Saving Vulnerable & Marginalized Populations with Real-World Innovations in Health Care

- Your company Carepro was founded on two pillars: preventive medicine and home care. Each has attracted plenty of attention, challenging common sense and even changing the law, but you had been thinking about entrepreneurship from an early age, is that right?

Yes, I first started thinking about becoming an entrepreneur the year I entered high school. My father had just been laid off after the collapse of Japan's bubble economy in the early 1990s. It was shocking, and I realized that even if I managed to land a stable position at a big company, I would never have job security. It created a sense of risk where I knew I had to become someone who could create work for themselves. I would always tell my classmates about how I would go on to start a company someday. That's how I ended up with the nickname "CEO." [laughs]

- So how did that lead to you studying at the Faculty of Nursing and Medical Care?

I'm a third-generation Nagasaki atomic bomb survivor, which may be why I've been interested in medical care since I was little. When I was in kindergarten, I was hospitalized to remove polyps in my throat. That was when I learned that some children in the hospital had intractable diseases and would never be able to leave. It broke my heart and is something that has stuck with me to this day. I began to envision a type of medical care where people could lead better lives with chronic illness. This is reflected in our slogan, "From cure to care."

- You could just as easily have studied at the School of Medicine.

True. One turning point that led to my current career came in high school. My mother was working as a caregiver to the elderly at the time, and I found an opportunity volunteering at a nursing home. The first thing I noticed when I stepped inside the nursing home was an awful stench. The home was severely understaffed, with only a small staff to take care of a whole home of elderly people, so they couldn't give everyone the care that they needed. I began having my doubts in the system as I volunteered in such a poorly run environment. I realized that only management reform could improve this terrible situation for both the staff and elderly alike. I decided that I wanted to start my own business to solve the problems that face medicine and healthcare. That's why I chose to study at the Faculty of Nursing and Medical Care. SFC had this image of entrepreneurs and start-ups, and I was lucky enough to be among its first cohort of students, so we were given free rein to build a new legacy for the faculty.

- What was life like as a student at the Faculty of Nursing and Medical Care?

In my first year, we learned the basics of nursing and medical care. Still, I wanted to experience real medicine as soon as possible, so I started working part-time as a nursing assistant at Keio University Hospital during summer vacation. Over spring break, I had an internship with a home nursing station, and in my second year, I experienced end-of-life care. I think these hands-on experiences helped me learn a lot about both medical care and management. At the same time, I teamed up with another undergraduate student, who was also interested in entrepreneurship, to contact and meet with prominent entrepreneurs.

- It seems you were already gearing up to start your business in the medical industry by this point.

Well, in my third year, I went to the United States as part of an overseas training program to participate in a clinical nursing course. When visiting the world-famous Mayo Clinic, I saw a walk-in retail clinic for the first time inside a local supermarket. These simple clinics are available at shopping centers and drugstores throughout the US and do not require doctors to be present. Nurses provide medical services that include simple diagnoses and treatments at an affordable price. My experiences in the US informed my idea for a "one-coin check-up," which was the first product I launched after starting my business. But before that, during my senior year and for one year after graduating, I worked at a management consulting firm where I had a crash course in management.

After my time at the management consulting firm, I began working as a nurse in the Department of Diabetes and Metabolic Diseases at The University of Tokyo Hospital. Working there allowed me to talk directly with patients, which ended up being very helpful for future business development. Many patients with severe symptoms remarked that they should have been more attentive to their health and should have undergone medical examinations earlier. Some patients even had to have their feet amputated from gangrene due to complications from diabetes. They expressed regret over going too long without getting health check-ups, saying they would have had their exams had they been more readily available. I felt that Japan needed a medical check-up system similar to the retail clinics I had seen in the US, and I knew that this would become the foundation for the business I would create. So I quit the hospital to establish Carepro in Nakano in December 2007. I began the one-coin check-up service, where users could quickly get tested and receive immediate results for blood sugar levels, triglycerides, cholesterol, liver function, and bone density, among other things—all for 500 yen per item.

Choosing the area of Nakano was a conscious marketing decision on my part. It is said that there are more than 36 million people nationwide who haven't had a medical check-up in the past year. Nakano is a densely populated area of Tokyo where many residents are unemployed housewives, self-employed individuals, and underemployed men in their 20s and 30s. These individuals can often be the most vulnerable, and they were the exact demographics I thought could benefit from this service. At first, people were suspicious of the pricing, and I had a hard time attracting customers. But once I started distributing flyers in front of Nakano Station, the media took notice, and soon I had plenty of people lining up to use my "one-coin check-up."

