He was a celebrity in international development circles, and the most famous person I have ever met. But he was virtually unknown in the country in the mid-1980s, and so there was no special treatment when I toured him around several hospitals, health centers and rural villages in Leyte and Biliran during his four visits in three years here.

He came to observe the community-based training activities of the School of Health Sciences (SHS), the distant unit of U.P. Manila based in Palo, Leyte, and to establish linkages between the SHS and some Japanese universities.

The country finally took notice of Dr. Noboru Iwamura after he was declared winner of the 1993 Ramon Magsaysay Award for International Understanding. Some national newspapers and magazines at the time featured articles that offered glimpses of the work and accomplishments of this humble man who had spent 18 years of his life as a Christian missionary doctor in Nepal.

But many Japanese had always viewed Dr. Iwamura as a folk hero. And so when he died at age 78 in a Hyogo Prefecture hospital last Nov. 27, the event was noted and featured by Kyodo News and other Japanese newspapers.

Iwamura was an 18-year old engineering student when the first atomic bomb exploded over Hiroshima, Japan, in the morning of August 6, 1945. He was then performing some experiment at his university’s laboratory about 1.2 kms. away from ground zero. It took three days for rescue workers to retrieve him alive from under concrete rubble and debris. He was the only survivor in a class of 80 members.

This experience firmed up in Iwamura the resolve to become a doctor and to lead a life of service for others. After he had sufficiently recovered, he took the preparatory biology course at a different college, which he completed in 1950, and then pursued the medical course at Tottori University School of Medicine in Japan’s southern Honshu Island. In 1958, he joined its faculty as associate professor.

Iwamura got married to Fumiko Kadowaki in 1954 while still a medical student. They met in the same non-denominational church where, as a social work graduate, she devoted time to help local orphans and many women widowed by World War II who were struggling to raise families of their own.

Iwamura had always wished to practice medicine somewhere off the beaten track - in a remote, doctorless area. Thus he prepared himself for public health rather than hospital-based practice.

In 1960, he volunteered to go abroad with the Japan Overseas Christian Cooperative Society (JOCCS). With his wife, he would spend the next 18 years in Nepal, the world’s only surviving Hindu kingdom north of India.

Nepal at the time was hardly the Shangri-La mythologized by James Hilton in “Lost Horizon.” The country was almost completely bereft of roads. Its nine million people were scattered across its forbidding mountainous terrain, clustered in thousands of small villages and fragmented into castes and ethnic groups. Only 6 percent of the population could read and write and there were less than 200 doctors in the entire country.

Iwamura was assigned to a post in Tanzing, the administrative center of Palpa District about 130 kms. west of Kathmandu, where a small mission hospital was the only facility with modern medicine for hundreds of kilometers around.

At Shanabhawn Hospital, named after the family that donated the land, Iwamura managed the tuberculosis (TB) clinic and a 50-bed TB ward. He was soon examining 40 to 50 patients a day in his clinic. He found out that many of his patients were too sick to be treated effectively, and his hospital ward was constantly overflowing.

To cope with the demand, Iwamura devised a system that he called “teaching treatment.” The patients were permitted to remain in the TB ward for only six months, where they were treated and taught how to medicate themselves when they left the hospital and to monitor their symptoms.

This system relieved some pressure on the TB ward and allowed Iwamura to deal with the disease among the affected population around his district. He experimented with a system to extend basic health awareness into the villages themselves.

Iwamura began with a simple outreach program to benefit the 150,000 population of the district. Together with his TB team, he climbed mountains, forded rivers and streams, and slept under the trees to reach out to the remote villages.

Traveling around with a portable x-ray machine strapped to the back of a horse, Iwamura and his team often lived for extended periods in many villages. In the process, the doctor treated a wide range of illnesses using supplies from his medical kit. He also instructed his hosts on basic sanitation, including the construction and use of toilets and the improvement of the village water supply and drainage systems.

As part of the effort to improve health habits, Iwamura recruited individuals to serve as village health workers. In a conservative culture, he looked for clever men who were already respected by their neighbors. He also recruited traditional healers and herbalists who made excellent village “doctors.”

Iwamura developed his human network one village at a time. In training sessions for village health workers, he taught them to treat wounds and common ailments and to assess conditions that required the services of a real doctor. They also learned to make use of locally available herbal medicines and assisted Iwamura in medical procedures when he made the rounds in the villages.

Over many years, the network of village health workers was expanded to more than 50 outlying villages in the district, some of them as far as five days’ walk from Tanzing. Through this network, Iwamura also introduced poverty alleviation measures such as livelihood projects and cooperatives, knowing fully well that he could not control TB through purely medical measures alone.

It was during one outreach trip that Iwamura was struck by the greatest insight of his life in Nepal.

