Exchange program in University of Padjadjaran
2015 14th September -9th October
Megumi Sato
Kobe University, 6th year student

Introduction
I went to Bandung, Indonesia for my medicalclerkship from 14th September to 8th October.
Indonesia is a multiethnic country and each ethnic
group has its own culture and language. Bandungis the capital of West Java and most people here areSundanese. They speak Sundanese language andsome of them can’t speak Indonesian.

About Padjadjaran University and Dr.
Hasan Sadikin Hospital
My clerkship was mainly at Dr. Hasan Sadikin
General Hospital (RSHS: Rumah Sakit Dr. Hasan
Sadikin). It is the biggest hospital in West Java,
with 996 beds, 20 medical specialties and 125 sub specialties. Since the established of
medical Faculty of Padjadjaran University in 1957, it has been assigned as teaching
hospital for the student of Medical Faculty.
The male-to-female ratio of medical students is 2:3 and the students come from manydifferent national origins. To cite our group as an example, we have 11 students (3 malesand 8 females) and 6 of them are Muslim
Indonesian, 2 of them are ChineseIndonesian,

1ofthemisIndian

Malaysian, and 1 of them is Chinese
Malaysian.
They respect their own culture eachother and learn medicine together.

Hall way of Dr. Hasan Sadikin
Hospital

Clinical clerkship
1st week (at RSHS)----I rotated internal medicine with medical students.
7:00-

Rounding only with students(We choose several hospitalized patients and take histories and physical examinations.)
9:00-

Rounding with doctor(The doctor checks the physical examinations we took and explains about the diseases)
11:00-

Lunch time

13:00-

LectureRSHS is a University hospital so there are a lot of
critical patients. In Indonesia people doesn’t havemedicalcheck-up(evenpeopleofhigher

socioeconomic status people like doctors) so patientscome to the hospital with advanced illness.
Students check the medical record of hospitalized
patients in the morning and take history and physicalexamination. Students in Indonesia are very good attaking physical examination because they practice itfrom head to feet every day regardless of the patients’chief complains. Doctors tell students over again andagain that “if you go to rural area, there are noequipments so you have to diagnose patients withlimited information.”

At outpatient department withIndonesian medical students

2nd week (at the secondary hospital)----I went to secondary hospital in Ujung berung with students.
8:00-

Rounding the patients in charge (2-3 patients for 1 student)(Taking vital signs and talking with patients)

10:00-

Rounding all the internal patients with doctor

12:30-

Lunch time

13:30-

Continuing rest of the rounding

14:00-

LectureIn Ujung berung, I could experience some common tropical diseases like dengue fever ortyphoid. These diseases are common in Indonesia so they don’t go to tertiary hospital.
I also experienced night shift on Monday. Students in Indonesia have to do night shiftonce a week and I accompanied them. During the night shift, many food-poisoning
patients rushed to our hospital. There was a big party on Saturday and the potato wasspoiled. The victims of that case came continuously until Wednesday so even the hall
way was awash with hospitalized patients. I learned coconut is effective against
dehydration because it contains a lot of electrolytes.

At emergency department

Food-poisoning patients
hospitalized in the hall way

3rd week (at RSHS)----I rotated infectious disease with aresident.
I observed HIV outpatient department
called “Teratai”. There are many HIV
patients in Indonesia and the number ofthem is increasing every year. Teratai isused by 50-70 patients a day. In Indonesia
HIV patients can get HIV treatment for
free (only in public hospital or clinic, not in
private one), but many patients dropout

B20 is used even in the medicalrecord

because of the financial burden of transportation. Moreover stigma to HIV patients is
also a big problem. Indonesian government enlightens accurate knowledge about HIV,but people still have prejudice. So we refer to HIV as B20 in order not other patients toknow the patient has HIV.
And I’m also surprised at the management of TB patients. There is a TB ward in RSHS,
but the door and the window are opened. And the patients who finish one monthtreatment are moved to general ward even though the sputum test is positive. Thereason why the management is so rude is the high prevalence rate of TB. Doctors saythat there are many TB patients on the street and all
people have a history of exposure to TB so it doesn’t
become a big problem.

Posters tospread
accurate
information
about HIV

4th week (at klinik Padjadjaran)----I studied about family medicine byobserving outpatient department
and emergency department.
Klinik Padjadjaran is half private andhalf public primary hospital. It has 8
beds and there are 4 departments(general internal medicine, emergency
department, obstetrics and gynecology,dentistry). I learned about primary
health care and public health there.

Pregnancy
In those days, giving birth at home is rare and most of pregnant women have maternal
handbook which is supplied by government.
Vaccination
In Indonesia 5 vaccinations (BCG, HBV, DPT, measles, polio) are supplied bygovernment if the children get them at puskesmas (public primary hospital). If theywant to get more vaccinations, they go to private hospital. There are pediatricspecialists there, but they can’t get them for free.
Health insurance
Indonesian government is building universal
healthcare

system“BPJS(BadanPenyelenggara Jaminan Sosial)”. Only 60% ofpeople are covered now, but government plan tocover whole nation by 2019. People covered withBPJS can receive medical service for free.
However there are many limitations. For
example, doctors at primary hospital can
prescribe medication only Rp.20.000 (¥179) aday.

At the reception of Klinik
Padjadjaran

Daily Life
There are more than 4 cafeterias and manysnackstands.

I

triedmanykindsofIndonesian foods and snacks there. Afterschool, my friends took us to cinema or had aparty at home. At the party, Indonesianstudents cooked Indonesian traditional foodand we cooked Japanese traditional food.
However I had great difficulty looking forJapanese food without sake. I learned mostJapanese seasonings contain sake and how
difficult for Muslim to visit and live in Japan.
At any rate, I enjoyed spending with othermedical students.

Home party

Lunch time at the cafeteria

Weekends
Saung Angklung Udjo
Angklung is a traditional Sundanesemusical instrument. It’s made of bambooand swung to produce sound. We enjoyedperformance and also playing together.

Tangkuban perahu
Tangkuban perahu is one of the biggest
volcanoes in Java Island. The latest
eruption was on March 2015 and thesmell of sulfur is filled all around there.
The view of caldera was very beautiful.

Taman Safari
Indonesia is a tropical country and there aresome national parks. However it’s too far
from Bandung to go. People can see many
Indonesian original animals like Sumatra
tiger or Komodo dragon at Taman Safari. I
enjoyed a lot seeing and touching them.

Komodo dragon

Museum of the Asian-African Conference
Bandung is famous for the place where
Asian-African Conference took place in 1955.
The conference was an important step
toward the Non-Aligned Movement during
Cold War after World War II. We can seepictures and documents at that time.

Conclusion
During this exchange program, I learned that the world biggest infectious diseases(AIDS, malaria, tuberculosis) is certainly true. There were many these patients becauseof their lack of the knowledge and poor hygiene. And I also learned the importance ofpublic health. In Japan almost all people get medical check-up and we take it forgranted. However in Indonesia even people in high socioeconomic status don’t get it sopatients come to the hospital with advanced diseases.
This one-month program has passed by like a flush, but it was an amazing experience
for me. I want to say thank you to all the doctors and students cared about me inIndonesia.