Practice Report
Airlangga university
RSUD Dr. Soetomo Hospital Clinical Clerkship
Hiroki Nakamura
6th year, Kobe medical school

hospital, so it was very important to choose
correct entrance to make the destination.

＊	 Overview	 
I joined Clinical Clerkship in RSUD Dr.

Medical staffs can use English but the same

Soetomo Hospital for a month(pediatrics

isn’t true of drivers or ordinary people infor 2 weeks and pediatric surgery for 2Surabaya. They don’t seem to use English asweeks). In pediatrics, morning conferencemuch as people in Bali or Jakarta. For thatis started at 8 followed by lecture or ward

reason, this phrase ”Saya mau ke RSUD

training. And I joined night shift, went toDr.Soetomo” will be helpful. The facility ofsee Puskesmas and Infection of Tropical

Soetomo Hospital is mixed the new one with

Disease in this 2 weeks. In pediatricthe old one. There is not enough waiting

surgery, I joined operation, lecture andsheets for patients or the room isn’tnight shift. The schedule for this one

air-conditioned well. So sometimes patientsmonth is following list.

lie on the corridor to wait for examination.	 

Patients records were written on paper and＊ RSUD Dr. Soetomo Hospital	  Dr. Soetomo Hospital lies in Surabaya,
having a lot of departments and accepting
many patients as the last referral hospital in
the east Jawa. It seems one of the three most
famous teaching hospitals in Indonesia (myfriend told me). The hospital area is fourtimes as large as Kobe university

some beds were in corridor. But university
hospital incampus C is thelatest building.
Some buildings
were built by
support ofCourtyard in Soetomo hospitalJapanese ODA.

Japan such as Dengue fever,Typhoid feverand HIV. Especially in April, transitional＊Pediatrics 40

period from rain season to dry season, there

to 50 medical

is the number of increasing mosquitoes andstudents werethe case of dengue fever is also influenced.

rotating forInterestingly, small fishes were swimming inthree months in

the groove to prevent eggs from hatching out

14 divisions forin the hospital.

each team. I

Dengue fever is one of infection mediated bychose tropicalmosquitoes. It is common in countries arounddivision as thethe equator. The vacctination is being

main. I had tosee patients with

Entrance for pediatrics

developed and if people get dengue fever, themain treatment is symptomatic treatment.

students in that week, but I was needed toOnce symptoms start, it accompanies withread patient records or ask patient infever,pain (headache etc)and rush. Fever will

Indonesian. I only learned some Indonesian

decrease within 7 days but there is the risk togreeting phrase or daily life words and it wasdengue hemorrhagic fever (DHF)in thisnot enough to understand patients.

phase, it is important to observe risk

Fortunately, my friends in that team wassymptoms( abdominal pain, vomiting,very cooperative and they translated whatemphysema, ascities, mucous bleeding,patients say or what is written in patientsthrombocytopenia etc). This risk is higher inrecords for me.In that way , I managed tochildren under 11 years old,patients who hadunderstand it. Students there were excellent.

preceded dengue fever before. The main

Without their help, I would not understandpathology of DHF is caused by plasma

anything and end.

leakage. For that reason, infusion of saline is

There were infection we don’t see often inneeded. This is my own summary about
dengue fever but surprisingly, the chief
doctor explained dengue fever fromepidemiology to treatment orally without
power point or notebooks. That was easy tounderstand I was impressed. That chief gave
us some lectures and I got a chance toprepare and explain Kawasaki disease. In
Indonesia, Kawasaki disease is not as
common as in Japan but she saw somepatients. And it is suspected that it is related

Playground for kids

to infection. After lecture, I searched again,Kawasaki disease has position ofgirl was brought to ER with suspected child

immunological disease in Japan butabuse. If doctor suspected child abuse inaccording to other reference, it says that itIndonesia, it appears that forensic doctors

has relation with infection. It is important

have to see that patient. The system may bethat we should discuss etiology from anotherinfluenced by clinical forensic science. By thepoint of view.

way, medical students has the rotation of	 

forensic department for a month and＊Night shift in pediatrics

experience judicial autopsy. I think it is quite	 different from that of Japan. Our clinicalrotation doesn’t have how to see criminal caseor what judicial autopsy is like.	  On the way to rest area for night duty, I
walked corridor of pediatric word and noticed

