vol. 2

March 2022

Bringing Japan's
Health Care to the WorldGood practice seen from a seven-year trajectory
Vietnam | Myanmar | Indonesia | Mongolia | Zambia |Democratic Republic of the Congo | Brazil

Contents
Introduction ……………………………………………………………………………………...……………………… 03
Bringing Japan's health care to the worldGood practice seen from a seven-year trajectory ……………………………………….………….… 04
──GOOD PRACTICE FILE No.01

Saving the lives of expectant and nursing mothers and babies by digitization ofantenatal examination ….….......................................................….........................…….… 08| Democratic Republic of the Congo | SOIK Co., Ltd.

──GOOD PRACTICE FILE No.02

Providing rapid and highly sensitive tuberculosis testing and diagnostic technology| Zambia | Eiken Chemical Co. Ltd.

──GOOD PRACTICE FILE No.3

Establishing a system for testing and treating sleep disorders ….……................…….…
| Mongolia | Center for Sleep Medicine, Ehime University Hospital

11

14

──GOOD PRACTICE FILE No.04

Popularizing hearing tests and hearing aids for people with hearing problems …...… 17| Vietnam | Rion Co., Ltd.

──GOOD PRACTICE FILE No.05

Spreading endoscopy and laparoscopy technology to save patients withgastrointestinal cancer ….…….........................…….......................................................…
| Brazil | Kochi University

20

──GOOD PRACTICE FILE No.06

Conveying water-quality management technology to improve the qualityof dialysis treatment….…….........................……............................................................… 23| Mongolia | Japanese Society for Technology of Blood Purification

──GOOD PRACTICE FILE No.07

Improving patient prognosis with dialysis water purification technology ….…...…….… 26| Indonesia | St. Mary’s Hospital──GOOD PRACTICE FILE No.08

Delivering temperature-controlled blood products to hospitals ….……...............…….… 29| Myanmar | Daido Industries, Inc.

──GOOD PRACTICE FILE No.09

Enhancing hospital quality management and patient safety in Vietnam
during COVID-19 pandemic ….…….........................................................................…...… 32| Vietnam | Bureau of International Health Cooperation, NCGM

Six tips on the international expansion of medical care in the future ….…….............… 35
2

TENKAI Project News vol.2 ｜ March 2022

Under the universal health insurance system, Japan has achieved the highest level ofhealthy life expectancy and healthcare standards in the world. The world’s leading
medically advanced country is supported by world-class medical services and technology,
such as high-quality pharmaceuticals and medical equipment, trained medical personnel,
and welcoming medical institutions.
The Project of Global Extension of Medical Technologies (hereinafter referred to as the"TENKAI Project"), implemented by the National Center for Global Health and Medicine(NCGM) and funded by the Ministry of Health, Labour and Welfare since FY 2015, is an
initiative to expand medical technology and services internationally, in collaboration withgovernments, companies, research institutes, and educational institutions. The objective
is to deploy Japanese medical technology and services to low- and middle-income
countries, thereby contributing to the resolution of global health issues and strengthening
Japan’s competitiveness. The project seeks to share knowledge and experience regarding
Japan’s healthcare system, transfer medical technology, promote the international
expansion of high-quality Japanese pharmaceuticals and medical devices, and stimulate
the growth of the Japanese medical field while contributing to the improvement ofpublic health and medical care standards in partner countries. The project is intended
to increase trust in Japan in the international community and create a virtuous cycle forJapan and the partner country.
The project is operated every year in the form of an open call for proposals, and morethan 30 projects are implemented. From FY 2015 to FY 2021, 234 projects have been
implemented. Through multiple years of project implementation, many projects haveyielded results, but other projects have also required the consideration of exit strategies.
In this issue, TENKAI Project News Vol. 2, we would like to introduce some of these 234
projects that are particularly representative of good practice.

					Noriko Fujita

					
					

Executive Director
Project of Global Extension of Medical Technologies

Cover photo: PURE-TB-LAMP operator training in Zambia“Expanding program of diagnostics for tuberculosis using PURE-TB-LAMP in the Republic of Zambia”
TENKAI Project News vol.2 ｜ March 2022

3

Good practice seen from a seven-year trajectory
Contributing to global health through international medical development
To solve global health issues, Japan recognizes the importance of sharing good technology
and delivering medical products. The TENKAI Project by the Ministry of Health, Labour andWelfare was launched in FY 2015 to support the international expansion of Japanese medicalcare. It is a new form of international cooperation that aims to grow Japan’s medical field aspart of its business, instead of adopting the traditional structure of rich countries giving aid tofinancially backward countries. The products and services of Japanese companies have many
excellent aspects, such as technology and mechanisms. They can contribute significantly tothe development of target countries by combining the operation system and management ofJapanese medical facilities, training and facility management, and operation. Further, Japanesetechnologies and medical products will continue to contribute to solving health issues in lowand middle-income countries by being listed in the prevention and treatment guidelines andinsurance of partner countries. Many companies hope to contribute to creating a better
society through their business. Developing cooperation as a business will lead to sustainable
development and improve medical standards in target countries. The participation of medicalrelated companies aiming to expand into low- and middle-income countries has not been
included in conventional official development assistance (ODA).
Focusing on medical personnel development
The TENKAI Project focuses on training projects based on the health and medical issuesof target countries and regions. Major areas include diagnostic technology (e.g., clinicalexamination, diagnostic imaging such as radiation, endoscopy, cancer diagnosis), prevention
and treatment technology (e.g., surgery, intensive care, blood transfusion, rehabilitation,
dialysis), medical device management, quality and safety of medical care, health checkups, andpharmaceutical certification systems. We also support areas that other partners do not support
by focusing on issues difficult to address with ODA (e.g., issues related to people’s quality of life
but not necessarily high morbidity/mortality rates).
Participating companies and organizations are screened and selected by public offering on anannual basis, receive funds under a commissioned project (project), and conduct activities forapproximately 10 months. A project evaluation framework has been introduced to clarify theprocess of project implementation (process), the results immediately after implementation(outcomes), and the results expected several years later (impacts), after which the project
results are refined. Some of the successful projects have been operated for multiple fiscal years
to achieve the impact indicators. Annual activities are announced at the end of the fiscal year
and published in a report.
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TENKAI Project News vol.2 ｜ March 2022

Outbound

Basic concept of international health care expansion

Export superior
medical devices
and services

Japan
Health care industries...

