Elective module
University of Indonesia
6th April-1st May,2015

Kobe university
Faculty of medicine
Saki Todo

Before Clinical Rotation
On 3rd April, I landed on Jakarta, Indonesia.
I was full of excitement for the new encounter and the great reunion with the friends
who came to Kobe University last year. The reason I decided to do my clinical practice inoverseas was "to know the difference of medicine between the countries”, "to improve
my English skill”, and "to touch the different culture from ours deeply”. Now I think I
achieved all the purposes in Jakarta.
On the arrival day, my friend picked us up at the airport and helped us a lot with thedormitory check in. She and another my friend also showed us around in Jakarta fornext two days, and guided us in the hospital. With their help, we didn’t have any
difficulty on the first day in RSCM, which is the main hospital of UI (University ofIndonesia). RSCM is a huge hospital and has many buildings .

pic1:The first dinner in jakarta with friends

pic3:the outlook of RSCM(1)pic2:In front of UI

pic4:the outlook of RSCM(2)Advanced life support module
For the first 2 weeks, I joined the Advanced Life Support module. This module ismainly supported by the anesthesiology department and divided into the emergency
room, the intensive care unit, and the anesthesia in the operation rooms. We wereintroduced to dr. Riyadh at first and we discussed the schedule for 2 weeks. As a result
we decided to study in the emergency room for the first 4 days, in the intensive care unit
for the next 3days, and in the operation room for the last 3days.
1) Morning report
In this department they have morning report every day from 7:00am. The morning
report is about the anesthesia plans for the patients who are going to have the surgeries
on that day.
When it was held in Indonesian language, dr. Fahmi and the students there explained
the cases in English . And the morning report is held in English for a few times a week !
It was my first surprise to know everyone in the department including the doctors,
nurses, and the students can handle English very very well .
2) Emergency room
What surprised me here was, the emergency room was being in charge of by theanesthesiologists in Indonesia. They don’t have the emergency room specialized doctors
and this fact makes the anesthesiologists ‘work much harder. We observed patients withthe heart attack from aspiration, pulmonary disorder, burn wound with gas explosion,
AMI, diabetic ketoacidosis, and so on. The doctors there were really busy in taking careof many patients but they were kind enough to split their time to explain to us.
They also have "code blue" system in the ward. If some patients go into bad condition,
the cellphone the doctor has let him know it is "code blue”. Then they run for thepatients and try to help them.
We had some chance to discuss the cases we found in the emergency room with dr.
Artha.We discuss not only the cases but also the medical issues Indonesia has. In
Indonesia, especially in Jakarta, it has large amount of population and the facility is notenough for all the patients. The beds in the emergency room were always full andsometimes we saw the "family ventilation”, which means the mask valve ventilation by
the family's hands, because of the lack of the ventilation machine. This scenery wasshocking to me. When I asked the priority of the ventilation, the doctor answered methey decide the priority depending on the patient's age and the condition.
And in Jakarta, the traffic jam is also an important problem. Every once in a while theambulances get stuck in the traffic jam and they don’t have the doctor helicopters yet.

Pic5:Emergency room inRSCM

pic6:with dr Artha

Next to the RSCM, they have another hospital connected. The name is "RSCMkencana" . RSCMis a national hospital , on the other hand , RSCM kencana is a private
one. The doctors and medical staffs are working both in two hospitals but they said thestudents are not allowed to do the clinical practice in the private one. Dr Fahmi took us
to the RSCM kancana and showed us the emergency room there, and what I saw there
was , there were many vacant beds and many ventilations . It is because the private
hospital was not covered by the national insurance and only the richest patients canadmit there . I also heard the fee is almost as 10 times as the national hospital.
3) Intensive care unit
In ICU, we saw the cases with herniation, and postoperative patient of livertransplant. Dr Yusuf and other doctors and the students there had discussion with us.
4) Operation room
I observed some surgeries with the students. For example I observed the surgery
about pancreas tumor, oral mass, thyroid tumor and skin tumor plus skin graft .The
drugs used for the anesthesia were almost the same as in Japan, but in the operation
room in RSCM we had to take off all the clothes (even the shoes & socks).

