Exchange program of tropical infectious diseases in Airlangga University
18/1/2014~9/2/2014
Faculty of Medicine, Osaka University
Akihiro Ono

I spent three weeks in Surabaya, the second biggest city in Indonesia, and studied tropicalinfectious diseases at Airlangga University. Through this program, many people helped us study
very much. Thanks to them, I had a very precious experience. I really appreciate it. I will use thisexperience for my future and would like to contribute to patients and the development of medicine.

Program content
We attended the morning report every morning with students of the medical school of Airlangga
University. In each morning report, two students reported about their patients and picked up one ofthem, of which we discussed the details of the patient’s condition and treatment. The hospital ofAirlangga University was the central hospital in that region and therefore patients in severe condition
were sent there. There were a lot of common cases such as diabetes and also there were many casesof tropical infectious diseases which are rare in Japan.
We saw patients in wards during the afternoon. In the first week of the program, we went to allwards of internal medicine in turn and saw patients there. There were a lot of patients of Hepatitis Band C. Education of infection route is not enough and infection is still spreading, doctors there said.
Tuberculosis was also a quite common disease in Indonesia and many patients of AIDS wereinfected with it.
In the second half, we studied whole processes of treatments in tropical infectious disease wards. It
was so beneficial to see whole treatment as a process from the start to the end: a condition of apatient when he/she was transferred to the hospital and the way of diagnosis and recovery.
When we were in Surabaya during the rainy season. The cases we followed were dengue fever,dengue hemorrhagic fever, typhoid fever, malaria and leptospirosis. Most of them were dengue fever.
Doctors told us a simple way of differential diagnosis of dengue hemorrhagic fever and treatments ofdengue fever and dengue hemorrhagic fever. Regarding dengue fever, patients normally did not get
worse and treatment was transfusion. On the other hand, regarding dengue hemorrhagic fever, weshould intervene it to prevent hypotension, doctors said.
In Indonesia, there are some areas where malaria is epidemic. A patient we saw stayed there forwork and got infected. When he was transferred to the hospital, he was in a very severe conditionand developed cerebral malaria. The treatment proceeded in the tense atmosphere and fortunately he
got well one week after the transfer.

Cultural differences
There were a lot of difference due to economic situation, culture and religion and sometimes it
made treatment different.
Doctors told us that patients do not go to the hospital until they are in a severe condition and that it
makes treatment difficult. One of the reasons was financial problems, but also patients didn’t reallyknow that it was important to start a treatment in an early stage. So, doctors insisted the importanceof education.
Indonesia is an Islamic country and there were a lot of differences compared to Japan due toreligion. One of them was that male and female wards are separated in hospitals. We didn’t see any
difference of disease between men and women in tropical infections disease wards, while in internal
medicine ward we saw more SLE patients in female wards and felt the difference of the incident rate
between the sexes.
Regarding organ transplant, some people refused to be a donor or recipient in terms of religion andthat prevented organ transplant from prevailing, some doctors said.
It was so nice to see and experience the difference on my own. I am sure that this experience
deepens my understanding of Indonesia and Islam and that it will be helpful when I become a doctor
and have a patient who has such a background.

Life in Surabaya
Living in Surabaya was also quite enjoyable. There were some exchange students in the dormitorywhere we stayed. They were from Poland, Nepal, Yemen and Afghanistan. The time shared withthem was precious. Students in the medical school and doctors were so kind and invited us for dinnerat their places and brought us to many places which might be impossible to go on our own. Outside
the hospital we talked a lot about not only medicine. I think I was able to experience the life ofIndonesian people. These experiences definitely enriched my life.
On the weekends, we went to see Borobudur. When we went there, it was Chinese New Year’s Day
and we could not get air plane tickets. With the help of students in the medical school, we finallymanaged to get train tickets. A trip by train in Indonesia took a lot of time but it was nice andBorobudur itself was spectacular. A sight of the heritage with morning haze in the dawn was so
inspiring and beautiful and I was touched.

In the end of my report, I would like to thank again all the people who helped me during theprogram. With their help, I had a great time in Indonesia. I really appreciate it. Thank you.