Invent produce new and better
pharmaceuticals, medical
devices, and services.
Produce pharmaceuticals andmedical devices that can be usedin harsh natural environments
such as high temperaturesand dry conditions, as well as
in environments with poor
infrastructure.

InboundCollaboration& Cooperation

Training of overseas
medical staff in Japanand acceptingof patients whenlocal treatment isdifficult

At clinical sites...

The Government...

Accept foreign health staff
and provide training.
Provide advanced medicalcare to foreign patients.

Develops organizations
and networks to promoteinternational expansion.
Support international expansion
by companies and organizations.

Overseas(mainly low-and middle income countries)

Create health systems anddeploy necessary devices
and services to meet local
needs.

For example...

Create systems to properly manage
advanced medical devices in
hospitals.
Build medical facilities thatprovide highly accurate medical
examinations and checkups.
Provide technical training for
medical staff in handling medical
devices and patient care.
Promote services for early detectionof diseases, such as simple tests
that can be used in a variety ofenvironments.
Outcome
Improve local health care.
Help people around the world to live
healthier lives.
TENKAI Project News vol.2 ｜ March 2022

5

Project data for FY 2015-2021
item/fiscal year

2015

2016

2017

2018

2019

2020

2021

Total

Number of project
implementationon countries

13

14

17

13

12

13

14

96

Number of projects

28

31

33

29

38

44

31

234

Number oftrained trainees

4,982

4,783

5,489

4,384

7,763

15,922

23,23966,562

Partner countries implementing Projects for Global Extension of
Medical Technologies (TENKAI Project) from 2015 to 2020

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

6

Oceania
Independent State of Papua New Guinea
AfricaFederal Democratic Republic of Ethiopia
Republic of Ghana
Republic of Cameroon
Democratic Republic of the Congo
Republic of Zambia
United Republic of Tanzania
Federal Republic of Nigeria
EuropeRepublic of Uzbekistan
Turkmenistan
Russian Federation

TENKAI Project News vol.2 ｜ March 2022

Middle East
Islamic Republic of IranKingdom of Bahrain
Latin America
Federative Republic of Brazil
United Mexican States

Transformation in COVID-19 pandemic and accomplishments over seven years
Seven years have passed since the inception of the TENKAI Project, and various results havebeen achieved. From FY 2015 to FY 2021, 234 projects were implemented in 96 countries,
and 66,562 medical personnel were trained. From FY 2020, domestic and international travel
have been restricted due to COVID-19 pandemic, making it difficult to conduct conventional
face-to-face training. The TENKAI Project have been converted to online training to obtainthe maximum effect.
Planning and implementing training online cannot confirm the resulting technology face-toface. However, training can be conducted using a mobile phone, which helps provide training
opportunities to more healthcare professionals. In many projects, teaching materials andtools adopting various digital technologies and innovations were created, such as remote
instruction applications, surgical videos, and simulated work experience using virtual reality.
Consequently, the number of trainees who learned through the project doubled comparedwith the previous year, indicating the unexpected effect of reducing the disparity in training
opportunities between urban and rural areas.
Moreover, as we continue to expand the project, the impact of the international expansionof medical technology and equipment is increasing. In FY 2020, eight cases of medical
technology were adopted as national plans and guidelines in implementing countries,
and 12 types of medical equipment were procured in implementing countries for sevenprojects. Looking at the three years from FY 2018 to FY 2020, we confirmed that 15 casesin 7 countries, out of 114 projects implemented, were listed in the guidelines, and 50 types
in 9 countries led to procurement. In some cases, the training conducted in the project was
designated as continuing education for healthcare professionals certified by national academic
societies and governments. Thus, by being listed in national-level medical guidelines, thetraining becomes widely known in Japan. Health insurance coverage is expected to promote
self-procurement and continuous operation of technology, leading to sustainability.
In Japan, suggestions and knowledge related to the international development of medicalcare have been accumulated through project activities and are being widely disseminatedthrough academic conferences, papers, and public relations activities.
Increasingly visible good practices
Currently, the interests and needs of the international community in the field of healthand medical care are at an all-time high. In international cooperation, the emphasis ison ensuring that the technology takes root in the country even completing the support
so that the people of that country can develop it autonomously. In the TENKAI Project,previous trainees have passed on their skills to medical personnel in their own countries,
spreading knowhow to surrounding medical facilities and eventually to the entire country,
thereby creating various impacts and new value in healthcare in each country. Seven years
since the project’s inception, we can see the good practices accumulated by the many
projects implemented.
TENKAI Project News vol.2 ｜ March 2022

7

GOOD PRACTICE FILE

No.01

Saving the lives of expectant and nursing mothers andbabies by digitization of antenatal examination| Democratic Republic of the Congo | SOIK Co., Ltd.
Photo: Training using the digital antenatal health app S-PAQ at a hospital in the Democratic Republic of the Congo

A project to deliver obstetric examinations to villages without electricity
The maternal and infant mortality rates in the Democratic Republic of the Congo（DRC）aretens to hundreds of times higher than those in Japan because of the lack of access to healthcheckup services and poor quality of medical care. SOIK is working on the development andprovision of S-PAQ, a digital antenatal examination package using a smartphone app as aplatform, which can enable high-quality antenatal examination services even in rural areas ofAfrica. S-PAQ comprises smartphones, smartphone apps, online applications, patient/medical
worker ID cards, medical
equipment required for
medical examinations, andsolar power units. With theintroduction of this package,even small rural healthcenters without electricity
can provide health checkup
services that meet national
standards.
Overview of S-PAQ configuration

