Report" What I learned in BKKM “In Facultas Kedokteran Universitas Airlangga

7th April 2014 ~2nd April 2014

Maho Sugimoto
Kobe University Faculty of Medicine 6th grade
1Contents
1. What is different from my country
・Program of training in rural area……………………3・About PHBS………………………………………….………3
・Health Care for Children……………………….…….…4
・Contribution to the community………………………4

2. Impressions
・Impression about lecturers……………………………5・Impression about my team……………………………5・Impression about Puskesmas…………………..……6・Impression about people in rural area…………….62

1. What is different from my country
・Program of training in rural area
I am interested in this program itself. In Japan, there is no program towork in rural area before graduation, and we learned less about publichealth centers in Japan, we call them "Hokenjo". After graduation fromuniversity, there is a training program in rural area, but the work place is
not in Hokenjo but in some hospitals. So we have no chance to work in"Hokenjo", and also we don't learn about it so much in university, thusactually I have little knowledge about it. So this program is new goodexperience to learn public health care for me.
Hokenjo does the health check-up for pregnant women, children and oldpeople, controls the infectious diseases or food poisoning, and maintains thesanitation of the community, so what they do seems to be the same as
Puskesmas. But in Japan sanitational condition is already in high level andinfectious disease is not severe problem in rural area, so what they do isdifferent from what Puskesmas does.
I think this program is good to educate medical students. That is
because all medical students can work as doctors in Puskesmas, that is,they do history taking, do medical examinations and give prescription to thepatient all by themselves. At first I was very surprised at this. That's why inJapan, we cannot do anything to patients, just looking, because doing
something to the patient is not allowed by medical law for 5th gradestudents. So the training in university hospital during 5th grade is only
looking, so it is boring. I became 6th grade in this April, so I was allowed to
do a few things to patients, but skills that we can do are still limited. Also
some patients don't want to be treated by students and sometimes theycomplain and refuse. But in Puskesmas, the patient trusts the medical
student and never complains or refuses. This is the most importantdifference between Japan and Indonesia, I think.

・About PHBS
From the lectures, I learned that there are some people who believe not
medicine but spirit. In Japan I have never seen any people like that, so I
was very surprised. In history taking in Japan, we never ask health belief.
So when some teacher asked me patient's health belief, I can't understandwhat it meant at first.
Also from the lectures, I learned that some people in Indonesia don't
know what behavior makes them suffer from diseases and what behavior
contributes to health development. Then I learned PHBS. It is very easy tounderstand for all people from young children to elderly people, and easy to3do in daily life. The most important merit is that this indicator needs nomoney.
Once I suggested the staffs should use mask more often in Puskesmas,
the teacher said that there is a problem about cost. I suggested, becausethroughout the work in Puskesmas I felt medical staffs in Indonesia shouldcare more about standard precaution. But thanks to the teacher's comment,
I understand the matter of medical cost in Indonesia.

・Health Care for Children
Throughout the lecture and working in Puskesmas, I learned much about
health care of children in Indonesia. I have learned pediatrics in Kobe
University, but there is much difference between what I learned in Japanand that in Indonesia. In Japan, we learned less about Infection than inIndonesia. Of course, there are some infectious disease in Japan, but thattheme is not so much emphasized in medical education, just only a part ofpediatrics. But in Indonesia there are more infectious diseases than inJapan, and sometimes the distance is so far to go to high level hospitals, so I
heard that sometimes "time" kills children. I understand that's why there isa special system like MTBS. In Japan there is no special system like that.
This lists is very educational for me, because it is easy to judge thechildren's condition comprehensively.
In one day, I went to Posyandu and see what it is. I saw not only
vaccination or health consultation about their children, but also good
relationships among the community. In Japan some people have nevertalked with neighbors. And there is no system like RT or Kadre. I felt that
this system contributes to the good relationships in the community.

・Contribution to the community
People in Japan are eager to learn about their health. So they have someknowledge about diseases. I think almost all Japanese know the common
disease like DM, hypertention, hyperlipidemia and so on. And because of
their knowledge they want more high quality therapy to the hospital anddoctors. I think that's why they refuse to be cured by students. People study
by watching news or TV programs for health promotion, or reading
newspaper. And all children are educated by schools.
In Sidoarjo I was very surprised because there are many people who
don't know TBC paru. In Japan almost all people know tuberculosis because
many people died with tuberculosis in the past time in Japan.
In this program, students not only work in Puskesmas but also do healthdevelopment programs with communities. I felt interested in the way of4

solving problems. We don't just educate people but discuss about theproblem with communities, so that means, people in communities can join
the health development more actively, not passively. I learnd what is "withcommunities". It is wonderful that medical students contribute tocommunity health, and all of my friends seem to feel sense ofaccomplishment.

