SUMMARY

Report: Study tour in Japan

Course title: Improving Maternal and Child Health through MCH
Handbook

Duration: 64 days (17th August - 19th October 2015)

Venue: Okayama University in Japan

Participant: Dr AKINTIJE SIMBA Calliope, from Rwanda

Table of Contents
LIST OF ACRONYMS/ABBREVIATIONS ...................................................................................... 3
ACKNOWLEDGEMENT .................................................................................................................. 4
INTRODUCTION ............................................................................................................................. 5
AIM ................................................................................................................................................... 5
OBJECTIVE ...................................................................................................................................... 5
ORIENTATION ................................................................................................................................ 5
TRAINING SCHEDULE ................................................................................................................... 6
TRAINING ........................................................................................................................................ 7
Japanese Language Intensive Course .............................................................................................. 7
Training at Okayama University ..................................................................................................... 7
1.

Educational Tours ................................................................................................................ 7

2.

Social Activities ................................................................................................................. 13

LESSON LEARNT .......................................................................................................................... 13
RECOMMENDATION.................................................................................................................... 14

LIST OF ACRONYMS/ABBREVIATIONSAMDA: Association of Medical Doctors of Asia
ART: Assisted Reproductive Technology
H.E: His Excellence
ICT: Information Communication Technology
MCH: Maternal and Child Health
MDGs: Millennium Development Goals
NGOs: Non Governmental Organizations
NICU: Neonatal Intensive Care Unit
NPO: Not for Profit Organization
OPD: Outpatient Department
OPIEF: Okayama Prefecture International Exchange Foundation
SDGs: Sustainable Development Goals
TAE: Think About EducationACKNOWLEDGEMENT
I wish to extend my sincere gratitude to the government of Rwanda and the Japanese government for
their good diplomatic relationship which allows all citizen of both countries to travel freely to each of
those countries. I also extend my gratitude to Okayama Prefecture which through AMDA and Think
About Education in Rwanda partnership have allowed me to learn more best practice in Japan underhostage of Okayama University and this has been possible because of the permission of H.E Bishop
of Cyangugu Diocese, the owner of Mibilizi Hospital

under which I assume my leadership

responsibilities. I also wish to appreciate and acknowledge the contributions from the wellexperienced Professors and the Training supervisors for their tireless efforts to share theirexperiences, skills and knowledge on Maternal and Child health in Japan.
Finally, I want to express my profound thanks to all Hospitals, Clinics, schools, Government offices
and Universities which accommodated and shared with me their internal operations which havecontributed to the development of Japanese Health especially Child Health.
Special thanks goes to Professor YORIFUJI TAKASHI, Mrs Marie Louise TOWARI, Dr
SUGANAMI (The Founder of AMDA), Mrs Tae NAMBA, Miss Yuka Tanabe, Mrs Kyoko Nomoto
and Fujita San for their kind support and advises from the beginning to the end of my training.
Above all, I thank my wife and Children for accepting me to be away from them during two months.
May God protect everyone of you all.

INTRODUCTION
Rwanda has made tremendous progress in reducing maternal and neonatal deaths and it is among
countries who have achieved MDGs. This success gives an opportunity to all health sector in Rwanda
to continually work hard to achieve more and keep the momentum. But still we need to do more andreach the level of Japan where it is now. Besides, we must also establish a follow up framework of allchildren born normal and continually support them through Maternal and child handbook. This tool
has been useful in Japan and Rwanda need to introduce it in all aspects so that we shall achieve
SDGs. The success is due to quality health care give to pregnant mother, new born and to children.
A Rwandan Doctor came to Japan under sponsorship of Okayama Prefecture, to learn about Maternaland child health focusing on MCH handbook, and also tapping into health care organization in Japanfor a period of two months.
AIM
Learn best practice in improving maternal and child health through a well organized health careservices and systematic medical checkup in Japan.
OBJECTIVE
o To enhance my experience about Maternal handbook in Japano To conduct field visits to overseeing the medical checkups in Schoolso To learn about Public Health issues affecting children in Japan and how they are prevented.
o To initiate partnership between health care providers in Rwanda and Japano To understand more Japanese society
ORIENTATION
The participant was given information on the following important issues:ooooTraining schedule
Accommodation and other important facilities
How to keep themselves healthy during the summer andOther useful information concerning participant