8

TENKAI Project News vol.2 ｜ March 2022

In 2021, SOIK, which started the project, offered an eight-day training to 11 doctors,
midwives, and nurses on digital antenatal examinations using S-PAQ and portableultrasound that can be used on smartphones. Further, the company entrusted theequipment to trainees from three hospitals in the country and had them work on
improving their practical skills through a six-week on-the-job training program. At the endof the program, a seminar was held for sharing experiences and presenting the results.
The seminar had been postponed after the invitation letter was sent out. However, theschedule was adjusted, the invitation was resent on a case basis, and the event was
ultimately held. The results of the project were presented to many aid agencies andmedical workers, including the General Secretary of the Ministry of Public Health, DRC,
with which SOIK is an official technical partner.
Project activities in FY 2021 were also significantly affected by the frequent local strikes.
Medical staff and government officials who had been working hard in response to COVID-19
appealed for improvements, as they had unpaid and delayed salaries. Nurses, midwives,doctors, government agencies, and even transport agencies went on strike in quick
succession during their training period. When a strike occurs, expectant mothers are also
worried about whether hospitals are open, leading to the number of antenatal examinations
decreasing. However, SOIK made rounds and provided OJT, and the company could conduct
500 practical training sessions at hospitals, mostly as planned.
Use of digital technology for safer childbirth
Through OJT, the trainees’ abilities in specific tasks clearly improved. In the digital antenatal
examination, a big step forward was the division of roles according to the flow in thehospital, such as inputting patient information by the receptionist and running ultrasoundand laboratory tests by another person. During OJT, trainees found suspected cases of twinsand hydrocephalus, leading to definitive diagnoses in the ultrasound laboratory. Trainees
could quickly share the ultrasound data saved on their smartphones with specialists andprovide remote guidance for interpretation.
In one case, a pregnant woman who was preparing to give birth found out that her fetus
was not sufficiently old for delivery after undergoing a digital examination on S-PAQ. Errors
occurred in the conventional manual calculation of the expected date of birth. Therefore,
automatic calculation of the smartphone app enabled a correction to the due date.
Additionally, there was the opinion that communication between nurses and pregnant
women was promoted by a digital antenatal examination app that covered relevant items.
Nurses can easily notice abnormalities by asking patients questions according to thenavigation on the app. For example, in cases where a vaccine that requires three doses
is only partially received, nurses could urge pregnant women to get fully vaccinated, andpregnant women who had not known the necessity of vaccination until then could get it
immediately.

TENKAI Project News vol.2 ｜ March 2022

9

Training in the Democratic Republic of the Congo

Sharing ultrasound photos on a pregnant woman’ssmartphone during training at a hospital

Together with the first public–private partnership agreement by a Japanese company
After the first year of the project, a relationship of trust was built between SOIK and the
top management of the Ministry of Public Health, DRC. In July 2021, a memorandumof understanding for a public–private partnership agreement was signed between thecompany’s local subsidiary and the Ministry of Public Health. It states that the company
will work jointly with the Ministry of Public Health to develop solutions that utilize
technology and innovation in the health sector.
SOIK is currently developing packages in collaboration with Lequio’s ultrasound, Melody
International’s fetal monitor, ARKRAY’s biochemical and urinalysis equipment, OUI.
Inc.’s ophthalmic camera, and MBS’s blood sampling equipment. Further, while further
expanding cooperation with other medical device manufacturers, SOIK is looking forpartners, such as research institutes and hospitals, that will publish data. In addition to
government and aid agencies, SOIK is also working to develop services for private hospitals
and patients and establish a business model that enables a financially sustainable andrapid spread. Thus, the company aims to expand to the Democratic Republic of the Congoand neighboring countries.
S-PAQ is characterized by the availability of its main functions even when offline.
However, remote support for medical workers is even more effective when connectedto the internet. SOIK is looking forward to the future to develop S-PAQ into an important
infrastructure as a digital healthcare solution platform for Africa by packaging it with
communication equipment to accelerate local deployment.
(Cooperation: Kuniyuki Furuta, SOIK Co., Ltd.)[Country] Democratic Republic of the Congo [Project name] “Training project on digital medical equipment and Japanese home visit
healthcare service” (2020) “Training project on antenatal examination with digital technology” (2021) [Implementing body] SOIK Co., Ltd.,
https://www.soik.co.jp

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TENKAI Project News vol.2 ｜ March 2022

GOOD PRACTICE FILE

No.02

Providing rapid and highly sensitive tuberculosis
testing and diagnostic technology| Zambia | Eiken Chemical Co. Ltd.
Photo: Training at Eiken Chemical

Status of tuberculosis testing in Zambia
The level of medical care in Zambia’s urban areas is relatively high among Sub-Saharancountries. Culture and molecular testing (GeneXpert)—the most reliable tuberculosis testing
method—is being implemented. Nevertheless, according to the latest statistics from the World
Health Organization (WHO), the prevalence of tuberculosis is extremely high at 319 per 100,000
people (2021), and WHO has designated Zambia as a high-burden country for tuberculosis.
One of the reasons for the prevalence of tuberculosis is the existence of unplanned residential
areas called compounds with inadequate medical environment, resulting in a situation in which
a rapid and accurate diagnostic system, which is important for tuberculosis control, cannot be
sufficiently established. In such an environment, complex examination techniques are required,but most facilities can only provide microscopic examinations with low sensitivity. Throughmicroscopic examination, professionals take a long time to make a judgment and even fail todiagnose approximately half of the tuberculosis patients.
PURE-TB-LAMP, an inspection method developed by a Japanese company
PURE-TB-LAMP is a diagnostic method for tuberculosis infection developed by Eiken
Chemical using the loop-mediated isothermal amplification (LAMP) method—a proprietary
nucleic acid amplification method. It is characterized by the capability to obtain results easily
TENKAI Project News vol.2 ｜ March 202211and quickly. Using this method,
tuberculosis molecular testing
can be realized in a testing
environment with limited
facilities. Many of the countries
designated by the WHO as
high-burden countries fortuberculosis are low- andmiddle-income countries.
Given that tuberculosis testingis conducted in an environment
with insufficient facilities,
these countries need simple
Procedure for Mycobacterium tuberculosis complex detection
by PURE-TB-LAMP
and highly accurate testing
methods. PURE-TB-LAMP,
which allows simple and rapid testing, was recommended by the WHO Policy Guidance in2016 as a testing method that can replace conventional microscopy methods.
Project to disseminate rapid and highly sensitive tuberculosis testing and diagnostic
technology
Eiken Chemical has built good relations with the Zambian Ministry of Health afterparticipating in the FY 2015 Project of Global Extension of Medical Technologies, called
Point of Care Testing (POCT) in Africa. With a deep understanding of each other’s situation,
the two parties discussed how the spread of PURE-TB-LAMP, a Japanese diagnostic
technology, could contribute to tuberculosis control in Zambia. Subsequently, under theagreement of the relevant organizations of both countries, a project for dissemination was
launched. The project began in 2017, based at the University Teaching Hospital (UTH), withthose at the hospital learning about molecular testing and PURE-TB-LAMP. Two laboratory
technicians each from UTH and Chest Disease Laboratory (CDL) and three laboratory
technicians from Matero Level 1 Hospital (the medical institution) participated as trainees
to acquire technological expertise in PURE-TB-LAMP.
The beginning was marked by various issues, such as difficulty handling pipettes used for
operation, difficulty understanding the procedure, and the question of why they had to learn
PURE-TB-LAMP when they could use a competing automatic inspection device. However,through repeated training and discussions locally and in Japan, the trainees learned thatmolecular diagnostics and PURE-TB-LAMP are necessary and important technologies
for tuberculosis control. Training at a tuberculosis research institute—a cooperatingorganization—proved fruitful in improving the overall knowledge on tuberculosis testing.
In a demonstration test by seven engineers, extremely good results were obtained, suchas improving the tuberculosis detection rate by more than 50%. A poster presentation wasmade at the 49th Union World Conference on Lung Health (The Union).
12

