Program Orientation

Overview of Workshop on Improving Maternal Health(Including Remote Medical Care for Maternal and Child Health)
Seto Inland Sea Regional Research Center
Coordinator Tetsuo Ueno
First of all, I would liketo give you a little
information, about
Kagawa Prefecture.
Located in the south westof Japan, Kagawa
Prefecture looks out, overthe beautiful Seto InlandSea, which is a richfishing ground and has
delicious seafood. There
are many islands in the
Seto Inland Sea made beautiful view. You can see the deep blue sea against the
backdrop of the bright blue sky as well as white sandy beaches with vividly fresh
green trees in the background. Because of its beauty, the Seto Inland Sea is thefirst national park to be designated in Japan. We plan to show you, some of thebeauty of Seto, when we take you for a cruise on our research center's ship.
I would like tointroduce briefly about
our Research Center.
The center was founded
by Kagawa University 10
years ago with the aim ofcontribution to the local
community.
The center covers
three research fields：(1) Marine andenvironmental research1(2) Culture, tourism and history research(3) Telemedicine research(1) The first, I will brief explain about our marine and environmental research.
The Seto Inland Sea had been suffering from a variety of problems such as
red tides affecting the aquaculture fishery industry along with pastindustrialization and urbanization.
By putting a great deal of effort into improving the environment, we haveregained beautiful landscape and good water quality. However, as the fishery
has not yet fully recovered, therefore our center is researching recovery ways incooperation with the local community.
Given this, our center built a marine station on the coast and has two
research ships. For this workshop, we plan to travel to the island on one ofthese ships.
(2) Next, I will briefly explain about our culture, tourism and history research.
Recently, many tourists from all over Japan and the rest of the world arevisiting the area to enjoy the beauty of Seto.
At present, the islands of the Seto Inland Sea are suffering from people aging
and depopulation. Japan itself is suffering from people aging, and a declining
birth rate, but the situation faced by these islands is even more severe. Given
this, local government and the islanders themselves are calling for young
people to stay in the area.
To achieve this, it is necessary to overcome
various forms of inconvenience, such as inadequate medical treatment andeducation on the islands. Our center research into the current situation andimplementing countermeasures together with the local people.
Finally, about our telemedicine research.
Kagawa Prefecture is a pioneer of establishing the medical information
network. This network has researched and developed for many years in(3)collaboration with Kagawa University, Kagawa Medical Association and
Kagawa prefecture. We call this network "K-MIX", based on the initials of its
full name which is the Kagawa Medical Information eXchange.
The aim is todeliver new medical care that is advanced and efficient.
K-MIX now connects 160 hospitals. K-MIX enables patient medical records
to be shared among doctors at various hospitals. This allows for the provisionof team-based medical care between facilities, such as between clinics, general2hospitals, specialty hospitals, pharmacies and so on. Of course, it is also
possible to provide team-based medical care between maternity clinics andhospitals.
Team-based maternal care has contributed to reducing the maternalmortality rate and to increasing the number of safe births. As this team-based
medical care takes place among distant facilities, it is also a type of remote
medical care.
I will explain this in a little more detail later.
This map of Japanshows 47 prefectures.
The northern parts ofJapan are cold inwinter and they aresparsely populated.
Tokyo is located of thecenter of Japan and
Kagawa Prefecture islocated the area of mild
weather.
We plan to visit threeprefectures that all have quite different characteristics.
Iwate Prefecture has a low population despite its extensive area. The inland
areas are covered in deep snow during the winter which can cause traffic
disruptions. As a result, pregnant women are difficult to get to a hospital.
Moreover, maternity clinics in these mountainous areas are not staffed bydoctors. Therefore, a remote maternal care system that links mountainous
areas and town areas has been developed and implemented in Iwate Prefecture.
We will be able to show you, this remote maternal care system, thanks to thecooperation of Tono city and hospitals in Iwate Prefecture.
The coastal areas of Iwate Prefecture, and other parts of north-east Japan were
hit hard by a huge earthquake six years ago. The earthquake killed about 20,000
people and injured about 6,000 people. The tsunami that was triggered by thisearthquake caused a huge amount of damage. Waves of between 5 and 40
meters hit coastal towns over and over. Houses and roads were washed away
and many towns were destroyed completely. The victims who were disappointed3

have been greatly encouraged by the support that they have received fromoverseas and from volunteers. Now, there are gradually being restored. Ourcenter is also cooperating by providing scientific support for the reconstruction of
the aquaculture industry.
We plan to show you the current situation.
Tokyo is Japan's largest metropolitan area and it is one of the most
overcrowded cities in the world. It has large number of huge hospitals that are
well equipped and well-staffed. We plan to show you some of these as well.
Kagawa Prefecture has 24 inhabited islands.