One day, far off in the mountains, Iwamura and his team came across an old woman who had collapsed on the roadside from illness and exhaustion. Suddenly, a Nepali porter appeared out of nowhere and volunteered to carry the sick woman on his back for three days, crossing three mountains all the way to the mission hospital.

Iwamura offered the man money as thanks for his kindness in carrying the woman such a long way. But the man refused and said, “No, no! I do not need any money. I was just happy to share the youth and strength I have been blessed with to help the old woman. After all, it was only three short days out of the long journey of my life. And anyway, life means sharing. One cannot live alone in the world. We can only live with the help of each other.”

The man left without accepting the money. He was a poor and unschooled Nepali, a man of the common people.

Fear of the effects of the A-bomb influenced the Iwamura couple to decide not to have children of their own. Instead they established a small home for orphans, an integral part of their household in Tanzing.

The Iwamuras eventually accepted 12 Nepali children, six boys and six girls, who had lost their parents to TB and other diseases. The daily burden of raising the children primarily fell on Fumiko, whom Iwamura fondly called his “home minister,” since he spent so much time in the hinterlands.

The children are all grown-ups now, with families and viable occupations. Some of the girls attended college and became nurses and community development workers. All are in Nepal, except for two girls that the Iwamuras had legally adopted and took with them home to Japan.

Iwamura chronicled his and Fumiko’s life and work in Tanzing in three books. “A Hospital in a Mountain” came first in 1965 and was followed by “Blue Sky in Nepal” in 1975 and “A Message from the Himalayas to Japan” in 1976.

In 1978, the government of Nepal reassigned Iwamura to Kathmandu and asked him to expand his public health initiatives to other areas and to train Nepali doctors to do the work that he was doing. It was goodbye to Tanzing as the Iwamuras and the 12 children moved to the capital.

Iwamura’s efforts to recruit Nepali doctors to the cause of rural public health met with less success. Most of them came from the country’s elite and preferred the lucrative practice in the capital.

But he found a dedicated convert in Firman Shah, the headmaster of Kathmandu School, who left his position and went to India to attend medical school. When he returned as a doctor, Shah joined forces with Iwamura in promoting rural health.

Although he had survived the A-bomb, Iwamura suffered from its effects afterwards. He developed symptoms of leukemia, a disease of the blood that would plague him for the rest of his life. After a particularly alarming episode in 1980, the medical officer of JOCCS concluded that Iwamura could no longer live safely in Nepal. He was evacuated to Japan, where the doctors treated and stabilized his condition.

Back home, Iwamura accepted a professorship at Kobe University School of Medicine, where he was affiliated with its International Center for Medical Research (ICMR) for five years. He taught epidemiology at the university and also traveled widely throughout the developing world, often in connection with World Health Organization projects or fact-finding missions.

It was during these trips that Iwamura visited me in Leyte. On his third visit in 1985, he accompanied a dozen students from two Japanese universities who came for a few days’ live-in exposure with SHS medical students in their laboratory villages.

Although Iwamura joined only the first group, I have facilitated study tours for Japanese university students almost every year since then.

Iwamura’s work in Nepal was recognized by the outside world since its early years.

In 1962, Dr. Ronald W. O’Connor was a medical student who worked in Nepal as a volunteer for a health project. His meeting with Iwamura changed his outlook on life; he found a new model of a doctor who went beyond the traditional role of providing medical treatment.

After returning to the US, he felt that he needed to know more about management theories and tools to work more effectively in projects for public health and medical cooperation in developing countries.

In 1971, O’Connor established the Management Sciences for Health (MSH), a private non-profit organization to realize the spirit he saw in Iwamura: to provide technical assistance in public health management for developing countries. With him as chief executive officer, the MSH has invested millions of dollars on more than 100 projects of various sizes in all parts of the world, including the Philippines.

Iwamura was always a member of the MSH board as honorary director.

In 1981, Iwamura received the first Rotary International Award for World Understanding for his work in Nepal. Subsequent recipients of this award included Pope John Paul II, the International Committee of the Red Cross, Czech Pres. Vaclav Havel, former US Pres. Jimmy Carter, and South African Pres. Nelson Mandela.

The 1993 Ramon Magsaysay Award for International Understanding capped the numerous awards that Iwamura had received from various bodies. He was cited “for heeding the call of the true physician in a lifetime of service to Japan’s Asian neighbors.”

In 2001, Rotary Districts 2640 and 2680 in Japan provided financing for the construction of the Dr. Iwamura Memorial Hospital and Research Center in Bhaktapur, Nepal. Established to continue the work of Iwamura, this hospital provides general medical and surgical services especially in cardiology, nephrology, gastrology and neurology.

The hospital is chaired by Purnima Gurung, a nurse who is the oldest of the Iwamuras’ adopted Nepali children.

In the end, Iwamura also had his body shared with others in death, as he did with his life.

After a private funeral service attended only by close relatives last Nov. 29, Iwamura’s body was donated to a medical school for use in anatomy classes or scientific research.

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