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Clinical Decision Making in Rural China

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Society for East Asian Anthropology
By Xisai Song
September 16, 2020

This piece is part of an SEAA series on “An Anthropology of Ethics in East Asia.” The articles examine how individuals cope with societal changes such as environmental crises, nationalism, economic development, and mobility through a lens of everyday ethics. 

As a life-sustaining treatment for patients suffering from kidney failure, hemodialysis has been ridden with controversies since its emergence. It is a “half-way technology” that can neither cure the disease nor provide a sense of comfort, but jams patients into a long and torturing status between life and death (see for example, Fox and Swazey 2001; Kaufman 2015). The life quality for patients on hemodialysis is extremely low: they have to constantly practice self-discipline in food and water consumption (only one small cup of water a day) and chronically experience a long list of complications such as itchy skin, sleeping problems, and bone diseases. Unless acquiring kidney transplants, patients have to depend on hemodialysis until death.

In 2019, I conducted fieldwork in the hemodialysis ward of a public hospital in Qiushui, a poor, mountainous county in northeastern Sichuan, China. There were 95 patients suffering from kidney failure who regularly visited the ward for a four-hour hemodialysis treatment two to three times a week. The majority of them were from the county’s rural areas, among whom most were former migrant workers. They used to work as laborers such as factory workers, construction workers, and truck drivers in coastal provinces in China, but returned to their hometown to receive hemodialysis treatments. Half of these patients were under 45 and 10 of them were in their twenties. In spite of their young age, only six patients in this ward were waiting to receive a kidney transplant. Why do so many patients choose the arduous hemodialysis treatment instead of kidney transplant? How is their clinical decision making formulated in the social-historical and political context of China today?

Photograph of the interior of a hemodialysis ward
Image description: There are about half a dozen beds in this corner of the ward, all accompanied by hemodialysis equipment. The ward is clean and well-lit. There is a large, partially opaque window stretching across one wall of the ward letting in a small amount of light.
Caption: A corner of the hemodialysis ward. Xisai Song

What shocked me when doing fieldwork in the hemodialysis ward was how grateful those patients were to the state, in sharp contrast to what has been documented in anthropological studies in other contexts where poor patients attributed their reluctance to receive kidney transplants to social and structural problems (for example, Hamdy 2012). Coexistent with their indebtedness to the state was patients’ intensive moral anxiety and self-blame. State-sponsored insurance schemes and the “Targeted Measures in Poverty Alleviation” (jing zhun fu pin) program cover 75 to 90 percent of patients’ medical expenses, making hemodialysis financially accessible. These state welfare programs made patients feel included into the political order. At the same time, although migrant workers are constitutive of creating the new socioeconomic landscape of reform-era China (Zhang 2001), they are displaced from it immediately as they lose their ability to work. Unemployment is common among these former migrant workers on hemodialysis because their bodies can no longer handle the heavy labor required to keep their jobs as blue-collar workers. As a result, families, both as a cultural source of support (Kleinman 1980; Yan 2017) and an agent of the biopolitical state (Ma 2020), become the default safety net that patients depend on for financial support and for care. Caring for a sick family member is a long-standing moral norm in China. In poor rural households, however, caring involves meticulous calculations and moral tensions; families strain to coordinate their limited resources including labor, money, opportunities, and life prospects. Consequently, clinical decision making, discursively framed as a private act of family responsibility, is in fact a dilemma of survival. Deciding on treatment options like kidney transplantation entails moral struggles of evaluating and comparing life values among family members.

For Shan, a patient in her early fifties, kidney transplantation was “meaningless.” Instead, her primary concern was her son’s marriage. Shan was from a rural village in Qiushui. She and her husband were factory workers in southern China. In 2013, Shan was suddenly diagnosed with kidney failure and came back to Qiushui to receive hemodialysis treatments. Shan’s husband also quit his job to take care of her, because Shan suffered from serious complications and couldn’t live by herself. Her son, who was 18 then, dropped out of school immediately and started working as a migrant worker to shoulder the financial responsibility of the family. In the past seven years, Shan and her husband had to rely on her son to pay Shan’s medical bills as well as their living expenditures. “I cried every time I received money from my son. I put too much pressure on him,” Shan once said to me. Shan’s son was 25 and remained single, which was absurd in rural areas where the marriage age was early. In Shan’s village, people called her “bottomless pits of trouble” (wu di dong) and no matchmaker ever introduced a girl to her son. Shan’s son also didn’t find a girlfriend in his workplace. Shan was extremely guilty that her son hadn’t finished school and blamed the difficulty of her son getting married on herself. Shan never considered kidney transplantation, refusing to add more burdens to her son. The financial cost of post-transplant medications was comparable to that of hemodialysis, while the possibilities of recurrent hospitalizations and relapse of kidney failure would further their trouble. Shan’s biggest wish was that her son would build a family of his own before her own death. Her family spent a large portion of their savings remodeling their house in 2019. A new house is an important cultural and economic symbol indicating that a family is ready to welcome a daughter-in-law. Bioethical principles of informed consents and patient autonomy have gained plenty of anthropological scrutiny.

