Public Health & Sanitation Programs were Keys to Economic Development

Okinawa Modernization was
Made Possible by U.S. Military
Health & Medical Programs
by Ryunosuke MEGUMI

by 惠隆之介

1. Medical Programs as the Best Deterrent to Terrorism

The best regarded programs of the US military occupation of Okinawa are those of public sanitation. These also won credence and respect for the rights of women that had hitherto been given little regard, by vesting numbers of women with medical skills and higher education. These programs, more than others, allowed Okinawa to aspire to the level of modernity needed to join the world.
What I am trying to emphasize here is the importance of educating women. Our emotional psychologies are largely formed in our infancy and early years. This means that enhancing the intellectual levels of women in general has a marked effect on social stability.
Prewar Okinawa was impoverished. With the limited efforts put into education, Okinawa was unable to offer its talent to Japanese society. Consequently, many youth of the day turned to Communism or radical movements. The first post war Se- cretary General of the Japan Communist party, Kyuichi Tokuda, was an Okinawan who endorsed violence. However, the 21 years of U.S. Occupation that followed WWII brought revolutionary changes to Okinawan society.
Let us review what conditions were relevant then.
The US Forces landed in Okina- wa on April 1, 1945, and controlled nearly the entire island by June 23, roughly three months later. The battle claimed some 12,510 American military, some 85,000 civilians, and nearly 83,792 members of the Imperial Forces. The toll was described by Rear Admiral Minoru Ota, Commander of the Imperial Navy 8th Combined Special Landing Force, Okinawa, in his dispatch to Imperial Headquarters just before his suicide: “Neither tree nor blade of grass remain unscathed. All rations will be
gone by the end of June.”
Post-war Okinawa was hit by famine and sickness. There was not enough food for the 325,769 survivors.
The fall of Japan the following year
DDT was sprayed from the air by U.S. military aircraft in the program to eradicate mala-
ria. Prewar, the Government of Japan had spent 18 years in an effort that took the U.S. military only two years to complete.
July 11, 1945
brought the end of Japan’s Imperial reach and the consequent return of many Okinawans who had emigrated to overseas settlements. Returnees averaged some 4,000 each week so that within just five years the population hit 698,827. This was one hundred thousand greater than the prewar population peak of 597,902 (circa 1937).
Since Okinawa was dependent on pre-modern agriculture, the land was unable to provide the food needed to support the burgeoning population. The prewar answer had been, inevitably, to seek opportunity elsewhere as migrant labor. The money sent home by the overseas migrant laborers was a major factor in Okinawa’s economy.
The war changed all that.
Also, in the prewar era, poverty was a major factor in lack of sanitation. The high temperature, high humidity semi-tropical climate and failure to adopt scientific methods resulted in epidemics of malaria, filarial infestation, dysentery, tuberculosis, leprosy, parasitic infections, and venereal disease. Many families struck by illness resorted to selling their daughters to meet the costs of medical care.
The post-war era began with destroyed sanitation facilities and housing; the conditions gave rise to rapid barrages of infections and disease. In the immediate post-war period, some 171,000 people (about 53% of the population) suffered from malaria, with the death toll reaching about 1,000 each year. Forty-seven local doctors were lost in the war, only 64 survived. Even with returnees, by 1946, there were only 127 local doctors in Okinawa.
The horrifying scenario deteri- orated as then, doctors began to die of exhaustion. The Yamato fatherland had dedicated all its resources to the war and had nothing left over to support the Okinawans.
The U.S. military immediately disbursed both medicine and food to the people, and established three general hospitals, five district level hospitals, and 150 clinics. Here, military medical personnel and public health officers treated people for free.
(By comparison, prewar Okinawa had one district level hospital and nine clinics.) The U.S. Occupation also provided for doctor training programs to combat the ravaging epidemics. A special task force supplied with military vehicles, was formed to combat malaria. The result: where the Imperial Govern-

