2015
Elective Program
Gadjah Mada University, Indonesia

Takumi Tsuchida
Kobe University
2015/04/03

1. Introduction
I did my clinical clerkship at Yogyakarta, Indonesia from 3rd April to 2nd May
2015. Within 4 weeks, I spent first 2 weeks at Pediatric department in
Gadjah Mada University hospital, and other 2 weeks at Puskesmas in
Klonprogo to study public health. In Klonprogo, I learned many things, so I
mainly write about Puskesmas.
2. Analysis situation of location
Klonprogo is a rural area in Yogyakarta, and Klonrogo has Puskesmas like ahealth center. Puskesmas is a little different from a health center because
Puskesmas has 20 beds. There are 14,476 people in the area of Puskesmas. 2doctors can’t sustain the population, so 8 midwives treat simple cases such ascommon cold, pains and so on. Regarding infections, in 2015, 25 cases of type
A hepatitis, 3 cases of dengue fever, and 2 or 3 cases of HIV have been
confirmed.
3. Daily activities
We see outpatients and inpatients every morning. The number of outpatientsis around 50, and main complaints are pain, fever, hypertension andpregnancy. We usually see about 5 inpatients.
In the afternoon, we often took part in some activities for health care called
UKM.
The education for people in avillage
wasofferedbyPuskesmas.
Women mainly gathered.
They said it was difficult tostop them husband smoking.

Every Friday morning, almost
all staff exercises for 30minutes. The movement is
unique for us, but the same
exercise is performed in schoolin Temon.

In this room, IVA screening
was offered. We used Cusco
speculum for the first time,soitwasvaluableexperience. We felt hygiene
was not good. Gloves andsheets were not changed one
by one.

On the last day of Puskesmas,
wetookpartinananti-mosquito fogging. It wasperformed because 3 cases ofdengue fever were confirmed. It
contains
Malathionwhich
affects adult mosquitoes. This
picture shows that the fog isshot toward houses.

We learned Javanese. The villagers
speakJavaneseandBahasa
Indonesia
dependingon
thesituation. For example, they use
Javanese in family, and Bahasa
Indonesia in school. Doctors use
Javanese to patients.
Matur nuwon means thank you, andEcho means good.

By the way, we enjoyed the naturein Klonprogo. This picture is taken
at Curug Setawing with our hostparents. We also went to Waduk
Sermo and beaches. All of themwere magnificent views.

4. Lesson learned#Puskesmas
Puskesmas not only treats patients as hospitals do but also contributes topublic health. Dr. Candra suggests ‘’CINTAKU’’ to keep people health.
‘’CINTAKU’’ means control health regularly, no stress, no smoke, activity,
consult doctors and enough nutrition. Especially, smoking is significant
problem. We heard smoking is a culture among Indonesian male. It refers tolow nutrition of children as well as the increase of cancers. So ‘’CINTAKU’’ isvery important to change their states of consciousness.

#Contraception
One of the important roles of Puskesmas is recommendation of familyplanning. Oral contraceptives and intra uterine device (IUD) are mostcommon ways. Other ways are progesterone injection and implant. It is said
that Condom use is not common, which also may be culture in Klonprogo. We
think it is based on recognition that contraception should be done by female.
In order to prevent STD from spreading, condom should become morepopular.
5. Conclusion
Through this program, I got irreplaceable experience in Indonesia by living
there and getting in touch with many people. I was not good at speaking
English and Bahasa Indonesia but people in Indonesia were so kind that I
could make many friends. They made my elective program much better, so I
want to tell them ‘’Terima kasih banyak’’ which means ‘’Thank you verymuch’’. And I appreciate all of them who supported me.