On Being Sick in Japan

Japan has two kinds of illnesses: colds, and the flu. The flu means you can take a day off of work. If you catch a cold, you are expected to do everything a healthy person does, but you’ll have to wear a ninja mask.

Colds are every disease that isn’t influenza. The Japanese word for influenza is in katakana, because it a disease imported by foreigners and they want everyone to remember that.

Right now I’m writing this post through the haze and headache of a two-week old cold. So, forgive the typos.

Getting a Cold
It’s easy to catch cold in Japan, because everything is a radically different temperature, and the country has a fondness for extreme temperature changes (hot-and-cold onsen baths, for one, air-conditioned subway cars that open into heated subway platforms, for another).

If you catch a cold in America – in my America, anyway, where nobody can afford health insurance or medicine – the first instinct is to call in sick to work or school so you can sleep the entire day. We have sick days for this, and rarely does one need a doctor’s note to actually use sick leave.

In Japan, my process is a bit different: I can take time out of my vacation pay, but I’ll have to go to the doctor, pay a 5,000-yen fee for a doctor’s note, then show the note to my school. This is the process for taking one to three days off, so in less extreme cases, I’d spend my sick day getting up early to catch a train to the city to find a doctor, waiting for the doctor, and then going to work with the doctor’s note so that I can go home and sleep, a process that could take about an entire work day.

The doctor’s note is good for about 3 days. After that I’ll need another one.

So rather than sleeping off a cold, I go to work, then come home and sleep at 6 p.m. until about 7 a.m. the next day, until the weekend, which I spend in bed and hope I heal before Monday.

Getting the Flu
Influenza is the name given to any disease that makes you throw up. This would seem to include actual influenza, poor reactions to antibiotics, and food poisoning. It’s basically “vomiting disease.”

If you get the catch-all influenza, you can be excused from school or work, though again only with a doctor’s note. I know teachers who have come to school, started throwing up and stuck around for an entire workday.

The Mask
The ninja masks are a perpetual source of fascination for westerners and admittedly they still strike me as a little weird even after three years of living with them. It’s especially distracting when someone comes up to me and takes a moment to start speaking; in that surreal moment I’m forced to look at them in a face mask, waiting in silence for something to happen.

Contrary to popular belief, they have nothing to do with air pollution. They’re actually a courtesy: You wear them when you think you’re getting sick to prevent the people around you from getting sick. You can cough into the cotton mask, cover up your runny nose, and prevent other people from catching your germs.

They are also a passive call for handling these people delicately. I once was convinced that a woman who had worn the mask for a month was merely trying to garner sympathy and get less work.

Then I got sick for a month.

Cough Medicine
Western cold and cough medicine is essentially nonexistent in Japan, and aspirin is extravagantly overpriced. You’ll actually get most cough medicines seized at the airport or in shipping, because Japan assumes that the only thing standing between itself and a meth epidemic is a 250ml travel bottle of Robitussin.

Honestly speaking, this is an old joke: Most companies in the US have stopped using pseudoephedrine in their products, and if the concentration is lower than 10% it’s allowed in Japan.

There is almost nothing like cough syrup in Japan, though. There is something called BRON, which has become notorious on Internet forums for destroying lives. In an extreme example of one set of standards for foreign products and one set for domestic, BRON is a nasty concoction of codeine and ephedrine. People in online support groups urge each other to “try to remember the good things in life” after taking this cold-and-fever tablet that is essentially a mix of speed and low-grade oxycodone.

In some countries a similar formulation is apparently used as an alternative to methadone, other countries regulate it to researchers or in a similar way to codeine. Here in Japan, they add caffeine and sell it over the counter without requiring a prescription.

I haven’t done this stuff, but reading about it I wasn’t surprised that a speed-based cold medicine would exist in Japan, where it will pretty much never be abused recreationally and will instead make sure that even the most exhausted workers continue to put in overtime.

I often wonder why Adderall isn’t added to the drinking supply in school cafeterias.

Can I stop writing now? Time to blow my nose. Which, by the way, you can’t do in public in Japan. All day at work I’ve had to excuse myself to the men’s room just to blow my nose.

You can catch This Japanese Life fever by “liking” its disease on Facebook. 

