cseas nl74 Sakamoto Ryota

From the High Mountains to Field Medicine: An Interview with Emeritus Professor KOZO MATSUBAYASHI


Professor Matsubayashi Kozo recently retired from CSEAS. A medical doctor by training, he has devoted a large amount of his time to working on high altitude sickness, care for the aged, and field medicine for the elderly. With over 190 articles (in English) and 245 ones (in Japanese), 8 book chapters (in English) and 59 ones (in Japanese) written over a long illustrious career, Professor Matsubayashi reminisces over his upbringing, achievements, career, and the passion of his life, mountaineering.

Sakamoto Ryota (SR): Firstly could you tell me about your childhood and the family life?

Matsubayashi Kozo (MK): We were three brothers born two years apart from each other; I and my immediate younger brother were born in Karatsu, Saga Prefecture and our youngest brother was born in Takanawa, Tokyo. As I had been hospitalized during our time in Takanawa due to infant tuberculosis for several months at the then social welfare corporation, Imperial Gift Foundation Boshi-Aiiku Hospital, I was not physically strong. Out of consideration for us, our parents looked for a place with cleaner air than that in Takanawa so we moved to a rural part of Yokohama when I was five years old. As we were all boys, I usually played with my little brothers and other boys from our neighborhood in the nearby fields and mountains, under the guise of “exploration.” Likewise, we would often go out to hunt for insects, such as beetles and cicadas or ask our mother to prepare lunch boxes for our day long walking expeditions, leaving home early in the mornings and coming back in the evenings. I also entered kindergarten, but playing or taking a nap was not in my nature and after a month or so, I dropped out.

I thought it was much more fun for me to play in the field than to join in activities in the kindergarten. Thinking back, I don’t think there was any particular precept in our family, but since the Matsubayashi family had, over generations, been upper-class feudal retainers of the Nabeshima Clan in Hizen-Saga Domain, I think there may have been some influence from the ethos of Saga people, such as Hagakure.2) Before entering an elementary school, my grandmother, born in 1885 and a self-proclaimed disciple of Koda Rohan,3) had trained me to do Sodoku (reading aloud without comprehension) of Chinese classics, Utai (the chanting of Noh text), and Sado (the way of the tea ceremony).

SR: You are also passionate about mountaineering. Could you tell me what were your reasons to start?

MK: I went to a public primary school in Yokohama, but my junior high school was a private school, called Gyosei Gakuen (L’Ecole de l’Etoile du Matin) in Tokyo, which was also my father’s alma mater. The school had designated French language as a formal subject and was an integrated missionary school for boys from elementary, junior high, and high school. Commuting to the school in Kudan, Tokyo from my home in Yokohama took me two hours one way. Gyosei Gakuen had encouraged us to join some club activities when we became second graders in junior high school. As I had enjoyed walking in the fields and mountains since I was a child, I joined the mountaineering club. I encountered it through the club activity at the integrated junior high to senior high schools, and through the mountains, I came to learn about the relationships between “seniors” and “juniors.”

Going to the mountains once a month to stay overnight and going to the training camps on summer or winter mountains for skiing were often physically tough, but those days were mentally fulfilling. Different from various subjects we studied in the classroom, what we learned on the mountains were practical techniques, such as how to set up tents, prepare food, read maps, and draw weather charts. Through the act of climbing mountains, we could experience beautiful nature, wonderful outdoor animals, and plants. Yet on the other hand, we could not avoid placing ourselves in danger posed by natural threats. Occasional reports of alpine accidents in Mt. Tanigawa (Tanigawa-dake) or in the Northern Alps during winter times were taken to be social problems at the time. It was also around this time when the Tokyo Metropolitan Board of Education put in place a prohibition on high school students climbing winter mountains.

