First Issue
March 2021

T E N KA I

PROJECT NEWS

Bringing Japan's
Health Care to the WorldA concerted eﬀort by Japan’s public and private sectors
to promote a new approach to interna�onal expansionof health care and interna�onal coopera�onVietnam | Cambodia | Philippines | Zambia |Ghana | Tanzania | Congo | Cameroon |Nigeria | Ethiopia

Contents
Introduction.......................................................................................................................................... 03
Bringing Japan's Health Care to the World............................................................................................. 03.
A concerted effort by Japan’s public and private sectors to promote a new approach .
to international expansion of health care and international cooperation............................................... 04
Providing High Quality Medical Care to Stroke Patients in Vietnam by a Team Medicine........................ 09
Center Hospital of the National Center for Global Health and Medicine (NCGM)(Team Medicine, Stroke Team: Neurosurgery Department, Rehabilitation Department, Pharmacy Department, Nursing
Department, Nutrition Office)Supporting the Safety of Perioperative Patients in Vietnamese Hospitals.............................................. 14
Center Hospital of the National Center for Global Health and Medicine (NCGM)(Team Medicine, Perioperative Team: Intensive Care Unit, Anesthesiology Department, Nursing Department)

Building Medical Device Management System for Hospitals in Vietnam................................................ 18
Center Hospital of the National Center for Global Health and Medicine (NCGM) (Clinical Engineering Department)

Promoting Safe Radiology Examination in Zambia................................................................................. 20
Center Hospital of the National Center for Global Health and Medicine (NCGM) (Radiation Physics and Technology Department)

Spin-Off: Another Side to the TENKAI Project
People who Support the TENKAI Project <Myanmar>............................................................................ 22
Developing Cambodian Human Resources in Pathology to Strengthen the Pathological Diagnosis System..... 24
Bureau of International Health Cooperation, National Center for Global Health and Medicine (NCGM)

Creating a System to Increase the Smiles of Children and Adolescents in the Philippines....................... 26
Kohnodai Hospital, National Center for Global Health and Medicine (NCGM) (Child and Adolescent Psychiatry Department)

Advancing Vietnam's Respiratory Care Standard One Step Ahead with Bronchoscopy........................... 28
Center Hospital of the National Center for Global Health and Medicine (NCGM) (Respiratory Medicine Department)

Strengthening the Emergency Medical System in Cambodia.................................................................. 30
Center Hospital of the National Center for Global Health and Medicine (NCGM)(Emergency Medicine & Critical Care Department)

Putting Japanese Medical Devices to Work in African Hospitals............................................................. 32
Bureau of International Health Cooperation, National Center for Global Health and Medicine (NCGM)

Spin-Off: Another Side to the TENKAI Project
People who Support the TENKAI Project <Cambodia>........................................................................... 34

Cover photo: Japanese experts teaching oral care skills in an ICU at Bach Mai Hospital, Vietnam (Ms. Yuki Yonehiro, second fromthe left in the front row).
“Project of Surgical Team approach to Health and Medicine based on Bach Mai Hospital, Vietnam: Perioperative”

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TENKAI Project News vol.1 ｜ January 2021

Introduction
The National Center for Global Health and Medicine (NCGM) has been implementing the Projects for
Global Extension of Medical Technologies (TENKAI Project) since fiscal 2015 with funding from the Ministryof Health, Labour and Welfare. Japan has achieved the world's highest level of healthy life expectancy
and health care standards under its universal health insurance system. The project aims to share thisexperience and knowledge to enhance Japan's credibility in the international community by contributing
to the improvement of public health and medical standards in partner countries while promoting the
growth of Japan's healthcare sector, transferring medical technologies, and promoting the international
deployment of high-quality Japanese pharmaceuticals and medical devices. In so doing, the objective of
the project is to bring about a virtuous cycle for both Japan and partner countries.
This project has the following features.

 T he project is a new type of international cooperation that is not based on a structure of support fromrich countries to poor countries, from supporters to recipients, but on the growth of Japan's medical
sector within the project. The products and services made in Japan are superior in many ways, including
technology and systems, and have great potential to contribute to the development of the partnercountries. Although it is a prerequisite to generate profits, many companies hope to contribute to thecreation of a better society through the project, and deployment of products and services as theirbusiness will lead to sustainable development and improve medical standards in partner countries. The
development of the medical industry will also lead to job creation and education in specialist knowledge
and skills.
 T he goal of this project is to develop Japanese medical technology and services overseas from thestandpoint of both the public and private sectors, together with the Cabinet Secretariat, the Ministry ofInternal Affairs and Communications, the Ministry of Economy, Trade and Industry, the Ministry of Health,Labour and Welfare, the Ministry of Foreign Affairs, related ministries and agencies, general organizations,medical institutions, universities and other academic institutions.
 T his project takes the form of training to realize its objectives. Based on the health and medical issuesof the partner country or region, Japanese experts in social security systems, medical professionals,
engineers from healthcare-related industries, and other experts are dispatched to the partner country orprovide training in Japan for participants from the partner country. Each year, applications are solicitedfrom a public offering, and more than 30 projects are implemented. The main fields of projects include
diagnostic technology (clinical examination, radiology and other diagnostic imaging, endoscopy, cancer
diagnosis, etc.), preventive and therapeutic technology (surgery, intensive care, blood transfusions,rehabilitation, dialysis, etc.), medical device management, medical quality and patient safety, healthcheckups, and regulatory systems for pharmaceuticals and medical devices.
 S ince the third year, a project evaluation framework has been introduced to clarify the process of project
implementation (process), the immediate results of implementation (outcome), and the expected results
in a few years (impact). In this way, the project aims to clearly communicate its results.
n response to the global outbreak of COVID-19, travel restrictions in Japan and abroad have made it I
difficult to conduct face-to-face training as in the past. On the other hand, the interest and needs ofthe international community in the field of health and medicine, whether related to COVID-19 or not,have never been higher. While we have been able to see results of the projects through multi-year
implementation, there are some projects that need to think about their exit strategies.

In this issue of the TENKAI Project News, we will introduce the results and activities of the project so far.
Noriko Fujita, Director, Projects for Global Extension of Medical Technologies
TENKAI Project News vol.1 ｜ January 2021

3

Bringing Japan's Health Careto the WorldA concerted effort by Japan’s public and private sectors topromote a new approach to international expansion of healthcare and international cooperation
Japan's growth strategy and international expansion of health care are contributing to global healthJapan has one of the world's highest life expectancies and is one of the most advanced countries
in the world in terms of health care. This is based on its universal health care system, high-quality
pharmaceuticals and medical devices, quality of medical personnel, and the excellent service found at
medical institutions, resulting in world-class health care. In recent years, there has been a concerted effort
by the public and private sectors to promote the export of the medical industry to overseas countries
under the name of “International Expansion of Health Care.” The government, companies, and research
institutes are working together to expand Japanese health technologies and services in outbound andinbound markets to strengthen Japan's competitiveness and contribute to addressing global health issues.
The international expansion of health care is also reinvigorating international health cooperation activities.
Traditionally, assistance in the field of health care for low- and middle-income countries has been
provided in the form of bilateral assistance through Official Development Assistance (ODA), multilateralassistance through international organizations, or multi-bi cooperation. With the establishment of
the MDGs (Millennium Development Goals) in 2000, Japan began to support low- and middle-income
countries as part of its global health efforts, focusing mainly on maternal and child health and infectious
disease control, with a view to solving problems on a more global scale. Since 2015, the international
community has been working to achieve new goals called the SDGs (Sustainable Development Goals). In
the healthcare sector, one of the targets to achieve the goal “Ensure healthy lives and promote well-being
for all at all ages” is to achieve “universal health coverage (UHC),” where all people have access to basic
health services at a cost they can afford. Japan, which has already achieved UHC through its universal
health insurance system, has been working to leverage its experience to expand its health care services
internationally, making further contributions to the world by linking this to its own growth strategy. In thisway, a new form of international health cooperation has been born, complementing conventional ODA,
with the participation of health care-related companies aiming to expand their business overseas (mainlyin emerging countries).
Projects for Global Extension of Medical Technologies with a focus on training
The Ministry of Health, Labour and Welfare of Japan launched the “Projects for Global Extension of Medical
Technologies” (hereinafter referred to as the “TENKAI Project”) in 2015 to support the international
expansion of Japanese health care technology. The National Center for Global Health and Medicine (NCGM)
Bureau of International Health Cooperation serves as the secretariat, and several departments including
NCGM Center Hospital participate in the projects.

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TENKAI Project News vol.1 ｜ January 2021

In the health care industry...

Accept foreign medical
staﬀ and provide
training.
Provide advanced
medical care to foreignpa�ents.

At clinical sites...

