Completion Report of Student Exchange Program“Education of Global Medical and Health Science Leaders in the Coming Generationin Cooperation and Collaboration with ASEAN Countries”
at Kobe University Graduate School of Health Science(10th January-18th February, 2017)
Reported by Supattra Sittiwang
Master degree student, Faculty of Nursing, Chiang Mai University, Thailand
Kobe university was original founded in 1902 as Kobe
Higher Commercial school, and institution of higher education.
Kobe university has 4 areas ( Rokkodai Campus, Fukae
Campus, Kusunoki Campus and Myodani Campus) including
11 faculties and 14 graduate schools. Graduate school of healthsciences got independent from the graduate School of medicine
in April 2008. Now has master causes and doctoral causes
including Nursing, Biophysics, Rehabilitation, Community
health, and International health.
As a postgraduate student of Faculty of Nursing at Chiang Mai
University, I had a good opportunity for participating in the Student
Exchange Program at Kobe University Graduate School of Health Science.
I had wonderful chances to participate in many activities, both inside andoutside of the university. Each activity gave me a different taste ofexperiences. Some are very useful to imply into my master thesis and mycareer.
Japan is a country with super aging society. Japan has population aged 65 or over is 33.9
million in 2015, accounted for 26.7% of all population. People both male and female get morelong life expectancy. Around Myodani campus can see many of elderly people walking around.
In field visit, I have a chance to participation in health education for the elderly people wholive in the community. This activity provide for support elderly people to go out and do some
activity together, not stay in their house all the time. Because it can cause the depression orseparate society. Many old people die in their house and no one notice about that. So this activity
might help this kind of people have their social and know each other. Many volunteer come andhelp to prepare lunch for the participant. They have menu foreach month and has the recipe. All food is good for aging
people, not hard, softness, not much of sugar and salt. They
also calculating the calories of food. In this time, 3 masterstudents from Kobe University also gave health education
about Alzheimer disease and did some activity with theparticipant for Alzheimer prevention.

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Community-based nursing includes home health care nursing and public health nursing.
Home health care nursing will be supporting patients to be discharge from the hospital andreturn to home. And also providing nursing care to the patient and their family at home. Publichealth nursing will be doing health promotion for whole population, identification of potential
health risk in the community, preventive care for people at high risk and develop policies andhealth system. It focuses on health promotion and on environmental, psychosocial, economic,
cultural and personal health factors that affect an individual’s and family’s health status.
Public health center has comprehensive functions providing more technical services in
the community, such as response to diverse and complicated health issues, to research, tosupport municipalities and to plan and coordinate health policy. In Nishinimiya, public healthcenter can be like office work and support group meeting of patients with chronic neurologicaldisease and their family. The participant who join the meeting are the patient with Parkinson’s
disease and spinocerebellar degeneration (SCD). This meeting group provide for develop therelationship among patient and family as a self-help group through interaction among members.
They have many topic of the meeting: oral care, nutrition, music therapy, tradition even and soon. I have a chance to participated in a music therapy class with 12 patients ( 2 SCD., 10Alzheimer) and 2 family members. The schedule of 2 hrs. in the class concludes 1. Greeting andGroup discussion, Nurse will join in the group and be the facilitator to stimulate patient to shareidea of disease management, empowerment the patient who doing good to control the disease.
2. Sing a song, this will help the patient exercise the muscle around mouth, cheek and face.
Singing can help about breathing or chest exercise. The music therapist will stimulate patient
to exercise by using some equipment and move the body. 3 After class, all staff will discuss
about patient, problem and the planning to help them. The music therapist said “the important
thing of music therapy class is a song” she has to understand the profile of the patient then she
can choose the song that suitable for them to make them enjoy and cooperate with the therapy.
The community health center in Nishinomiya also provides the health checkup for thebaby after delivery. The checkup including 4 time (4-month old, 10-month old, 1.5 years old
and 3 years old). The staff from the public health center will make the appointment to the motherto take the baby for checkup. The process of 4-month baby checkup begins with register point,in this area the staff will checking the baby health book and sign the name of participant. The
2nd point is for measure weight and high. The 3rd point is physical examination by Orthopedic
doctor. The 4th point is health assessment and baby developing assessment by the pediatric. In
this point mother can ask some question to the doctor about baby health. The 5th point isnutrition education, the nutritionist will teach mother about when and how to give some foodto the baby. The appropriate time to begin giving food to baby is 10 AM. Because at that time,
mother can assess how is the food reaction to baby. If baby get allergy with some food, so they
can take the baby to the hospital in working hour. The last point is giving health education bynurse. Nurse will describe about baby health status and be a consultant for mother. Nurse also
assess about depression in mother by using the depression assessment questionnaire. If motheridentify of depression, nurse will refer to psychologist for more evaluate and problem solving.
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Pictures of 4-month baby health checkup provide by community health centerI have a chance to participation in the community base program for mothers andchildren in Nishinomiya City. Nishinomiya City is located on the south- east of Hyogo
Prefecture. It is located midway between Osaka and Kobe. It has been developed as an“ Educational living district” by taking advantage of convenient location and rich naturalenvironment. Many Population in this area move from the other prefecture. Almost people has
a nuclear family and do not know other family. This program provides for helping mother andchild to meet and play with other people. This place also has many toys, books, music
instrument to stimulate child developmental. This place also has staffs that can help, take care,share the information, giving child care education and mother can talk and release their stress.