Unlike in the classroom, the one who was to give instructions as well as those listening to it were both quite serious on the mountains. What makes a mountaineering club different from many other sports clubs might be the sense of camaraderie as on the mountains people share a common destiny of living together. While finding favor with the seniors from members of a society or university students, who had established the Gyosei Gakuen mountaineering club, from time to time, I was introduced to the unique traditions of mountaineering in Kyoto. By the time I was an upper grader in high school, I was determined to join an alpine club again in university

On my enrollment at the Faculty of Medicine, Kyoto University, I quickly joined the Alpine Club. There were about 10 fresh members from all over the nation who joined the club in the same year, but they did not necessarily have the experience of climbing in their high school days. Neither was club policy concerned with such an issue. Among the university alpine clubs in the Kanto region, a Spartan style was quite common to some extent, I was prepared for some kind of “hazing.” However, there was nothing of the sort. I remember this felt as somewhat unexpected. Nevertheless, they were strict, irrespective of the seniors or the juniors, when it came to acquiring a philosophy of climbing, party-ship and methods of researching literature as well as climbing techniques. The frequency of going to the mountains had greatly increased so that it was incomparable with my high school days. It was possible to climb mountains for nearly 100 days of the year. In club meetings, expeditions to the Himalayas were being discussed as a real issue and there were a lot of occasions for me to get close to eminent superiors, represented by Dr. Imanishi Kinji, who established the Kyoto Exploration School (Kyoto Tanken Gakuha).

In the Faculty of Medicine, there were quite a few splendid lectures by outstanding professors. For a bunch of medical students attending such lectures in the large lecture hall, learning medical biology—as an enormous amount of information—was inspiring in its own way. Learning medical science through listening to lectures and consulting textbooks provided us, for the first time, with a valuable intellectual experience of encountering mysterious laws and the universality of living organisms.

However, on the other hand, as a person with academic desire to reveal something new, the arena of medical science was far too specialized. Recognition obtained through those essential fields for medical students; anatomy; physiology and biochemistry; as well as a romanticism for the future; appeared to me (an immature medical student) to not go beyond the passing on of concepts.

Setting one’s own agenda with an awareness of problems, searching literature through my romanticism, organizing teams to actually make explorations, scrutinizing and reporting what was recorded, then setting the next agenda; I think I was thoroughly trained with these basic attitudes toward scholarship while I was in the Alpine Club, rather than in the Faculty of Medicine. What to study and how are the frameworks that make up the basic nature of the research. The tradition of inextricable relations between those frameworks and mountaineering I largely owe to such people as Dr. Imanishi Kinji, who had founded Kyoto University Style mountaineering and the Kyoto Field School (Kyoto Fuirudo Gakuha).

SR: What were the reasons that inspired you to study medical science?

MK: Why did I decide to study medical science? In my case, the reason was not voluntary. It was largely because of my grandfather’s last words. He was born in 1882 and was a man of Choshu.4) At that time he was in the Yamaguchi Junior High School under the old system of education, when his adoption into the Matsubayashi family in Saga Domain was decided. Since his adoptive family had been operating coal mines for generations, he was to graduate from the Department of Mining at Tokyo Imperial University after studying at the former Daiichi Koto Gakko (the First High School) before being adopted into the Matsubayashi family and taking on their mining business. It seems like it was a political marriage, as it was an adoption from Choshu (Yamaguchi) to Hizen (Saga), among the Sacchodohi (Satsuma, Choshu, Tosa, and Hizen), the major domains during the Meiji Restoration. It appears that my grandfather originally wanted to be a medical doctor, but for the sake of the adoption, he had no choice but to major in mining science, as it was their family business. However, it seems to me that my grandfather was not so good at mining engineering. Though the Matsubayashi family had been in charge of the Takashima Coal Mine in Nagasaki, he handed it over to Mitsubishi, and what was more, my grandfather was likely to have established a coal mine on his own, but only to ruin their family property. My grandfather passed away from gastric cancer when I was two years old. I was told that my grandfather, on his death bed, had asked my father to make sure one of the children became a physician. By the time I started to form my own thoughts, I was told about the last words of my grandfather and it appeared that I would become a physician in the future over before I was in primary school. Earlier than understanding the reality of medical studies, my aspiration to become a medical student had been congenitally imprinted on my mind. When I became a senior student in high school and was about to start preparing for university entrance exams, I was also interested in the world of physics and philosophy. Yet, I never deviated from this “imprint” and went on to take exams in the faculty of medicine.

SR: All teachers and researchers have people who influence them. Could you tell me who were those who most influenced you?