Create new and be�er
pharmaceu�cals, medical
devices, and services.
Create pharmaceu�cals andmedical devices that can be usedin harsh natural environments
such as high temperatures anddry condi�ons, as well as inenvironments with poor
infrastructure.
Collabora�on& Coopera�on

Japan

In the government...

Create organiza�ons andnetworks to promoteinterna�onal expansion.
Support interna�onal
expansion by companies andorganiza�ons.

Export superior
medical devices
and services

OutboundTraining of overseas
medical staﬀ in Japanand accep�ng
of pa�ents whenlocal treatment isdiﬃcult

InboundCreate health systems
and deploy necessary
devices and services tomeet local needs.

Overseas(mainly emerging countries)

Figure 1: Basic concept of international health care expansion⇔

Improve local health care.
Help people around theworld to live healthier lives.

OutcomePromote services for early
detec�on of diseases, such as
simple tests that can be used in avariety of environments.

For example...

Create systems to properly
manage advanced medical
devices in hospitals.
Build medical facili�es thatprovide highly accurate medical
examina�ons and checkups.
Provide technical training for
medical staﬀ in handling medical
devices and pa�ent care.

⇒⇔

TENKAI Project News vol.1 ｜ January 2021

5

Asia
India
Republic of Indonesia
Republic of Korea
Kingdom of Cambodia
Republic of Singapore
Kingdom of Thailand
People's Republic of China
People's Republic of Bangladesh
Republic of the Philippines
Brunei Darussalam
Socialist Republic of Viet Nam
Malaysia

Republic of the Union of Myanmar
Mongolia
Lao People's Democratic Republic

Turkmenistan
Russian Federation
Middle East
Islamic Republic of IranKingdom of Bahrain

AfricaFederal Democratic Republic ofEthiopia Republic of Ghana
Republic of Cameroon
Republic of the Congo
Republic of Zambia
United Republic of Tanzania
Federal Republic of Nigeria

Latin America
Federative Republic of Brazil
United Mexican States
Oceania
Independent State of Papua
New Guinea

EuropeRepublic of Uzbekistan

Figure 2. Partner countries implementing Projects for Global Extension .
of Medical Technologies (TENKAI Project) from 2015 to 2020
Item / ﬁscal year

2015

2016

2017

2018

2019

Total

Number of project
implementa�on countries

13

14

17

13

12

69

Number of projects

28

31

31

29

38

157

Number of trainees visi�ng
Japan

242

244

280

247

254

1267

Number of trainees in theimplemen�ng country

4740

4539

5209

4137

7509

26134

Table 1. Number of partner countries, projects, and number of training participants in Projects
for Global Extension of Medical Technologies (TENKAI Project) from 2015 to 2019
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TENKAI Project News vol.1 ｜ January 2021

Figure 3. Composition of the key performance indicators (KPIs)
of Projects for Global Extension of Medical .
Technologies (TENKAI Project)
Training

Issues tobe solved
through the
project

How to tackle
the issues/Whatto convey in the
training

Goals achieved
after training(output
indicators)

Goals achieved
during the
project period
after training(outcome indicators)

Desired state/goal/
new value creation
at the end of the
project or after theend of the project(e.g., 5-10 years
later) (impact
indicators)

The projects aim to introduce and disseminate Japanese medical technologies, high-quality medicines,
medical devices, and health services in a way that suits local needs, and to improve health and medicalcare issues in the partner country, thereby enhancing Japan's credibility in the international communityand creating a virtuous cycle for both Japan and the partner countries. In order to meet the healthchallenges and needs of the partner countries, medical experts conduct training, introduce Japanese
products, and provide technical assistance to address the challenges.
The projects address a wide range of global health issues. In addition to maternal and child health, andinfectious diseases such as AIDS, tuberculosis, and malaria, which have been addressed globally in the
MDGs, there are a variety of emerging health challenges that many countries are facing, such as aging,cancer, stroke, and other non-communicable diseases.
The themes for solving these issues are also diverse. For example, the themes for solving the above issues
include diagnosis and treatment technologies (diagnosis and treatment of cancer, diagnosis and treatmentusing devices such as bronchoscopes and endoscopes, dysphagia diet and rehabilitation technologies,etc.), hospital administration and management (patient safety, quality medical care, team medicine, etc.),
and the systems that support medical technologies (medical device regulatory system, maintenance andmanagement of medical devices, and training of pathologists and nutritionists, etc.). Training is conducted
through the dispatch of Japanese experts in medical technology and policy, the acceptance of trainees
from the partner country into Japanese medical institutions, and online training between Japanese experts
and trainees from the partner countries.
The outcomes of the projects are expressed in terms of improvements in people’s health (Figure 3). The
indicators are: what is to be achieved after the training (output indicators), what is to be achieved during
the project period after the training (outcome indicators), how the health care and health status of thepeople in the partner country will be improved through the project or after it ends, and what new value
will be created (impact indicators).

TENKAI Project News vol.1 ｜ January 2021

7

Debriefing session held at NCGM

Companies and organizations participating in the projects are screened and selected through a yearly open
call for proposals, and can receive funding as a commissioned project that will run for about 10 months.
Some of the projects that achieve good results in the 10-month project period apply for the next year's
project, and there are projects that have been running for multiple years to achieve the impact indicators.
The annual activities are presented at a debriefing seminar at the end of each fiscal year, and the results
are published in a report.
Impact of 5-year activities on partner countries
As shown in Table 1, in 2015, when the project started, 28 projects were implemented in 13 countries,
and 242 and 4,740 medical personnel were trained in Japan and the partner countries, respectively. Since
then, a total of 157 projects have been implemented in 69 countries over the past five years until theend of fiscal 2019. The number of medical personnel trained in Japan and the partner countries reached1,267 and 26,134, respectively. In the two years from 2018 to 2019, a total of eight medical technologies
were adopted in the national plans or guidelines of the partner countries, and 41 types of medical devices
were procured in the partner countries under 16 projects. In Japan too, expertise, and many suggestions
and insights obtained from successful projects have been widely disseminated through conferences,
documents, and public relations activities.
Of Japan’s international cooperation, the emphasis is placed on ensuring that the technologies becomea part of the partner country and develop sustainably by themselves through the work of people in thepartner countries even after the project has finished. In the project, even after the completion of the
project, the technologies are passed on from the trainees to health care personnel in their institutions, andthen to surrounding medical facilities and eventually throughout the country. In fiscal 2020, the sixth yearof the project, more than 30 projects have been implemented, creating new value to healthcare in partnercountries.
(Chieko Matsubara)

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TENKAI Project News vol.1 ｜ January 2021

Providing High Quality Medical Careto Stroke Patients in Vietnam by a Team Medicine
Photo: Seminar on early movement and dysphagia held by stroke team at BMH in Vietnam in January 2019

Surgical Team Medicine Project
In Vietnam, the number of patients suffering from stroke, one of the non-communicablediseases, is increasing along with the aging of society and the westernization of lifestyles
due to the recent economic development. In 2017, about 200,000 people were diagnosed
with the disease annually, with about half of them dying, and even if their lives are saved,
90% of patients are left with some kind of permanent disability. In order to improve thissituation, Center Hospital of the National Center for Global Health and Medicine (NCGM)
has been conducting a surgical team medicine project at Bach Mai Hospital in Vietnam since2015 to provide high quality medical care and treatment to stroke patients. Along with theadvancement of medical care, instead of the traditional approach of having a single physician
be the main focus of providing care, team medicine provides medical treatment and carethat is tailored to the patient’s condition by a team of medical doctors, nurses, pharmacists,
dieticians, occupational therapists, physical therapists, speech-language therapists, clinicalengineers, and other professionals. The various medical specialists provide safe medical
treatment and care tailored to each individual patient, consulting with them and theirfamily from the onset of illness to recovery, complementing the coordination of their highly
specialized knowledge and skills in areas such as nutrition, early start of post-operative
rehabilitation, and infection control.
BMH is one of the three major national hospitals in Vietnam, located in the capital city of
Hanoi, and has a history of more than 100 years since it was established in 1911. It is a huge
hospital with 3,100 beds and more than 150,000 inpatients per year. Although it accepts
a large number of patients, team medicine is not common. The TENKAI project involves
the collaboration of many departments and medical sections of NCGM Center Hospital,
including Neurosurgery, Rehabilitation, Nursing, Nutrition Center, Pharmacy (stroke team),
Intensive Care Unit, Anesthesiology (perioperative team), and Clinical Engineering (ME team,collaborating on another project from 2020).