Americans doctors caring for children post war. Okinawans were amazed that the U.S. military medical system would have pediatricians. The U.S. military later established orphanages in
Yonabaru and Koza, where many orphans were adopted by American families. June 15, 1945
ment had spent 18 years to no avail, this task force eradicated malaria from Okinawa in a mere two years.
Today in Okinawa, we see widespread anti-American censure. This is because the media and education boards have chosen to note only the tragedies of the war to rally against the military base presence. Nonetheless, there have been recent moves to laud the medical policies of the military Occupation. This is because, even as Okinawa boasts of having the greatest longevity in Japan, heart disease, diabetes, and lung cancer have afflicted wide numbers throughout Okinawa, bringing a sharp decline in the state of general public health in Okinawa. Concurrently, the rigid structure of the Japanese medical care system has allowed spiraling costs, and widespread medical care errors. This has led some people of Okinawa to begin expressing their appreciation for the contributions of the U.S. military doctors, nurses, and teachers.
Here, let me introduce the work of two in particular who helped change Okinawa. The U.S. Civil Administration’s Doctor William Smith of the Medical Corps and director of the public health nursing program, Juanita Watterworth.
In 1947, Doctor Smith was stationed in Okinawa for two years. During his stay, he established a scholarship program to train physicians.
Juanita Watterworth spent 10 years and five months in Okinawa after her arrival in 1950. She established a network of public health and sanitation nurses (a system of direct Nurse care in every Okinawan community), directly tackling the Achilles’ heel of Japan’s prewar medical care: prevention. (This system was eliminated at Reversion.) The result was that home care for victims of leprosy and other diseases was available here in Okinawa 45 years before it was seen in Japan. Notably, the incredible successes of this program were rooted in its ability to develop well trained nurses.
The Military Administration established the Central Okinawa Hospital Annex Nurse Training Center in May of 1946 (changed to Koza Nursing School in 1959). In the 45 years before the school closed its doors in March of 1991, it graduated 2,554 nurses (post-Reversion, became a Pref. School). The school system provided a full dormitory with stipends paid to students as they each amassed over 5,000 hours of broad based experience and clinical training over the three-year course.
The curriculum is a complete one, covering both general education and specific subject expertise. In fact, in April 1951, the school was awarded college credits. In fact, any graduate who desires need spend only one additional year at the four-year university or college of his or her choice, to obtain a baccalaureate.
Here, I wish to introduce the work done by Juanita Watterworth who established the system.

2. Results from the Nurse Training (1) Principles of Education
Immediately following her arrival on Okinawa, Watterworth (then 47) gathered Nobu Madanbashi (then 32), a leader of the local nurse corps, and seven others for serious lectures. All had been nurses attached to the Imperial Forces, serving on the Okinawa, Luzon, or even the China front. Listening to Watterworth gave them a renewed sense of life.
“You might feel hopeless that you lost the war, but everyone, whether the people of a defeated nation, or the people of a small island, has the right to life, and that right is the same for everyone, Americans or you.” (sic)
“If we are going to have good medical care in Okinawa, then we need medical leaders. And you people will have to meet the standards of the world.”
“Nurses are not doctors’ servants, they are Assistants. So you have to know just as much about medicine as doctors. If a doctor is wrong, go ahead and argue with him.” (In contrast, nurses in Japan even today remain in an almost servant status, and are restrained from disagreeing with the doctors.)
“You always have to put yourself in the place of the patient, and you have to let the doctor know what the patient is thinking.”

(2) Leadership
Watterworth was constantly at the training sites, to spur on and encourage the trainees. Nor was it just nurses that benefited from Watterworth’s attention. She cared, too, for young doctors just returned from post-war mainland Japan or from the medical school in Taiwan.
Watterworth always pushed the doctors and nurses to “Study more!” She was always arranging training at the U.S. Army hospital at Camp Kue or for scholarships to the United States. U.S. medicine in general was, at the time, almost a half-century ahead of medical care in Japan, and where clinical services are concerned, it still leads.
In another sense, the visits to the U.S. military hospital also served to counter the paradigm of males dominating females. In one diary, a trainee noted that “Military nurses (officers) give orders to uniformed (male) soldiers, a considerable culture shock to us all.”
The prerequisites for entry to Nursing School were stringent. It required a high school diploma, and since both employment and social status were practically guaranteed, the