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33 Responses to On Being Sick in Japan

  1. mypandahero says:

    That sounds awful! I hope you get well soon. My friend, who was an exchange student in Japan last year, was forced by her host family to go see a doctor when she just had a normal cold. The doctor then gave her antibiotics, which, as far as I know, isn’t something you should take if you don’t really really need it. The whole doctor/getting sick-thing is probably my main reason for not wanting to live in Japan. But maybe I just got the wrong idea of it all.

    • owwls says:

      Seeing a doctor has mixed results. I still haven’t gone to see one, except for when I needed a prescription for malaria before going overseas. But the people who have say it’s very different from seeing a doctor at home, but also very different by doctor.

  2. Skhylar says:

    I’m sorry you’re sick and hope you feel well again soon! When I first learned about the face masks, or ninja masks as you call them, I found it rather clever. Of course, it made me feel less crazy too because I use to wear them here, in America, like that. I was working as a PCA at the time and had boxes and boxes of gloves and, yes, masks. I used the masks all the time when I felt sick at work, so I didn’t get my clients sick- although I got quite the array of funny looks. I’m actually sad that I can’t now that I don’t work in the medical field anymore, but the only people who wouldn’t think I’m crazy is my Japanese language teacher and my 8 month old son. Anywho, hope you feel better soon!

    • owwls says:

      I’ve read that the masks don’t really work, but then I’m confused by why they’d be used in hospitals. Any insights?

      • Skhylar says:

        Unless new medical knowledge has come to light that proves otherwise, a mask keeps the germs of the one wearing it contained within the mask and, thus, keeps their germs from spreading to- and possibly infecting- other people. That’s why all personnel participating in a surgery [or are in the OR for any reason whatsoever] must wear masks [plus gloves, booties over their shoes, surgical cap and scrubs with a sterile gown cover over them]. In the healthcare field, the focus is on reducing the spreading of germs. The misconception I hear most people having about masks is that they think wearing one will protect /them/ when, in fact, it is the other way around.

      • SK says:

        Unless the masks contain some chemical/disinfectant killing the microbes, then are just decorative.

      • Brian says:

        So why hasn’t the common cold been eradicated in Japan? If everyone is wearing them to prevent colds from spreading, why are other people even getting colds?

        I understand the need to wear masks in surgery when you’re dealing with openings with the human body. However I do think the mask thing is bit of a superstition.

      • TokyoDoc says:

        There is actually little scientific evidence that they are effective in surgery (I am a surgeon) !!! One of the problems is that masks don’t work when they are wet and they should be changed often. Few people do this. In Japan, people believe they work but there is no evidence. Yes, it is total superstition.

  3. Brandi says:

    So what do you do if you get a migraine? Like a vomiting, seeing auras, light hurts your head, want to die migraine? Can you leave work and go to the dr? Will they give you a note or something for the pain? Sorry, as a migraine sufferer that’s the first place my mind goes. I hope your cold clears up soon!

    • owwls says:

      Thanks! I don’t have migraines, but I think the answer is “lay your head on your desk.” Sleeping at your desk is OK, if you don’t have a class. But probably you’d be expected to suffer through a class or, if you get excused, you might need a doctor’s visit anyway. You: “I have a migraine” Doctor: “OK we believe you, 5000 yen please.”

    • MrsKytro says:

      As a fellow migraine sufferer, I can tell you that people here are not very understanding. When I was finally able to get across the full meaning of migraine, I was told to go to the hospital, even though there’s nothing they can do, every time I need to take work off because of it. Oh, and every time I’ve attempted to explain it, I’ve been told with full confidence that it is because of stress, and I should outside when I get one.

    • I am a migraine sufferer living in Japan. When I came here 25 years ago, no one understood about migraines. If I said I had a headache, everyone immediately said: “Do you have a cold?” That is still pretty much the response, but now I am able to explain better in Japanese what a migraine involves to those who don’t know. If you are a sufferer, you will know when you have one coming on and so you will take painkillers as early as possible, or not go to school in the first place or just tell the school that you are getting one and will have to go home. If you have a real migraine with vomiting, I cannot see how you would be able to even go to the hospital and wait for hours, which is what you would have to do here. As you know,a true migraine is totally incapacitating. I ignore people who tell me to go to the hospital. I just crawl into bed and hope to die!! One thing i would say to you if painkillers do not work: once when I had one, and had no meds in the house, my husband gave me one of his suppository painkillers he had had from his doctor and wow! the pain had gone in 20 mins! After that, I got supplies from my doctor! I remember when I asked a new doctor for a repeat prescription, he said to me: “Oh do you have one now?” I said of course I didn’t. I wouldn’t even be able to stand up!! Either doctors still don’t understand migraines, or a lot of people who just have bad headaches claim they suffer migraines. Anyway, nowadays, if I am able to catch it early, normal painkillers suffice. Sorry to hear you suffer too. Migraines are a bitch! Best wishes.