TENKAI Project News vol.1 ｜ January 2021

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In the sixth year of the project, we havebeen able to provide high quality carewith the expectation of early recovery,such as early movement rehabilitation
for post-operative neurosurgery patients,and orally administered meals forpatients who used to be tube fed due
to difficulty in swallowing. Currently,
the project is working on improving
the level of stroke treatment and care,which is necessary to extend the healthy
life span of people in Vietnam. The
project members are not only improving
surgical treatment techniques, but also
simultaneously working as a team on
primary stroke prevention and earlyrehabilitation intervention.

Team medicine for stroke treatment
Emergency service(pre-hospital)

Emergency
physician

Neurosurgeon, neuroendovascular doctor, neurologist

Cer�ﬁed stroke rehabilita�on nurse

Rehabilita�on physician

Laboratory technician/radiologist

Stroke pa�ents
SCU (Stroke Care Unit)

AOT・PT・ST

Pharmacist

Nutri�onist
AMSW
Smooth discharge and transfer(Tetsuo Hara, Chieko Matsubara)

Stroke team that supports stroke patients from onset to recovery through team medicine
Neurosurgery Department
Analysis of treatment results and prognosis using databases
Neurosurgeons in Vietnam are few in number and perform a huge number of operations. At BMH, only
10 doctors perform 2,400 surgeries per year (400 cerebral aneurysms and 100 cerebral arteriovenous
malformations). The Japanese experts started by establishing a database of stroke patients (subarachnoid
hemorrhages and cerebral arteriovenous malformations) in order to understand the situation of patients
who underwent surgery in Vietnam. Although the criteria used to enter data into the database differedslightly from doctor to doctor, a large number of ruptured cerebral aneurysms (about 800) were registeredin just 18 months.
In Vietnam, inpatient and outpatient medical records are kept
separately, and even during hospitalization, they are kept
separately for each department, such as neurosurgery andrehabilitation. However, the database will be analyzed fromthe perspective of surgical results and prognosis. It will be used
for team medicine, especially in collaboration with nursing andrehabilitation, to not only improve surgical techniques but also
to build a system to support stroke patients as a team. The
Nursing Department is also creating its own database, and theneurosurgery database will incorporate items from the nursing
database that can be shared in the future.
(Tetsuo Hara)

Training in an operating room

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TENKAI Project News vol.1 ｜ January 2021

Nutrition Office
Promoting nutritional management by introducing dysphagia foodNutritional management for stroke patients requires the provision of meals suitable for preventing
aspiration pneumonia and enhancing swallowing exercises for dysphagia. However, there was not
dysphagia food with thickening agent in Vietnam. At the beginning of the project, there was little
recognition of its importance and insufficient knowledge and skills. Therefore, the Japanese experts
proposed the introduction of “dysphagia food” with thickening agent that had not existed before, andprovided guidance on dysphagia food and how to prepare it. Training sessions and seminars were heldin Japan and Vietnam. A large number of medical staff and companies attended training in Vietnam. As aresult, the number of dysphagia food provided and the number of nutrition consultations increased year
by year.
Dysphagia food is divided into four stages so that the patient can train to eat from lower stage to upperstage. The provision of dysphagia food began in November 2017, initially about two meals per month,
but the number gradually increased, and in fiscal 2018, a total of
about 9,000 meals were provided. In fiscal 2019, a total of 18,172
meals were provided, doubling the number of meals served, andnutritional guidance was provided to all patients who were offereddysphagia food and their families.

Dysphagia
foodSome patients who were unable to eat due to swallowing difficulties
have been pleased to find that their oral intake has increased
through training by eating the dysphagia food. In addition, there isa possibility that the dysphagia food will be covered by insurance,
and if this happens, it will mean that dysphagia food is recognized ashaving a clear therapeutic effect. It takes a lot of time to understandeach other due to the language barrier between Japan and Vietnam,
but the sincerity and enthusiasm of the people involved in nutrition
management at BMH have been a great achievement.

From top: The kitchen at Bach Mai Hospital |Training in the NCGM kitchen | Tasting of easyto-swallow food(Yuichi Egashira, Chika Tanahashi)

TENKAI Project News vol.1 ｜ January 2021

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From left: A meeting to discuss therole of nursing in team medicine| Dysphagia food training | Skills
check before administering topatients

Nursing Department
Nurses Support Patients’ Rehabilitation
Vietnam does not yet have a universal health insurance system and there is a shortage of rehabilitation
therapists, so stroke patients do not always have access to rehabilitation. At present, only nurses canprovide rehabilitation to patients at the neurosurgery ward. Japanese experts in nursing have trained
the nurses at BMH in rehabilitation nursing that enables stroke patients to early movement. Nurses inVietnam, who are even busier than in Japan, have the strong intention of, “If the patient needs it, we must
do it! We have to provide family guidance!” and started the “nurse-assisted movement.”
During the training in Japan, the Vietnamese nurses studied the significance of movement, procedures andmonitoring. Together with Japanese nurses, they conducted a series of bedside rehabilitation practices anddeveloped a protocol that could be applied to patients in Vietnam. In fiscal 2018, they wrote a “report on
the practice of nurse-assisted movement.” Since then, we have continued to revise the protocol to ensure
further patient safety. They are continuing their activities with the aim that “early movement,” which had
previously been “zero” in Vietnam, and rehabilitation nursing will be practiced for patients other thanstroke patients in the future as part of the nursing services provided at BMH.
(Keiko Horiuchi)

Project Story
With multidisciplinary team medicine playing an increasingly important role in improving medical skills and knowledge
through training, it is inevitable to ask the question, “What is nursing?” In my opinion, nursing is “working to make theperson in front of you happy,” and it changes depending on the needs of the person in front of you.
During the training, nurses from Vietnam and Japan discussed “the role of nurses in team medicine”. Even though there aredifferences in culture and social security, and the content of work varies, our goal is to improve the quality of life (QOL) of
stroke patients and their families by practicing rehabilitation nursing.
Through this project, the medical needs of stroke patients in Vietnam have become clear, and the various professions havestarted to take action. However, if we try to implement all the actions, the work will be concentrated on the ward nurses.
Vietnamese nurses are very passionate and if there is a need, they will do their best. I feel the difficulty in carrying out the
project, wondering if we are not overwhelming the Vietnamese nurses, who have their hands full even at present, anddepriving them of the time to feel the joy of nursing. The challenge for the future is to reintegrate the specialized care andprovide care that makes patients happy through team medicine.

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TENKAI Project News vol.1 ｜ January 2021

Pharmacy Department
Efforts for Appropriate Use of Drugs
At BMH, when administering drugs through a tube, the patient's family
crushed and prepared the drugs, and the nurses administered them tothe patient. There was no standard for whether or not the drugs could
be crushed, and we found out that drugs that should not be crushedwere being crushed and administered through a tube. Therefore, NCGM
Pharmacy Department conducted a training program to ensure the safety
and efficacy of drugs administered through tubes. The trainees learned
about case interventions by ward pharmacists using the “List of drugs
that can be crushed or suspended in tube administration at NCGM.”
As a result, a “List of drugs that should not be crushed in tube
administration at BMH” was developed by the pharmacists. The list
was also posted on the website (http://canhgiacduoc.org.vn/Home.
aspx), which Vietnamese pharmacists visit to gather information. In theneurosurgery ward, the simple suspension
method introduced in the training course
was newly introduced and is being practiced.
In addition, the knowledge acquired during
the training has been disseminated throughlectures held by the trained pharmacists tothe staff of the Emergency Department andPoison Control Department (about 30 people)
and 380 nursing students. At present, theproject team is continuing its activities toprovide drug guidance to patients and theirfamilies using drug information sheets, withthe aim of further promoting appropriate
drug use.
(Hirotake Ohashi)

From top: Pharmacists’ activities in the wards| Tube administration of drugs | Training for
appropriate drug use at NCGM

From top: Implementation of
simple suspension method | Nurses
distributing medicine to patients’families

Project Story
By visiting BMH and directly
understanding the current
local situation, we were able
to find needs of the patientsin the partner country thatthey themselves were notaware of. By spending timewith them, we were able
to get to know them andproduce results that better
met their needs. This isalso one of the important
aspects of team medicine,where we work with otherprofessionals to solve
problems.
I hope that the resultsof this project will leadto the implementationof appropriate tube
administration ofdrugs in a wide area ofVietnam through thedissemination of various
types of information by thepharmacists of BMH.