MK: On selecting a university for a medical department, my teacher, who was an advisor to the Gyosei mountaineering club and a specialist in biology, recommended that if I was interested in exploration and climbing, Kyoto University would be a good choice. These words led me to set my sights on the Faculty of Medicine, Kyoto University. As shown by the results of my trial examinations, I was expected to be able to enter. However, in 1969, the year of my graduation from high school, entrance exams for the University of Tokyo were suspended due to disturbances on the campus.5) Many applicants to the University of Tokyo, Natural Science III, thus turned to the Faculty of Medicine, Kyoto University. Due to my shortcomings, I failed the exam in 1969, but I passed on my second attempt in 1970.

Although teachers who were advisors to the mountaineering club at Gyosei Junior High and Senior High Schools had significantly inspired me by suggesting I go on to Kyoto University, if I think about exploration and climbing, the influence of the professors of the Kyoto Field School, including Imanishi Kinji, was even greater (Fig. 1).

Fig.1 Matsubayashi Guiding Prof. Imanishi Kinji at Mt. Hotaka in 1982

Imanishi Kinji, Nishibori Eizaburo and Kuwabara Takeo, who graduated from Kyoto Imperial University in 1928, were the climbing partners at the Third High School and Kyoto University, and were the pioneers of the Kyoto Field School. We were the last generation to be recognized and favored by those people as their second generation disciples.

Imanishi conducted a survey of Mt. Manaslu in Nepal in 1952 and led the first Japanese national party to its summit, the 8,163-meter peak, in 1956 for the first time, and Imanishi organized another research expedition to Karakorum in 1955. Nishibori organized the first winter team for observing the Antarctic area in 1958 and succeeded in spending a winter there in the same year. Kuwabara, who had already been famous as a scholar of French literature was also a leader of the first expedition from Kyoto University to the Himalayas and succeeded in leading the Chogolisa expedition (Karakoram region, Pakistan) to the summit for the first time in 1958.

Since then, mountaineering, exploration and field work have been inherited in the indistinctly mixed and inseparable thoughts of those who aspire to climb mountains at Kyoto University. Academic romanticism to pursue undiscovered and untrodden fields and academic disciplines that place emphasis on field were thus developed.

For Imanishi, exploration and scholarship were indistinctive and integral components. The field workers and founders of respective disciplines today, including Umesao Tadao, Kawakita Jiro and Nakao Sasuke used to gather around Imanishi, who was an Fig. 1 Matsubayashi Guiding Prof. Imanishi Kinji at Mt. Hotaka in 1982 Center for Southeast Asian Studies Kyoto University 007 unpaid lecturer when they were in their 20s, the days of their youth. Our generation had significantly learned from them to go beyond the limits of scholarship.

In this way, the Academic Alpine Club of Kyoto (AACK) had already been equipped with an unbroken academic culture and tradition of strict and empirical fieldwork that went beyond the respective domains of expertise that operated in tandem with mountaineering. Thus, the ground for inheriting academic romanticism had, more or less, been prepared by our forerunners. I feel that my attitude to life was critically changed by being a member of the AACK rather than by being a student of the Faculty of Medicine.

As such, the climbing tradition of the Kyoto Field School, indistinctly intertwined with scholarship, greatly influenced our mentality as club freshmen who became members in the 1970s. By the time we became senior students, a number of our peers were considering to make an expedition to the Himalayas a reality.

However, during the time between 1973 to 1974, we had consecutively lost eight of our precious alpinist friends in the mountains. We once used to be proud of things we might never have expected without spending life as a member of the Alpine Club in the university; to interact with nature and our friends, to discover beautiful aspects to practice, and a romantic pursuit of an unknown Himalayas together. However, in the face of daily challenges and enduring sorrow and a sense of helplessness at the loss of our friends in the mountains, we came to lean toward obscurity, which even our romanticism could not dissipate. During my student days, I didn’t get the chance to go to the Himalayas.

SR: Here in Japan, you are known as a founder of “field medicine.” What opportunities led to establishment of this field?

MK: The establishment of “field medicine” arose through a number of opportunities. It started through mountain climbing in the Himalayas, then became established as geriatric research in Kahoku-cho, and finally expanded to Southeast Asia.

Let me explain field medicine through mountain climbing in the Himalayas. After I graduated from the Kyoto University Alpine Club, I joined AACK. In 1980, AACK was expecting to celebrate its 50th anniversary since it had been established by members including Imanishi.