TRAINING SCHEDULE
Schedule for Dr. Calliope’s Training
Japanese Language Training at Okayama Prefectural International Exchange Foundation：
September

18th August - 15th

Yorifuji's research office of Department of Human Ecology at Okayama University Graduate School of Environmental
and Life Science <http://www.okayama-u.ac.jp/user/envepi/en/lab.html>：16th, 18th , *26th , 28th September, 8th ,9th
,15th and 16th October①Division for Children, Department of Health and Welfare, Soja City Council： 17th September, 10:00～②Okayama Saiseikai General Hospital： 24th , 25th and 29th September③Health Promotion Division, Public Health Department, Okayama City Council： 30th September 10:00-16:00④Division for Health and Physical Education, Education Bureau of Okayama City Council：
11:30

1st October 10:00-⑤Division for Health and Physical Education, Education Bureau of Okayama Prefectural Council： 1st October
13:30-15:30⑥Soja Municipal Board on Education (Visiting Tokiwa Primary School)：

2nd October, 10:00～

Session on Rwanda@ Okayama International Center: 3rd October, 10:00-11:30⑦Visiting Ms. Marie Louise in Fukushima, Embassy of Rwanda and Dr. Shibuya in Tokyo：⑧Reporting Session＠AMDA： 13th October⑨Notre Dame Seishin Elementary School：⑩Summation：

15th, 16th October

14th October

4th -7th OctoberTRAINING
The training was done in two phases : Intensive Japanese course language and the Training.

Japanese Language Intensive Course
The first day of Japanese language course was opened by Fumie sensei and introduced by Mrs
Nomoto San who is a staff of OPIEF.
During the period of one month, the participant has acquired intensive
course of Japanese language and this was in the aim of giving an insightabout culture, manners

and behavior of local society in which

Participant was supposed to live in during two months.
The course was about learning writing and speaking Japanese by using
Hiragana, Katakana and Kanji.
After that period of one month, participant was able to write hiragana alphabet and some katakana
characters but Kanji was a bite difficulty and needed more time which the participant didn't have.
With the time, the participant have been able to accommodate Japanese styles of living like eating.
The food of Japan seems to be healthier and not causing so much harm to eater. Participant could
challenge green tea without sugar and some other drinks like saken.

Training at Okayama University
This training took one month and the main objective was to understand a well structured medical
checkup in schools of Japan, understand perinatal care in some hospitals of Japan and analyze somedata of Maternal and child health.
The main activities done were supervised by Prof Takashi Yorifuji, an associate Professor at
Department of Human Ecology at Okayama University Graduate School of Environmental and Life
Science
1. Educational Tours
The activity started on 14 September 2015 by visiting Okayama University, Tsushima Campus and be
introduced by Prof Yorifuji at the Department staff. He helped the participant to understand more

about the schedule and analyze together all circumstances in which the training will be done. Some
assistant were introduced to me like Mrs TOKINOBU, Mrs IRIE and Mrs SASAI.
All material to use during reading were provided and university Library and entrances access cards.
After this day, the visiting flow were :ü Division for children, Department of Health & welfare, SOJA City council
On the visit, the participant attended the Press conference of AMDA about the field work in
Natural disaster prone region. The day was also reserve to meet the may of Soja city who, withkindness received the participant in his office. He was introduced a bite about Rwanda and the
project under which Dr Calliope went to Japan.
A team of two staff in the department of Health and welfare explained, during a short session,
about the maternal and child health system including medical checkup for kids and the advantageof this initiative.
A site tour was also done to show how the medical checkup is organized.

Lesson learnt- Medical checkup and MCH handbook are very helpful in improving Maternal and Child health- Plaza place for parents gathering- Soja City birth rate is 1.55 compared to 1.41 of Japan- Existence of counselors to provide supportive counseling for single mothersü Training at Okayama Medical Center and at Okayama Saiseikai General Hospital
The participant welcomed by Dr Nakahara, The head of Neonatology and pediatric department
and Prof Aoyama, senior Pediatric surgeon. During the stay at Okayama Medical Center, theparticipant learned about a well organized NICU and the Pediatric ward which offered a highspecialized service. The rate of death is very low at this hospital, motivated staff and high techbased health services care.
At the end of the stay I met Prof SATO Toshio, theDirectorof Okayama

Medicalcenterandthediscussions were evolving around the feasibility to
exchange Doctors and Nurses from Japan to Rwanda
and vice versa.