[Partner country] Socialist Republic of Viet Nam [Project name] “Project for the Development of Human Resources in Clinical Departments
Using a Base in Vietnam (Neurosurgery Team, Perioperative/ICU Team, Respiratory Surgery, Respiratory Medicine)” (2016), “Project for
the Development of Human Resources in Clinical Departments Using a Base in Vietnam” (2017), “Project of Surgical Team approach tohealth and Medicine based on Bach Mai Hospital, Vietnam: Stroke Care” (2018, 2019, 2020)

TENKAI Project News vol.1 ｜ January 2021

13

Supporting the Safety of Perioperative Patients in
Vietnamese Hospitals
Photo: Lab practice at NCGM Center Hospital

The perioperative team supports safe surgery and early recovery
The Intensive Care Unit (ICU) and Anesthesiology Department at Center Hospital of the National Center
for Global Health and Medicine (NCGM) have been working on TENKAI project to support patient safety
in the perioperative period by collaborating in a perioperative team based at Bach Mai Hospital (BMH) in
Vietnam since 2016. The perioperative period refers to the period from pre-operation to post-operation
recovery. In order for patients to undergo surgery more safely and recover well, it is important to manage
the perioperative period appropriately according to each patient’s condition. Managing the generalcondition of the patient, pain control, and infection control throughout the entire perioperative periodrequires cooperation not only between the surgeon and nurse in charge, but also between multiple
departments and professions, including the Anesthesiology Department, ICUs, Pharmacy Department, andClinical Engineering Department. The comprehensive team medicine makes it possible to increase patient
safety.
BMH carries out 45 to 60 surgeries a day, and the surgical ICUs see 40 patients simultaneously, yet thiskind of team medicine was not widely applied. Before the start of the project, the wards were crowdedwith patients, and there were many points that needed to be improved, such as hygiene management
and risk of patient misidentification. In particular, the ICU was facing the problem that many patients who
were put on ventilators after surgery suffered from ventilator-associated pneumonia (VAP). Therefore,
the project focused on disseminating the World Health Organization's (WHO) Surgical Safety Checklist,
VAP prevention, and postoperative pain control, with associated efforts to reduce perioperative infectious
complications and improve safety management.

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TENKAI Project News vol.1 ｜ January 2021

Intensive Care Unit (ICU)
Protecting patients on ventilators from VAP
A ventilator is a medical device that sustains life by assistinga patient’s breathing until recovery from respiratory failure
through treatment. However, use of ventilators requires
appropriate management and nursing care because of associated risks such as medical complications. One such risk
is VAP, a nosocomial pneumonia that occurs after 48 hoursof ventilation with a mortality rate of 20-60%. In many lowand middle-income countries, there is a need to address
the high rate of VAP in ICUs.
To prevent VAP, it is necessary to understand the manyrisks of ventilator management and develop preventive
measures. Since the risks are interrelated, previous studies
have shown that bundling multiple measures together is aneffective strategy for VAP prevention. Therefore, the project
team held a workshop to help the staff at BMH understandthese issues and developed a 10-item VAP prevention carebundle that could be feasible at the hospital.

From top: Discussion between ICU doctors andnurses | VAP prevention care bundle poster

VAP prevention care bundles are SDGs for ICUs
Implementing a VAP prevention care bundle for only a short period of time is insufficient; it must be
sustained by all the nurses who care for patients every day. Experts from NCGM and BMH shared theimportance of prevention and promoted the VAP prevention care bundles as “Sustainable Development
Goals (SDGs) for the ICU” by creating a poster and displaying it in the ICUs and nurse stations. The poster
was very popular and a number of other wards expressed their desire to display it in their wards.
In the beginning, the VAP incidence rate did not decrease despite the high compliance rate for each item.
However, by reviewing oral care, purchasing of equipment and materials supported by BMH, the VAP
incidence rate, which had been difficult to reduce in the past, came down. The director of BMH was very
impressed with these results, and decided to introduce the VAP prevention care bundles to 14 ICUs at
BMH.
Over the three years since the project began, the bonds between the Japanese and Vietnamese experts
have gradually deepened through the many activities carried out in Vietnam and Japan. Sharing successful
experiences is one of the most important factors in making a project successful. With these bonds, theproject will continue to expand the VAP prevention care bundles throughout BMH and Vietnam.
(Tatsuya Okamoto, Yuki Yonehiro, Chieko Matsubara)

TENKAI Project News vol.1 ｜ January 2021

15

Anesthesiology Department
Safe surgery and protecting patients from postoperative pain and risk of infectious complications
At the beginning of the project, BMH staff took for granted that patients would feel pain after surgery, andlittle consideration was given to pain control and other measures. Pressure ulcers (bedsores) also occurred
frequently. In addition, medical staff cared for many patients at the same time in cramped conditions,family members brought patients meals and helped them with the toilet, and hand disinfection was not
implemented thoroughly. Inadequate hand disinfection is also a factor that increases the incidence of VAP.
In order to move forward with the project, the team started by inviting the Vice Chief of Anesthesiology
and the ICU Chief of BMH to NCGM to observe the perioperative management, especially infection control
and safety management, and share understanding of the issues and approaches for improvement. Since
fiscal 2017, Japanese experts have visited to BMH in June, two to four Vietnamese doctors and nurses havereceived training at NCGM in the fall, and Japanese experts have conducted follow-up training in Vietnam
again in December or January.
During the training, the trainees observed the Anesthesiology Department, operating rooms, and ICUs of
NCGM Center Hospital, as well as the operating rooms and ICUs of several other hospitals. They learned
that safety and hygiene management is thoroughly implemented in all hospitals in Japan. They also
learned how to control patients’ postoperative pain.

From top: Trainees learning at NCGM Center Hospital | Lecture on VAP prevention

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TENKAI Project News vol.1 ｜ January 2021

The trainees said that they learned a lot from thehygiene management methods and VAP prevention carebundles conducted at NCGM. In addition, after observing
how nurses in Japan carry their own rubbing alcohol
for frequent hand disinfection, they have started toconsiderer the introduction of this practice in Vietnam aswell.
As part of the project, the Surgical Safety Checklist
promoted by WHO worldwide was translated into
Vietnamese and introduced in BMH. This has made it
possible to check patients entering or leaving operatingrooms during surgery and to check for any objects
left inside the patient’s body. The administrationof antibiotics to patients prior to surgery has also
become widely practiced, and postoperative infectious
complications have been reduced.
In terms of pain control, Japanese experts provided
hands-on guidance on ultrasound-guided nerve blocktechniques. In addition, in response to strong requests
from nurses who had learned about postoperative pain
control in Japan, the project team supported to develop apain control manual based on drugs used in Vietnam, andnurses began to introduce pain control to patients after
surgery. The initiative began with a simplified version of
the manual and the project team plans to improve it in
the future.
NCGM will continue to support through the project sothat it can further build on the cross-departmental team
medicine that started at BMH. The project team aims tospread perioperative care to other areas in Vietnam in
addition to BMH, focusing on patient safety and infection
control.
(Yasuhiro Maehara)

Top: WHO Surgical Safety Checklist practiced in an
operating room | From bottom left: Patient identification by wristband | Notice for infection control

Project Story
Throughout our five years of project activities,
we have always been welcomed and treated ina friendly manner by the staff at BMH.
They have been very proactive in our
discussions, and meetings often go beyond
the scheduled finishing time. I realized thatthey are highly motivated to promote bettermedical treatment and care.
We started the project without knowing what
we would be able to do, but we have gradually
started to see results. With the cooperation ofmany people, the project has been expanded
to include the entire BMH, and we are startingto achieve great results. I would like to thankeveryone who has cooperated in this project.

[Partner country] Socialist Republic of Viet Nam [Project name]: “Project for the Development of Human Resources in Clinical
Departments Using a Base in Vietnam (Neurosurgery Team, Perioperative/ICU Team, Respiratory Surgery, Respiratory Medicine)” (2016)“Project for the Development of Human Resources in Clinical Departments Using a Base in Vietnam” (2017) “Project of Surgical Teamapproach to health and Medicine based on Bach Mai Hospital, Vietnam : Perioperative” (2018, 2019, 2020)

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17

Building Medical Device Management System for
Hospitals in Vietnam
Photo: YouTube Live streaming of the inspection practice

A system to ensure the long and safe use of medical devices
In Japan, clinical engineers are nationally-licensed medical professionals who are responsible for the proper
operation, maintenance, and inspection of medical devices, and support safe and smooth medical treatment
as members of medical teams. Departments and teams led by clinical engineers centrally manage medical
devices and play an important role from planning replacement plans that take into account the useful life andstate of repair of devices to hospital management. On the other hand, since there is no national license forclinical engineers in Vietnam, nurses have to manage ventilators in the ICU, so there have been many issues
with the medical device management system. Staff from the Clinical Engineering Department at the Center
Hospital of the National Center for Global Health and Medicine (NCGM) started to work for NCGM's surgicalteam medicine project team based at Bach Mai Hospital (BMH) since 2017. In 2020, in addition to BMH,
we also collaborate with Hue Central Hospital in the central region,
Cho Ray Hospital in the south, the National Medical Device ResearchInstitute, and the Ministry of Health to systematize the medical device
management system by providing information on the Japanese clinicalengineer system and hospital evaluation criteria including medical
device management as well as on-site management of medical devices.
At the beginning of the TENKAI project, when Japanese experts visited
BMH, they found that although there was a department that managed
medical devices, even very old models were not disposed of and werestacked up in a messy manner. There was no system for centralized
management with a management ledger, and there were insufficient
records of when the devices were purchased and how many times
they had been repaired. Furthermore, the department was asked to
From top: Cluttered work desk | Piles ofrepair all kinds of device other than medical devices, and was put indocuments
charge of gas piping, boilers, air conditioners, and electrical wiring in
the hospital.
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TENKAI Project News vol.1 ｜ January 2021