Pictures of participated in thecommunity base program formothers and children in
Nishinomiya City

Japanese has developing of policy and health care system for promoting maternal andchild health. In the pass japan has high rate of Infant mortality and crude birth but now a day
Japan has the national campaign “Sukoyaka Family 21”. This campaign aims to create a society
in which people can live happy and in good health in an aging society with a declining birthrate. Because they are many risk factor of an expectant mother (teenager pregnancy, unwanted
pregnancy, late of notification of pregnancy etc.). When the women notice about pregnancy, thecommunity health will service for well-being during pregnancy and child birth by giving thematernal and child health handbook and give the health check ticket. Then, the pregnancy
women required to checkup. Since notice of pregnancy until 24 weeks has to check up at least
once a month, 25 weeks until 35 weeks has to checkup at least twice a month, and after 36
weeks has to check up once a week. The community health service also provides parent’s
classes, home visit service, consulting service and etc.

3Private maternity Home Center in the community “HINATA” is one of health care formaternal. This center basic activities are concluding natural childbirth with family support,breast feeding support, community child care support, midwife/nurse training support. They areproviding a safe, comfortable, and peaceful environment for pregnancy, childbirth andparenting. This center has 6 staff nurse; they all have the certificate of midwife. The nurse’swork time separate to 3 shift, 2-3 nurse in day shift and 1 nurse in night shift (1 nurse stand byfor emergency delivery at night). Nurse who work in the night shift have to take care the patientand prepare the breakfast. Before the end of the shift nurse have to tell the detail of case to thenurse who going to work next to them. In the day, Cook will prepare lunch and dinner for
mother. About OPD case, when pregnancy come for checkup the nurse will ask them tocollecting urine for sugar and pH test. After that nurse will talk and ask about discomfort
symptom during the pregnancy and give health education, problem solving and prepare
pregnancy ready to be mother. The nurse will measure blood pressure, high of fundus, pitting
edema and fetal heart sound. In pregnancy with over 36 weeks the nurse will monitor ECG. andwill do the ultrasound in pregnancy with 28 and 37 weeks just for measure size of baby. During
the delivery time, 2 nurse will take care of pregnancy and after delivery one nurse will takecare of infant. In case of emergency they have the equipment such as Intravenous solution,
suction, some medicine and can use the ambulance to refer mother and/or newborn baby to thehospital.

Pictures of Private Maternity Home Center in the community “HINATA”

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At YOYO club (Support program for low birth weight infants and the family) supportedby Kobe City.The staff include Pediatric, Midwife, Preschool teacher, nursery teacher andphycologist. This center is support for the Mother and child with low birth weight (lower than1,500 gram) the activity conclude…
1. Let Childs and Mather play and relaxing together.
2. Greeting by sing a song
3. Physical exercise by play and do some activity, run, craw.
4 . Mother make a group discussion with the professional healthand teacher about their child by using the diary that they are recorded. This center is very goodfor mother to join because almost family in japan is nuclease family. So, no one support abouttake care of children and be a consultant. This center is where can give the information to them
about how to take care of their child. The problem that mothers are concerned and discussed
today is about viral infection and causing vomiting and diarrhea of their child, some childscream after they are get angry, the skull at forehead not closed after 1.5 year.
5 . After finish, all staffs and volunteers had a meeting and discuss about each child. I
think this center is very good for help the parent and baby who faced to low birth weightproblem.
At Myodani Campus, Yuko Uesugi teacher presented about Nursing education in Kobe
university and showed the nursing practice room that use for teach the student to care patient,
bed bath, use the sterilize technique to open the sterilize set. The equipment and process are
similar to Chiangmai university nursing faculty but Kobe university has more supply and morenew.
Mio Hosona teacher presented about health assessment by used the patient models. thestudent can learn how to measure blood pressure, EKG, pupil reaction, bowel sound, heartsound and breath sound by used the patient model. It is very useful and the sound was veryclear and easy to understand.

Pictures of health assessment by used the patient models

5The visiting nursing system provides nursing service at home for individuals requiring
assistance because of disease or disability. This system managed under Long Term Care
Insurant system and/or the national health insurance. This system begins since prepare patientdischarge from the hospital. The physician is who decided about treatment plan. Also the caremanager will be planning of home care visit.
Nursing services at home provide by visiting nursing station. The nurse who work invisiting nursing station has the same certificate and same nursing care similar with working in
the hospital. But the different things are the area. In home visit will use “User” to call instead of“patient”. 20 years before, home visit focus on long term care and preventing but now a day
nursing service include End of life care, rehabilitation, nursing care for individual withdementia, information support to family member, bedsore and wound care, management ofcatheters, administration of medicine and etc. I have a chance to participated in home visit for
2 days and I had learned about Japanese home visit system. In my opinion this system isdifferent from Thailand but It is fit with Japanese society. The nurse known about profile ofuser. They give the high quality of nursing care to the user and caregiver. In home visit’s bag
has many things that will help the nurse to provide the good quality of nursing care.