In addition to worries over financial and caring burdens, many young patients regarded kidney transplantation as “useless.”  The story of Jinwei, a patient in his mid-thirties, is one example. Growing up in a rural village of Qiushui, Jinwei went to Guangdong, a southern province at the age of 16 in 1998. Jinwei aspired to make a fortune and to snatch a good place in China’s emerging market economy. He started as a factory worker, but later became a gang member. Although his income was much higher, he ended up getting imprisoned for three years. After his release, he went back to working in a factory. Jinwei described the 1990s as a golden age of opportunity. Seeing some of his old friends getting rich, Jinwei was determined not to be left behind. He went to Beijing and invested his life savings into running a restaurant. The business failed a few years later, and Jinwei returned to work in a factory. This was where he met his wife, a fellow worker. In 2018, they got married and his wife became pregnant with twin boys. However, in the same year, Jinwei was diagnosed with chronic kidney disease (CKD). His CKD quickly progressed to the end stage and he started hemodialysis in early 2019. His boys were only three months old. Jinwei firmly refused to sign up for a kidney transplant waiting list. People with kidney transplants should still avoid heavy labor. That is to say, transplantation would not change the fact that Jinwei had lost his ability to work. Reflecting on the past 20 years, Jinwei demonstrated a strong sense of regret and failure, thus having no confidence to build a new life with a disabled body if he were to receive a kidney transplant. Jinwei didn’t bother to undertake the risks of a transplantation surgery, but would rather spend the surgery fees on raising his boys. He was immensely remorseful for his inability to provide his boys with an adequate life. Jinwei strictly practiced self-discipline in everyday life in order to maintain his body in a stable condition and to prolong his life, which extended beyond following medical advice to his moral endeavor to be a good father.

Bioethical principles of informed consents and patient autonomy have gained plenty of anthropological scrutiny. Scholars critique bioethics’ underlying liberalism and science-centric frameworks that overlook the complexity of local moral worlds and obscure structural inequalities (see for example, Kleinman 1995; Mol 2008; Pinto 2014; Rapp 2000). For Shan and Jinwei, their treatment choices are neither autonomous nor orient toward themselves. Instead, they gauge the overall well-being of their families and prioritize the benefits of the ones with relatively better life prospects—their children in both cases. Their seemingly intergenerational moral acts such as the sacrifice of Shan’s son, Shan’s motherly love, and Jinwei’s pursuit of good fathering have, however, obscured these poor patients’ predicaments caused by socioeconomic marginalization. For Shan and Jinwei, the chronic effects after transplantation—including the inability to work, long-term medication, and dependence on care—outweigh the benefits that transplantation can bring. Thus, they deem kidney transplantation worthless. Like Shan and Jinwei, most former migrant workers in the hemodialysis ward of the hospital in Qiushui regard kidney transplantation as being of little help to their life hardships, which challenges biomedical standards of medical efficacy. Instead of applying to individual biological bodies, medical efficacy is unevenly distributed to patients of different social statuses.

Xisai Song is a PhD candidate at Cornell University. Her study examines how lower-class patients struggle with chronic kidney disease in China. Her research interests include chronicity, medical ethics, health inequality, and the ways in which biomedicine is contextualized into non-Western contexts.

Cite as: Song, Xisai. 2020. “Clinical Decision Making in Rural China.” Anthropology News website, September 16, 2020. DOI: 10.14506/AN.1498

Copyright [2020] American Anthropological Association

Changing Mortuary Practices in Japan

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Society for East Asian Anthropology
Yohko Tsuji
August 13, 2020

The typical inscription on most Japanese tombstones does not show the names of the deceased. It says instead “Ancestral grave of the X family,” reflecting a lingering political heritage of the Meiji oligarchy (1868–1912). The imperial government established the ie (家), or the patrilineal family to which every citizen must belong, and mandated ancestor worship with the family grave as its locus to ensure the ie continuity (Tsuji 2002, 177-199). Hence, generations of family members in the direct line of descent—the family head, his wife, their heir, the heir’s wife, and so on—are buried together. Their descendants are responsible for looking after the family grave and worshipping their ancestors. A tale of two cemeteries in northern Osaka shows us much about recent changes in Japanese mortuary traditions.