  4. Duck says:

    Im comfortable with it, I grew up around hospitals (both of my parents worked in one) and staff would usually wear one, several reasons, they obviously don’t want what you have, or they are sick themselves and a trying to stop the spread. My friends on the other hand.. They find it hard to keep a normal conversation….

  5. zoomingjapan says:

    I found the masks weird at first, too.
    In my home country Germany people only wear those masks if they’re about to die or have a very severe illness.
    I’m going into my 6th year here in Japan and now I’ve gotten totally used to them.
    Actually so much that I’m annoyed if people cough like they’re about to die without wearing a mask.
    I’ve had students with the flu, with high fever, even with pneumonia … and none of them had a mask. In the end I decided to wear a mask, hoping they wouldn’t pass it to me.

    In my previous job I didn’t get any sick leave.
    In 4 years, I only stayed home ONCE when I had over 40°C and a severe tonsilitis.
    At my new job I do get a bit of paid sick leave, but I haven’t had to take any yet.
    I suppose I would have to get a doctor’s note just like you do.

    I think Japan’s health care is extremely expensive.
    You even have to pay for the flu shot!
    Germany’s health care is much cheaper …
    I totally agree about what you said concerning cold meds in Japan. Very annoying.
    No matter what symptoms you have, they usually just give you the so-called “cold medicine” in powder form and that’s it.
    It ususally doesn’t help at all.

    I have to go to the hospital or a local clinic very often, so unfortunately I have some experience with the Japanese health care.
    I recently wrote a blog entry about it, so check it out if you’re interested.
    I’d love to hear about your experience as well!

    Get well soon!!

  6. Nick says:

    I lived in Japan for 10 years and caught a lot of colds that would last for months. I hated seeing the doctor to be prescribed 4 different types of tablets and powders (one for the infection, one for the pain, one for my temperature etc.) that I knew would do nothing.

    Getting summer colds in Japan was the worst. Head colds, stomach colds. Japan has it all.

  7. Paperdoll says:

    Laughing out loud…only so I don’t cry. I went through the nightmare of being sick last winter and I’m dreading the prospect again this season…

  8. spartan2600 says:

    This taboo about getting off work for illness seems to me a problem with the virtually-nonexistent labor movement in Japan and due to the culture seemingly designed by bosses. In the US, much of the middle-class and up get relatively generous sick leave, but most workers have it about as bad as it is in Japan (except more expensive or no healthcare). I was one of the lucky ones. Before I got back into school, my union job gave me 4 paid sick days and I could take 7 total sick days a year before any kind of discipline. Sick days doubled as impromptu holidays, vacations, and vacation-extensions. Its wonderful.

  9. Archana says:

    Not sure if this will help but i brought paracetamol tablets with me when i went to japan (it’s just part of my travel stuff – i didnt even know it was in there – around 10 tablets)
    You could ask someone coming back from britain to get you some. an hour before sleeping – have a cup of tea with 3 spoonfuls of brandy. take 2 paracetamol before going to bed and sleep with a thick sweatshirt, flannel pants and thick socks. you will be a sweaty mess in the morning – take 2 vitamin c tablets and drink a huge glass of water. any fever will be gone and you will feel weak for 3-4 days maybe. works every time :)

  10. Olivia says:

    In terms of masks, there have been a few studies done that stated they lose their effectiveness after 20 minutes. So wearing one doesn’t really protect you at all considering that 20 minutes is probably spent not seeing very many people at all compared to the total of your day. Also, no wonder many mangas feature sick people being able to stay home all comfy being taken care of by their loved ones: it’s everyone’s fantasy.

