Patients with hidden physical impediments — internal conditions not immediately recognizable by others — are increasingly wearing badges as they try to increase awareness of the difficulties they face.

“In all my life, I have never once been able to run,” said Nobuyo Shirai, 45, an activist who has a serious heart ailment and is registered as disabled.

Shirai visits a large hospital in Tokyo from her home in Saitama Prefecture once a month, but the one-hour train ride is tough because she is physically weak.

It is a huge ordeal when she cannot get a seat. But it is even more painful when other passengers glare at her for taking a priority seat designated for elderly and disabled passengers, she said.

People with invisible impediments can be those with heart, kidney and liver conditions. Like people with visible physical disabilities or visual and hearing problems, they are eligible for physical disability certificates.

Figures from the Health, Labor and Welfare Ministry show there were an estimated 930,000 patients with internal ailments as of 2011. They accounted for 24 percent of all certificate holders, a number surpassed only by people with limb disabilities.

To enhance public awareness, Shirai’s non-profit Heart Plus organization created a “heart plus” symbol in 2003 to signify an internal ailment.

People with invisible impediments used to have no way to indicate their needs, Shirai said. “People who have had ostomies would get yelled at for using the toilets for the disabled,” she said.

The mark is winning public recognition. Five years ago, Kitakyushu City Hall began placing heart plus stickers on priority seats on trains, buses and other public transport and providing badges with the mark to those who wish to wear one.

Eriko Yoshida, an associate professor at University of Nagasaki, surveyed 471 people with internal impediments last year and found that 52 percent of the respondents reported being in need of assistance or support.

Fifty-four percent said they need assistance or support even with such household chores as cooking and cleaning. A further 42 percent cited daily shopping, with a similar number saying they needed help to make hospital visits or commute to work or school.

Even people who said they needed no help may in fact be struggling, Yoshida said.

Author Sarasa Ono thus developed an “invisible impediment badge” to help people with internal ailments discuss their difficulties with others.

Ono, who suffers from an intractable immune-system condition, writes about people who receive insufficient support because of shortcomings in public assistance.

The badge, which costs ¥350, has received 30,000 orders, Ono said, with interest both from patients with chronic diseases, developmental difficulties and mental ailments, and their families.

“People need the courage to talk about their own impediments,” Ono said. “I hope they don’t feel alone, because everyone with a badge is in the same situation.”

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