In the meantime, relations between Japan and China had gradually improved with a greater degree of friendship. In the past, AACK had dispatched five expeditions, to the Southern side of the Himalayan mountains, including areas in Nepal and Karakorum, with all of them successfully making their way to the summit for the first time. They were also able to conduct academic investigations in the surrounding areas. However, Tibet, as a territory of China, the Northern side of the Himalayan Mountains, had been closed to foreigners since the end of the WW II.

In Kyoto, prior to the diplomatic relations between Japan and China being restored, members of AACK, including elder founders such as Kuwabara and Nishibori had been making constant efforts through all possible channels to interact with China so as to be able to carry out mountaineering and science activities in the country.

On October 31, 1979, they heard news of the Chinese government opening up eight mountains to foreign parties. This made things in Kyoto become a little more hectic.

In April, 1980, I was transferred from Shizuoka Rosai Hospital to the Department of Neurology at Tenri Yorozu Sodanjo Byoin (Tenri Hospital). Meanwhile, I came to receive frequent notifications from Kyoto that there was the high possibility of dispatching an expedition to Tibet in 1982 and thus those who wished to join the party had to be prepared. However, the system at Tenri Hospital does not easily let their workers take a leave of absence.

In 1981, I made up my mind and got ready to NEWSLETTER No. 74 008 leave at any time for the expedition by finding a new job at a private hospital in Kagoshima for a short period of time. Later, I was told that back in those days in Kagoshima, there had been some speculations about me that I had drifted to their place as I might have caused a scandal at Tenri Hospital, which made me laugh bitterly.

On April 21, 1982, Kyoto University dispatched their first expedition to Tibet and they succeeded in climbing to the summit of Gang Ben Chen peaks (7,281 m) for the first time, and I enjoyed the privilege of being one of the first climbers on the summit. With the opportunity of this expedition, I was ordered to return to the Department of Neurology at Kyoto University and started the first four years of my academic life working on clinical neurology under Professor Kameyama Masakuni.

Meanwhile, AACK stepped up their efforts to climb Gurla Mandhata (Chinese name: Naimonanyi: 7,684 m) in Western Tibet, which had been their ardent wish since before WW II. Finally, Japan and China reached an agreement to conduct a joint expedition to Naimonanyi in 1985 with three parties composed of Doshisha University, Kyoto University, and the Chinese Mountaineering Association.

As I was willing to join the climbing team to Naimonanyi in 1985, I was compelled to complete my academic dissertation by the end of 1984.

In Kyoto University, there were two simultaneous plans to climb the unscaled peaks of Naimonanyi in the spring of 1985 and Masa Gang (7,200 m) in Bhutan, in the autumn of that same year. In 1985, I resigned from my job as medical staff and got ready by becoming a research student. Hence, I was able to stand on the peaks of Naimonanyi and Masa Gang, respectively on May 26 and October 14, 1985.

From 1982 to 1985, while climbing the three peaks for the first time, we also conducted research on high altitude medicine. Thus, it could be said that I had finally begun to practice mountaineering and field science in the Kyoto University Style.

My determination to establish field medicine was directly triggered by the “Kyoto University Medical Research Expedition to Himalaya,” which I had established with my peers in 1990.

A year after my return from the expedition to Masa Gang peak of Bhutan, i.e., April 1986, I was ordered to take a new post at the Department of Geriatrics at Kochi Medical School (Kochi Idai Ronen Byoka). Led by Professor Ozawa Toshio, the Department of Geriatrics, Kochi Medical School offered a course of clinical lectures composed of the three pillars of geriatrics, cardiology, and neurology. For a time, I dedicated myself to be involved in clinical practice, research and the education of neurology.

Frameworks that define the basic nature of research, such as what to study and how are known as “paradigms.” When someone who had climbed various mountains would go to the world of medical science and review mountains from within that world, they look quite appealing as a subject of medical research. Paradigm change in mountain climbing is, as a matter of course, inextricably linked to that of our own research. The forefront of research can be opened up quite drastically by means of creating a brand new paradigm or urging that an existing paradigm be changed. I assume that the clues lie beyond the frameworks of existing fields of research.

It was at the end of 1987. In one of the dim corners of Kyoto University’s campus, six persons promised each other that they would concentrate their efforts to realize a “plan.”