The first is a municipal cemetery established in 1969. It had 4,000 graves by 1987 and was expanded to 6,364 in 2000. On the large terraced hillside overlooking the skyscrapers of Osaka City, one can see countless rows of traditional three-tier graves in which the cremains of several generations of family members are interred. Most inscriptions on them say “X family’s ancestral grave.” A few newer gravestones are carved with Chinese characters, such as serenity (寂), dream (夢), and appreciation (感謝).

Photograph of a cemetery.
Image description: Numerous stone grave markers line different levels of a cemetery. They all have wide, broad bases with smaller tiers stacked atop each other. The stone on the top tier of each grave is taller and narrower than those underneath and has a vertical inscription on it.
Caption: Traditional three-tier graves at the Municipal Cemetery. Yohko Tsuji

Yet this cemetery is not quintessentially traditional, because graves were not inherited but newly purchased; it is affiliated with neither Buddhist temples nor neighborhood communities; and it is an individual, not a family, who contracts a cemetery plot, though after the individual’s death the contract is transferable to another individual. This cemetery, like numerous public and commercial cemeteries, sprang up during Japan’s economic growth that began in the 1960s. The mass migration to urban areas at that time caused an acute shortage of graves because newcomers, whose family graves were located far away and hard to visit, tried to find alternative graves near their new homes. In 1971, the shortage and high cost of urban graves resulted in the construction of a columbarium with 552 locker-style repositories, adding another nonconventional feature to this cemetery.

More notable modifications of burial traditions occurred in 2019. The municipal government built a large monument to collectively entomb the cremains of 14,000 unrelated people in order to economize the burial space and to memorialize those entombed, thereby relieving each family from maintaining their own grave and worshipping their ancestors there. This monument helps to solve two major death-related problems in contemporary Japan: an increasing number of deaths as the baby boomer generation ages, and a growing number of people who have no grave or no family members to take care of their grave and afterlife.

Photograph of flowers placed on a monument.
Image description: A black sphere sits atop a raised circular platform that rests on a tiled circular pattern of dark grey stone. On the edge of the largest circle are four bouquets of flowers with colorful blossoms of yellow, pink, orange,and white.
Caption: Monument for Collective Burials at the Municipal Cemetery. Yohko Tsuji

The second cemetery,  established in 2012 and known as sakurasō (桜葬) or a cherry blossom cemetery, offers a different approach to resolve the same problems. Adopting the principle of jumokusō, or tree burials (Boret 2014), no tomb stones or monuments exist at the park-like site of this cemetery. Instead, cherry trees are planted to signify six burial areas, where unrelated people’s cremains are buried without markers. Each burial area has a few stones with small metal plates on them bearing varying inscriptions: some show the deceased’s names and dates of birth and death, and others include words of thanks or personal messages, such as “Good-bye. It was an interesting life.” A service to commemorate all of the dead is held annually.

Though the land of sakurasōcemetery belongs to a Buddhist temple, it is managed by a nonprofit organization (NPO) and is available to anyone regardless of religious belief. Like the monument at the municipal cemetery, these graves require neither maintenance nor descendants. The NPO offers support both before and after death by performing tasks that have traditionally been undertaken by next of kin but have become harder to do: checking on older people living alone, assisting with hospitalization, serving as the stand-in chief mourner for a funeral, and so on. The NPO also organizes regular meetings of those who will be buried together, creating a community of hakatomo which literally means “grave friends.”

This tale of two cemeteries illustrates the unmistakable transformations in Japanese mortuary tradition (Tsuji 2018, 17-30). They reflect and adapt to the changes in Japanese families, neighborhoods, workplaces, economy, ecology, and demographics that have occurred in the last half a century. Particularly, the family’s central role has diminished. Instead individual choices and decisions have become more important. Despite myriad societal changes however, death continues to be significant in people’s lives. Indeed, over 33 million websites are available to check the cost of a cemetery lot. Choosing a nontraditional grave and entrusting the care of the afterlife to extrafamilial entities, such as the municipal government and the sakurasōcemetery management, provides a tenable means of securing care of death and the afterlife. It does not necessarily mean that people have stopped practicing mortuary rituals. Rather, their nonconventional choices of graves and conformity to mortuary tradition coexist. During biannual religious weeks in the spring and the fall, extra buses are operated to the municipal cemetery for people who worship their ancestors. Some family members regularly visit the sakurasō cemetery, including on death anniversaries of their loved ones.