Registered nurses after just completing at the U.S. Army Hospital at Kue. The postwar nurse training programs of Okinawa were designed by the U.S. military to meet world standards. (159 trainers went through the programs over a period of 23 years.)
entry exams were actually harder than the exams for the University of the Ryukyus. Great emphasis was placed on character and integrity, and those found wanting were expelled (vis-à-vis the scholastic achievement emphasized in modern Japanese nurse training).
Many of the skills for which the school’s students won historical renown are still not allowed in medicine in Japan today. For example, students were trained under the concept that as “Good Samaritans” in dire emergencies, nurses must provide the proper minimum lifesaving treatment such as fundamental surgical procedures, sutures, or medication.
At the same time, the Nursing School dorms were supervised by nurse instructors who were former members of the Imperial Military nurse corps. They ensured strict discipline. While Okinawans are not particularly known for swift action, the demands on the student nurses were enough to instill immediate reaction as a lifelong response. To provide for the gentler sentiments of the fairer sex, Christian missionaries provided classes in ethics and Sunday services. All these efforts bore fruit.

As an example, in 1962, Nursing School public health program graduate Ms. Humiko Yamada (then 29) was sent for additional training to the national hospital in Osaka. There, she was placed with a group of nurses who were watching a doctor struggle with a basic incision into a major blood vessel. Frustrated, she took the scalpel and quickly made the simple cut, saying, “Doctor, here’s how it’s done!” Her fellow nurses were both aghast at the violation of the Medical Practitioners Law of Japan and awed by what Ms. Humiko Yamada considered basic skills. Certainly the group was astounded by the openness of practice under U.S. medicine. Consequently, the nurse was asked to provide information and insights not only to the Chief Nurse of the hospital but also to give several lectures to the physicians. On every occasion, the personnel repeatedly noted that she was giving them glimpses into the “world’s most advanced nursing principles.”
Nor did Watterworth stop there. She drafted the military Occupation ordinance requiring nursing licenses to be renewed once a year. This obliged all the nurses of Okinawa to renew their licenses each year, with renewals predicated on training updates. This system was abolished at Reversion in favor of the lifelong validity of licenses issued to nurses under Japanese law. In a similar move, the U.S. military also debated requiring doctors’ licenses to be renewed every five years but in the end this ordinance never passed.

(3) A Sense of Mission
Up until Reversion, graduations at the Nursing School were attended by both the three star U.S. Military High Commissioner and the Chief Executive of the Government of the Ryukyu Islands (equivalent to today’s Governor). This was also due to a proposal by Ms. Watterworth.
From 1955 to 1957, the CG, U.S. Army Far East Command and Governor of the Ryukyu Islands Civil Affairs Commander General Lyman L. Lemnitzer and his wife took the Nursing School under their wing. Staff and students were often invited to tea parties at the General’s official residence. This would have been unthinkable under the prewar Imperial Military.
Also, VIPs and other special guests routinely visited the Nursing School to encourage the students. Notably, on November 20, 1953, the wife of then Vice President Nixon paid an official visit to Okinawa Central Hospital in particular to see the nursing students.

(4) The Cross Border Ties of Women
Ms. Watterworth made every possible effort to alleviate the poverty that afflicted the citizens of Okinawa. Knowing that sheets and lockers were scarce in hospitals, she appealed to the Military Officers’ Wives Clubs for used items and even cast-off large (cloth) flour bags. The flour bags were a particular find, easily turned into soft bed sheets. The Wives Clubs responded to these calls from Watterworth by establishing their public assistance programs. We need to keep in mind that Watterworth began her crusades at a time when Okinawa had absolutely no support functions, either in terms of goods, textbooks, people or even education system.
In June of 1957, tetanus struck a small elementary school in one of the outlying islands; several children died. Watterworth petitioned the Mrs. Black of the Kadena Air Force Officers’ Wives Club, who in turn pressed the Air Force Commander to form and dispatch a medical care team. This turned into an annual round of the outlying islands by a small flotilla of U.S. Navy medical vessels.
In June of 1955, the Wives Clubs put on a rodeo show to raise funds for handicapped Okinawan children. The event was a huge success both among the U.S. and Okinawan populations, with over 2,000 people attending the event. All the money for entry tickets went to help the children. In March of 1955, Uniforms for Public Health Nurses were provided through the generosity of the Zukeran Officer’ Wives Club. They were very stylish at the time, and served to attract many young female candidate to the Nursing School.
Her efforts came to be broadly supported by the general public in Okinawa. This led to April 27, 1960, when Admiral Harry D. Felt, Commander in Chief, Pacific, testified before the U.S. House of Representatives that in his personal view, “The people of Okinawa would prefer to remain under U.S. Occupation than to
revert to Japanese rule.” (sic)