The pillars of the plan would be to organize a medical research expedition intended for 8,000 meter peaks by 1989 or 1990 at the latest, in order to carry out physiological research on the climbing process under a super-high altitude with low oxygen, while at the same time, conduct epidemiological, cultural, and social research on highland inhabitants. Based on the achievements, we would create interdisciplinary areas of research whose field is the Himalayas. With the area of medicine, we would make an ultimate goal of looking at problems through new perspectives to clarify what had been difficult to solve by means of contemporary medicine.

The six members, who had been discussing such a vision that could only be described as a dream in those days, were Matsuzawa Tetsuro (Associate Professor at Primate Research Institute, Kyoto University: 36 years old), Kawai Akinobu (Lecturer at the Faculty of Agriculture, Kyoto University: 38 years old), Seto Shiro (Assistant at the Department of Pediatrics, School of Medicine, Shimane University: 36 years old), Hirata Kazuo (Assistant at the Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University: 35 years old), Furukawa Akira (Lecturer at the Department of Sociology, Chukyo University: 35 years old) and myself (Assistant at the Department of Geriatrics at Kochi Medical School: then 36 years old).

These were all fellow members of the Alpine Club of Kyoto University during almost the same period, who had shared the experience of climbing as well as getting lost in the mountains. Since graduation, as they had taken their own paths of specialization, they had always had “mountain climbing” somewhere in their hearts. And 10 years on from graduation, they were to join hands again toward one shared goal.

Each of the six core members was a medical researcher, psychologist or sociologist and none were biologists, however, they had inherited an “ecoCenter for Southeast Asian Studies Kyoto University 009 logical” spirit in the manner of Imanishi Kinji: to love nature and to place emphasis on the unknown territories and fields through mountaineering in the Kyoto University Style.

If there was a common point that existed between “mountain climbing” and “scholarship,” I suppose it would be the way we kept searching for unknown fields with an endless passion no matter the difficulty. Though I already mentioned that we have called such spirit “academic romanticism,” in regards to medical studies it was to open up the field of medical studies in the Himalayas.

When we travel to places of high altitude, we experience severe headaches, nausea or vomiting: symptoms of altitude sickness that afflict people at around 5,000 m. By going further beyond 6,000 m, there are more than a few occasions that can trigger fatal cases, such as cerebral edema or pulmonary edema. Even if we can manage to adjust ourselves safely, at a height of over 8,000 m, there will be a state in which humans can no longer hold normal judgment. They are all considered to be influenced by low oxygen to the human body.

Based on a few cases of alpinists and on observations on the ratio of maximum oxygen intake of humans at very limited high altitudes, the American Physiological Society announced the result of an experiment in 1964, though it was only according to their calculations: “on the summit of Mt. Everest (8,848 m), humans can do nothing but quietly lie flat on the ground without oxygen.”

“Is it ever possible for the human race to climb Mt. Everest without oxygen?” is an explorational proposition which had been repeatedly discussed countless times since the prewar period, and was finally given a conclusion by medical studies, that is, it was physiologically impossible for humans to reach the summit of Mt. Everest without oxygen.

However, in 1978, Reinhold Messner and Peter Habeler reversed the negative conclusion presented under the name of the American Physiological Society, by reaching the summit of Mt. Everest without an oxygen supply. Surprised that Messner and the party had made their way to the summit of Mt. Everest without oxygen, the American Physiological Society organized a medical expedition to Mt. Everest, the “American Medical Research Expedition to Everest (AMREE)” in 1981, to substantiate physiological evidence for the fact. As a result of their Exercise Stress Test under low-pressure, conducted at the camp at an altitude of 6,300 m, they figured out the physiological possibility of climbing Mt. Everest without oxygen, though again, it was only based on calculations.

Therefore, in order to clear up a specific issue in physiology—the possibility of humans climbing Mt. Everest without oxygen—AMREE, the medical expedition was organized. By risking themselves, they moved on to carry out experiments on problems relating to their own theory.

Since then however, problems regarding the physiology of high altitude have not been studied in the Himalayas, but in relatively safer and huge lowpressure laboratories. Despite a lot of knowledge obtained through experiments in low-pressure laboratories, details of the physiological mechanisms of humans adapting to low oxygen was still unclear. At around 5,000 m above sea level, where levels of oxygen in the air fall to half of that found at sea level, many highland residents have been living there for their entire life, but it was not clear as well, what sort of diseases could have been observed among those residing permanently under chronic low-oxygen environments.