As Japanese society is rapidly aging, death and dying are becoming even more visible with the mass media constantly featuring pertinent information and people’s concerns about shūkatsu (終活), or preparation for death and the afterlife, escalating. Furthermore, as these cemeteries demonstrate, mortuary tradition is evolving and generating new types of practices.

Another such example is the practice of burial with one’s pet. Traditionally, pets are not allowed to be entombed with humans. Behind this ban is the Buddhist worldview, which places animals and humans in separate stages of the reincarnation cycle. However, in the last few decades, this clear demarcation has been blurred as pets have become increasingly regarded as indispensable family members. Called uchi-no-ko, or “our child,” just like human progeny, the pet shares daily life with many Japanese inside their residences rather than in a kennel outside. Uchi-no-ko is fed pet and human food rather than the leftovers given in the old days. People also clothe their pets with sweaters, caps, and socks and have them groomed regularly. They buy pet medical insurance and take them to veterinarians for illness and injury, not to mention check-ups and shots.

When uchi-no-ko dies, many Japanese have a funeral, hiring a pet funeral operator or asking a Buddhist priest to chant a sutra. They bury their fur child in a pet cemetery and visit it frequently, dismissing a more customary method of calling the health department to have the pets’ remains incinerated or, if the family has a yard, burying them in a hidden corner.

These pet parents suffer the loss of their children and are concerned about their pets’ afterlives as much as their own. Because the burial of pets in human graves is not permitted at most cemeteries, the everlasting separation from their pet and the uncertainty of the pet’s afterlife aggravate their grief. Buddhist priests frequently receive questions, such as: “Can uchi-no-ko rest in peace or go to heaven?” and “Can I and uchi-no-ko meet again after my death?” These pet owners strongly wish to be reunited with their pet in the same grave after their death. To address such sentiments, some cemeteries, including the aforementioned sakurasō cemetery, allow humans and pets to be buried together.

The tale of two cemeteries and the burial with one’s pet attest to the malleability of tradition. For its persistence, tradition must change, adapting to social transformations and accommodating people’s altered needs. Japanese mortuary tradition continues to evolve to handle death, “the supreme and final crisis of life” (Malinowski 1948, 47), in a contemporary world awash with immense changes.

Yohko Tsuji is an adjunct associate professor of anthropology at Cornell University and the author of the forthcoming book, Through Japanese Eyes: Thirty Years of Studying Aging in America. She has conducted fieldwork in America, Japan, and Thailand, and published articles on aging, death, conception of time, and social change.

The SEAA column is currently accepting submissions. Please contact Shuang Frost (shuanglu@fas.harvard.edu) and Hanna Pickwell (hpickwell@uchicago.edu) with your essay ideas and comments.

Cite as: Tsuji, Yohko. 2020. “Changing Mortuary Practices in Japan.” Anthropology News website, August 13, 2020. DOI: 10.14506/AN.1471

Copyright [2020] American Anthropological Association

Cultivating the Ethical Self in the Way of the Sword

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Society for East Asian Anthropology
Jingyi Tian
February 26, 2020

For Hongkongers, kendo offers practice in the pursuit of self-cultivation and ethical work.

This piece is part of the SEAA series “An Anthropology of Ethics in East Asia.” The articles highlight different aspects of moral values and ethical practices in a range of Asian regions. They examine how individuals cope with societal changes such as environmental crises, nationalism, economic development, and mobility through lens of everyday ethics. 

“Many people can’t control their egos in kendo. They hit one after one—pong, pong, pong! It’s pointless. This is where kendo mirrors their inner characters,” said a senior Hong Kong practitioner who has been practicing kendo, a Japanese combative martial art, consistently for more than five years. The practitioner told me that kendo helps him to cultivate a strong mind. Many practitioners had similar ethical reflections, which led me to ask, How does kendo serve as a tool of self-cultivation?

