Padjadjaran University, Bandung, Indonesia

Exchange program

2015/9/14 – 2015/10/10

6th year (final year) medical student of Kobe UniversityNobuyasu Ikai

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Introduction
Padjadjaran University locates in Bandung city, Indonesia. As exchange
students, we performed clinical clerkship at two hospitals and one clinic thatare related to the university.
-Hasan Sadikin Hospital …tertiary hospital of 2000 beds.

-Ujungberung Hospital … secondary hospital of 200 beds.

-Klinik Padjadjaran …primary clinic of 8 beds.

Hasan Sadikin HospitalIn this tertiary hospital (cover photo, photos 1-3) for two weeks, weperformed clinical clerkship at general internal medicine, Emergency unit,
infectious disease and Rheumatology. Exchange students from Holland also
did clerkship at the same period (photo 4). We met a 27 years old woman who
has thalassemia with hepatomegaly, splenomegaly and short stature. Her
height seems less than 140 cm due to developmental disability. At HIV
outpatient room, we saw a mother who suffers HIV but not checked herchildren yet because of shortage of money. We also studied how to treat apatient who has complication of HIV and tuberculosis.

Photo 1. Emergency Unit.

Photo 2. Paper chart is mainly used to record
medical information.

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Photo 3. An X ray film checked by a doctor atmorning round.

Photo 4. From left, I, Megumi Sato (aclassmate of mine at Kobe University), andtwofemale
medicalstudents
fromNetherlands.

Dr. Laniyati (photo 5), a rheumatologist, kindly taught me a lot aboutcollagen diseases such as systemic lupus erythematosus (SLE, photo 6),
scleroderma or rheumatoid arthritis. For SLE, anti-malarial drugchloroquine is used in Indonesia. To remember criteria for SLE, DOPAMINERASH is used. D=Discoid lupus, O=oral ulcers, P=photosensitivity,
A=arthritis, M=malar rash, I=immunologic criteria, N=neurologic changes,
E= ESR, R=renal, A=ANA, S=serositis, H=Hematologic.

Photo 5. Dr.Laniyati, a rheumatologist.

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Photo 6. A book ‘‘HOPE for the
Butterflies; Living well with Lupus’’
written by Dr.Laniyati.

Ujungberung HospitalIn this secondary hospital (photo 7) for one week, together with medical
students (they are called Koas) of Padjadjaran University, we performed
bed-side learning for hospitalized patient in internal medicine ward. Because
Koas should do night shift eight times per month as obligation, they are very
good at taking physical examination such as shifting dullness for ascites orvocal fremitus for pneumonia. At vocal fremitus, patients say ‘’tujuh puluh
tujuh’’ (Indonesian word which means seventy-seven). In Japan ‘’hito-tsu’’(Japanese word which means one) is pronounced to detect the spoken voice ofthe chest wall. It was interesting for me because numbers are spoken in
vocal fremitus in both countries. We also observed patients with leptospirosis
or Djenkol poisoning (photo 8).

Photo 7. Ujungberung Hospital (a secondary hospital)
that locates 1hr by car from Hasan Sadikin Hospital.
Photo 8. Djengkol, a bean in Indonesia,
contains Djengkolic acid which causes
poisoning when eaten a lot. Its taste issimilar to ginkgo nut (Gin-nan inJapanese).

4Klinik Padjadjaran
In this clinic (photo 9) for one week, we observed general outpatient andvisited patient’s home. In outpatient, we saw tropical diseases such asdengue fever or typhoid fever. For diarrhea under 18 years old, zinc tablet inaddition to oral rehydration solution are prescribed. Because zinc could
reduce the number of diarrhea, government encourages the use of zinc. Zinc
is not used in japan for diarrhea, so I was surprised. With a doctor of theclinic, we visited the patient’s home. Doctor checked the hygiene of the house(photo 10) and encouraged the use of soap for washing hands or dishes toprevent further infectious disease.

Photo 9. Klinik Padjadjaran. Padjadjaran clinic thatlocates 1hr by car from Hasan Sadikin Hospital.