On one hand, contemporary medicine is facing difficult problems relating to various adult diseases, such as cerebrovascular dementia, brain infarction, cardiac infarction and chronic lung disorders, whose clinical conditions are based on the hypoxia of internal organs. On the other hand, taking into account the actual situation surrounding highland dwellers leading healthy lives under chronic low-oxygen environments, they thought it was urgent for contemporary medicine to extend the focus of pathophysiological studies to a global scale.

Those were the historical developments that drove us to the idea of using medical researchers themselves as subjects to unravel the still unclear parts of the human mechanism that adapt to chronic lowoxygen from the perspective of respiration, circulation, brain and nerve functions, as well as behavioral physiology, at 5,000 mts or higher in Tibet. At the same time, they also motivated us to make a comparative review of highland inhabitants in Tibet who had adapted to highland life over many years.

We used to hold meetings twice a month in Kyoto, and while making applications for Grants-in-Aid for Scientific Research to the Ministry of Education, conducting diplomatic negotiations with China, drawing up a plan of research for high altitude medicine, requesting the then director of Kyoto University Hospital, Professor Tobe Takayoshi to assume the post of the expedition leader, selecting candidates for the team and dispatching the preliminary expedition, three years passed in the blink of an eye. There, the attempt to go beyond the existing paradigm of medical studies, evolved into the “Kyoto University Medical Research Expedition to Himalaya,” which I had planned with some of my fellows since 1987.

Between May 17 and 21 in 1990, 15 of the 32 members of Kyoto University Medical Research Expedition to Himalaya succeeded in climbing NEWSLETTER No. 74 010 Shishapangma peak (8,027 m) located in Tibet. Among the 15 climbers, 6 persons were doctors and 2 of them were 60 years old.

The results of the two-month-long “Medical Research as Field Work in Himalaya,” carried out on the peak of Shishapangma, using medical researchers themselves as subjects, were later published in the Himalayan Study Monographs No. 1–7.

Members who launched the plan of “Academic Medical Research Project in Himalaya” in 1987 were some of my close friends, then fellow members of the Alpine Club of Kyoto University. Since they had assumed middle-career positions in society, it was not easy for them to take leave from daily work, but they accomplished the project in the end. In the process of putting it into practice, each of them devoted themselves to the project, probably for three years, as a top priority issue that one could have tackled as an individual, even at the expense of their positions in society. Whether it would be possible to immediately connect medical studies to the act of exploration or not, whether we could create a paradigm of medical studies or not; I was reminded at that time, that at some time in the future, someone would solely be dependent on our passions and abilities.

Field medicine, which would develop and spread all over the world, seems to have originated from pioneering work backed by Kyoto University Style mountain climbing and the spirit of climbers: academic romanticism. That was the background for establishing the field medicine of visiting aging people (in Japanese Oi wo tazuneru fuirudo igaku).

After having climbed Shishapangma, some of the doctors including myself spent approximately a month to conduct epidemiological research on highlanders living at an altitude of 4,000–5,000 m at the foot of the Himalayas. In contrast to their strong body and excellent athletic abilities, all the highland dwellers looked terribly old. When we asked the age of a lady who looked like an old woman, it often turned out that she was in her 30s. It was extremely rare to encounter elderly persons over 65.

Through epidemiological research, I realized how differences in an ecosystem would impact upon the aging processes of a person. “Field medicine” is an academic method to understand elderly people as they are; living in different ecosystems and possessing different histories and cultures and to search for a universality and diversity of “aging” shared by different people through the window of medical studies. It was also around this time when I began to see “field medicine” in a more concrete fashion.

Now let me turn to elderly field medicine in Kahokucho, Kochi Prefecture which became the first focus of long term geriatric field medicine study. When I came back from the Himalayas to my post, in the Kochi Medical School in July 1990, a health check program for elderly residents in the community was taking shape led by the then Professor Ozawa Toshio at the Department of Geriatrics of the same university.

Inducers of chronic diseases in elderly persons such as exercise, smoking, drinking, obesity, sleeping hours, eating breakfasts and snacks every day, when practiced for life, are known to be influential factors. At the core of the health check program, there was a recognition that disabilities of the elderly deriving from aging and chronicle diseases could not be minimized by traditional curative medicine, but only by preventive medicine. The basic idea was that it was impossible to conclude geriatrics through clinical medicine alone, but it was necessary to examine it within the framework of the ecosystem and culture of the community (that is the field).