TENKAI Project News vol.2 ｜ March 2022

Left: Training at UTH | Top and bottom right: PURE-TB-LAMP operator training

Contributing to tuberculosis control in Zambia
By being selected for the Project of Global Extension of Medical Technologies for three
years, the POCT project has effectively promoted the spread of PURE-TB-LAMP in Zambia.
The memorandum of understanding signed at the 7th Tokyo International Conferenceon African Development in 2019 stipulated the agreement to adopt PURE-TB-LAMP and
was approved by the Technical Working Group. This agreement is to be included in the
tuberculosis diagnostic guidelines and national strategic plan. Further, we will focus on
training engineers to expand the inspection system continuously. Talented technicians
among the trainees in the first and the second fiscal years were designated as local PURETB-LAMP trainers. In the FY 2020 project, despite the impact of COVID-19, PURE-TBLAMP was introduced to 14 facilities in medically underpopulated areas through remote
guidance from Japan and local trainers, and 32 engineers were trained.
Furthermore, PURE-TB-LAMP was installed in 20 facilities in Zambia in FY 2018–2020. In
the FY 2021 project, 10 facilities will be added. Thus, highly sensitive tuberculosis testing
will be installed at 30 facilities. Additionally, in February 2022, the PURE-TB-LAMP Training
Center was opened in CDL as a base for disseminating PURE-TB-LAMP, facilitating medical
technology transfer in Zambia. PURE-TB-LAMP has been demonstrated to yield a higher
tuberculosis detection rate compared with microscopy. It is expected that morbidity will
decrease owing to improved tuberculosis detection rates in the future.
(Cooperation: Keiko Watanabe, Eiken Chemical Co., Ltd.)[Country] Republic of Zambia [Project name] “Expanding program of diagnostics for tuberculosis using PURE-TB-LAMP in the Republic ofZambia” (2017–2021) [Implementing body] Eiken Chemical Co., Ltd., https://www.eiken.co.jp/en/

TENKAI Project News vol.2 ｜ March 2022

13

GOOD PRACTICE FILE

No.03

Establishing a system for testing and treating sleep
disorders| Mongolia | Center for Sleep Medicine, Ehime University Hospital

Photo: Trainees practicing polysomnography using a head model at the Polysomnography Hands-on Seminar in Mongolia

Start of sleep medicine project
In Mongolia, the number of patients with sleep disorders, mainly sleep apnea syndrome(SAS), is increasing as lifestyle habits have become more westernized in recent years.
Polysomnography (PSG) is necessary for diagnosing sleep disorders, and implementing this test
requires examination and interpretation techniques as well as the appropriate equipment.
In 2019, Ehime University started the Human Resource Development and System Development
Project in the Field of Sleep Medicine in response to Mongolia’s strong desire to launch sleep
medicine. Based on the experience of the introduction and development of sleep medicine
in Japan in the 1990s, the university intended tobuild a sleep medicine clinical system and develop
the required human resources. It also aimed to
introduce Japanese sleep diagnosis and treatment
technology and medical equipment to the country.
The treatment of SAS, which is closely related tolifestyle-related diseases, such as cardiovasculardisease, respiratory disease, and diabetes, is an
important field for the healthy life expectancy of
CPAP demonstration at the Mongolian Academy
Mongolian people.
of Medical Sciences SAS workshop
14

TENKAI Project News vol.2 ｜ March 2022

Mongolian Neurology Society hands-on seminar

Fostering human resources to create a sleep medicine clinical system
The project proceeded smoothly with the cooperation of organizations such as the
Mongolian Academy of Medical Sciences and Mongolian Neurology Society. At the SASworkshop for medical academy members, those involved in the project gave a lecture
on SAS examination and treatment for doctors. Further, training was conducted forneurologists and laboratory technologists in the country in addition to on-the-job training
at the Ehime University Hospital Center for Sleep Medicine.
The first sleep center in Mongolia was established at the General Hospital for State Special
Servants, where the doctors and technicians trained in Japan work. With this core facility,
training could be conducted more effectively. Additionally, under the Japan International
Cooperation Agency project, support was provided for the start-up of PSG at theMongolia–Japan Teaching Hospital, and its reach was expanded.
Owing to the spread of COVID-19, after the training in January 2020, it became impossible
to conduct on-site training; hence, training had to be conducted online. During the final
on-site training in 2020, hands-on training—a major goal of the project—could not be
implemented. Therefore, regular online training and seminars were conducted throughthe Mongolian Neurology Society and the local sleep center. In the online training, efforts
were made to create video content, study booklets, study sleep test record sheets, andother materials to enable effective study.