At Saiseikai Hospital, I was welcome by Prof Kazuhide Yamamoto, the director of this hospital.
The plan was to attend OPD consultations and discuss with Dr Tanaka about major diseases takencare of in this hospital especially those affecting children. Attending Doctors' round by ICT(Infection Control Team), visiting premature baby centre and attending immunization in OPD.
I was introduced to the head of Pediatrics department and other staff. The main activity was toassist to OPD consultations and hospital tour to know what is done and where is done and by
who.
The impressive thing during the tour was the volunteer-ship policy at Saiseikai Hospital and the
level

of

motivationofretired nurses and social
workers to come back andwork for hospital freely.
Another thing is that thehospital has a high techbasedhealthservices

especially : Laboratory, Pharmacy and Electronic medical records without considering othermedical activities performed there. The component of helping disabled people and other poor
patients is also important to mention.

ü Health Promotion Division, Public Health Department, Okayama City council anDivision
for Health and Physical Education, Education Bureau of Okayama City Council
At this department, I was welcomed by the Head of department and explained about the system of
medical checkup.
I listened to local government system of medical checkup for 3years old child, how they do premeeting and site management. In afternoon, participant assisted to the medical checkup andinterviewing mothers with 3 year old child at Okayama Health Center.
The observation is that the system of medical Checkup is well organized and mothers attended it
as well. The data are recorded manually and later entered into software. The follow up of non
participatory children is mandatory even though its rate is low especially they are foreign
children residing in Okayama city and who can move any time.

ü Division for Health and Physical Education, Education Bureau of Okayama Prefectural
CouncilAt this office, the participant was explained by Mrs MAYUMI Suchiro, about the role ofprefecture level in Child health. At this level it is like a surveillance system for school children
health. Their role is to deal with High school and special schools children in terms of healthpromotion and medical checkup but also be as center of all data collected from school medical
checkup and make a comparison among schools to know where more interventions can bedirected.
Many materials about Child and mother health including MCH Handbook were given and will
help in organizing medical checkup activities in Rwanda.
ü Visiting Tokiwa Primary School, in presence of Staff from Soja Municipal Board on
Education
The school was founded in 1885 and is a public school. On arrival, I was welcomed by School
Principle and introduced me to other staff. A short orientation was done to let me know thehistory of school but also more information about it. The area of interest was to attend the school
eye check up performed at school infirmary but School nurse and later on attend a presentation

with School Doctor about how they organize Medical checkup at school. Many form s are used
and filled immediately after checkup and one is sent to parents informing them the eye problemof their child another one is sent to Soja Board of
Education. When the child is transferred fromschool to another, he/she must go with the form
from the former school.
In general motivation behind such checkup is thatthey protect children both physically andpsychologically and help them grow for further
future of Japan.
Therefore, school lunch is also among supportive program to the well being of children.
Participant has also taken the opportunity to share lunch with students and experienced a wellbalanced diet give to them.

ü Visiting Fukushima Medical School, Embassy of Rwanda and Dr. Shibuya in Tokyo
University
Everyone knows that Fuksuhima has been hit by Earthquakes which has triggered Tsunami andthis has also caused the destruction of Nuclear power plant. The region was at risk of irradiation
spreading and which might cause Public Health problems.
In that regard, the visit was organized to know more theincident but also understand how surrounding population
was copping up after this natural disaster. In addition, I
wanted to have a clear picture on the impact of this on
daily life of Japanese living in this region.
Welcomed by Prof. Hiroyuki YAGINUMA the Vice
president of Fukushima Medical University, I have been introduced about the University
organization and structure. A session on Fukushima Nuclear power plant leakage and its
consequences have been held and the participant was updated about how they deal with theconsequences.
I have also took opportunity to meet Professor SHIBUYA Kenji who also visited me in Rwanda
2014, just after I was appointed Director of Mibilizi Hospital. At Tokyo University me and theteam of AMDA, and Mrs Marie Louise have been introduced by Prof Kenji to the team ofstudents journal Club. We have also discussed about the
future collaboration through MCH handbook project inRwanda.
A courtesy visit has been also done to Rwanda Embassyin Japan, and discussion about Ambassador support to the
MCH project has been on table. She

