Hope Without Borders: Isona Kakuchi

When Isona Kakuchi stepped foot into the bustling halls of a hospital in Niger for the first time, she knew that it was where she was meant to be. Kakuchi’s love of humanitarianism and medicine brought her to the front lines of aid as a doctor for Médecins Sans Frontières (Doctors Without Borders), bringing not only health, but happiness to underserved communities. For Isona Kakuchi, medicine is not just about curing illness, but also about restoring hope.

Isona Kakuchi is a Tokyo native, growing up in the city until 18 years old. Apart from one year in the United States during second grade, Kakuchi attended the International School of the Sacred Heart from kindergarten to high school. 

From learning braille in options classes to visiting an orphanage in Thailand, Kakuchi attributes Sacred Heart as an environment that facilitated a love for service, sparking her own passion for humanitarianism. The International School of the Sacred Heart (ISSH) created unprecedented opportunities for high schoolers to get involved in volunteer-work, encouraging social activism in both simple and elaborate ways. “I think I only really realized that once I left,” Kakuchi says. “When you’re there, it feels normal because we all do it. But once I left, I realized that it really facilitates that kind of work for us with lots of opportunities and lots of options on how to get involved.” In addition to the value of service that Sacred Heart instills in its students, it also uplifts the importance of international-mindedness and cultural awareness – a value that Kakuchi notes as something that contributed greatly to paving her career in humanitarianism. “I think we’re naturally exposed to different settings, being surrounded by such international friends and staff,” she explains. “Japan is obviously very privileged, but you can see what life is like for others.” She also thanks her Sri Lankan mother as being a significant inspiration, still to this day. “I remember coming home from school and witnessing my mother working hard to set up her own charity back home.” The ability to think in others’ shoes and see the world from others’ eyes is a factor that would follow Kakuchi throughout her career and her life. 

In addition to the humanitarian passion that had grown within Kakuchi from an early age, another inspiration had paved the way for her future career: her family doctor. Kakuchi’s doctor was a special figure in her life, providing care to both her and her parents as well as serving as a role model.  “He was quite elderly and he was very kind, but also down to earth and I found that really fun when I used to go see him,” Kakuchi describes. “You would always see the waiting room packed and he always seemed like he was helping a lot of people. He also always had an answer for everything, so that was quite cool.” 

While an interest in medicine sparked in Kakuchi from an early age, she found herself unsure of what exactly to pursue following graduation. “I didn’t have people directly around me who were doctors apart from him when I was finishing at ISSH, so I didn’t go straight into medicine because I wasn’t quite sure,” Kakuchi recalls. “I wanted to try other things related to science first.” Despite her passion for medicine, Kakuchi initially pursued a natural sciences degree – a more broad major with studies in all fields of science – at Cambridge University. Kakuchi recalls having to do “quite a lot of lab work”, which partially served as a turning point in her studies. “I found it interesting, but I didn’t really enjoy it,” she notes. “I realized that rather than being in the lab and crunching numbers, I wanted to be closer to patients,” Kakuchi says with a laugh. “I also had this dream to go out in the field and work directly with people who are in need – that was what medicine felt like to me.”

As a doctor for Médecins Sans Frontières, many would imagine that the ‘medicine’ aspect of the job comes first, but for Kakuchi, it was the humanitarian aspect. The human connection factor was the most important part of medicine for Kakuchi – it was what lab work and numbers lacked, but what she sought for the most. While medicine may be a field that is more commonly associated with biology, calculations, and body parts, the human connection aspect is indispensable. “It was quite a big factor for me,” Kakuchi explains. “It's so applicable to everybody – we all need healthcare. It’s non-discriminatory and you can go anywhere with it,” she says. “That’s why the humanitarian factor came first, and then it was the question of ‘How do I combine that with my other interests in science?’”