3. Truth Will Win Out
A few of Okinawa’s medical
practitioners found it difficult to endure Ms. Watterworth or the medical policies of the Occupation Government. The memories of kin and brothers lost in the war would not allow them to consort with what they considered ‘the enemy.’ Some had been so abashed by Japan’s surrender that they committed suicide rather than live.
Whenever local medical care facilities ran short of blood supplies, military officers and men lined up to offer their own. Dangerously ill patients in need of advanced care were often treated free at the U.S. Army Hospital.
However, something happened which led to great changes.

At 11:30 AM on June 30, 1959, a jet fighter from Kadena Air Base crashed, after the pilot ejected, directly into students studying in their classes at Miyamori Elementary School in Ishikawa. Local doctors provided on-site medical care under the supervision of U.S. military medical personnel.
The methods of locally trained doctors were exactly as practiced under the Imperial Forces. Burn injuries were coated with silver nitrate, then swathed in layers of bandages. This risked not only infection but generally meant that scars from the burns would remain. The heavy bandages also meant that rehabilitation therapy came much later as a time consuming final stage. In contrast, the U.S. military moved every available helicopter throughout Okinawa to carry the injured to the U.S. Army hospital. Patients were not wrapped in bandages but instead, direct burns were first washed with Phisohex to deter infection, and patients were placed in whirlpools to cleanse the burns and provide total body care. Patients did not wait but began rehabilitation therapy as soon as they were able. Serious cases that needed skin grafts or plastic surgery were airlifted to the United States to hospitals with greater expertise.

Local doctors were taught by U.S. military personnel to provide Keloid operations, plastic surgery, psychological care, and dermatology services as both serviced patients together; the Americans taught what was then the world’s foremost medical technology. This meant that local doctors and U.S. medical staff spent a great deal of time together.
June 15, 1962. Marines at MCAS Futenma- loading medical supplies onto a helicopter car- ryng nurses to outlying islands
4. Humanism for Forever
Such support from the military government led to steady advances in medical care in Okinawa.
The result of these medical assistance programs from the military government was to move Okinawan medicine into modern times. The medical care environment has also made possible a stable society with a current population of 1,318,281, more than twice the prewar peak.
The people of Okinawa have a great deal of confidence in their medical care. In April of 1972, in the month prior to Reversion, the Government of the Ryukyus Chubu
Hospital (The Military Occupation (USCAR) bore 95% of all construction costs), a team entirely composed of Okinawan doctors suc- cessfully conducted advanced open-heart surgery. Additionally, the hospital maintains today the internship training programs in conjunction with the medical college at University of Hawaii, which began in 1967. In attempts to rectify some of the issues with Japan’s medical education system, candidates for the internship program come from all throughout Japan.
Juanita Watterworth passed away at the age of 62, five years after leaving Okinawa. However, her students are now arrayed along the medical forefront. Their children are now beginning to take their own places as they follow in the parents’ footsteps.
The Okinawa Nursing Association commemorated its 30th anniversary in 1982 by issuing a medal bearing the face of Juanita Watterworth to all its members. Also, in September 2002, representatives of the Association staff paid a visit to the grave of Ms. Watterworth which had been found after long years of searching in Seattle.
It is my personal belief that the scientific philosophies and abiding humanity of the American people can overcome all hurdles born of religious or ethnic differences. It is my hope that the Americans will employ the same civil action medical assistance programs so integral to Okinawa’s progress in Iraq to help the people there attain true freedom and prosperity.

—Article issued by East Asian Institute, Columbia University

Mrs. Watterworth sitting in the middle of the front row.
Nursing school Graduation ceremony (March, 1956)