Research Internship In Airlangga University(Indonesia)

Kobe University School of Medicine Faculty of Health Sciences
Sadakuni Mami

[My main study]
I have attended the program of Re-Inventing Japan Project, and I have studied in theInstitute of Tropical Disease(ITD), Airlangga University, Surabaya, Indonesia between
28 July and 23 August. I visited Indonesia to detect the CREs (Carbapenem-Resistant
Entetobacteriaceae) and to decide the gene type of CRE.
CREs are drug-resistant bacteria which are taken up as a subject for discussion allover the world now. In Japan, the law of infectious diseases was revised in 2014, and theinfectious disease related to CREs came to be known as one of the dangerous infectious
diseases. The genus Esherichia like Esherichia coli (E.coli), the genus Klebsiella like

Klebsilla pneumoniae (K. pneumoniae), the genus Serratia, the genus Shigella, thegenus Salmonella and so on belong to the family Enterobacteriaceae. There are many
antibacterial agents in the world, but bacteria have shown resistance against the drugs
in several ways. One of the drug-resistant mechanisms is production of β-lactamase.
β-lactamase is a breakdown enzyme, and it breaks up the antibacterial agents which
can block composition of the bacterium`s cell wall. Carbapenemase is a kind of the β-lactamase, and it can show resistance not only carbapenem antibiotic(Imipenem,Meropenem etc) but also other β-lactam antibiotic(penicillin, cephem antibiotic etc).
CREs have carbapenemase, so many medicine do not work for them and they are paid
attention all over the world.

Picture 1. The classification of β-lactamaseI have studied CREs at the Gastroenteritis/Salmonellosis Laboratory in AirlanggaUniversity. I have used urine and stools sent from Sutomo hospital or those stored in
the University. In the laboratory, I experienced the gram stain and cultured in theseveral test medium to isolate the bacteria or to judge species of bacteria. After that, I
performed drug susceptibility using some drug disks. I actually used 2 stool samples
and 4 urine samples, but I could not find Enterobacteriaceae. I found only

Staphylococcus aureus.
There were 29 strains isolated as carbapenem resistant E. coli or K. pneumoniae in thelaboratory. So I also tried to perform the DNA extraction from all strains and to decide
the gene type of them. I was able to extract the DNA from all strains, but I used 5 stains
and did PCR by using 2 kinds of primers (for IMP1, KPC) because a PCR machine had
broken down or there were different reagents from ones which I had used in Japan andbecause of lack of samples. When I used primers for IMP1, I could not decide the genetype because I was not able to extract the positive control. Using primers for KPC, I was
not able to find the same type as positive control.

Picture 2. In the laboratory

Picture 3.the result of PCR (for KPC)

[Others]
・Experience in Avian Influenza Laboratory
ITD studies many diseases. There are some laboratories which connect with Kobe
University and there are Japanese teachers in some laboratories. In Avian Influenza
Laboratory, there are 2 Japanese teachers. I had a tour of the laboratory in the researchfacility for a day, on 18 August. I learned the real-time PCR, and I actually looked at thechart of PCR. I also helped them with Hemagglutination (HA) test or Hemagglutination
inhibition (HI) test and observed the results. They performed HA test to check the titerof the flu virus, and did HI test to research titer of the antigens against flu virus. I wasalso able to enter the biosafety lebel (BSL) 3 room where the members of the laboratory
have used dangerous virus like H5N1-avian influenza virus. There was a front room infront of main room, and double-entry doors which I could not open both from inner sideand from outer side. When they did something there, they had to wear protective
clothing. I was surprised at the nice facilities.

・A tour of Sutomo hospital
Sutomo hospital is located in Surabaya, Indonesia to the east of Java. It is a statehospital and has about 1500 beds .It is the largest hospital in Surabaya. It cooperates
with Airlangga University, and staff of the University examines samples from Sutomo
hospital. I had a tour of the hospital on 5 August. There were some stands in front of theentrance and the hospital had a shop at the center of the entrance of the hospital. Therewere many patients in the entrance. The hospital was larger and kept cleaner than Iexpected it. In Japan there were more male doctors, but there are many women in thehospital. I was surprised at it. There were no air conditioners at corridors of the hospital,and some corridors were not covered with walls. I thought that it was hard for patientsto go along there on a hot day and a rainy day.

・Experiences on holidays or memories in the everyday life
I had dinner with members of the university and we went there by taxi or by bike.
They took me to the karaoke. I went shopping mall near the University to do shopping
and to eat lunch or dinner on holidays. I also went to the zoo in Maran with ITD`smembers and saw the sights of Surabaya by sightseeing bus. I had a lot of experiences
as well as study about bacteria in Indonesia. In Japan, I had never ridden a moped
motorcycle. There were many people who rode a moped motorcycle in two or more inIndonesia and I was able to really experience 2-crew.In Surabaya, most people havebelieved in Islam, so I did not eat pork. I often ate chicken, turkey, beef and seafood. I
usually went lunch or dinner with Indonesian. They taught me the food and I had ameal while enjoying conversation.

Picture 4. Nasi Gudeg

Picture 5. A one day tour bas in Surabaya[Conclusion]
Through this studying abroad program, it was most difficult thing for me tocommunicate with Indonesian. In the days of the beginning, I could not hear the content
that the partner said and it was hard for me to say technical terms in English because I
knew only easy words. When I was asked to translate a manual written in Japanese
into English, I made a great effort while remembering the word that I knew. Almost all
the people spoke Indonesian language at the place except the university, so I could
hardly understand what they said. If I go to Indonesia again, it may be important tolearn Indonesian language before I go there. Through this studying abroad program, I
could improve abilities to listen or to speak English and got stronger mentally as well as
could gain knowledge of the research field.
I had never been abroad by myself, and had never been to Indonesia, which were adeveloping country. I was afraid whether I could spend a month there. However,Indonesian people were peaceful and very kind, so I could have many pleasant andprecious experiences there. One month passed in an instant. My study did not advanceas expected because of brief period, different facilities and reagent. I am going tocontinue a similar study in the graduate school and want to make good use of thisexperience.
Finally, this program made me grow and I could have many precious experiences. I
thanks for that I was able to have such an opportunity. I want to make this experienceuseful for my work in the future.

Picture 6. With teacher (center) and staff (lower left) of the Laboratory and students
from other university in Surabaya (right 3persons)Thanks for everyone concerned of Airlangga University and Kobe University, andeveryone who supported me for this program.