The largest one is Shodoshima,

which has a population of 30,000. On the way to Shodoshima, the ship's captainwill take a detour, so you can see some of the smaller islands from the ship.
The smaller islands that you will see have a population of 100 to 200 people.
We developed the remote medical care system for the residents of these islands.
This picture shows
the workshop schedulefrom October 10 toNovember 2.
In Tokyo, we will beholding lectures andvisiting hospitals forseven days. Also, as
the Japanese
government is situatedin Tokyo and there arevarious large-scalecomputer system vendors, we will study trends in maternal care and remote
medical care from the viewpoint of central Japan.
On October 16, we will travel to Tono city in Iwate Prefecture by bullet train.
We will hold lectures and visit hospitals for three days. We will also visit the
mayor of Tono city. And visiting a maternity hospital and local hospitals. We
will tour some of the earthquake-hit areas.
On October 19, we will fly to Kagawa Prefecture via Kansai Airport.
At first,
we will visit the governor of Kagawa Prefecture. We will hold lectures and visit
hospitals for 14-days. The lectures will be held at the campus of the university's
medical faculty and the campus of its headquarters. The two campuses are about415 km apart.
The medical faculty has an attached hospital which operates a perinatal center
which we will visit. At the university, the professors will give lectures on
various topics, such as perinatal care, the K-MIX and remote medical care.
In addition, we have scheduled some remote lectures from other universities
and foreign countries that will be conducted via a video conference system. We
have also arranged for some companies to give lectures and demonstrations of
products for maternal and remote medical care.
On the tour, we will visit Shodoshima Central Hospital. And we will visit a
screening center for breast cancer, uterus cancer and some other cancer. We
will also take a trip to an elderly care center that is promoting collaboration in
the provision of medical care and nursing care.
Not only that, we will also visit some companies that are developing healthproducts in collaboration with the university. We hope that, these company
tours will give you a feel for production sites and society in Japan.
At the university, you will present your Inception Report, then formulate an
action plan and announce it at the end.
The medical systemsof ours have beendeveloped and are now
operated, in cooperation
with local government,
academia,
andindustries. In fact, thisworkshopwillbeconducted
incollaboration
with
them.
We will conduct thisworkshop with our Center and JICA as core partners and in cooperation with eHCIK and BHN. Melody International and several other companies will also becooperating in the holding of the workshop.
The NPO, e-HCIK is e-Health Care Innovation in Kagawa. It was establishedto enhance the medical system at the request of Kagawa Prefecture.

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The BHN Association is a NPO in Tokyo that has "Basic Human Needs" as its
slogan. BHN is also working to support efforts to improve maternity careoverseas.
Melody International is a local medical ICT company. ICT is Information
Communication Technology. Melody's female president hopes that, Melody
products will be used by pregnant women around the world.
The first aim ofworkshop is to learn
about the medical
technologies andequipment used at the
medical sites throughthe hospital tours andthe meeting.
The second aim isteam-based medicalcare that we areadvancing also involves
remote medical care using ICT. You will learn through the lectures.
The third aim is that your health is important before medical treatment, so
we are working to seamlessly connect medical care and health care using ICT.
You will learn through the lectures and the tours.
The other aim that for people to live healthy, it is necessary for their living
environment to be improved, including in terms of their lifestyles and meals aswell as utilities, such as the water supply and sewage handling.