Fostering people to take on the role of clinical engineers
The project invited people in charge of device management to Japan as
trainees and provided them with training on medical device managementat NCGM, university hospitals, and medical device manufacturers. Throughthe practical training, the trainees learned that maintenance and a system
to monitor the management status of each piece of device are important
for the long and safe use of medical devices, and discussed issues andimprovements at BMH. After returning to Vietnam, the trainees conducted a
training course in the hospital to disseminate what they had learned and topromote understanding of medical device management.
Later, the Japanese experts visited Vietnam again as a follow-up to check thestatus of improvement. They found that the corridors that had been filledwith medical devices had been cleaned up and the piles of medical devices
were neatly organized on shelves. Each piece of device was numbered andmanaged in a list on the computer. The state of repair was also recorded indetail. In addition, Japanese experts co-hosted a “Japan-Vietnam Medical
Device Management Seminar” with BMH to teach the importance of
medical device management, barcode management methods, ventilator
handling, and dialysis techniques. As many as 120 people participated in theseminar, including not only the staff of BMH but also those from neighboring
hospitals, the Ministry of Health, research institutes, universities, andmedical equipment technology colleges.

From top: Training in Japan(October 2018) | Well-organized syringe pumps in the
ICU | Introduction of barcode
management

Project Story

Never stop learning with online training
In 2020, although experts could not travel abroad because of the prevalenceof COVID-19 worldwide, technical assistance continued to be provided despite
the difficulty in direct human interaction. The project goal is to raise the levelof medical device management in Vietnam, to spread the technology from thenorthern part of the country to hospitals in the central and southern parts, andto disseminate it throughout Vietnam. This year, the project has switched toan online system, where lectures and practical training are provided by video
so that trainees can learn at their preferred time, and real-time training isprovided via live streaming. This has made it possible for trainees from all overVietnam to participate in the program, and has also produced the effect ofmore than 150 trainees learning at the same time.
(Shigeru Hosaka)During my stay in Vietnam, I
saw a beautiful and fantastic
sun every morning from myhotel, but I was told that it
looked beautiful because of
dust and photochemical smog.
I am looking forward to seeing
the power of young people in
the hustle and bustle of the city
become like a sun to brighten
the future of Vietnam andprogress the country. I am surethat even if COVID-19 changes
the training methods, they will
still produce good results.

[Partner country] Socialist Republic of Viet Nam [Project name] “Project for the Development of Human Resources in Clinical Departments
Using a Base in Vietnam” (2017), “Project of Surgical Team approach to health and Medicine based on Bach Mai Hospital, Vietnam: ME(2018, 2019),” and “The Project of Medical Equipment Management for 3 Core Hospitals in Vietnam” (2020).

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19

Promoting Safe Radiology Examination in Zambia

Photo: Japan-made angiography system owned by the University Teaching Hospital of Zambia

Zambia needs to develop human resources skilled in using medical device for
examinations and treatment
In the Republic of Zambia, where economic development is advancing, the number of lifestyle-relateddiseases such as myocardial infarction is increasing rapidly, as are traffic accidents due to the spread of
automobiles. However, the current situation is that the environment for cardiovascular care and treatment
is not yet sufficiently developed. To improve this situation, the country needs not only the necessary
medical devices, but also human resources who can use them for examination and treatment. The
Radiology Department at Center Hospital of the National Center for Global Health and Medicine (NCGM)
has been working together with Japanese medical device manufacturers since fiscal 2018 on TENKAI
project to promote safe CT examinations and cardiac catheterization and treatment techniques in Zambia.

The first coronary CT scan in Zambia was successful
In fiscal 2018, one doctor and four radiologic technologists were invited to Japan for training, and in fiscal
2019, one doctor, one radiologic technologist, and one nurse were invited. They learned a variety of
topics, including the basic operation of the installed CT, how to read and diagnose images, how to store
image data, and how to treat patients undergoing examinations. Japanese experts also went to Zambia tosupport the activities of the trainees back in their home country. One of the major achievements was thatthe trainees successfully performed the first coronary CT scan in Zambia under the supervision of Japaneseexperts. The event was reported on TV and in newspapers in Zambia and drew a great response.

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TENKAI Project News vol.1 ｜ January 2021

From top left: Japan-made angiographysystem | Project teamreceiving TV coverage| Trainees performing
coronary stent treatment | Trainees receiving solo interviews(cardiologist)

Treating patients with coronary stents successfullyusing a Japanese product
Another major achievement of the project was the successful useof coronary stent treatment by Zambian medical staff alone. Until
then, patients had needed to travel to South Africa to receive thistreatment. It was also the first time that a stent made in Japan, which
had never been used in Zambia, was used. The success of the project
was widely covered by the mass media, and one of the trainees,a cardiologist, met the Vice President after the TV broadcast andreceived his words of appreciation.

Exchanges continue even after the project ends
Once the training was over, Japanese experts and trainees got to knoweach other as colleagues and had a good time together. On weekends,
we would go to safari parks together or hold parties for dancing.
We shared many memories and developed good relationships, andeven after the project is over, there is ongoing exchange between theJapanese experts and the trainees.

What is a stent? ....
A stent is a medical device used towiden tubular parts of the humanbody (blood vessels, trachea,
esophagus, duodenum, colon, biliary
tract, etc.) from the inside.

Project Story
One of our trainees went
to university to further his
knowledge. I believe that this isdue to the fact that he learned
the importance of improving his
medical skills and knowledge
through the training.

(Yuzuru Kono)
In Africa, if you can't dance well,
you may feel ashamed. If you areplanning to go to Africa, I highly
recommend that you practice
your dance skills!

[Partner country] Republic of Zambia [Project name] “The project for strengthening operations of image diagnostic using Computed
Tomography device and intervention using Angiography device at University of Teaching Hospital: Zambia” (2018, 2019)

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21

Spin-Off: Another Side to the TENKAI Project

People who Support the TENKAI Project<Myanmar>In the Projects for Global Extension of Medical Technologies (TENKAI Project), there are various
tasks such as budget management and procurement of necessary materials, and many staff
members support its operation. In some cases, administrative staff members are responsible
for these types of administrative tasks in the partner country and accompany experts on
country visits to support their activities. The following is an introduction to the activities of theadministrative staff in the partner countries.

Project Treasurer
In 2018, 2019, and 2020, I traveled to Myanmar as a member of the project team to help organize
the “Blood Transfusion Safety Improvement Seminars” held as part of “The project to support the
improvement of blood transfusion safety” in Myanmar. About 100 people attended the seminars fromall over Myanmar. The main role of the on-site administrative staff was to be the project's treasurer inthe partner country. We were in charge of accounting, payment, and currency exchange but we faceddifficulties that were unique to the partner country. For example, 10,000 JPY in the local currency(Burmese kyat (Ks)) is approximately 130,000 Ks, so if you exchange ten 10,000 JPY bills, you will get 130
10,0000 Ks bills. In Myanmar, 10,000 Ks bills are avoided because they are not easy to use, and payment
must be made in 1000 Ks or 5000 Ks bills. Therefore, if you exchange your money into 1000 Ks bills in
anticipation of this local context, you will have 1300 bills. You will be working surrounded by bills andlooking like a rich person, but you will also feel very nervous if you have to manage so many bills.
Also, because of the large number of bills to be handled, discrepancies in cash balances due tomiscounting are more likely to occur. In order to prevent this from happening, we separate the cash forthe next day's payment into envelopes the day
before. Once, we found that the cash balances
did not match after about 100 envelopes had
been sealed, and had to open all the envelopes
and recheck them. Even then, the on-site staff
always informed us if they found a mistake insealing the bills.

