Necessity of Toilets for Ostomates

 Many Japanese ostomates are hesitant to leave home and have active lives in the community because they worry about how they will empty their pouches or handle leakage problems should they occur away from home. It is particularly stressful and instills panic to deal with leakage of stool or urine while in public. In a JOA survey, 50% of ostomates reported these helpless feelings.
Therefore, it can be said that the availability of public toilet facilities to meet ostomates' needs is the key to their sense of well-being and rehabilitation in the community.

In this report, the term "Toilet Facilities for Ostomates" will be abbreviated as "Toilets for Ostomates." is a great honor and pleasure to address you as newly elected President of JOA at the opening of JOA Home page.

Installation in Buildings of Local Authorities

 The installation of toilets for ostomates was triggered by the positive action of Mrs. Teruko Murayama, the current Vice-president of JOA and Head of the Chiba Chapter.
Realizing the unique need for toilets to help ostomates trying to solve the above-mentioned problems while away from home, Mrs. Murayama appealed to passers-by on the streets and to the prefecture officials. Fellow ostomates of JOA in her district joined and cooperated with her efforts.

As a result, the first toilet for ostomates was installed in Narashino Prefecture Office in l998.

This accomplishment encouraged similar activities in other JOA branches, and the installation of toilets for ostomates was gradually expanded to various city offices, public halls, and other buildings of local governments in Chiba and other prefectures. JOA reported that installation of 70 of these toilets has been achieved with an additional 120 under planning or under application by the middle of 2000.

Though these installations are not numerous enough to cover entire areas where ostomates often frequent, they stimulate the establishment of additional installations in private buildings, and further arouse public awareness of an ostomate's unique needs.

Installation at Transportation Terminals

The Japanese Government enacted the "Transportation Barrier Free Law" in April 2000, aimed at creating a smoother and more comfortable transportation system for the aged and disabled. The specifications for toilets for disabled persons were also revised under this law. It is the first time that the requirements of ostomates were incorporated into law as a result of discussions within the planning committee of MLIT (the Ministry of Land, Infrastructure and Transportation). Additionally, signage (a pictograph) was developed to indicate the presence of special toilet facilities for ostomates to be displayed at the entrance of each toilet room.

In line with this legislative movement, JR (the Japan Railways-former National Railways) installed prototype toilets at 3 major stations in the Tokyo area in September 2000 that were open for ostomates' use. Collection and analysis of ostomates' opinions in the field are ongoing and will be reflected in future installations.

Toilets at transportation terminals need to cope with heavy and complicated use (for instance, frequent use by people of various ages and medical needs), space restrictions, and severe cost requirements to make wide and numerous distributions feasible.
On the other hand, it is believed that the establishment of the toilets over most transportation terminals will greatly contribute to the active lives of ostomates.

This trial is being extended to the private railways and trial installations are already in place at some stations in major cities.

Examples

Ex.1: Installation in a City Office - full functional type (Fig.1 and 2)
Facilities and equipment needed by ostomates in a variety of situations are assumed and arranged in a spacious room.
Note that a) and c) are facilities for general use. Also, toilet paper holders are installed at arm's
length of a), b) and d).

(Fig.2)	(Fig.1)

a) Toilet
b) Small-sized sink with a warm water nozzle (for discarding stool in the pouch and washing in an upright position)
c) Wash stand
d) Medium-sized sink with a mirror and a hand held warm water shower (for washing or changing the wafer, and for rinsing and cleaning the peristomal skin)
e) Large and deep sink (for washing soiled clothes, etc.)

This prototype has an additional objective to study the trade-off between cost and the needed function to determine the most practical and optimal design.

Ex.2: Installation at a JR station - simplest type (Fig.3)
In this design, the facility b) in Ex.1 was combined with a) as a water nozzle fixed to a).
This installation was planned as a prototype to begin from the minimum function provided by modifying the existing facilities to eventually reach the practical optimum for distribution throughout the country.

(Fig.3)	(Fig.4)

Ex.3: Installation at a hotel - intermediate type (Fig.4)
This toilet has already been put to practical use by ostomates registered as hotel guests. It has facilities a) to d) mentioned above and is an intermediate design between Ex.1 and Ex.2.

The primary difference of Ex.3 from the two preceding examples is the way b) and a) are combined. In this set up, a warm water nozzle b) is pulled out from its stored position (see figure) and hung in front of the water tank at a suitable height to facilitate washing stool out of the pouch. This exemplifies the difference of a trade-off between cost and function on a case-by-case basis.

Basic Requirements for Toilet for Ostomates
(Extracted from the guide line of MLIT previously mentioned)

1) Toilet and Related Facilities
- Toilet or sink with flushing system for discarding stool in the pouch - a) or b) in the above   examples
- Sink with a flushing system for washing soiled pouch - a) or b)
- Warm water shower for washing or changing the wafer, and for rinsing and cleaning the   peristomal skin - d)

2) Accessories - Small container to discard and store soiled things - Hooks or shelves - Large mirror to facilitate fitting a wafer or pouch 3) Environmental arrangement - Powerful ventilation - Signage at the entrance of the toilet room to indicate it is a facility for an ostomate (Fig.5,6)
	(Fig.5)	(Fig.6)

Note for Future Installation

As a result of the installation and use of the toilets for ostomates that are currently in place, the following findings for future installations have been obtained.

1) Consideration for a Variety of Uses
- Ostomates with different types of ostomies have different needs and issues that must be dealt with   on various occasions.
- Basically, toilets for ostomates in Japan are shared with other disabled persons; therefore, their  needs must also be considered (such as securing adequate space for free movement of a wheelchair and height-appropriate access to the equipment etc.)

2) Total Optimization
- In addition to the necessary functions, other factors such as cost, space, mode of usage, and use control must be considered and optimized as a whole.
- The difference in the need for toilets according to the installation site must be considered in buildings of local authorities and at transportation terminals.

3) The ease of using the facilities and equipment must be examined in view of the flow of an ostomate's body movements and various changes of posture required from the start to the end of caring for his problem (such as changing the entire pouching system, standing, sitting, etc).

4) Preparation of the Environment
- Clear instructions on how to use each facility and its equipment
- Control of access to the toilet room. Easy access and use by ostomates is the basic premise, but safeguards against use by unauthorized persons are also important, especially at transportation   terminals.
- Signage indicating the availability of ostomate facilities should be clearly visible at the entrance   of each toilet room.

Conclusion

The installation and practical use of toilets for ostomates in Japan is just beginning, and we are in the process of trial and error to establish an optimum facility. To attain this goal, ostomates must be responsible for cooperating with the related authorities, owner organizations, and facility developers on all stages from planning to use and improvement.

It is expected that with increased availability of toilets for ostomates throughout the country, the rehabilitation of ostomates into the community will be accelerated, providing a better Quality of　Life for Japanese ostomates.
It is also hoped that through this initiative, public awareness of ostomates' problems will be enhanced. The pictograph illustrated in Fig.5 is expected to be a mediator for this purpose as is the case of wheelchair signage.

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