She found her answer through Médecins Sans Frontières. Even before stepping foot into Niger, Kakuchi had slowly been paving her path towards MSF. Through her experiences in Model UN in high school as well as listening to an alumni presentation, a lasting impression of MSF had been made on her.  “I kind of always had that at the back of my mind,” Kakuchi says, explaining that the organization had been a quiet motivating factor in her head. Knowing MSF required some specialized expertise, Kakuchi enrolled in an accelerated course in medicine following her natural sciences degree, for a total of seven years of intensive study. Throughout her time at both university and during her accelerated medical degree, however, Kakuchi actively sought out volunteering opportunities in the humanitarian field like visiting Sri Lanka to volunteer with physiotherapists as well as going to Thailand to work at a clinic. She describes these pursuits as opportunities to “test the interest that [she] had in the back of [her] mind in humanitarian work.” After receiving her degree and officially becoming a doctor, Kakuchi’s specialized in pediatrics, training in the United Kingdom. She then continued working in Switzerland, spending three more years practicing and completing all professional prerequisites for becoming a pediatrician. With her skills and experience now fully realized, Kakuchi took the next step she had envisioned for years: joining Médecins Sans Frontières.

A world away from Tokyo, Kakuchi began her new life in Niger with Médecins Sans Frontières. She notes facing new obstacles that were unfamiliar at home in Tokyo including “living in quite difficult conditions, not having the freedom to walk around whenever, and not having good internet, let alone electricity.” However, Kakuchi was so moved by her work that her biggest challenge was something much more personal: not knowing when to stop. “There were moments when I would work all 7 days a week and I didn’t realize how tired I was,” she explains. “Because I was new and inexperienced, I wanted to be there everyday, learning and also showing my overworked team that I wanted to help and be a part of them. Slowly, I felt the team warm to me and it was very gratifying to see them more motivated. But our efforts seemed to never be enough to overcome the overwhelming needs of the community. It was very hard to accept the limits that we had there – accepting that you can’t do everything and that you can only do what you can with the time that you have.” 

Kakuchi’s personal challenges were part of a larger adjustment to a world that was completely different from Japan, the UK, or Switzerland. Training and working as a pediatrician in the UK and Switzerland, Kakuchi had firsthand experience as a doctor in medically advanced countries. The modern facilities and medical technologies were resources that were readily available and at Kakuchi’s disposal without a second thought. The idea of having to “choose” who needs care the most is a question that is unheard of in the UK or Switzerland. However, it is an incredibly real decision that Kakuchi had to face every single day during her time at Niger. “One of the biggest differences is the facilities and what you are able to provide,” she says. “It is very very basic in Niger.” Kakuchi explains that in Niger, while there were certain resources, there were not enough for every patient. “We had oxygen, but not enough for everybody. So we kind of had to pick and choose who needed it most,” she describes. “For things like machines to monitor heart rate, we didn’t have enough batteries. So we always kind of had to make do. We didn’t have an x-ray machine, so we learned how to use ultrasound machine and sought advice from experts abroad through an online portal

When asked about a memory or a particular story that stands out to her, Kakuchi smiles and pauses, searching through an endless amount of unforgettable moments. “There’s so many,” she says, laughing softly. “There’s one patient that I looked after for a very long time.” The patient, a young boy, had come to the clinic with severe malnutrition and a fever. “We saw a lot of children with malnutrition which is also a big difference, so much so that we had over half the hospital dedicated for children with severe acute malnutrition associated with other medical problems” she notes, reflecting on the very different realities of healthcare in Niger compared to Japan or the UK. She remembers these patients as particularly challenging, with unique problems related to malnutrition that are still not well understood. This particular boy was diagnosed with tuberculosis, and Kakuchi began treatment on him quickly. While she began treatment on the boy, she encountered many setbacks and challenges in his progress. “He was also very unwell and we saw that he needed oxygen and he was breathing poorly,” she recalls. “But we could see that once we started treatment, he was able to gain weight and gain strength. So that was really positive.”