WHO text

that mother lied on bed and slept with herkid. I thought parent’s feeling for child may

Entrance of ER

Students here

be common everywhere around world. But

have to work forafter that , I had to fight with more than 5night shift inmosquitoes in the rest area and couldn’t sleep

emergency

department with duty doctors and about 3

well and take the risk of infection into
consideration, finally I got back hotel.

students. And after they finish it, they makepresentation about it and show it to everyone＊Textbook	 

and advising doctor in the morning, called	  1st line medication is sometimes different

morning conference, then they can getfrom that of Japan because of that price or

feedback and share their experience. This is

resistance of antibiotics. They use textbook

close to that of resident (kensyui) in Japan.

made in this university or WHO handbook.

This method is physically and mentally hard
but it is a good occasion of education at the＊Puskesmas

same time. I also joined it and saw patient

Akahige , the leading roll in the movie

with DHF grade3. He doesn’t have apparent“Akahige”, says that there is always poverty

hemorrhage like patient in Dr.Koto but hisand knowledge-less behind disease. As hevital is unstable and his history told us it issays, the disparity of wealth is a big problem

Dengue fever. Duty doctor saidin Indonesia. According to patient’s history,“If you givehim adequate infusion to him , he will bemany of them are referred by puskesmas.

saved. If you know how and do it .” and told

Puskesmas is free-clinic and health center in

us infusion therapy. That was precious.

Indonesia. They provide patients withBecause She teached me seriously.	  And amother-child education, immunization,

friend told me that a man called preman
managed parking. According to dictionary,preman means a rogue, hoodlum. Maybe he isa kind of that man. The story that thispreman acts in Suharto regime can bewatched in the movie ”Out of killing”.
＊Research	 	  I got interested in how much research they
Puskesmasdelivery and ordinary examination. 	 
There are more than 200 patients coming
here and only 3 doctors see them. People inIndonesia can have social insurance but thre
are a lot of people who can’t pay it everymonth. And rate of TB is very high because ofmisunderstanding and knowledge-lesss
immunization. For that reason, there were alot of patients in division of respiratory.
Vaccination rate is specially low in theMadura island. There are also diseases
caused by malnutrition and vitamin
deficiency such as kwashiorkor, spina bifida.
I saw these patients in the word. Hygiene is
not good. For example, even toilet in hospital
is not good. Water tank is in toilet, people
here wash after defecation to use it? I am notsure of that detail.
But keeping waterin tank makes timeto increase

do because there are a lot of tropical diseases
here. Airlangga university has institute oftropical disease. This institute is cooperatingwith Kobe university. They investigated what
serotype is major to use extracted dengue
virus from mosquitoes. This serotyoe change
is related to the number of increasing DHF.
Because patient who had dengue fever got
again different serotype of dengue virus, it
makes the possibility of DHF high. Some
researchers think that cross-reactivity ofantibodies cause it. And they also do research
about the effect of cooper for stopping
mosquitoes eggs hatching. Indonesia has a lotof tropical diseases but they don’t research forimmunization. This research is very
fascinating but it requires financial powerand development skills. Even in our country,
this reason may be one of problems. I thinkbasic science in Indonesia should be invested
more to increase circumstance for talented
persons. 	 

mosquitoes. And
there was a hand
crafted wheel-chair.	  During visiting
Hand crafted wheel-chair puskesmas, myInstitute of Tropical Disease

＊Pediatric surgery

rotation includes night duty and holiday	  I could see

shift, it is close to our resident life.

patients with theUnfortunately?, they don’t have any

early phase ofsalary and have to pay tuition in thishirschsprungrotation. It is very severe.

disease,There are some younger students here

gastroschisis, omphalocele, neuroblastoma,

because Indonesia has grade-skipping

crowzon syndrome, hydrocephalus, analsystem.

malformation. Triad of Hirschsprung disease

They learn clinical medicine and thewas precious. To be honest, technic andsystem see clinical manifestation andequipment for anesthesia are not as good as

physical examination is important.

