SHARE and help the world

Volunteer group struggles for survival

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SHARE is Japan’s version of Medecins Sans Frontieres, a small nongovernment aid organization that sends volunteer doctors, nurses and health workers to assist in stricken areas abroad. It also helps those in need on the domestic front — women involved in the sex industry and people who have overstayed their visas and are working here illegally.

It operates out of a tiny apartment in Iidabashi, just inside Tokyo’s Bunkyo Ward, which is where I found SHARE’s exhausted but still enthusiastic founder and chairman, Dr. Toru Honda, and five workers (some salaried, some volunteers) toiling elbow to elbow, with only a box of ice cream bars in the fridge to keep them going. “Have one,” Honda offered. “It must have been very hot walking from the station.”

The name SHARE came first, he explained. Only later did staffers think to make sense of it as an acronym: “We came up with Services for Health in Asian and African Regions. In spirit, it’s about sharing our skills and knowledge with people in developing countries for their improved health and increased material wealth.”

Honda’s dedication and resilience take your breath away. Born in Aichi Prefecture, his parents brought him to Tokyo when he was very small. Reaching 18, he went to Hokkaido to study medicine. “I wanted to become independent. Medical studies are usually for six years, but in the late 1960s, many universities were closed. Radical dissent reached us six months after the troubles at Todai (Tokyo University).”

Rather than turning activist, he sought escape by horseback. “Our riding club was the poorest in Japan. We made our own hay, subsidized activities by working part-time in the racing industry.” (Hokkaido is awash with stables.) “Getting up at 5 a.m. was tough in winter.”

Graduating in 1973, he worked as a kind of apprentice pediatrician for two years. (During the “troubles,” medical students were against the idea of unpaid internships; it took time for the system to be reinstated.) Volunteering to work downtown, he was posted to Kushiro for 12 months. He then applied to the Japan Peace Corps to gain experience abroad. “I was sent to a Tunisian island. I was very interested to live in Africa and a Muslim culture.”

This first encounter with the health problems of the developing world affected him deeply. Then in 1978 came the epoch-making declaration of Alma Ata, where 140 countries under the auspices of UNICEF and the WHO approved basic principles toward the improvement of health worldwide. “Reading that the move was away from high-tech development to low-tech application and self-reliance, I was inspired.”

Returning to Japan the following year, he worked at Saku Hospital in Nagano, founded by Dr. Toshikazu Wakatsuki. “I was impressed by his notion of rural doctors. He led a movement to improve health conditions in rural areas. Wakatsuki initiated primary health care in Japan.”

After four years in Nagano, he returned to Tokyo to work at a metropolitan hospital in Setagaya Ward. “By this time I was a general physician with a specialist interest in gastroenterology. Pediatrics? Too sophisticated. I wanted to work from a more practical side.”

He had not given up on volunteer activities. “I’d become involved with the Japan International Volunteer Center, founded by that brave woman Masako Hoshino. I say brave because it was she who initiated volunteer assistance from Bangkok along the Thai border to help Cambodian refugees fleeing genocide. By encouraging us to organize development education seminars in health and medicine, she helped get SHARE off the ground. We began with one desk in the JVC office.”

SHARE began operations abroad with a joint venture with JVC in Ethiopia in 1985, running a makeshift hospital. “We supplied the medical personnel and JVC the project organizer and all the rest. It was tough, a truly challenging situation, yet one nurse stayed the full 11 months.”

In 1988 SHARE went to Cambodia, working within the strictures of the tripartite coalition to open a mother and child health practice. “The four pillars of our work, sponsored by UNICEF, were immunization, oral rehydration therapy, health education for mothers, and feeding the malnourished.”

It was just a few years later that SHARE became independent of JVC, moving downtown in 1990, and then to its present address because “Edogawa proved too far to travel for our staff.”

With a new Cambodian government in control, and only 45 doctors left alive in the whole country, Honda organized a team to return to Phnom Penh. “We based our activities in a rural rice-growing area near the capital. Our aim was to re-establish a local health-care system and encourage staff to be more professional. We were also concerned with reproductive health and encouraging birth spacing.”

In 1998 SHARE entered a new phase of operation in Cambodia; its focus shifted to HIV and AIDS. “Seven years ago when UNTAC was ruling, there were few visible signs, but there are lots of cases now. We’re organizing basic education and care programs.”

Thailand has so aggressively tackled the problem that reported new cases of HIV infections are in decline. Clinical cases, however, are on the rise; with more than 120,000 requiring attention, SHARE believes community care indispensable. “At the 14th AIDS Congress in June in Durban, the emphasis was on how to make low-cost drugs available. In the meantime, families need support and training in caring for the dying.”

SHARE went to Thailand in 1990 to learn from government-backed primary care systems. “We went to the poorest area in the northeast, after a prominent doctor invited us to participate in a diarrhea prevention program.” One marvelous woman, Fumiko Kudo, was with the project for seven years. Now she’s in Honduras, working for the Japan International Cooperation Agency. (JICA often “borrows” SHARE’s best people, Honda noted, with a brief tired smile. Government relief organizations in the North are stealing a vital message from NGOs: Low-cost, low-tech, people-centered programs are the most effective.

The method devised for the program in northern Thailand was ingenious, Honda believes. It rallied community health volunteers. Local farmers and mothers were given basic training over a few days, then handed a small pack of medicine and a bundle of notebooks and pencils, and off they would go.

In October 1999, some members of SHARE voiced concern over East Timor. Many volunteer activists supporting East Timor’s campaign for independence and free elections had been forced to flee when things got nasty. Many carried a strong sense of guilt and moral responsibility to have abandoned so many to their fate.

“In November, on my last trip, I met a brave and wonderful American named Daniel Murphy, who had worked as a doctor in Mozambique and spoke Portuguese. He encouraged me to start a project in East Timor. Now we’ve a dispensary in Emera, and are training nurses and midwives. Most of our activities are mobile, taking help into remote communities by four-wheel drive.”

SHARE’s domestic project supports migrant workers, illegal workers and those in the sex industry. Health counseling is provided through churches, and SHARE also offers telephone counseling in Thai and English. “There’s a lot of fear about contracting the HIV virus. Also, if workers get sick, who will help them?”

One of SHARE’s contributions is to help terminally ill patients return to their own countries to die, with volunteers accompanying them to ensure their families are waiting at the other end. In one case, the woman died at the airport just after touching down. “She was aware until the end. She knew she was coming back home. Her parents were so appreciative.”

Like most NGOs, SHARE is struggling for survival. “The economy is killing us,” he said. “Companies give so little. Individuals are tired of giving. I’ve no idea how long we can go on.” (Which was news to his staff, who all turned around from their desks, looking aghast.)

Toru Honda, who once enjoyed life as a vagabond but is now a father of three, living with his parents in Waseda — three generations under one roof. Dividing his time between the demands of family, Horikiri Central hospital in Katsushika Ward and SHARE means little sleep; he survives on four hours a night, with maybe eight on Saturdays.

“In Japan I find it hard to smile. But I have to say a little sake helps. Anywhere else, I’m smiling all the time.”