6The development of
ICT has had a great
effect on society. For
example, theavailability of ATMs
means that we nolonger have to go to thebank to use many of its
services. Thanks to
the Internet, we can
now make various
purchases from home.
The development of themobile phone means that we can now talk to anyone, anywhere and anytime.
Medical care is no exception, as ICT is completely transforming the medical field.
First, let's take a look at how the medical field is being transformed, throughthe advancement of medical ICT. In a sense, ICT is like a road map for therealization of team-based medical care and remote medical care as shown here.
The first major transformation is the provision of team-based medical care by
medical staff at hospitals. This development has made it possible to deliver
more accurate medical care and for further improvements to be made to hospitalwork efficiency. The hospital system has made this possible.
The second major transformation is the provision of team-based medical careby hospitals. The sharing of patient records among hospitals has made thispossible. K-MIX is on this second step.
Mobile equipment, video phones and so on, are some of the tools that are used
to support the provision of remote medical care, home care and other suchservices.

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Next, I will explainthese steps in a bit
more detail.
The first step is theprovision of team-based
medical care by
medical staff at
hospitals. In
conventional medicalcare, the doctor is at
the center of theprocess while thenurses, pharmacists
and other medical support staff follow the instructions of the doctor. This isbecause medical staff other than the doctor do not have easy access the paperbased patient medical records. However under the hospital system, all memberof the medical staff can easily gain access and use the electronic medical records,
anytime and anywhere from a terminal. This is because electronic medical
records have been developed and the medical records have led to thecomputerization of entire hospitals. As a result, nurses can make full use of
their nursing expertise and pharmacists can make full use of theirpharmaceutical expertise.
But, for team-based medical care to be fully realized the medical staff
themselves have to change their mindset which obviously takes time. Given
this, three universities in Kagawa Prefecture that have facilities such as a
medical faculty, a pharmacy department and a nursing science department areproviding training on how to conduct team-based medical care, in cooperation
with.
The hospital system improves the efficiency of hospital operations which in turnimproves patient service by reducing waiting times and allowing the hospital totreat more patients.
For example, the ICT support process starts from a staff member at reception
room input basic information of the patient.
The doctor inputs information
obtained during the consultation and the examination. In the examination
room, medical staff carry out the examination, according to the instructions fromthe doctor that are displayed on the computer screen. Next, the doctor makes a8diagnosis and inputs treatment instructions. When the patient arrives at theaccounts section to make payment, the invoice and prescription have been
prepared already.
The second step isthe provision of teambased medical care byhospitals.
In this step, general
hospitals, specialty
hospitals, clinics, andother medical facilities
share patient medical
records via the medical
hospitals network. By
this, Doctors referpatients to theappropriate hospital
based on their symptoms.
For example, if a doctor working at a clinic thinks that it would be difficult toprovide treatment, the doctor refers the patient to the appropriate hospitalinstead. After the patient has undergone surgery or another treatment at thereferred hospital and is in the recovery stage, the patient is then referred back,to the original clinic again. The hospital and clinic share the patient records via
the hospitals network. In this way, the clinics take on the role as the family
doctor. The Japanese government recommends that referrals be given between
hospitals.
K-MIX supports this.
Under the team-based medical care by hospitals, each hospital can utilize theirexpertise to treat the patient in cooperation with other hospitals.
K-MIX was initially used that specialist remotely read medical images. Now,
it has a wider range of applications, such as referring patients between hospitals
and treating patients by referring to medical records, received from otherhospitals.
Each hospitals and other medical facilities can clarify their respective
characteristics and enhance their specialties. This can help reduce the overall
9medical expenses in Japan since this means that each hospital can focus on its
own specialty, thereby allowing them to purchase the latest expensive
equipment without having to spend money on unnecessary extra equipment.
But, the hospitals network requires the use of advanced technologies to build
and strictly manage security systems for its operation. In addition, it takes
time to train the medical personnel required for the provision of team-based
medical care and to gain the understanding of local residents.
KagawaPrefecture is attempting overcome these two steps as a pioneer.
Next, I would like toexplain a little about
the next step that weare now starting toresearch.
Ideally, we would liketo link K-MIX, not justto hospital but also tonursing homes, gyms,
homes and so on.
For example, doing
this would allow thedata obtained from
regular health checks,
such as blood pressure monitoring and electrocardiograms to be input into thesystem automatically. If the system detects any health abnormalities, a hospital
doctor can check their health condition. Of course, public health nurses andexercise trainers will also be able to provide appropriate guidance by getting
their health data with their consent. This will allow us to expand the systemfrom a medical care to a health management.
We also hope to expand the system, from birth to lifetime health management,
by inputting data on people's health of whole life. Regular health checks are
conducted every year in Japan, so if we can link this health data automatically,
we will be able to monitor the trends in health conditions. By realizing thisgoal, we will be able to seamlessly connect cooperation with activities such as
health management, medical-care, elderly-care and home-care.