Hong Kong fans of Japanese culture are often drawn to the sport by the iconic image of samurai fashion. Although kendo is not the most popular sport in Japan (the All Japan Kendo Federation counted 1.8 million practitioners in 2017), the martial art is noteworthy because its practitioners devote themselves to the practice for years, even decades, in pursuit of moral self-cultivation. Like the man quoted above, many kendo practitioners regard kendo as a life practice (Cantonese: sau hang; Mandarin: xiu xing, 修行). This term has a strong connotation of spiritual exercise in Chinese, and an association with ascetic practices. It accurately reflects a feature of kendo—practitioners engage in a highly intensive, exhausting, and challenging combative activity that forces them to endure hardship and injuries. Yet, many dedicated practitioners are more than willing to endure such rigors.

Photo of a practice room with numerous people in kendo gear.
Hong Kong kendo practitioners in their regular practice. Jingyi Tian

The ideal status and traits of the better person produced through kendo practice vary from individual to individual. Practitioners have similar physical experiences, but their own interpretations and goals. Kendo works as a tool for personal growth for some practitioners. Others find kendo helpful in learning how to cultivate social relationships. I will highlight three examples to showcase the range of practitioners’ ethical desires: a financial trader who wants to become a person who can make sharp and accurate decisions at work through better control of his ego; a Christian who aims to practice compassion and love through kendo, which helps him to do a better job as a manager; and a young practitioner who seeks self-empowerment to cope with the harsh yet routinized work. They all have a telos in a Foucauldian sense, namely, a goal of pursuing an “ethical self”—a status or a state of being that they wish to achieve.

A financial trader
Edward is a financial trader in his forties. Before he began learning kendo, he read the book Gorinsho (TheBook of Five Rings), which is filled with stories of a famous Japanese swordsman, Musashi Miyamoto. Edward told me that both kendo and his job require making the right decision at the right moment under pressure. In kendo, a combatant needs to practice how to manage their fear or anxiety, which helps to build up inner power. Edward insists that kendo helps him make good decisions. In that sense, he believes that kendoinstills self-control and a tranquil mindset, both of which benefit his career. Although the inner power that practitioners seek is unlikely to solve all their worldly problems, their dedication to developing such power reflects their keen ethical aspirations.

A Christian
Christopher is a pious Christian and entrepreneur who opened his own business when he was in his forties. He adopted kendo as a training regimen that helps him learn how to get along well with his coworkers. Christopher has found that kendo’s moral messages align with his Christian beliefs—especially the call to show love and care in practice. When he spars with less experienced opponents, he tries to help them improve their kendo skills through courtesy, which he sees as another kind of training that he applies in his work life as well.

A young practitioner
Melissa is in her mid-twenties and works as a legal clerk. She told me that her routinized job made her feel powerless for not being able to make a difference. She wants to be more energetic and positive toward life, and kendo offers her a scheme in which she can transform herself.

To reach their goals, kendo combatants seek self-improvement and self-advancement through exhausting bodily practices that challenge their limits. They often trace kendo’s moral codes to Inazo Nitobe’s famous 1905 book, Bushidō:The Soul of Japan, which offers a genealogy of kendo’s moral framework that various practitioners’ find useful. Practitioners regard the moment they are faced with an attack as the moment to transcend their fear like a warrior; when presented with opportunity to initiate an attack, they practice self-control to repress the impulse. They strive to refine their inner selves in combat with a diligent attitude, and such refinement will not happen unless they keep practicing over the long term. In this process, physical combat not only trains the body but also constitutes ethical work, as the moment when one faces a challenge in combat is a good time to train “heart” (心). The written character of the heart is the same in Japanese (kokoro) and Chinese (Mandarin: xin; Cantonese: sam). In kendo culture, the heart represents inner power that can be obtained through training.

Although the inner power that practitioners seek is unlikely to solve all their worldly problems, their dedication to developing such power reflects their keen ethical aspirations. Recalling Michel Foucault’s theoretical reflections on ethics and self-formation, practitioners adopt the moral framework of kendo practice as a “technology of the self” through which they hope to transform themselves and attain an ideal state of being. Practitioners hold that kendo practice helps them find the weaknesses in their own characters and become better people.

The demand for self-cultivation through kendo reflects a larger neoliberal social milieu in Hong Kong where individuals are left to individually cope with intense pressure from their jobs, including finances, harsh demands in the workplace, and routinized work life. Kendo’s moral framework provides a means for practitioners to build up a strong mindset to cope with their anxiety and suggests a culture of the body that emphasizes self-reliance, self-improvement, adaptability, and individualism. Their experiences resonate with similar patterns of self-cultivation among practitioners of yoga, judo, wingchun, and taichi.