Thus, the Department of Geriatrics of Kochi Medical School set the goal of their geriatric research as follows. First of all, to establish a way to measure the “comprehensive health degree of the elderly,” which had previously been difficult to measure, from all directions including physical and mental aspects as well as social background, and then to detect factors from among their daily habits that could bring disorder to their abilities, and at last, to seek “ideal aging” by preventing those factors.

The idea was realized under the umbrella “Kahoku Longitudinal Aging Study” (Kahoku-cho Kenko Choju Keikaku).

There is a town called Kahoku-cho, in Kami- District, Kochi Prefecture. It is a beautiful town, located 30 km northeast of Kochi City, with a population of about 6,000. The Monobe River runs through the middle of the town. Stretching in parallel along both banks of the river were mountain ranges, which were the source of six tributaries that formed lovely gorges. There were plenty of rice terraces dotting steep hills. According to legends, the Heike Clan used to live there in a hermitage long time ago. Elderly persons over 65 years old made up 30% of the population. Considering population aging rates in those days, which marked 12% for national average and 16% for all of the Kochi Prefecture, it was one of the nation’s leading towns with an elderly population.

At first, we asked all the residents over 65 years old in Kahoku-cho to answer a questionnaire to report their physical and mental health conditions. For those over 75 years old, doctors, medical staff or medical students physically went over to Kahoku-cho to practically check up their health and functional conditions.

The purpose of the project was to clarify factors, isolating the “degree of healthiness” of the elderly or contributing to maintaining their health, in order to Center for Southeast Asian Studies Kyoto University 011 prevent a decline in abilities that occurs with aging by objectively evaluating their degree of healthiness from mental, physical, and social relations, and by annual follow-ups. Such a study had yet to be conducted domestically or internationally, and was the first of its kind.

The “Kahoku Longitudinal Aging Study” was making steady achievements every year and since then, it continued for another 16 years until town and village consolidation took place in 2006. Starting with Kahoku-cho, “field medicine of the elderly,” was then to be deployed in Urausu-cho in Hokkaido, Yogo-cho in Shiga, Sonobe-cho in Kyoto, Tosa-cho in Kochi and so forth. Since I joined CSEAS, Kyoto University, it has come to be expanded into different regions in Southeast Asia.

SR: In 2000 you joined CSEAS as a faculty member. Can you describe your encounter with and contributions to Area Studies in Southeast Asia?

MK: In January 2000, I moved from the Kochi Medical School to CSEAS, Kyoto University. Until then, I used to look at regions through the window of medical studies, however, I began to see geriatric medicine within the framework of area studies. During my days in Kochi, I had also developed field medicine in such foreign fields as South Korea, Hunza, Pakistan, the Andes, South America (Fig. 2), Tibet, Yunnan Province, China, and Mongolia. But, I did not have much experience in Southeast Asia. I just knew that in Irian Jaya, Indonesia, there was a frequent occurrence of intractable neurological diseases, which was our specialty, so we had already begun probing into New Guinea. Supported by the efforts of my colleague, Okumiya Kiyohito, the investigation has continued almost for 16 years until today, revealing facts that intractable neurological diseases, such as amyotrophic lateral sclerosis and Parkinson disease, are occurring more often in some regions, and that the patterns of the disease are changing with the transition of time.

A survey of geriatric field medicine on senior residents in communities was then developed for Singapore, West Java, Vietnam, Laos, Myanmar as well as in Thailand, producing a picture of the health of the elderly in Southeast Asia. We could see that rapid population aging was also taking place in the region, and that changes in lifestyle had caused a sharp rise in diabetes among the elderly. The “High- Altitude Project,” represented by Okumiya Kiyohito of the Research Institute for Humanity and Nature (RIHN), has attracted the attention of not only those in the field of global health, but also among the field of ecological anthropology. Many young graduate students of field medicine have now collaborated in conducting research on the elderly living in highlands such as in the Qinghai province in China, Ladakh in India, the Andes in South America, and revealed that there is a connection between the amount of hemoglobin in the blood and diabetes.