Bundles of cash

22

Sealing cash in envelopes for payment

TENKAI Project News vol.1 ｜ January 2021

What you see when you go to the partnercountry
It is very challenging to prepare documents in mypoor English that meet the accounting systemstandards of National Center for Global Health andMedicine (NCGM), while taking into account the
local culture. In Myanmar, fractions of the invoiced
amount are often rounded down to the nearest
1,000 Ks, so if you just total up the amounts on the
Preparation of Materials
receipts, the cash balance at the end of the day will
not be quite right. The administrative staff keep arecord of these roundings as well as payments madeduring stays, and efficiently prepare the necessary accounting documents.
Receipts written in the local language need to be translated into English or Japanese to be able tounderstand the details of the statement, so settling overseas business trips can be very time-consuming.
Accompanying someone on an overseas business trip, you can see things that you couldn't see when
you were working in Japan handling receipts. For example, in our project in Myanmar, we often receive
receipts for baked goods with similar names from the same store. This is because Myanmar, which hada British colonial past, has a culture of tea time and tea cakes are allowed as meeting expenses. I also
understood from seeing the many receipts for bottled water, which are always available on the desks in
Myanmar where the tap water cannot be drunk.
For the administrative staff, projects that are only visible in Japan in the form of reports and accounting
slips become much more understandable when we actually travel to the partner country. It also allows
us to see the activities of the experts up close. In the project to support the improvement of bloodtransfusion safety, I saw the experts instructing Myanmarese trainees on how to determine their blood
type, and the trainees listening intently and intently. This made me feel that something is steadily moving
forward in the field of healthcare in Myanmar. Such experiences and understanding lead to ingenuity in
our work in Japan and support the smooth operation of the project in the partner country.
(Shoichiro Negishi)

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23

Developing Cambodian Human Resources in Pathology
to Strengthen the Pathological Diagnosis System
Photo: Laboratory technician training held in JapanThe number of chronic diseases is increasing, but there isa shortage of human resources in pathology
In recent years, the number of chronic diseases such as cancer has been increasing in many low- andmiddle-income countries due to the aging population and changes in lifestyles, but human resourcesin pathology are often lacking for reliable disease diagnosis. In Cambodia as of 2017, there were only
three public hospitals with pathology laboratories for a population of about 14 million, with only four
pathologists and 15 pathology technicians. It is evident how human resources are lacking in Cambodia bycomparing with a situation in Tokyo, where there are about 350 pathologists for a population of 13 million.
In diagnosing cancer, for example, a clinician first takes a whole or a part of the suspected lesion(specimen) from the patient's body, and a laboratory technician carries out preparation of specimens,such as fixation, embedding, sectioning and staining enabling microscopic examination. The pathologist
then uses a microscope to observe cancer cells, their morphology, degree of invasion, etc., and then finallymakes a diagnosis. Strengthening this process of pathological diagnosis will lead to early detection of
diseases and appropriate treatment. In Cambodia, however, it is difficult for patients to have their diseases
diagnosed, and even if a diagnosis is made, it is a very lengthy process.

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TENKAI Project News vol.1 ｜ January 2021

Developing the existing human resources in pathology
In an effort to change this situation, the National Center for Global
Health and Medicine (NCGM) has been working on a technicalassistance project (TENKAI Project) to increase the number of highquality pathology personnel and strengthen the pathology diagnosis
system in Cambodia in collaboration with the Japanese Societyof Clinical Cytology and the Japanese Society of Histopathologic
Technology since 2017. The project started with the training ofexisting pathologists and pathology technicians working at public
hospitals in Cambodia. Japanese experts traveled on-site to givelectures and practical training. Trainees were also invited to Japan for
activities such as training at universities and hospitals, and making
presentations at academic conferences. The project also supported
clinical pathology conferences in Cambodia for pathologists andclinicians to have discussions on actual cases to improve multidepartmental communication and the quality of medical care.

Fostering future human resources in pathology
Since 2019, the project team has been working with the Faculty of
Medicine and Technical School for Medical care at the University
of Health Science to review and improve pre- and post-graduate
education, and to support the establishment of new pathology
laboratories which can accommodate the human resources fosteredthroughout this project. Aiming to increase pathology laboratories
in the future, a guide for establishing pathology laboratories wasdeveloped and approved by the Cambodian Ministry of Health in2020. In 2020, while the project team was unable to travel on-site
due to COVID-19, online conference system was used for trainingof six pathology residents and 60 laboratory technicians. A senseof belonging was highly considered during the online sessions. The
training was fruitful because the trainees actively asked questions
over the screen. Until the time when face-to-face training becomes
possible again, we will expand the contents of online training andprovide more interactive programs including practical training.

From top: Practical training at a pathology laboratory in Cambodia | Changes in
Papanicolaou staining before and after the
training | Clinical pathology conference |Online training for pathology residents(Hiroyuki Kiyohara)

Guide for establishing pathology laboratories[Partner country] Kingdom of Cambodia [Project name] “Human Resource and System Developments for Cervical Cancer Early Diagnosis
and Treatment in Cambodia” (2015), “Human Resource and System Developments for Cervical Cancer Early Diagnosis and Treatment”(2016), “Human Resource and System Developments for Cervical Cancer Screening” (2017), “Pathological capacity and system
improvement for cervical cancer screening” (2018, 2019), “Strengthening educational system for pathologists and pathology techniciansin Cambodia” (2020)

TENKAI Project News vol.1 ｜ January 2021

25

Creating a System to Increase the Smilesof Children and Adolescents in the Philippines
Photo: In front of the Faculty of Medicine, University of the Philippines Manila

Aiming to increase the number of medical personnel who can treat children's andadolescents’ mental health
The Child and Adolescent Psychiatry Department at Kohnodai Hospital, National Center for Global Healthand Medicine (NCGM) was established in 1948 to treat mental disorders in children from infants to juniorhigh school students. Even in Japan, where the birthrate is declining and the population is aging, interestin children's mental health, including abuse, school refusal and Hikikomori (social withdrawal), suicide, anddevelopmental disorders, is increasing every year. Japan’s medical care system and treatment techniques
are at an international standard that can provide appropriate treatment while taking into consideration
the human rights of patients.
The Philippines is a country with a young population, with 37% under the age of 14. With the enactment of
the Mental Health Act in 2019, mental disorders will be covered by the national health insurance system, andchildren's and adolescents’ mental health is an important issue in the country. Although 16% of children andadolescents have some kind of mental illness, only 2% of all children and adolescents are admitted to inpatient
facilities. Therefore, the Child and Adolescent Psychiatry Department at Kohnodai Hospital, in collaboration
with the Philippine Society for Child and Adolescent Psychiatry, the Philippine Psychiatric Association, thePhilippine Mental Health Association, the Philippine General Hospital, and the National Center for Mental
Health, holds workshops on community mental health related to diagnostic techniques, pharmacotherapy,
psychosocial treatment, and disaster psychiatry for child and adolescent-specific mental disorders such as
autism and engages in activities under the TENKAI Project to improve the clinical capabilities of the regionsin the country. This activity is part of a project to improve the capacity of local communities in the Philippines
to diagnose mental health problems in children and adolescents. In particular, the project team is focusing on
reducing the time from onset of illness to consultation, which is a prognostic factor for mental illness.
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TENKAI Project News vol.1 ｜ January 2021

Japan and the Philippines Learning Together
Workshops
The fiscal 2019 workshops were held for professionals such as
doctors, clinical psychologists, social workers, nurses, and publichealth nurses. Japanese experts, together with the Dean of theCollege of Public Health at the University of the Philippines Manila,
explained the current status of child and adolescent psychiatry
in both countries. The lectures provided an opportunity to learn
about a wide range of topics related to child and adolescent mental
health, including diagnosis and pharmacotherapy, abuse, disaster
psychiatry, child and adolescent welfare, medical treatment systems
at university hospitals, training systems, and the work of comedical staff. In addition, participants were introduced to facilities
for children's and adolescents’ mental health in the Philippinesand related facilities in Japan (child guidance centers, boards ofeducation, schools, etc.). The Japanese experts summarized theprevious training sessions and the recommendations of experts
from both countries and presented them in a paper (Estrada et al.,2020; Usami et al., 2018) (Usami, 2019).