- So your customers are able to get information about their health without having to go to the hospital.

Well, users take their own blood, so it's not technically considered a medical procedure. And at first, I received some complaints from nearby hospitals. So I went to the medical association and did my best to explain what I was trying to do, and they eventually came around. The doctors and I shared the same desire—to reduce disease. However, at the time, the legality of self-administered tests was ambiguous. So I worked with local legislators and business people to gain the support of the Ministry of Health, Labour and Welfare (MHLW) and bring about legal reform.

- The other pillar of your business, home care, is said to have started with the Great East Japan Earthquake.

Yes, after the earthquake and tsunami, many Carepro nurses and healthcare professionals, myself included, went to the affected areas and worked with local nurses to provide home care for those unable to receive treatment at a medical institution. Working there, I often heard about people who had died alone in shelters or temporary housing. It was painful to hear, and I realized that this was a problem that affected not only these disaster-stricken areas but all of Japan as a hyper-aged society. Especially in big cities, where interaction between neighbors is scarce, the problem of vulnerable people with unmet medical needs, called mitori-nanmin or "nursing refugees," was expected to become more and more serious.

Based on lessons learned from the Great East Japan Earthquake, I started preparing for a home care business in December 2011. That was when I remembered the "Introduction to Nursing" class that I took in my first year at the Faculty of Nursing and Medical Care. Shizuko Muramatsu, a pioneer in Japan's home care industry, visited Keio as a guest speaker, and her lecture left a lasting impact on me. So I took a chance and reached out to Ms. Muramatsu, who graciously agreed to speak with me about my new business. She introduced me to Mr. Rokusuke Ei, who was suffering from Parkinson's disease at the time. Though he has since passed away, I served as his attending nurse, visiting his home and workplace, which taught me a lot about the home care industry.

- What is your vision for the visiting nursing station?

It is said that in 2020 there are now 300,000 of these nursing refugees in Japan. Our mission is to save as many of them as possible. We currently have two visiting nursing stations in Nakano and Adachi, staffed with about 20 people each, who respond to our users' needs 24 hours a day, 365 days a year. Few places in Japan offer 24/7 service, and training young visiting nurses is essential to maintaining these services. In the past, home visits were considered to be a job for veteran nurses, but I would like to change that preconceived notion. At Carepro, we invest time and money in training new graduates to become visiting nurses. In fact, there are plenty of young nursing students who want to do home visits. Together with St. Luke's International University, I'm now holding a seminar on the theme of training new graduates to become visiting nurses.

This past March, I launched Dococare, Japan's first "traffic medicine" platform, as a new form of home care. Think of it as medicine's answer to Uber. While Uber matches passengers with drivers, Dococare matches the elderly, disabled, and other patients with available nurses and helpers in the area who help them with their daily needs. This can be anything from visiting the hospital, going shopping, or attending an event to simply taking them to enjoy the cherry blossoms or visiting a family grave.

- Could you say a few final words to current students?

I think everyone has things that they like and things they are good at. When I talk to first-year students at the Faculty of Nursing and Medical Care, I tell them to identify the greatest common denominator for what they like and what society needs. It doesn't matter whether your idea is profitable or compatible with the current system. It is crucial to determine whether society really needs it. But whenever you try to change the status quo, there will, of course, be friction. But that is where opportunities lie. Approach those who oppose you and passionately explain to them why you think your idea will work. I also recommend that students listen to other people's success stories. Once you can envision the process of success and feel confident in yourself, you will be one step closer to your dream. I look forward to seeing the next generation of Keio students take on their own challenges.

- Thank you for your time.

Takashi Kawazoe

Takashi Kawazoe graduated from the Faculty of Nursing and Medical Care in 2005. He learned about business while working at a management consulting firm and gained first-hand experience in the medical field as a nurse at The University of Tokyo Hospital. In December 2007, he launched Carepro Co., Ltd. in the Nakano neighborhood of Tokyo. The business initially began as a provider of a "one-coin" preventive medical service that allows users to have a health check for a flat fee of 500 yen and later expanded into home healthcare after providing support to areas affected by the Great East Japan Earthquake in 2011. Seeing potential in the market, Kawazoe began to provide training to early-career visiting nurses in addition to launching Dococare, a service that matches nurses with vulnerable road users, a group that includes the elderly, and the disabled, among others.