Study sleep test recording sheet (width 120 cm)
TENKAI Project News vol.2 ｜ March 2022

15

Left: Wearing electrodes and sensors during PSG training at Mongolia–Japan Teaching Hospital
Top right: Lecture on sleep disorders for neurologists
Bottom right: Commentary on sleep test cases during practical training at Mongolia’s first sleep center

Potential of sleep medicine spreading in Central Asia
In Mongolia, most of the patients with sleep disorders, especially SAS, have not been
diagnosed, confirming the high need for medical care. At the first sleep center in Mongolia,
more than 200 patients were diagnosed in a short period, and we successfully introduced
continuous positive airway pressure therapy (CPAP), a treatment device. Further, thesmooth introduction of PSG, including electroencephalogram measurement, was madepossible by neurologists. Subsequently, the project disseminated knowledge about effective
development methods for sleep medicine that targets sleep disorders in general.
Even when travel was impossible owing to COVID-19, we realized the potential of providing
training to a wide range of participants by promoting online training using videos andteaching materials. Through the activities of the project, the clinical system for SAS was
improved. Nonetheless, further training is needed to deal with various other sleep disorders.
Online training has been successful, but it has limitations. Improvement in the COVID-19
situation will allow the project to resume its activities locally. Additionally, many countries
in Central Asia need sleep medicine. Ehime University will continue to work to expand sleep
medicine to more countries.
(Cooperation: Yasunori Oka, Center for Sleep Medicine, Ehime University Hospital)[Implementing country] Mongolia [Project name] “Development of human resources for clinical sleep medicine” (2019) “Developmentof human resources and medical system for clinical sleep medicine in Mongolia” (2020, 2021) [Implementing body] National University
Corporation Ehime University, https://www.ehime-u.ac.jp

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TENKAI Project News vol.2 ｜ March 2022

GOOD PRACTICE FILE

No.04

Popularizing hearing tests and hearing aids for people
with hearing problems| Vietnam | Rion Co., Ltd.

Photo: Trainees observing a surgery during a short-term study tour in Japan

Urgent need for early detection of hearing loss
Since Rion, a hearing-aid manufacturer, launched Japan’s first mass-produced hearing
aid in 1948, it has developed various hearing aids using its own technology, including theworld’s first waterproof, digital, and cartilage conduction hearing aids. The company has
also developed hearing-test equipment needed in clinical settings and group hearing-aid
systems used in schools and places where many people gather. The company is working tobuild a system for hearing tests and hearing-aid fittings in Vietnam by utilizing their technicalcapabilities and knowhow.
Compared with Japan, hearing-test equipment are not widespread in Vietnam, leading todelays in discovering and dealing with hearing loss. There are concerns that hearing may
deteriorate and that hearing aids may not be properly adjusted. In response to this issue,
Rion worked with local public hospitals to establish a system for conducting appropriate
hearing tests and hearing-aid adjustments. Thus, the company is attempting to spread theuse of hearing tests and hearing aids and train local experts and technicians.
The company signed a memorandum of understanding with Bach Mai Hospital in Hanoi in
2014. For three years, from 2016, the company has established a system at the Vietnam–
Japan Audiology Center, which was set up in the hospital, where medical staff can provide
services from hearing tests to hearing aids. Since then, in cooperation with Hue Central
TENKAI Project News vol.2 ｜ March 2022

17

Lecture at Hue Central Hospital

Hospital in central Vietnam, Ho Chi Minh City, and Ho Chi Minh City Ear, Nose, & Throat
Hospital, the company has established a system for conducting hearing tests and selling
hearing aids.
A project to impart skills for hearing tests and hearing-aid fittings
After these activities, local hospitals asked for continued cooperation, and the company
started A Spread of Fitting Technology for Hearing Aids & Promotion of Diagnosis Equipment
under the Project of Global Extension of Medical Technologies in FY 2019. The projectprovided educational opportunities for training Vietnamese doctors, laboratory technicians,
and nurses as specialists in hearing diagnosis and testing. Hearing loss can now be detected
early at the hospital, and appropriate hearing-aid prescriptions and after-sales follow-up canbe performed.
During the training, Rion and the medical staff of the otolaryngology department of the
NCGM hospital worked together to explain the necessity of hearing tests and the importanceof hearing-aid fitting to local doctors and nurses. In FY 2019, three short-term study tours
in Japan, 40-day long-term training, and a local seminar at Hue Central Hospital were held.
From FY 2020, owing to the impact of the COVID-19 pandemic, travel between Japan and
Vietnam was restricted, leading to significant changes in the content of the implementation.
The company created a video material that summarizes the procedure from diagnosis
to inspection and treatment and then held an online seminar. Through explanations by
Japanese experts, the trainees learned the necessity of hearing tests, the usefulness ofhearing aids, and the importance of proper hearing-aid fitting. The trainees who attended
the training praised it as a good opportunity to understand the basics and mechanisms ofhearing tests and hearing-aid fittings.
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TENKAI Project News vol.2 ｜ March 2022

Above: Commemorative photo after the online seminar | Left: Preparing for a lecture at Hue Central Hospital |Right: Trainees and Japanese experts who have completed long-term training

Not stopping to create a system to support people with hearing loss even during
the COVID-19 pandemic
Even during the COVID-19 pandemic, the company has continued to create a system tosupport people with hearing problems in Vietnam without stopping technical support
through training. It is expected that the knowledge and medical techniques learned will
spread throughout the region, centering on the hospitals that have built cooperative
relations through project activities.
Rion believes that the value of this project is not in merely promoting the spread of medical
equipment but in its potential to encourage collaboration among medical institutions andexchange technology—from examinations and diagnoses to after-sales follow-up—using theequipment. While utilizing these efforts to expand its business, the company will continue
to conduct activities to deliver comfortable hearing and the joy of hearing to the world andrealize its corporate philosophy of “contributing to people, society, and the world.”(Cooperation: Takehiro Isobe / Tadayuki Watabe / Akira Hayashi, Rion Co., Ltd.)[Country] Socialist Republic of Vietnam [Project name] “Spread of fitting technology for hearing aids and promotion of diagnosis equipment”(2019, 2020, 2021) [Implementing body] Rion Co., Ltd., https://www.rion.co.jp

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19

GOOD PRACTICE FILE

No.05

Spreading endoscopy and laparoscopy technology tosave patients with gastrointestinal cancer| Brazil | Kochi University

Photo: Training at Kochi Medical School Hospital (2018)