Bringing Smiles to Children and Adolescents AcrossSoutheast Asia
It is hoped that through the training, literacy on children's andadolescents’ mental health will spread in the Philippines. Whilesolving the shortage of specialized medical personnel is a major
issue, the project is also working with local academic societies tocreate a system in which those who have received training become
trainers and conduct “in country training” (dissemination courses).
In addition, the improvement of the project's capacity to treat childand adolescent mental health will lead to appropriate assessments
and therapeutic interventions for the rapidly increasing numberof mental disorders in children and adolescents, while taking into
consideration the human rights of patients. In the Philippines,
where the number of mental disorders is on the rise due to theincreasing population of children and adolescents, introducing
the system that has been established in Japan is an opportunity tointroduce quality diagnostic and treatment techniques. The projectis being carried out with a vision of expanding Japanese child andadolescent mental health treatment techniques to other Southeast
Asian countries.
(Masahide Usami)

From top: In front of the Philippine General
Hospital | Lecture in Manila | Lecture in Japan| Inspection of an education center | Inspection of a child care support unit

[Partner country] Republic of the Philippines [Project name] “Project to reinforce medical treatment, care, and the promotion of mental
health among children and adolescents: the Philippines” (2018, 2019)[Paper Link (in Japanese)]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6299512/pdf/12919_2018_Article_159.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398056/pdf/12919_2020_Article_194.pdf
https://ci.nii.ac.jp/naid/40022070332

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27

Advancing Vietnam's Respiratory Care Standard One
Step Ahead with Bronchoscopy
Photo: Practical training at Bach Mai Hospital in Hanoi

Boosting the standard of respiratory care in Vietnam
Currently, medical needs in Vietnam are rapidly expanding, ranging from infectious diseases and acuteconditions to lifestyle-related diseases and cancer. When one considers chronic respiratory diseases,
pneumonia, and tuberculosis in addition to the very common lung cancer, the Respiratory Medicine
Department is one of the most common departments dealing with diseases that cause death inVietnam. In particular, bronchoscopy is an important essential technology for the diagnosis of these
respiratory diseases, ranging from lung cancer, infectious diseases such as pneumonia and pulmonary
tuberculosis, and interstitial pneumonia. However, due to the lack of device and learning opportunities forbronchoscopy, Vietnam has lagged behind the global standard in terms of this technology.
Since 2017, the Respiratory Medicine Department at the Center Hospital of the National Center for
Global Health and Medicine (NCGM) has been working on TENKAI project to improve the technical skills
in bronchoscopy, a field in which Japan leads the world, with a doctor who can give direct instruction in
Vietnamese. The project aims to share awareness of the issues while consulting with doctors from theViet Nam Respiratory Society, raise the standard of diagnosis and treatment using bronchoscopy and, inturn, raise the level of respiratory care in Vietnam. By doing so, it is expected to provide better medical
treatment to patients who have either given up on diagnosis and treatment or have been diagnosed using
other methods that are less safe and more physically demanding.

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TENKAI Project News vol.1 ｜ January 2021

Providing Learning Opportunities
to Talented Young People
In order to increase the number of medical personnel who can diagnose
and treat patients using bronchoscopy, NCGM conducts five to six training
sessions per year for three weeks each, with two to three trainees persession, for outstanding young doctors and nurses recruited from allover Vietnam. The training consists of classroom lectures (including basic
anatomy and CT image reading), practice with models, and observation ofpractical skills at NCGM, followed by lectures by Japanese experts at therespective hospitals in Vietnam, reviews with models, and bronchoscopy
on patients under direct supervision. The three weeks at NCGM is a
study-intensive period for the trainees, with 7 to 10 hours of study per
day and sometimes homework, but it is an opportunity to learn not
only about the subject of bronchoscopy, but also about respiratory careand Japanese medicine in general. The practical training in Vietnam has
been safe, and we have been able to perform applied bronchoscopy inseveral hospitals. So far, a total of 45 doctors and nurses from 13 medical
institutions have completed the training in Japan, and on-site guidance
and lectures have been given at four related academic societies and ten
medical facilities in Vietnam. The certificate of this training at NCGM isalso qualified in Vietnam.

Continuing the project evenwhen faced with COVID-19
Due to the global outbreak of novel COVID-19, we were unable toaccept trainees or provide on-site guidance in 2020. Nevertheless,we continued to receive requests for training from Vietnam andconsultations on cases via email. We are continuing the project in any
way we can, including writing textbooks in Vietnamese, and giving
online lectures.
(Masao Hashimoto)

From top left: Observation of bronchoscopy at NCGM | Review of anatomy usinga model | Interpretation by trainees todoctors from neighboring hospitals at Cho
Ray Hospital | Participation in the NCGM
respiratory medicine conference | Handson seminar at Pham Ngoc Thach

Project Story“In an age when even people inthe countryside can freely accessthe latest medical knowledge
with just a smartphone, why isthere a difference in medicalcare between developed
countries and Vietnam?” This is
one of the questions raised by
Vietnamese doctor (sometimes
in bars). In addition, we often
receive insightful commentsfrom excellent doctors who havedeveloped their skills under
the severe medical conditions
in Vietnam, and we learn a lot
from them.

In addition to bronchoscopy, I
personally have the impressionthat there is much more that canbe done in Vietnam. While doing
my best to help the patients infront of me in Japan, I would liketo continue to find things that I
can do as a clinician within myreach.

[Partner country] Socialist Republic of Viet Nam [Project name] “Project for the Development of Human Resources in Clinical
Departments Using a Base in Vietnam” (2017), “Development of bronchoscope technique and spreading rerated device in Vietnam” (2018),“Development of bronchoscope technique and spreading rerated device in Vietnam” (2019, 2020)

TENKAI Project News vol.1 ｜ January 2021

29

Strengthening theEmergency Medical System
in Cambodia

Photo: Teaching by TOTThe emergency medical system cannot keep up with growing needs
The NCGM Emergency Medicine & Critical Care Department is working on TENKAI
project to strengthen the emergency medical system in Cambodia. The project
promotes the establishment of an emergency medical system by conducting
training for developing human resources in emergency medicine in Cambodia incollaboration with related organizations in Japan and Cambodia.
With the rapid economic growth in Cambodia in recent years, the need for
emergency medical services has been increasing due to the increase in traffic
accidents and changes in the structure of diseases, but the emergency medical
services system has not been able to keep up. Ambulances are dispatched to thescene after receiving a call at a hospital. Basically, the team consists of a doctor,
a nurse, and a driver, but in some local cities, due to a shortage of personnel,
sometimes only the nurse and the driver go to the scene. The ambulance isequipped with only an oxygen cylinder and a stretcher, and other necessary items
are brought out from the emergency department. When the project team evaluatedthe ambulance's equipment and pre-hospital rescue activities according to theindices recommended by international organizations, it found that most of the items
were not met.
Therefore, the project aims to: (1) Train medical directors (MDs) as supervisors; (2)Train trainers of trainees (TOTs), who will actually supervise the trainees, to create afoundation for continuous training of emergency medical personnel; and (3) Provide
training tailored to each region, mainly in major cities, to create a foundation for
training that covers a wide area. Based on Japan Prehospital Trauma Evaluation andCare (JPTEC™) and Japan Advanced Trauma Evaluation and Care (JATEC™), whichhave been widely accepted as standardized education for trauma care in Japan,
the project team created programs suitable for the local areas and conductedparticipatory training.
From top: Inside an
ambulance | Training inJapan (study of necessary
equipment and materials)

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TENKAI Project News vol.1 ｜ January 2021

Training in Japan and Training in Cambodia
During the 10-day training in Japan, three MDs and four TOTs
from the national hospital in Phnom Penh were trained with thecooperation of fire departments, paramedic training institutions,and tertiary emergency medical institutions. They visited relevant
institutions, rode in ambulances, and learned teaching methods ina practical training format based on the JPTEC instructor course.
They discussed what is needed to strengthen the emergency
medical system in Cambodia and summarized it into ten actionplans. Although it would be difficult to achieve these in a few years,
they were able to set goals so that the level of emergency medical
services would improve by realizing the goals in stages.
The training in Cambodia was conducted in Phnom Penh and fourother provincial cities. A practical skills training program basedon JPTEC™ and JATEC™ was conducted together with TOT, mainlyfor personnel involved in emergency medicine. Japanese experts
provided support, while TOTs trained in Japan took the lead inproviding instruction. TOT training was also conducted in local
cities, and 21 TOTs were trained over a period of three years. In theevaluation recommended by international organizations, all medical
institutions showed improvement. In the future, the project team will
follow up with the MDs and TOTs so that they can take the lead in
conducting the training by themselves.

Toward the realization of the ten action plans
It takes a long time and a lot of effort involving the government
to establish an emergency medical system. There are still someunachieved items in the ten action plans that the trainees cameup with. It is also necessary to verify how much the project hascontributed to improving the level of emergency medical services
in Cambodia. Currently, the project is beginning to work on thedevelopment of a trauma registry at the strong request of Cambodia.
The project team will continue its activities so that emergency
medical services in Cambodia can continue to develop sustainably.
(Manabu Kitahara)

From top: Training in Japan (instructional
practice) | Practical training on traffic
traumaProject Story
A few days before our fieldtraining in a provincial city, wewere in Phnom Penh when alarge-scale building collapsed in
the provincial city, killing many
people. We had conducted
field training in that city theprevious year. The scene wasvery close to the hospital where
we were training, and a teamwas dispatched from Phnom
Penh to help. I saw the situation
on TV, and many of the people
from the hospital who hadparticipated in the training theprevious year were very active.
Afterwards, when we went to
the local hospitals, we received
words of appreciation frommany people who said that what
they learned in the training wasvery useful. I was very touched
to see that the project hadborne some fruit.