Pic7:Operation room

pic8: with the students in international course5) Case presentation & lecture with the students
Other than the activities above, we also joined the international class students.
When we greeted for the first, they gave us a warm welcome. For the 2 weeks we rotatedthe anesthesiology department together. Since they are international students, they
have almost all medical lectures in English and their case presentations were also inEnglish. Nobody in the class seemed to have any trouble with using English and I wasvery impressed by that. We talked about many things like our cultures and medical
issues. After we left this module they still keep in touch with us and we hanged out
together many times.

pic9:with dr Maggie and the students

pic10 with the students in the classroom

Plastic surgery module
In the third week and fourth week in the elective program, we enrolled the plasticsurgery. In plastic surgery, we were introduced to dr Handa first. She introduced us tomany doctors in plastic surgery and they welcomed us.
Plastic surgery department in UI has burn wound unit, one operation room only forburn wound patients. And also this department has two own operation rooms besides
the fact they can also use the common operation rooms. As a reason why they have a
special facility for burn wound patients, I heard that some Indonesian electric cords are
fragile .
For a first few days we followed dr Teddy's team. We followed the inpatients roundwith them and observed many cases such as pressure ulcer and congenital biliaryatresia. He and other doctors (dr Forry and dr Bayu) in his team were very nice toexplain the cases to us and have discussions with us.
And we also observed many operations. When I was in plastic surgery rotation in Kobeuniversity, we didn’t have much time for the operation so all operations in UI were newto me. We observed the operations with facial fracture, contracture after burn injury,
hypospadias, sgap flap, mandibular reconstruction, metacarpal bone fracture and morethrough these 2 weeks. We never got bored in operation rooms because we always had
the doctors who were explaining to us or taking care of us.
We also attended the journal reading and research report, and both of them were a bit
difficult but understandable because it was all in English.

Pic11: with our supervisor;dr Handa

pic12: with the resident doctors(dr Risa and dr Delly)

Through these two modules, the most impressive part for me was everyone's ability touse English. Not only the doctors but also the nurses can speak English, and they evendo their presentations / conferences in English. What is more, the students can use

English without any problem, even if they are the students in regular course, not ininternational course. The students we met in the anesthesiology module were ininternational course, so they take lectures in English and they make presentations inEnglish as well. I was very stimulated by every moment, and recognized again how
important handling international language is.

Other activities
On the weekends we had two trips to Jogjakarta and Bali.
In Jogjakarta, we met up the students from Kobe and the Indonesian friends who
studied in Kobe last month. They showed us the great places in Jogjakarta, and wemade brilliant memory there. And at this month we had 7 students in Indonesia fromKobe University, and we succeeded to meet up in Bali! This time again my Indonesianfriend helped us a lot with the itinerary and we enjoyed the stay in Bali as much as wecould.

In the afterschool & other weekend
One of the greatest things in Jakarta was the reunion with 5 friends who came to
study in Kobe University last year! They helped us during our stay in Jakarta and they
showed us around many nice places. We have been close friends since we met in Kobe ,so this reunion was unforgettably fabulous to me . And also we made many friends withinternational class students in anesthesiology module. They are also nice andsupportive, and we went out together many times. Needless to say, our Jakarta life got
much more enjoyable thanks to all of our friends. I think we were able to experience“what Jakarta really is " more than expected.

Conclusion
Supported by many people I made the most of my stay there. Now Jakarta is one of thebiggest cities in the world, and sometimes I even felt Jakarta might be bigger than thecity in Japan. Jakarta is the attractive city which has both of highly developed aspectand developing aspect.
And the most remarkable thing is, in Jakarta, medical education in English is muchadvanced. Almost all doctors and students can use English as they want, and they caneven discuss something in English. Indonesian language uses alphabets and it has
many similar vocabularies with English, so maybe that is one reason for it. But I started
to think we have to make more effort to improve our English skill to be the ones who cantell our own opinions to the world.
I would like to say thank you to all the people who helped us during our stay inJakarta. It was an honor for me to have such a great experience, and surely I will study
medicine harder with this experience.