A View from the School Health Center: Supporting Japanese Children’s Physical and Mental Well-Being

Physical and Psychological Care

Every elementary and junior high school in Japan has a health center (hokenshitsu). There can hardly be a Japanese adult who made it through compulsory education without paying a visit for treatment of an injury or after getting a sudden fever. The room’s role has changed over time, but today it is increasingly crucial, serving the needs of not only sick or injured children but also those suffering the effects of poverty, abuse, and other problems.

In the health center, children find the yōgo, or “health education,” teacher. This is a special position in Japanese schools, requiring training, usually at university, and acquisition of a license, but still many people are unaware of its correct name. Basically, there is one yōgo teacher at each school. While medical treatment is limited to on-the-spot measures, the health education teacher is stationed in the health center to deal with children’s daily issues.

In other countries, medical and psychological needs are typically handled separately by school nurses and counsellors, but the yōgo teacher adopts a combined approach to both. Elementary and junior high school children often cannot clearly describe their problems and give ambiguous comments like, “I’m tired,” or “My head hurts,” when they come to the health center. The health education teacher responds by carefully drawing out any worries the children might have while providing treatment.

Despite their importance, many in Japan do not know what goes on in school health centers. Here I introduce a day in the life of an elementary school hokenshitsu.

Suspicions of Abuse

A suburban elementary school in the Kansai region has more than 500 students. On a busy day, as many as 60 children might come to see the yōgo teacher, Ms. Suzuki (all names given are fictional).

It is eight o’clock on a Monday morning. The day’s first visitor is Daichi, a first grader. His homeroom teacher has brought him to the health center as he has a cut on the end of his nose. The wound is about a centimeter long and a scab has already formed. Daichi says that he fell over and hit it on the stairs at home.

“That must have hurt. Did you cry a lot?” Suzuki asks gently.

“Yeah.”

“When did you do it?”

“. . . This morning.”

“Not this morning, surely? It’s healed too quickly.”

He looks worried, so Suzuki does not pursue the matter and starts first-aid treatment.

The head teacher has heard Daichi is in the health center and arrives holding a camera. He takes a picture of the boy’s face before an adhesive bandage is applied. “I might use this for your graduation photo,” he says and Daichi smiles, but then winces as Suzuki’s probing fingers show he is feeling pain across the bridge of his nose.

This is not the first time he has come to the health center with unnatural injuries. The school has already contacted a child guidance center, reporting suspicion of possible abuse. The photograph is taken so it can be used as evidence, if necessary.

Sometimes abused children hide the truth to protect their parents, especially when questioning is excessively persistent. Maybe Daichi is happy that Suzuki took a softer approach, as he returns several times during the day to report further that “On Saturday, I hit it in the same place and it hurt,” and “Last night I went to bed at nine and I woke up at three in the morning.” Suzuki listens carefully, taking note of the information to share with the head teacher and other concerned parties.

A Valuable Space

When the school bell rings for the start of the day’s classes, a first-grade boy and a sixth-grade girl take out arithmetic and kanji worksheets and start studying on the health center table. They are afraid of entering their own classrooms, but feel comfortable here. While still in the school, the health center is a valuable space where children do not feel like they are being assessed or that their individuality is being denied. There is even the word hokenshitsu tōkō for attending school by spending time in the health center alone. This can be a steppingstone for many children who might otherwise refuse to attend altogether to return to the classroom.

At recess, a succession of children come in with nosebleeds, headaches, and other problems. In winter, fevers are common. While Suzuki rushes around, handing out thermometers and contacting parents and guardians, she explains how people catch colds and what to do for a quick recovery.

A sixth-grade boy called Shin enters wearily. “Even sitting down, I feel terrible,” he says. When Suzuki asks him what he wants, he responds immediately, “I want to die.”

Suzuki says the number of times she hears children saying they want to die or “reset” their lives is growing every year. Shin says again, “I want to die.”

He is known for becoming unruly and grabbing out at others when things do not go his way. Classmates are scared of him, and adults see him as a problem child. He wears name-brand clothing and at first glance seems to be a spoiled child from a rich family. In the health center, however, where he shows weakness, this is shown to be untrue.

A Message of Support

Shin’s parents are divorced. He lives with his father and stepmother, but watches television and eats meals alone in his room. Some days, meals are not even prepared for him; he also does his own washing and cleaning separately from the rest of the family. He has told Suzuki that his father hits him sometimes “for his own good” or as “discipline” and that he tries the hardest he can just to avoid any hassle.

Having been raised with violence in an environment of neglect, his repetition of the phrase “I want to die” seems to distill the suffering he cannot fully express in words at his stage of development. It is a sign of the severe distress he is going through.

Suzuki does not give the common response, “You can’t say that,” instead telling him, “I want to see you go on to junior high school and high school.” She conveys to him unobtrusively that she is watching over him and that he is important to her.

Emotional Sustenance

There is no let up to visitors through the rest of the day. After the children have gone home and the health center is finally quiet, I say to Suzuki that many do not seem to get the emotional support at home that they need to develop.

She replies, “I try to help those children in the health center. I remind myself—and them—that I want to get them through junior high and high school too. I want to give them emotional sustenance at this important stage, as someone who has shown them love can pull them back if things get rough later and they really feel they want to die.”

This reminds me of a girl I met when I went to a junior high school health center and then later as an adult, who told me that whenever she felt like she was straying from the right path, “More than my family, I remember my yōgo teacher and it stops me going wrong.”

Having an adult spend time and effort on them raises children’s self-esteem and is a major resource to draw on in building an emotionally healthy life.

Recognizing the Work of Specialists

Japan once had school nurses as in the West, but while these have remained public health workers in those countries, in Japan they became part of the teaching staff. (To qualify as a yōgo teacher, there is no need for a nursing license). As they are continuously in schools, dealing with children’s mental and psychological needs, they are more approachable than counselors.

Yōgo teachers are responsible for both care and education. To raise the profile of the position around the world, volunteers from the field established the National Network of Yōgo Teachers in Japan (NNYJ), which has participated in and given presentations at International Union for Health Promotion and Education conferences, held once every three years, since the 1990s.

Former health education teacher Shishido Sumi, a professor at Teikyō Junior College, founded NNYJ. She laughs that there was a lot of confusion with yoga teachers at first, but other conference participants have reacted positively. School nurses and researchers from countries like France, Britain, and Canada, have told her, “While we sense the children’s needs, we only meet with them once or twice a week, so we envy yōgo teachers in Japan,” and, “Having the same person provide daily care and health education is ideal, and we’d like to learn from Japan.”

Shishido says, “The use of yōgo teachers has been shown to be effective against such health issues as obesity, abuse, and sexually transmitted diseases, which affect children around the world. We hope our example will be useful for helping children in other countries.”

Unfortunately, yōgo teachers are not sufficiently appreciated in Japan. The fact that their correct job title is not generally known is just one sign of their obscure existence. Some other teachers even look askance at their actions, thinking that they are spoiling the children. Wider recognition of their specialist work in supporting youngsters’ physical and psychological development would give them free scope to apply themselves fully and help as many Japanese children as possible.