  11. Bobert says:

    Unique experience I take it? Nothing like that in the sticks here. Our drug stores carry cough syrup and influenza isn’t regarded as just the flu. We don’t require a doctors note and I hope you have health insurance which will bring that steep 5000 yen bill down at least 75%. Surely you learned this already since it’s been another year, but just in case the other posters are wondering it’s not always like this. In before moderated posts so they’ll never see it anyway.

  12. TokyoDoc says:

    Hilarious misinformation here. Masks do very little in the operating room except prevent particulate matter from entering the wound. No one wears booties anymore because they do NOTHING. The masks in Japan are a joke and have no practical function.

    The reason health care in Japan is not expensive is that it stinks. Don’t ever get sick here. The quality of care here is below most third world countries. Being hospitalized in Japan is the scariest thing that has ever happened to me. And while you may disagree with me, as someone who has practiced medicine for more than 20 years, my perspective is backed up by education and experience.

    • Chris says:

      Whut!? I live here in Japan with my wife who has an incurable disease and my newborn son. I thought I was in one of the best country for healthcare, if not the best. But that’s based on just a few experiences during my 6 years here. My job allows me to build my career anywhere in the world, and I’d like to choose one of the best country for healthcare. Therefore, I’m really interested in your education and experience-backed perspective. Could you please expend?

      • owwls says:

        This is a lighthearted look at a time I got a fever in Japan. I’m not at all qualified to talk to you about the medical field as a whole or to give you medical advice on your wife’s disease. I wish you the best of luck!

      • TokyoDoc says:

        I am an fully trained physician living in Japan and unfortunately have many interactions with Japanese health care as a patient. Care here is far worse than a homeless person receives in a civilized country. There is no sense of urgency in care in Japan. Doctors would much rather do nothing than do something with a slight risk, even if that means the patient dies. There is no consideration of individual patient needs. The evaluation of a patient is entirely based on tests and there is no consideration of basic things like a patient history or physical examination.

  13. Ana says:

    My experience is similar, just for the record. I have heard a variety of stories from others who have lived here, so I guess it’s like any other country of a fairly large size: it varies. However, I will add that the medicines they give do typically have a lower mg concentration of drugs in them compared to my home country of the US. My assumption is that it has to do with the average body weight being much lower. Personally, I love it because I think they are too strong in the US and the lower dose of ibuprofen works great for me without giving me stomach problems. Maybe if you are a larger person, you need a slightly higher dosage of certain medicines. Of course you should ask the doctor first!

  14. Pingback: Vivre a tokyo: être malade au Japon, ce n’est pas une sinécure | Le Japon par la lorgnette

  15. Pingback: Être malade au Japon, ce n’est pas une sinécure | Le Japon par la lorgnette

  16. Felicia says:

    I have a high sensitivity to caffeine and avoid drinks that contain it, and yet the medicine in Japan with some caffeine such as EVE never affected me badly. Actually I never even knew it had it until a much later trip; when I found out, at first I panicked but then I stopped and thought, hey, if it didn’t do anything to me, it must be okay haha. I heard the reason they add caffeine is that it makes the medicine more effective, so they can use a lower dose. Still, would be nice if there were more options for everyone though. If I lived in Japan, I would probably opt for a no-caffeine version if they had that available.

  17. Tav says:

    And i thought Americans had bad Health Care.
    In Germany you can (and will) get fired when you go to work while sick.
    Most companys have enough human resources to to tolerate one or two sick workers. But they cant tolerate a droppage in production efficience because one worker infected half of all coworkers. I once went sick to work (i work alone) and needed 4 hours for a work im doing usually in 2 hours.
    Seems like the Japanese office employees really dont do much at work. I once heard only attendance is important, not effort/performance. No wonder Japanese is in a regression since 1970

  18. RaySnaps says:

    I just discovered this blog and I really enjoy reading your posts.
    You write in a way that’s incredibly comfortable to read.
    Ray from http://www.raysnaps.com

  19. Bex says:

    Thanks, this article summed up my sickness experiences in Japan perfectly! It actually cheered me up, in a weird way, to have it confirmed. There is one difference. Where I live in Japan, people blow their noses in front of others all the time. I was told repeatedly before my arrival that blowing your nose in front of Japanese people was bad. It was so confusing that later I asked a couple of Japanese people and they both said they didn’t think blowing their noses in front of others was rude. I think it could be because I am in Hokkaido? Anyway thanks for a great article.

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