Japan. In one neuroblastoma surgery,Resources of medicine in Indonesia,

anesthesiologist kept pushing BVM because

equipments for test, is not as enough as

the apparatus of artificial breathing brokethat in Japan. And those are very

down.

expensive. When I take this into

I got chance to see other surgery such as

consideration, I think this system isvascular micro surgery because of shark bite

rational and reasonable. Meanwhile, ourreferred from Papua.

country has many equipments such as

In night duty, I saw a lot of patients withCT and MRI.

trauma. There are always accidents of motor
cycles in Surabaya. I did suture in this time

＊Life and culture in Surabaya

overseas. That was the first time and I got aSurabaya is provincial capital of east jawa

little bit nervous.

and the second largest economic city.
(people here are proud of it) Before I get
there, I searched on web or read somebooks about Indonesia, I found that theemblem of Airlangga university is the god

Entrance of surgery＊	 Educational system	  Students here have lectures for 4 years
and clinical rotation for 2 years. After that,they work as a training doctor and will bea resident to have specialty. But clinicalCityscape of Surabaya

carrying a water jar, Garuda. This god is

tunjungana plaza providing Japanesevery popular because it is used in not only

price and has SOGO, a neat shopping mall.

the name of Garuda airline, but alsoThis town has a lot of trees, mosquitoes

enshrined at Sanjusangendo as Karura.

and ants. We can’t stop seeing ants inThis god is seen in Kitaro, Japanese

your room. The gap between high and low

animation. The name of city is derived

income is seen in town. For example, town

from the myth of suro (shark) andlike slum is around the high grade

boyo(crocodile). We can see monument in

shopping mall. I thought Japanese food isfront of Surabaya zoo and buy T-shirt withthe best until eating foods in Indonesiathat picture.

but I got surprised at those foods here, it	  The road is always busy because ofwas great! How to use spice on every

shortage of public transportation. Rushcousins like soup,chicken was veryhour in the morning and around 16 is

sophisticated.

Emblem of Airlangga univ

Surabaya T-shirt

awful. Four people riding on bike, running

Indonesian cousin

on side walk, horn instead of yell arecommon everyday. Becha cant’t be seen
here as often as in Jogjakarta for thatreason. We should cross the road betting
our life.	  What about the price in Surabaya? It is
like basic fare for taxi is 70 yen, sate ayam
in local mall is 200yen. But there is

You can’t spend life here without seeing
religion. Muslim is one of major religion andit occupied a part of their life. For them, 5times pray a day is basic. Pray sound echothroughout the town in the early morning.
Every Friday is special day for muslim men.
Even if they are medical staff or students,
they go to pray at noon. There is always thepray room near toilet. Women drape a clothon their head even in job time. You may think
it is ceremonious but they change color ordesign, so it is more like that they enjoy
dressing up.
And it is a batick day on Friday. I tried batick

Tunjungan plaza

my friend gave me.

past. And after war, we accepted	  It could be my imagination but I felt likewesternization and our country developedthat women are working harder than men

economically under yoshida doctrine and oureverywhere. Added to that, I thought thenationality. Also, countries in Asia got

gender of good position has higher ratio ofindependence. Now we supports these

women than in Japan. For example, a dean ofcountries through ODA or JICA and we also

faculty of medicine is woman. We shouldhave some benefit. I made recognition ofnever forget that this country had a woman

history deeper.

president.

＊Finally	  Friends there	  I appreciate government, staff in Kobe

took me someuniversity, my family and people in Indonesia

places. That waswho accepted me. They prepared thisprecious time. And

excellent program. Thank you very much.

I had chance to go＊Reference for Surabaya

to kindergarten inchurch to teach・現代インドネシアを知るための６０章	  明石children how to書店
・地球の歩き方	  2015~2016 インドネシア ダfold Japanese

イヤモンド社

balloon.
＊Looking back history

Kindergarten

・旅の指差し会話帳②インドネシア	  情報セン	 ター出版局

I am really glad that I joined this program in・ブログ	  鮫鰐通信

Indonesia. I feel like catching a glimpse of・スラバヤガイド	  現地日本人会オフィス発行

care systems in this nation, is totally

・Wikipedia : Surabaya

different from Japan in the point of that theyhave a lot of ethnic groups,languages,religion
and races. Sometimes they ask translation if
they can’t understand. In Surabaya, I saw thestatue of the president Sukaruno. I think heis great that he got over this diversity andstarted this nation. Indonesia had been undercolonization of Netherlands for a longtime
and it was occupied by Japan during WWⅡ.
Soetomo hospital is also influenced and therecord was kept in museum. We colonized
Asia and opposed to western countries in theBatick