A system to systematically observe and treat the gastrointestinal tract is necessary
Endoscopy and colonoscopy are technology developed in Japan, and the transfer of thistechnology can significantly contribute to medical care globally. In Brazil, increasing number ofphysicians and surgeons have interest in endoscopic diagnosis and treatment, but systematic
observation of the gastrointestinal tract, which is commonly performed in Japan, is rarely done
there. Surgical operations are not as specialized as it is in Japan; Brazilian surgeons are using
laparoscopic techniques to general surgical operations on various organs. In response to thesituation in Brazil, Kochi Medical School (KMS) has created a base that can differentiate treatment
according to each organ. Experts at KMS identified the need to train endoscopists who haveproficiency in early diagnosis of diseases, which can be treated with minimal invasive surgery.
When signing a memorandum of understanding on academic, scientific, and cultural
cooperation with the Federal University of Mato Grosso do Sul (UFMS) in Brazil in March
2012, KMS took initiative to provide technical support in medicine in response to UFMS’s
requests for cooperation in diagnosis and treatment using endoscopes. In addition, a similar
request from the director of the Mato Grosso do Sul State Department of Health prompted
KMS to dispatch medical staff and accepting trainees since 2016.
The UFMS Medical Hospital uses endoscopic technology but unsystematically. However, a doctor
who participated in the KMS training "Spreading endoscopy and laparoscopy technology to save
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TENKAI Project News vol.2 ｜ March 2022

patients with gastrointestinal cancer" in 2018 successfully performed endoscopic submucosal
dissection for the first time in the State during the local training in 2019. As the basic techniques
for laparoscopic surgery are not yet stable, Kochi University has established an endoscopic andminimally invasive surgery center within UFMS and is preparing a training system.
Projects for human resource development for improving endoscopic diagnosis andtreatment techniques
Based on these achievements, KMS participated in the Project of Global Extension of Medical
Technologies in 2020. It is working on Technical Training in Endoscopic and Laparoscopic
Procedures in Pantanal, Brazil, to develop human resources and improve endoscopic diagnosis
and treatment techniques at Mato Grosso do Sul in Brazil. The project aims for the following:
the establishment of a basic educational system for endoscopic diagnosticians, therapeutic
physicians, and laparoscopic surgeons in the state; the development of guidance on theeffective use of allied health professionals (medical staff other than doctors and nurses);
contributions to improving the cure rate of gastrointestinal cancer.
As the COVID-19 epidemic continues, it is difficult to conduct training locally and in Japan.
Therefore, KMS devised a program that delivers video content; thus, participants need
only the internet to improve their skills. For endoscopic diagnoses, guidance is provided forthe insertion and observation of an endoscope to ensure that a systematic diagnosis canbe made. For medical endoscopic treatments, KMS faculties instructed staff on advanced
endoscopic treatment techniques, such as endoscopic submucosal dissection for doctors
who have already mastered basic endoscopic techniques. Additionally, in surgical endoscopic
treatment, KMS faculties made it possible to learn through observation of a standard
patient’s surgery performed by a supervising doctor. The content of the online course has
evolved to meet local needs through repeated feedback from trainees.

Training in Brazil (2018)
TENKAI Project News vol.2 ｜ March 2022

21

Left: Surgical observation during training in Brazil (2018) | Upper right: Online lecture |Middle right: Completion process of the online course | Bottom right: The training was introduced in a local newspaper.

Skills improvement with the benefits of distance learning
Many trainees could deepen their understanding of educational material provided throughthe online course, which the COVID-19 pandemic urged KMS to introduce, as it has theadvantage of repeated viewings. Some trainees have video-recorded their surgeries andsubmitted cases.
Regarding the division of roles among local doctors, the extent to which endoscopists
perform invasive treatment differs from that in Japan. However, it is necessary to change thestatus quo of advanced cancer being the main treatment target in Brazil by improving thetechnique of systematic observation of the surface of the gastrointestinal tract. By solidifying
the basics through training, many early-stage cancers that are targets for internal endoscopic
treatment and surgical laparoscopic minimally invasive surgery will be discovered.
KMS will continue to work with the state and federal governments while adhering to thecountry’s medical policy. The objective is to contribute to communicating Japanese―style endoscopy, procedures, and minimally invasive surgery and the development ofgastrointestinal examination, early detection/early treatment, and endoscopic technology asa measure against leading causes of death in Brazil. KMS will continue developing Japanese
medical equipment and technology as a package and its efforts to spread endoscopy
technology not limited to the gastrointestinal tract.
(Cooperation: Narufumi Suganuma, Kochi University)[Country] Federative Republic of Brazil [Project name] “Technical training in endoscopic and laparoscopic procedures in Pantanal, Brazil”(2020, 2021) [Implementing body] Kochi University, http://www.kochi-u.ac.jp

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GOOD PRACTICE FILE

No.06

Conveying water-quality management technology to
improve the quality of dialysis treatment| Mongolia | Japanese Society for Technology of Blood Purification
Photo: Hands-on seminar

Urgent need to purify dialysis fluids
In 2006, Japan installed more than 100,000 dialysis machines in 3,985 dialysis facilities.
Conversely, Mongolia had only one dialysis facility and only four dialysis machines that could be
used. Then, Mongolia revised its health insurance system to allow anyone to receive dialysis. By
2020, Mongolia had 49 facilities and 265 dialysis machines across all provinces. However, it lacks
an equipment management system and guidelines for the management of dialysate used fortreatment. As such, the cleanliness of dialysate varies among facilities. Indeed, occasional cases
have been reported where treatment could not be performed under a favorable environment.
In addition to doctors and nurses, engineers and technicians who specialize in the maintenanceof medical equipment require a dramatic improvement in skills in the correct methods.
The Japanese Society for Technology of Blood Purification utilizes the knowhow cultivatedthrough activities aimed at improving dialysate purification and dialysis technology in Southeast
Asia. Since 2016, based at the Central Military Hospital, the Society has co-sponsored seminars
to improve dialysis treatment techniques for dialysis facilities throughout Mongolia. Since
FY 2020, the Society has been participating in the Project of Global Extension of Medical
Technologies and working on a project to support the improvement of dialysis equipment
management technology and formulation of a standard of fluids for hemodialysis to improvedialysis treatment technology.
TENKAI Project News vol.2 ｜ March 2022

23

Left: Guidance on water-quality measurement at a hospital in Ulaanbaatar | Right: Fourth Joint Seminar (held online)