first thanked

Okayama Prefecture to have offered an opportunity to
Mibilizi Hospital Director to come and learn how Japanese system is built and what can be learnt
from them. She reiterate that the achievement of every initiative is due to good leadership of
Rwanda and it may last long.

ü Notre Dame Seishin Elementary School
At this school, the visit purpose was to give a lecture on "The Importance of Life" based on
Rwandan experience of Genocide against the Tutsi in 1994. The welcome remark was deliveredby School principle and we took a time of touring the infirmary of the school and listened to the
School nurse. After that, a two hours lecturer has been given to student of junior six and they
were so attentive and participative as the methodology used was also attractive. Some questions
were asked and good answers were awarded a gift of Rwandan traditional crafts.
Personally, I was touched by the way children understood the subject and the strong questions
they have asked after expose. They were motivated to listen more and very eager to learn from my
hospital experience as Medical Doctor. I liked the session.
At the end of the session, I have met Father HARADA Toyoki, the Judicial Vicar of Hiroshima
Diocese and the Professor at Notre Dame Seishin University. The discussion was about possible
collaboration between Cyangugu Diocese and Hiroshima Diocese.
The conclusion was that as Hiroshima Diocese is in process of doing big projects, it can be very
hard to carryon other additional activities outside Japan, but he promised to keep in contact and
we shall continue to explore the feasibility of collaboration and partnership toward Mibilizi
Hospital based projects.

2. Social Activities
During the stay in Okayama, some extra activities have been performed in order to allow participant
to socialize with Okayama Prefecture people and also learn about Japanese culture. Among the majorsocial activities, there are:
Ø Session on Rwanda@ Okayama International Center held at Okayama PrefectureInternational Exchange Foundation and was attended by many people from acrossOkayama City.
Ø The Visit at Korakuen Garden
Ø The Visit to Tokyo and some meeting up friends
Ø I have visited various private Clinics ( Momotaro Clinic, ART Clinic, Takasugi Clinic,
Nakano Hospital, Tanabe Dental Clinic among others)Ø Watching Volleyball world Cup 2015
Ø Visiting Washuzan High land and Seto Bridge
Ø Visit at Hiruzen mountains
Ø Okayama Castle
Ø Miyajima Shrine at HiroshimaØ Attending AMDA conference
LESSON LEARNT•MCH Handbook is key in reducing Maternal and Child mortality,•

Medical Checkup can help to follow up children and can contribute in preventing or
diagnosing some diseases (Non Communicable diseases).

•Hospital Infrastructure in Japan is highly developed and use high tech skills to deliver services
to patients.

•

Partnership of government, Private entities, NGOs and individual add value to good healthcare services delivery and good quality of education.

RECOMMENDATIONThe exchange program was given to Dr Calliope as part of reinforcing health education in Rwanda
and also to incite the participant about MCH handbook which has helped Japan to reduce maternaland child mortality rate. Therefore as far as sustainability is concerned there shall be:•

Support further Medical checkup in Mibirizi Hospital zone and at UMUCO Mwiza School•

Follow up of MCH handbook project until it is implemented in Rwanda and Mibilizi Hospitalin Partnership with NPO Think About Education in Rwanda shall be the pioneers of thisproject.

•

A close follow up of all promises gotten in Japan from Saiseikai hospital, Okayama Medical
Center, Fukushima University, Hiroshima Diocese through Father Harada, Soja City andOkayama Prefecture, Tokyo and Okayama Universities to collaborate with NPO TAE andMibilizi Hospital,•

The exchange is very important, and it should be good to keep supporting more staff from
Rwanda to do the same study tour in Japan toward health care services improvement andfocusing on maternal and child health.

******************どうもありがとうございます*****************