[Partner country] Kingdom of Cambodia [Project name] “Strengthening the Capacity of Emergency Medical Service (EMS) System in the
Mekong countries” (2016, 2017), “Project for Strengthening Emergency Medical System through Participatory Development in Cambodia”(2018), “Strengthening the Emergency Medical System in Provincial Cities of Cambodia” (2019), “Supporting establishment of a trauma
registration system in Cambodia” (2020)

TENKAI Project News vol.1 ｜ January 2021

31

Putting Japanese Medical
Devices to Work in African
Hospitals

Photo: At Nigeria's National Agency for Food and Drug Administration and Control (NAFDAC)

Working to promote the use of Japanese products in hospitals in Africa
In order for medical devices to be widely used around the world, they must be approved by the World
Health Organization (WHO) and regulatory authorities in each country as safe and reliable products. In
recent years, the deployment of medical devices in African countries has become increasingly competitive
internationally, with growing imports of products from China, Western countries, and other emerging
economies. While Japanese-made motorcycles and cameras are well known in African countries, medical
devices are not so well known. In order to promote the international expansion of medical devices, since
fiscal 2016, Center Hospital of the National Center for Global Health and Medicine (NCGM) has beenworking on TENKAI Project in Ghana, Zambia, Tanzania, Cameroon, Democratic Republic of the Congo,
Ethiopia, and Nigeria related to Japanese medical devices that offer excellent technology and strict quality
control, and the regulatory systems that are used to ensure that products are delivered to the market
safely. The aim of the project is to promote understanding of Japanese medical devices such as in vitro
diagnostics and test kits as well as Japanese regulatory review processes among regulatory authorities andrelated organizations in African countries. It is envisioned that this will lead to the adoption of Japanese
medical devices by local medical facilities and the provision of better medical care.

Introducing Japanese regulatory systems and product safety
In order to promote understanding of Japan's regulatory system for medical devices, under this project
regulatory officials from various countries were invited to Japan for training in collaboration with thePharmaceuticals and Medical Devices Agency (PMDA). NCGM also provided training to give an opportunity
for the officials to learn about the consistency between PMDA and WHO pre-approval of medical devices
including test kits. Seminars for Japanese companies and ministry officials were also held at NCGM, where
regulatory officials from African countries served as lecturers to exchange information on regulatory
systems and the penetration of Japanese products in their countries. These events also provided
opportunities for Japanese companies to hold individual meetings with the regulatory authorities in eachcountry.

32

TENKAI Project News vol.1 ｜ January 2021

What is needed to promote Japanese medical devices in Africa?
Opening up untapped markets and promoting bridges between
Japanese companies and regulatory authorities in different countries
takes time and requires skilled coordination. Especially in low- andmiddle-income countries, it is important to capture the unique needsof the country, and key questions include: Can the product perform
under harsh natural and infrastructural conditions, such as hightemperatures and unreliable water and electricity supplies? Is it easy
for anyone to operate the product with little technical knowledge? Is
it possible to provide support for consumables such as reagents andmaintenance of equipment so that the product can be used for a longtime? Has the product been officially recognized by an internationalorganization?
At the same time, Japanese companies are working hard to ensurethat their products are used in more medical facilities to help improvehealth issues, despite the difficulty that adding value and improving
services results in high cost and this cost makes it more difficult forlow- and middle-income countries to purchase such products. If
Japanese products that have passed strict quality control standards
can contribute to medicine in various countries, the number of healthypeople will increase, and the financial resources for health care in
those countries can be expected to improve.
The project created opportunities for Japanese companies tounderstand what is needed to promote Japanese medical devices
in Africa, what laws and regulations act as barriers, and what needs
exist in each country. The regulatory officials from each country whoparticipated in the project showed a high level of interest in Japanese
products and regulatory systems through the training, and indicatedthat they would positively consider adopting such products andsystems in the future.

From top left: At NCGM with regulatory
officials from Ethiopia and Nigeria ｜ At
the Ethiopian Food and Drug Administration (EFDA) ｜ From top right: Study
session at NCGM ｜ Discussions between
Japanese experts and trainees ｜ Seminarfor Japanese companies

An example of a medical facility in
AfricaA rural health center in Zambia(Naofumi Hashimoto)

Tank for storingwater used fortesting

Refrigerator forstoring test reagents[Partner countries] Republic of Ghana, Republic of Zambia, United Republic of Tanzania, Republic of Cameroon, Democratic Republic of
the Congo, Federal Republic of Nigeria, Federal Democratic Republic of Ethiopia [Project name] “The project for African inspection device
approval and technical capacity enhancement” (2017) “The project for developing basis of expanding Japanese medical devices in Africa”(2016, 2018, 2019, 2020)

TENKAI Project News vol.1 ｜ January 2021

33

Spin-Off: Another Side to the TENKAI Project

People who Support the TENKAI Project<Cambodia>
In the Projects for Global Extension of Medical Technologies (TENKAI Project), there are various
tasks such as budget management and procurement of necessary materials, and many staff
members support its operation. In some cases, administrative staff members are responsible
for these types of administrative tasks in the partner country and accompany experts on
country visits to support their activities. The following is an introduction to the activities of theadministrative staff in the partner countries.

I want to see the project in action at the partnercountry
In 2017, I traveled to Cambodia as a member of the “Strengthening
the Capacity of Emergency Medical Service (EMS) System in the
Mekong countries” project. Against the backdrop of increasing
road accidents and non-communicable diseases (heart disease,stroke, etc.) in ASEAN countries, the project has started to create asystem to develop human resources who could provide high quality
emergency medical services in Cambodia and Laos, countries where
there was a growing need to establish emergency medical systems.
The administrative staff supported the project activities in general,
including the management of expenses. While performing daily tasks
in Japan, such as arranging flights and settling travel expenses for theexperts' overseas business trips, I began to think that I wanted to see
Cambodia itself, so I raised my hand and was given the opportunity
to travel there.

Supporting a Medical Rally

From top: Checking documents with thetrainees | Checking the arrangements fora medical rally | Greeting the trainees

34

In Cambodia, Japanese staff from the NCGM Emergency Medicine& Critical Care Department, in collaboration with other partner
institutions, conducted a “Medical Rally” training for local medical
personnel.

TENKAI Project News vol.1 ｜ January 2021

In the Medical Rally, teams of medical professionals
competed to quickly and accurately diagnose andtreat patients in a limited amount of time. The
trainees were divided into six groups and competedin the process of giving life-saving measures toa patient who had been knocked unconscious ina motorcycle accident, transporting him to thehospital in an ambulance, and treating him in thehospital. The office staff helped manage the process
as timekeepers. A real ambulance was used for thedemonstration, and the training was filled with asense of realism, just like an actual accident scene.

Giving Back to Project Promotion
In addition to supporting the medical rally, theadministrative staff was responsible for purchasing
Scene from the medical rallymaterials and equipment, paying expenses,
confirming schedules with Japanese experts
and local staff, preparing training materials, andcoordinating the venue. Although administrative
staff cannot instruct trainees, by accompanying themto the country and taking care of accounting andcoordination tasks, we can create an environment
where experts can concentrate on project activities
such as seminars and trainings. In addition, by
experiencing overseas business trips themselves,
Commemorative photo after the medical rally
administrative staff will be able to more accurately
calculate the expenses required to conduct seminars
and symposiums. The accumulation of know-how of
the administrative staff, who work as a team with the experts, is utilized to promote projects behind thescenes.
(Kyoko Takizawa)

TENKAI Project News vol.1 ｜ January 2021

35

Health Careto theWorld| Secretariat | Bureau of International Health Cooperation,
National Center for Global Health and Medicine
1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan| TEL | +81-3-3202-7181 (main) | EMAIL | kokusaitenkai@it.ncgm.go.jp| WEBSITE | http://kyokuhp.ncgm.go.jp/activity/open/index.html

TENKAI Project News
(English edition) vol.1
Published
March 2021
Secretariat of the Projects for Global Extension of Medical Technologies
National Center for Global Health and Medicine

1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
tel: +81-3-3202-7181 fax: +81-3-3205-7860
dghp@it.ncgm.go.jp

http://kyokuhp.ncgm.go.jp/© National Center for Global Health and Medicine ALL RIGHTS RESERVED.

Secretariat of the Projects for Global Extension of Medical Technologies, Na�onal Center for Global Health and Medicine

For inquiries and applications, please visit the website.

Published March 2021 ISSN 2436-1968

Bringing Japan's

TENKAI Project News vol. 1 2021

Ministry of Health, Labour and Welfare
Fiscal 2021 Projects for Global Extensionof Medical Technologies