Aiming for local self-sufficiency without relying on support
Similar to low- and middle-income countries in Southeast Asia, Mongolia has expensive
medical equipment donated by many countries and organizations to major hospitals.
However, most of these hospitals cannot maximize the original specifications even if they
are brand new. If proper maintenance is not ensured, the equipment will deteriorate over
the years and eventually become unusable. Moreover, the equipment may become unusableowing to the difficulty in procuring the parts necessary for maintenance.
The project focuses on human resource development. For maximizing the capabilities ofthe dialysis machines in Mongolia, advanced medical care can be made sustainable byconducting training from the basics—rather than applying them—and improving the skills of
local medical staff. The medical staff in Mongolia are extremely diligent and highly motivated,
and the educational lectures given by Japanese experts often exceeded the scheduled time
limit owing to question-and-answer sessions. The Japanese teaching staff also reaffirmed the“obvious things” in Japan from their questions and learned considerably, which has led to theimprovement of their clinical skills in Japan.
Increase in training participants even during the COVID-19 pandemic
In 2020, owing to the COVID-19 pandemic, the project could not conduct local training
or accept trainees to Japan. However, with the introduction of online training, medical
workers in rural areas who originally could not attend because the distance to the capital
Ulaanbaatar was too far could receive training without traveling. Many medical professionals
from across Mongolia could participate in the online training. The number of participants did
not decrease even during the lockdowns that the government implemented to prevent the
medical system from collapsing. Meanwhile, equipment maintenance training was difficult
to implement. The specifications of the same dialysis equipment are different in Japan
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TENKAI Project News vol.2 ｜ March 2022

and Mongolia in various respects, andproblems that cannot occur in Japan
often occur owing to differences in parts
supply systems. This is because it isdifficult to explain such cases online, andthis will remain a problem in the future.

Hands-on seminar

Toward the formulation of a standard of fluids for hemodialysis
The Japanese Society for Technology of Blood Purification transported water-quality testing
equipment to Mongolia in 2021 and completed water quality testing for all dialysis facilities
in Mongolia while providing online testing technology guidance. In Mongolia, which has anenvironment where the temperature reaches -40 °C in winter, making it difficult for bacteria
to grow, there are many facilities with better dialysis solution water quality comparedwith Southeast Asian countries. It is important to formulate guidelines for water-quality
management to improve the quality of dialysis treatment. To maintain and manage purified
dialysis fluids, the Society highlighted the need to make the following a commonly recognized
point among medical institutions nationwide: “reviewing the cleaning method, such as
performing daily water-quality measurements and intensive cleaning of equipment when
the water quality falls below the action level stipulated in the standards (or guidelines).” TheSociety will support the formulation and dissemination of the standards for water-quality
management suitable for Mongolia while continuing to elucidate the current situation to
improve the level of dialysis treatment in Mongolia.

Project Story

Mongolian medical staff often take Japanese peers to ger (mobile

dwellings) in the grasslands on the outskirts of the city to welcome
them. Vodka is always served on these occasions. The toast iscalled “Togtooy.” When people shout “Togtooy,” the shot is drunkin one gulp. Mongolian people are strong drinkers; it is important
not to be overwhelmed by their pace.

(Cooperation: Hirokazu Matsubara / Kenichi Kokubo, Japanese Society for Technology of Blood Purification)[Country] Mongolia [Project name] “Technical training on hemodialysis and water-quality management and support for survey and making
guidelines for water-quality management in Mongolia” (2020) [Implementing body] Japanese Society for Technology of Blood Purification,
https://jstb.jp

TENKAI Project News vol.2 ｜ March 2022

25

GOOD PRACTICE FILE

No.07

Improving patient prognosis with dialysis water
purification technology| Indonesia | St. Mary’s Hospital

Photo: Training participants observing a demonstration of endotoxin measurement

While the number of chronic dialysis patients is increasing, the quality of treatment is
not improving
In Indonesia, hemodialysis treatment for patients with chronic renal failure is rapidly
spreading owing to improvements in the medical environment and the adoption of dialysis
treatment in the universal health insurance system. The potential demand for dialysis
treatment is high: the number of patients requiring chronic maintenance dialysis was
30,554 in 2015, which then increased to 52,835 in 2016, 77,892 in 2017, and 132,142*1 in
2018—quadrupling in only four years. However, according to a nephrologist in the country,
the average life expectancy after the introduction of dialysis is only about three years, andthe treatment results are not good. Approximately 80% of dialysis machines are made inJapan, and there is a big difference in treatment results from those in Japan. The reasons
may be the delay in training dialysis nurses, shortage of dialysis machines and equipment
management systems, and delay in water-quality control technology for dialysis water,which is important in dialysis medicine. Moreover, Indonesia has no medical qualificationequivalent to the clinical engineer in Japan. These engineers maintain dialysis and othermedical equipment but are not allowed to come into contact with patients. If many dialysis
engineers understood the significance of purifying of product water and learned to put it
into practice, then the quality of dialysis treatment could be significantly improved.
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TENKAI Project News vol.2 ｜ March 2022

2019 Dialysate Purification Seminar

Trainees undergoing live bacteria culture test training at
St. Mary’s Hospital

A project to develop human resources who can manage dialysis equipment
In April 2017, St. Mary’s Hospital in Kurume City, Fukuoka Prefecture, signed a memorandumof understanding for medical technology cooperation at the request of Airlangga University
Hospital in Surabaya, the second largest city in Indonesia. For two years, from FY 2018, St.
Mary’s Hospital conducted a project called Building a Medical Equipment Management
System Beginning with Dialysis in Indonesia, under the Project of Global Extension of Medical
Technologies, and conducted training in Japan for four dialysis engineers from Airlangga
University Hospital.
Product water is used for dissolving/diluting powders of concentrated dialysate agent, andcleaning and disinfecting the piping and equipment. After raw water is processed using
methods such as filtration, ion exchange, adsorption, and reverse osmosis, it is managed
below the standard value. Japan’s control standard values for chemical substances andbiological pollutants are strict standards that conform to ISO13959 and ISO23500. The
training aimed to explain the purpose of using product water and the treatment method of
raw water, as well as be able to perform the acquired skills.
Through the project, the Airlangga University Hospital could build a system that can continue
to improve the quality of product water (to meet Japanese water quality standards).
Interviews with nurses in dialysis units have confirmed the reduction in indefinite complaints,
mainly fever, chills, and fatigue. After completing the first year of training, the trainees
achieved the standard for water quality and are continuing their training in maintenance andmanagement. St. Mary’s Hospital also organized a two-day seminar at Airlangga University
Hospital for the second year in a row to spread awareness on the importance of dialysate
purification. In both years, the seminar had more than 100 participants, indicating the highinterest of engineers and related parties.
Delivering training from Japan
In January 2020, Airlangga University Hospital asked St. Mary’s Hospital for support for a plan,saying “we would like to open a training center for dialysis engineers within the university as
TENKAI Project News vol.2 ｜ March 202227

a pilot project. In the future, we will develop it
into a center that covers all medical equipment
in hospitals and contribute to improving thequality of medical care in the East Java region
as a training facility for engineers who will playa role similar to Japanese clinical engineers.”
However, this plan was postponed because theuniversity hospital was designated as a core
hospital for COVID-19 countermeasures.