Pictures of visiting nursing station

Awaji city is a big area for the elderly people to stay. It has population aged 65 or over
32. 6% ( 2013) and has population with long term care needs 21. 3% ( 2011) . For preventing
accidents and disease which require long term care and created local communities where people
support each other. So the government provide Iki Iki 100 sai Taisou (an exercise for being
active until 100 years old) to this city. Elderly people who live in the community and do notneed long-term care are the target of this program. This program was developed by the national
institute on aging in the USA. It consists of warm up exercise, doing seven movements using
weights and stretching exercise. The aim of this program is to preventing accidents, Preventionof dementia and prevention of retreating.
After an exercise, elderly people will enjoy with tea and talking. One person in thegroup said that she like this part of program because she like to talk and meet the other people.
Even if this program starts at 9:00 am. But she wakes up early and get dress up for join theprogram. She Does not want to missed this program.

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One person in the group said that before she joins the program she has back pain
problem. Now she getting better after exercise.

Pictures of Iki Iki 100 sai Taisou in Awaji city

Every people in this group very kind and welcome me to join the program. At first meetthey are very shyness but after we spent time together they are feel free, more relaxing andconfident to talk and ask the question. I think this program provide both benefit of physical andmental. I can see the result of this program from the people who joined the program. They havegood health, good emotional and good society.
I also have a chance to visited Kobe University Hospital. The important role of thishospital is educating medical doctors as well as advancing medical standards through its
activities. The Hospital is also responsible for providing preventive medicine, sanitation
education, and advisory service on medical procedures in the University and other general
hospitals in the Kobe area. This Hospital consists of 35 clinical divisions with 920 beds.
I visited Intensive Care Unit, Emergency Room, Operating Room and Special Clinic. The nurseis very professional with providing nursing care. The patient in ICU. need many of caring andnurse can do very well to take care of them. It is my first time to see Artificial heart machineand robot for operating. That is very excited. Kobe University Hospital has a good system andhigh technology to provide a good caring for patient.
This Hospital has many kinds of special clinic. The nurse who work in the special clinic
also very professional. One of nurses who specialist in colostomy field explained about thesystem of health education given in the clinic and IPD. We also discussed about the patientwith depression because they cannot accept about colostomy. It was a good time for me to havean opinion exchange.
Moreover, Kobe University Hospital has adistinguished feature that it is playing an important role as abase hospital for disaster and emergency medicine. DAMT.
(Disaster Medical Assistance Team) is a group of professional
and para-professional medical personnel. DMAT designed to bea rapid-response element to supplement local medical care
until other Federal or contract resources can be mobilized, orthe situation is resolved. They will be the leader of work andmanagement when disaster occur. In my opinion, I think this team is very importance anduseful to provide medical care during a disaster or other event.

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In Kobe university, I’m joined in the paper meeting for 2 times. The first time is about
Alcohol’s involvement in recurrent child abuse and neglect cases. The second time is about
Null association between workplace social capital and body mass index results from a fourwave panel survey among employees in Japan (J-HOPE study) and Community HealthWorkers as Agents of Health Promotion: Analyzing Thailand’s Village Health Volunteer
Program. The Students will study and translate the articles before joined the meeting. They will
present what they had learned to the other students and teachers. After that is the step ofcomment and knowledge exchange.

Pictures of paper meeting class and presentation

I had 3 presentations during study in Kobe University, 2 times of Health care system inThailand and 1 time about my topic research “Effects of Self-Management Promoting Programby Family Participation on Health Behaviors and Blood Pressure among Persons withUncontrolled Hypertension”. It is a good opportunity for me to learn and participated in thisprogram.
I'm also have a chance of travel to Osaka, Kyoto, Tokyo and Chirakawa-go. I had many
good Japanese friends. I learn many things about Japanese culture and history. Japan is a very
good country, good of technology, transportation and economic. Japanese people has very
long life span. I think "health" is the one that Japanese people concerned and realized theimportance.

Pictures of life experience and travel in Japan8

After I join this program I got many knowledge and life experience. I have a chance toparticipated in nurse home visit, child health checkup, elderly health education, midwife andchild care. All of that is very useful for me because I can integrate and use the good things formy own country. In addition, I’m able to find my own idea of problem solving. I can share myopinion and have a chance to discuss about health care system with many expert people. I canunderstand and accommodate people who has different culture and background. I have a crosscultural experience. I have knowledge of Japan country, culture, social, behavior, food andhealth care system. Many teachers in Kobe university teaches me about healthcare in Japan andthey are very kind to me. Thank you so much for provided a good program and for every goodthings in Japan. It will be my impression of Japan forever.

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