Joseph Alter’s study on yoga in India shows that middle-class yoga practitioners adopted yoga practice as a spiritual antidote to the anxiety and pressure in their fast-paced capitalistic lifestyle.  This work has inspired other scholars to contextualize bodily practices within a larger socio-moral landscape. The case of Hong Kong kendo practitioners suggests that kendo’s moral framework is particularly appealing to middle-class practitioners who experience extraordinary pressures in daily work life and culture.

Cite as: Tian, Jingyi. 2020. “Cultivating the Ethical Self in the Way of the Sword.” Anthropology News website, February 26, 2020. DOI: 10.1111/AN.1356

Copyright [2020] American Anthropological Association

Family in the Ruins of Nuclear Risk

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Society for East Asian Anthropology
Jieun Cho
April 29, 2020

This piece is part of the SEAA series “An Anthropology of Ethics in East Asia.” The articles highlight different aspects of moral values and ethical practices in a range of Asian regions. They examine how individuals cope with societal changes such as environmental crises, nationalism, economic development, and mobility through lens of everyday ethics.

“I chose to not worry about radiation anymore, for as long as I stay living here; to live normally again for my children and my family,” said Kazumi, a mother of two children, who had decided to stop trying to move out of her neighborhood for the time being. Nine years after the Fukushima Daiichi nuclear disaster, I was listening to her confession of choosing to “live normally again” at a tea party for parents who were managing their anxieties in the face of long-term exposure to low-dose radiation in nuclear-affected areas. Employing the term “choice”, which has become all too familiar for people living in conflict-ridden areas that have not been evacuated (cf. Little 2019), Kazumi chose to give up “endless worries” as her own child-raising strategy. But what does this choice do for her in such an extraordinary environment? And what is this new normal life Kazumi is trying to make if it needs to be constantly chosen and confessed as such? Based on my ongoing fieldwork with families living with lingering post-Fukushima radiation, I take such choice as indexing an ethics of what I call balancing. Familial norms fail to provide actionable options when clearly the most effective way to protect children is to relocate to a risk-free elsewhere.

Kazumi lives in Koriyama City, one of the regions slightly outside the officially demarcated evacuation zone in Fukushima. In such a shadow zone, a life amidst unrecognized forms of nuclear risks has been effectively normalized with a newly introduced level of permissible radiation exposure—20 times the pre-disaster level for Fukushima. Although public debates over the long-term effects of low-dose radiation have escalated over time, amounting to what one may call science wars among ministries, academia, and citizens (Kimura 2016; Polleri 2019; Sternsdorff-Cisterna 2018), children’s health from the perspective of radiological protection has come to hold a central place in the imaginaries of biological vulnerability. However, those who have chosen to remain or return are left largely on their own with only limited help from central and local government (Lies 2017; McCurry 2017). Resources available for mitigating nuclear risks are differentially distributed along pre-existing lines of social, political, and economic inequalities; some could afford to leave while others were forced to make do by purchasing food from cleaner areas. Still others could scarcely afford anything. In a prolonged nuclear disaster, the matter at hand is not only the radioactive material itself, but also its construction as social facts, knowledge, and public feelings (see for example, Morris-Suzuki 2014; Hecht 2012; Masco 2008), all bearing on the actual lives of ordinary people.

Without doubt, living in the ruins of nuclear risk is a demoralizing situation for all the parents involved. Operating within the discursive domain of “family’s choice,” familial norms—specifically the injunction that parents should protect children until adulthood (Allison 2013; Borovoy 2005; cf. Doi 1973)—fail to provide actionable options when clearly the most effective way to protect children is to relocate to a risk-free elsewhere. Because they could not do this, the parents I encountered felt stuck and immobilized in the face of unavoidable risk, both physically and socially, and were struggling to raise children with limited resources outside the officially designated evacuation zone. In such moral struggles, “striking a balance” (baransu o toru, or oriai o tsukeru), to keep living, was a phrase I heard time and again in interviews and conversations, as a practical way to live through unwanted nuclear risks.

Photograph of a child trying to catch an ant.
Image description: A photograph showing a small child’s arm extended, reaching down to the paved ground with finger and thumb extended in an attempt to capture an ant crawling on the ground.
Caption: A three-year-old girl trying to catch an ant when allowed to play on the ground during a retreat for families from nuclear-affected areas. Jieun Cho

Like hundreds of thousands of others, Kazumi fled to the home of a relative in another city in Fukushima Prefecture after the disaster. As revealed by data that had been published over the following months, both her home and that of her relatives were exposed to the fallouts of radioactive iodine, which was recognized as the cause of childhood thyroid cancers after the Chernobyl disaster by the In