms repeatedly to move the care receiver bit by bit. In this way, the caregiver uses the strength of his or her hands, arms and back together, reducing the burden of lifting.

While working at an elderly nursing care facility, Okada continued searching for nursing care methods to replace conventional ones. In the process, he learned of the kobujutsu practiced by martial artist Yoshinori Kono, and in 2004 he proposed the concept of kobujutsu nursing care. Okada now teaches this form of nursing care at about 250 locations every year, in seminars held at medical institutions, nursing care institutions, and for the general public. He has taught a total of some 100,000 people. Many participants have noted that they now find nursing care easier and their back pain has improved.

"The movements found in kobujutsu are useful not only for nursing care; these rational movements can be applied in many aspects of our daily lives, such as when holding a baby or lifting heavy objects," says Okada. "There is a plan to have my book on kobujutsu nursing care translated into English. Both as nursing techniques and as ideas for care prevention, kobujutsu nursing care could be popularized in societies where aging is progressing."

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