10We have been using
mobile equipment toprovide maternal care
for a long time and thishas proven to be very
effective. For
example, if a maternity
clinic in a remote area
is without a doctor, it isvery important to
identify pregnant
women whose risk ofbirth is expected, thento transport them to an
obstetric hospital in advance.
To identify such pregnant women, we measure the fetal heart beat with amobile CTG, “mobile Cardio tocoGram”, that we have developed and transmit itto the obstetric hospital. After that, a doctor can assess the risk of childbirth.
This is also a form of remote maternal care.
This system is also attracting attention in countries, despite having a highbirth rate, have many difficult-to-access mountainous areas without any doctors.
In fact, the system is now being used in Chiang Mai, Thailand.
A summary of
the situation will be provided from Chiang Mai by video phone.
By using a mobile electrocardiograph, instead of a mobile CTG, we can also
monitor the health state of people living in remote areas.

11Kagawa Prefecture ishome to a lot of remoteislands, that have nodoctors. Given this,we developed a remote
medical care systemthat allows nurses tovisit these islands andtreat patients there
based on medical
instructions given by aremote doctor via a
video phone. We callthese nurses "olive
nurses", because the islands in Kagawa Prefecture are famous for their olives.
This remote medical care system helps us to deliver more effective maternity
care by using mobile CTGs in combination. This system also can offer an
effective home maternity care.
The data center is a key facility in the ICT system, because the servers used inthis system must be protected against not only disasters but also other risks suchas terrorism and data breaches.
Consequently, thebuilding has been
specially designed toensure that it isrobust and resistantto natural disasters,such as earthquakes
and floods and thatcountermeasures
have been
implemented toprevent power or
network failures. Moreover, it is managed and operated in strict compliancewith security standards such as International Standard (ISO).
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The servers for K–MIX, for the CTG system, and for the video phone system,
are installed in a highly secure data center. These servers are connected toterminals via the Internet, so they can be used from all over Japan, andanywhere else in the world. Of course, you can use them, from your country too.
The health of themother, during her
pregnancy isimportant, for
ensuring a healthy
birth. Given this,
we would like tointroduce someother health-related
products of Kagawa
prefecture.
• Rare Sugar.
Rare Sugar isaproduct developed by Kagawa University. This mysterious type ofsugar is effective in helping to prevent obesity. It has already beensuccessfully commercialized and it is now used for sweets, drinks and othersuch products. We will be taking you on a tour of the Rare Sugar factory.
• Products made using traditional fermentation technologies
A well-known company in Kagawa Prefecture is developing new products
using rice fermentation technologies. This company creates high-quality
cosmetics using traditional Japanese technologies based on Japanese sakebrewing techniques and it also produces a type of jelly that is effective inpreventing allergies. You will see this factory on the tour.
• Drones
In Kagawa Prefecture, drones are being experimented as a transporting
medication to the islands in the event of an emergency. I think that it will
also prove useful in remote mountainous areas with poor road conditions.
• Udon noodles and soy source
Kagawa Prefecture is famous of udon noodles. Will you try it. By theway, soy source is a key ingredient for the taste of udon soup. Large
quantities of soy source are made in Shodoshima.
Soy source is a core13

ingredient in many types of Japanese food which is said to be very healthy.
We will show you the soy sauce factory on the tour.
In addition, for thematernal care, otherfactors are importantin ensuring a safe andhealthy birth include
the country's politicalstability, hygiene
levels, nutritional
status, family ties andso on.
Also, to develop a
new maternal caresystem, it needs to adapt the system to its local circumstances.
For this reason, we aim to not only provide you with information on maternalcare but also introduce many aspects of the situation in Japan as possible.
To start, we will ask you to present your Inception Report which provides theactual circumstances of your country.
At the end, we will ask you to formulate an action plan based on this training.
And we will cooperate in helping you to realize your action plan as possible.
Just like the personal
computer, smartphone,and Internet, ICT can beused in developed anddeveloping countries as
equal. I think the mostimportant point is how
to use ICT well.
Let's
take
this
occasion to build lasting
friendships and work
together to create a brighter future.
Thank you.
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