Photo 10. Home visit of a patient’s house with adoctor of Klinik Padjadjaran. Doctor checked thehygiene of a home.

Foods and people
Indonesian foods such as Nasi goreng or Mie goreng and so on (photos11-14) are very good. Tropical fruits such as Mango, Dragon fruits or Coconut
are cheaper than in Japan (photos 15-16). We Japanese students talked
about research and lifestyle in Japan to the students of Padjadjaran
University (photo 17). I feel so happy to eat lunch and dinner with medicalstudents (photos 18-21).

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Photo 11. Mie goreng (Indonesian fried noodle).
Photo 12. Nasi goreng (right, Indonesian fried rice),
Sate ayam (lower, stickroast chicken).

Photo 14. Lunch at a buffet restaurant. It costs 13000
IDR (=110 JPY)

Photo 13. Omelette (left), Sambal (upper, Indonesianchili sauce), Tempe (lower, soy bean food) and Tafu
(lower, tofu). This lunch costs 14000 IDR (=120JPY). IDR : Indonesia rupiah, JPY : Japanese yen, 1
JPY = 118 IDR, 1000 IDR = 8.3 JPY.

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Photo 15. Tropical fruits such as Mango, Dragon
fruit etc.

Photo 16. Coconut.

Photo 17. In front of students of Padjadjaran university, we talked about researchand lifestyle of Japanese medical students.

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Photo 18. Lunch at a restaurant near Hasan Sadikin
Hospital with Koas (medical students in Indonesia).

Photo 19. Lunch with Koas in Hasan Sadikin
Hospital.

Photo 20. At a party, we Japanese students cooked Photo 21. Dinner at a restaurant in a shopping male
tempura and Indonesian students cooked ordinary with Koas.
Indonesian food.

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Daily life and climate
During our stay in Bandung for one month, we lived in a guest house (SangSurya guest house; photo 22) that locates near (3 minutes walk) from Hasan
Sadikin hospital. My room is about 10 square meters and contains free wifi
(fast enough to watch movies), air conditioner, shower and toilette. There is arefrigerator in a common room.

Clothes are washed and dried within 10hours by the staff of the guest house. A convenience store is in the samebuilding. There are several shopping males (Ciwalk, PVJ etc) near (15minutes walk) from it. Angkot, a regular passenger bus, is available to movearound the city (photo 23).
Bandung is cool. Temperature in Bandung on September is almost the sameas that in Kobe on September. It is about 18 degrees Celsius at night and 28
at noon. Because September and October are the end of dry season, it rained
only 3 times during our stay of one month.

Photo 23. Angkot, a regular passenger bus, thatcosts 3000 IDR (=25 JPY) for each ride.
Photo 22. The guest house I lived in for 4 weeks.

9Holiday
On holidays, we visited lots of sightseeing spots in and around Bandung,
including Angklung Udjo, Tangkuban Perahu, rafting, Luwak coffee, Taman
Safari and Batik shop (photos 24-30).

Photo 24. Angklung Udjo. Children sing withAngklung, a musical instrument made by bamboo.
This museum was made by Udjo in 1966.

Photo 25. Tangkuban Perahu, an active volcano
near Bandung.

Photo 27. Luwak coffee plantation (coffee
bean digested by an cat called Luwak). Kopi
means coffee in Indonesia.
Photo 26. Rafting on a river.

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Photo 29. Sumatran tiger at Taman
Safari.
Photo 28. Elephant ride at a zoo Taman
Safari.

Photo 31. Dr.Atik very kindly
arranged our schedule in Bandung.
Photo 30. Batik shop. Batik is a cloth made by atechnique of wax-resist dyeing.

Acknowledgement
I would like to thank all the people I met in Bandung, especially students
and doctors. I want to thank Dr.Atik (photo 31) for arranging the schedule ofour clerkship. This exchange program is supported by Ministry of Education,Culture, Sports, Science and Technology (MEXT), Japan. I also appreciateProf. Takayoshi Kuno and Prof. Tomoo Itoh of Kobe University for their help.
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