Dr. Matsubayashi examining a 120 year-old male living in Vilcabamba,
which is a renowned village with long life agenda in Ecuador in 1993

Since 2010, Research on Building Healthcare Design for the Elderly in Bhutan (led by Associate Professor Sakamoto Ryota), has been carried out and the project has been adopted for the 11th Five Year Plan by the Ministry of Health of Bhutan. It is likely to be rolled out all over the nation in the near future.

Though I was an amateur researcher in area studies, what I felt by encountering area studies on Southeast Asia was that in order to know the region, we should not just concentrate on the area alone, but have a perspective of examining the area in comparison with other surrounding areas including South Asia, East Asia and our own country. Moreover, as a person in the medical field, the greatest lesson I have learned from area studies on Southeast Asia, was “historical perspective.” This does not only refer to the period within some thousand years covered by written literatures, but also to the evolutionary perspective that goes back 200,000 to 7 million years ago: the history of humans and our 4 billion years history of life. On this point, I feel appreciation to my colleagues in the field of liberal arts at the institute, as well as to discussions that developed through a G-COE project (FY 2007–11).

SR: What difficulties did you encounter in developing your academic studies and what kind of support did you receive from friends and family?

MK: As a first step in developing field medicine, it is necessary to rally comrades who share the same aspirations. Field medicine, unlike for instance, the field of anthropology, cannot be conducted alone. You need company. When planning an oversea academic investigation team, it is definitely necessary to have young people with flexible minds and endless dreams. We have organized “the Field Medicine Research Club of Kochi Medical School” as an inschool group with the aim of conducting fieldwork on medical studies at home and abroad. Alumni and alumnae of the school have been kindly collaborating in the following projects; a survey from 1990 in Kahoku-cho, Kochi Prefecture, presently ongoing research in Tosa-cho of the same prefecture, and field medicine studies in various Southeast Asian regions. In Kyoto University, a number of graduate students have grown through field medicine and after graduation spread out to various universities and hospitals all over Japan and are developing “field medicine.”

Fig.3 Recent snap photo at a bed-side

It is indeed, gratifying to see “field medicine,” which had originally been nothing but one of the club activities of the students in Kochi Medical School, taken up in a department of the Faculty of Medicine at Kyoto University as well as to see many “field medicine” graduate students being fostered and playing active roles, such as teachers at different places after their graduation.

In field medicine, various efforts are required, such as training fellows, carrying out preparative literature study, conducting tenacious diplomatic negotiations, conducting on-the-spot medical surveys, analyzing data retrieved from surveys and writing papers. But, advice from friends, specializing in any kinds of fields is essential. Medical research in various Southeast Asian nations was also a collaborative affair with area studies field workers at CSEAS, Kyoto University. Activities carried out in collaboration with transdisciplinary researchers of area studies in Southeast Asia expanded the viewpoint of field medicine to go beyond medical studies. Until then, I had been looking at elderly people from within the framework of medical studies. Now, I have also learned to redefine them in cultural, social, political, economic and ecological contexts. The viewpoint of field medicine has enlarged, mostly owing to inspiration from my colleagues at the Center.

Personally, as I have been away from home for such a long period of time, support from my family was also essential for me. I would also like to express my profound gratitude to my friends and family.

SR: Finally, do you have any expectations for the next generation of scholars?

MK: On a final note, I suppose the next generation will make use of what they have learned so far as sustenance for developing new fields and for building new paradigms in their own ways. For the next generation, I would like to dedicate the spirit of the following lyrics from the anthem of the former Daiichi Koto Gakko (First High School).

“Flowers bloom but never stay,
Like dew that falls and dries,
Constellations pass by, while people are gone,
The boatman could be replaced,
But my ship sails forever,
Towards an ideal autonomy.”


Himalayan Study Monographs No. 1 (1990)–No. 7 (2000). (Readers can access Himalayan Study Monographs through www.kyoto-bhutan.org)


1) Translated from Japanese by Yoshida Chiharu
2) “The way of the Samurai” as described by Yamamoto Tsunetomo in Hizen in 1716.
3) A novelist from the Meiji era (1867–1947) famous for the novel The Pagoda (1891 Gojyu no tou 五重塔) and other works.
4) Choshu was a domain during the Edo period (1603–1867) in what is present day Yamaguchi Prefecture. The feudal lords of the time were the Mori family.
5) In 1969, Japanese students with leftist sentiments were protesting