2. Impressions
・Impression about lecturers
From 7 April to 11 April, I got many lectures about public health BKKM.
But I didn't know there were many lectures in this week at first, because
secretary in FK UNAIR inform me that my training schedule start from 13April. My flight schedule had already reserved by Kobe University before
this information from secretary, so I asked secretary whether there wereany lecturesfrom 7 April to 11 April or not, but the answer is"Unfortunately, there is no schedule...". So...I almost went to trip to Jakarta
in that week!! Next time, you should inform foreign students that there aresome pre-lectures before the program starts.
By the way, thanks to pre-lectures in English in that week, I could learn
many important things about community medicine in Indonesia. If there is
no lecture like that, it is difficult to understand the public health andcommunity medicine in Indonesia, the role of Puskesmas, or the aim of thistraining program. Also I got lectures after the BKKM program withIndonesian students started, but the lecturers speaked all in Bahasa
Indonesia. So it's hard to know what the lecturers were saying. I thinkforeign students who study in BKKM had better got pre-lectures before theBKKM program will starts.
In the pre-lecture in English, powerpoint in English did the importantrole for me, because it is easier to understand than a lecture with nopowerpoint. We both are not native speakers in English, so we sometimes
pronounse differently from the true pronounciation, and it makes trouble inverbal communication. Thus power point is necessary to educate us.
By the way, thank you for giving me pre-lectures in English. I think ittakes time to translate a Powerpoint into an English version.

・Impression about my teamThey are all kind to me. If I asked them what people said, they werealways happy to translate them into English. So I could learn many things5easily in rural area. For example, in outpatient room in Puskesmas, ofcourse, they take the patient's history in Bahasa Indonesia, and also theconversations are all in Bahasa Indonesia. Sometimes medical staffs inPuskesmas cannot speak English. They are busy doing history taking,making diagnose and giving them prescription, nevertheless, before next
patient coming, they always gave me the summery of the patient. And it's
not only in outpatient room, but also when visiting the house of patient or
during the workshop.
The life in rural area is a little hard for me at first, because I had to livewith no shower, no air comditioner and live with mosquitos, ticks,
cockroach. I have Atopic dry skin and allergic to dust or ticks, so my skin
had been always itchy, and also I had felt some stress to get along until I
became familiar with my team members. But after I got accustomed to life
in rural area, I enjoyed living there, going to the restaurant at lunch, eatingIndonesian foods, studying community medicine and so on.
Thanks to the life with Indonesian students, I learnd more Bahasa
Indonesia than other 3 friends from Japan. And I found that Indonesian
people have different habits from Japanese people, for example Japanesepeople usually take a bath once in a day at night, but Indonesian people
usually take a bath not only once a day and the bath time is in the morningand in the afternoon. And eating style and sleeping style are also different
from me.
In rural area, my friends helped me everywhere and in every time, so I amvery thankful to them. In the near future I want to meet them again, andalso I want them to come to Japan and know Japanese culture or habits.

・Impression about Puskesmas
I already wrote my impression about Puskesmas in the above, so I will
write my impression about staffs in Puskesmas.
Almost all medical staffs in Puskesmas couldn’t speak English, so I
wasn’t able to communicate with them so much. We couldn’t communicate
with each other by using languages, but we could sometimes talk by using
gestures. And I felt that they welcomed me very much, so I could enjoy
studying in Puskesmas. On the last day in Puskesmas, they wanted to takepictures with me eagerly. I thought that it is rare case for exchange students
to come to this community.

・Impression about people in rural area
In Desa Singkalan, there were many animals like cats, chickens, birds,ducks and so on. I liked watching them and it reminded me of the old days6

in Japan. In front of our home, a car that sold cheap sweets came frequently,
and it also reminded me of them. At night, some neighbors came and gave
us some sweets. I felt the people in rural area related each other verystrongly.
In the TB educational Program, I shook hands with many people in
Sidoarjo, and they welcomed me very much. So I liked to go to some eventsin the community every times.
I thought, in the rural area in Indonesia, people have what people inJapan lost. They lived slowly and peacefully, and it made my heart warm. Ilike the city because there are air conditioner, malls and delicious
restaurants. But I also like the countryside because there is warmth, peaceand slow life. In rural area in Japan, almost all young people want to go tothe city and some village have a problem of depoplulation. I think there aresame problems in Indonesia, so I hope this good relationships in thecountryside in Indonesia to protect in the coming generation.

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