Although the boy was slowly making progress, Kakuchi notes that there was still one major struggle: his dependence on oxygen. After a month in the clinic, the team considered transferring him to a larger hospital for more specialized care, but the boy’s mother intervened. “She said no, that’s not possible, we’re going home,” she says. Kakuchi’s initial reaction was shock. “I was like, what? Your child is sick, you have to go to the hospital.” However, the boy’s mother explained a situation that Kakuchi had never experienced before in her training. “She said that soon it would be the harvest season for her crops, so she doesn’t have time to go to the hospital,” Kakuchi explains. “And she has five other  children, and the dad is unwell, so if she doesn’t do the harvesting, they won’t have food for the winter.” 

This moment revealed a moment in medicine that goes further than any textbook. “I worked with nurses and healthcare workers who are local people, and they were really, really helpful because they had a much better understanding of local culture and beliefs,” she says. With the help of the local medical staff, Kakuchi was able to convince the mother to go to the hospital for her son to receive treatment. Kakuchi had to not only think in terms of medicine and the best treatment for the young boy, but also considering all aspects of the mother’s situation, even coming up with a solution for her crops. For Kakuchi, it was a lesson about culture and humility, understanding the importance of health in relationship with the cultural context of people’s lives. Providing the best care incorporates more than science and numbers: the empathy and openness of seeing the world through other perspectives. “What I really liked about working there is that you really think outside the box and you have to be really creative sometimes,” Kakuchi says. “It doesn’t always work, but in this case it did. So that’s one child that will really stick with me, and I also got to know him and his mother really well.” 

Another cultural aspect that Kakuchi found incredibly moving during her time in Niger with MSF was the significance of religion in every aspect of life. The majority of people in Niger are Muslim, and the gravity of their faith was something that struck Kakuchi deeply. Although she is not religious herself, Kakuchi found it truly impressive how dedicated people are to their faith and simultaneously the ways that faith brings comfort to people’s lives. “I think [religion] brought  my local team and the families a lot of strength,” she explains. “The conditions are very difficult with a lot of deaths, and I think it was a really important part of their coping strategy.” Kakuchi remembers being very moved as she witnessed the rituals performed by the staff and families after the passing of a child.  Although the staff did not shed tears, she could sense their sadness, frustration and fatigue. During Ramadan, her staff were clearly very tired with the timing coinciding with the hottest month of the year. “People splashed water on themselves but never allowed themselves to take even a sip of water”. She was amazed at their resilience and ability to continue to provide care for the hundreds of patients. Prayer was a source of strength. “When it was time for prayer, the units were suddenly very quiet, which you would never see in Japan or Europe.” 

Looking back on her journey, Kakuchi emphasizes a lesson that has guided her through her life: “If you think about it, then don’t hesitate to act on it.” At the beginning of her journey, she experienced doubt and worries about her passion for humanitarian work – a path that sometimes felt uncommon or alone. “Sometimes there are moments where you will find yourself a bit lost or alone in your quest to pursue that dream or interest, and it can be a bit disheartening,” she says. As a woman, she also wondered if this path would be possible for her, whilst envisaging having her own family eventually. However, through her own  enriching experiences, she has found that there will always be a wonderful community of people willing to support you and people who share your vision. “I knew that this was something that had been on my mind for a long time,” she says. “So I thought, if I don’t do it now, then years will pass. And I’m really, really glad I did. Since then, I have become a mother, and so I will not be going on a mission straight away. But thanks to my experience, I have ideas on what I need to work on professionally before returning to the field. The time in Niger has given me the confidence that being a humanitarian is indeed important to me, and is possible in many different shapes and forms,” She emphasizes that hesitation will only allow for time to pass, leaving a clear message: “Don’t be afraid to reach out, because once you do, you’ll find your way.”

#TheTokyoTalk #HealingBeyondBorders #StoryBehindTheStethoscope #WomenInHumanitarianism