Above: Discussion with engineers and nurses from
Airlangga University
Bottom: State of live distribution of training

Under such circumstances, St. Mary’s Hospitalcreated teaching materials (e.g., videos, slides,and documents) for dialysate purification training
with engineers, based on the materials prepared
for the training thus far. For two months, from
November to December 2021, St. Mary’s
Hospital held online training for dialysis engineers
in the East Java region. Using on-demand lecturesand self-study materials, St. Mary’s Hospital also
conducted live online training for two days. The
number of registered participants exceeded 160,
and 100 people participated in the live online
training, which exceeded expectations.

Toward improving the quality of community medical care
The online training was conducted after widely recruiting participants in the East Java region.
With the support of a professional organization for medical engineers*2, approximately 20%of the participants were registered from medical institutions from multiple regions andislands outside East Java.
Indonesia continues to face challenges in many aspects of medical care. Japan’s medical
experience is helping the country, which is striving to change the status quo. Moreover, face-toface training is again required. In Indonesia, which comprises many islands, conducting training
online helps enable the development of medical personnel not based in urban areas. St. Mary’s
Hospital aims to expand the content of online training and create a training system as good as
face-to-face training. These efforts reflect the unchanging feeling of St. Mary's Hospital, “withoutbuilding trust, trust in medical devices will not last long. Even if it is a small collaboration, we
would like to work on something that can contribute to a good relationship with Indonesia.”*1: Indonesian Renal Registry 2018 (reference: 344,640 chronic dialysis patients in Japan as of the end of 2019)*2: Ikatan Elektromedis Indonesia(Cooperation: Nobuyuki Ono, St. Mary’s Hospital)[Implementing country] Republic of Indonesia [Project name] “Building a Management System for Dialysis Equipment in Indonesia” (2018,2019, 2020) “Building a Management System for Medical Equipment in Indonesia”(2021) [Implementing body] Our Lady of the Snow Social
Medical Corporation, St. Mary’s Hospital, https://www.st-mary-med.or.jp

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GOOD PRACTICE FILE

No.08

Delivering temperature-controlled blood products to
hospitals| Myanmar | Daido Industries, Inc.

Photo: Shooting teaching material video at University of Nursing, Yangon

Need for a system to store and supply safe blood products
Daido Industries, a manufacturer of equipment for storing blood products for transfusion, is working
on a project for the delivery of temperature-controlled and safe blood products in Myanmar.
In Myanmar, universal health coverage has been launched as a policy, and the country’s
Ministry of Health and Sports has implemented free blood transfusions since 2015 and otherblood projects. The number of blood donors is increasing, but that of advanced surgeries andtreatments is also increasing along with rapid economic development. In advanced medicalcare, blood transfusions are often required as adjuvant therapy, and the demand for both
quality and quantity of safe blood is rapidly increasing. However, hospital blood banks are
the mainstream of the country’s blood business, and the blood testing systems at individual
hospitals are weak. Blood testing and the supply of blood products require equipment that canbe properly temperature-controlled and medical staff with specialized knowledge and skills.
Therefore, since FY 2016, Daido Industries has been participating in a project implemented by
the NCGM as a partner company and has been working to strengthen blood transfusion andhematopoietic stem cell transplantation medicine in Myanmar. At the time, Myanmar only had
the National Blood Center, which mainly supplied blood products to Yangon General Hospital.
Other hospitals used blood products supplied by blood centers and blood donations andtransfusions from in-hospital blood banks. The National Blood Center had testing equipment for
TENKAI Project News vol.2 ｜ March 2022

29

nucleic acid amplification tests, which was equivalent to Japan’s, but the in-hospital blood bankwas not fully equipped with the appropriate test system. The NCGM project continued until FY
2019, and Daido Industries also continued to cooperate in activities aimed at strengthening theinspection system. In 2018, an application was made to the Japan International Cooperation
Agency (JICA)'s Small and Medium Enterprise Overseas Expansion Support Dissemination
Demonstration Project. For a year-and-a-half, efforts were made toward the construction ofstorage and transport systems for blood products at blood centers and hospitals. These efforts
were the introduction of platelet product storage (shaking constant temperature bath) andtransportation equipment, donation of red blood cell storage equipment (blood refrigerator),and human resource development.
A project to deliver temperature-controlled blood products
In 2019, within Myanmar’s Ministry of Health and Sports, an initiative was launched to expand
the number of national blood centers from one in Yangon to nine nationwide to supply
hospitals with safe blood products. However, the transfusion specialist system had only beenlaunched; there were only eight specialists. Training medical staff for blood transfusion andstrengthening the blood transfusion management system at hospitals were urgent issues.
Under such circumstances, Daido Industries received a request from the Myanmar government
to support the development of adequate human resources for the next-generation bloodand transfusion medicine based on the relations of trust the company had built with theircounterparts, the National Blood Center, Ministry of Health and Sports, and the Japanese
blood and transfusion industries. From FY 2020, Daido Industries newly launched The Projectfor Sustainable Safer Blood Transfusion in Myanmar in collaboration with the Bureau ofInternational Health Cooperation of the NCGM, Osaka Medical and Pharmaceutical andUniversity Hospital Blood Transfusion Laboratory , and experts that included former Japanese
Red Cross employees.
The project team met with the National Blood Center in Yangon in February 2020, before the
COVID-19 epidemic in Myanmar. At the time, there was the assumption that travel and arrivalin Japan would be possible around summer. Plans were made for technical guidance training
based on the standard blood transfusion procedures by the Bureau of International Health
Cooperation, technical guidance training in cooperation with Osaka Medical and Pharmaceuticaland University Hospital Blood Transfusion Laboratory, and holding a symposium. However, theLeft: Myanmar medical staff reproduces the standard procedure and creates an educational video
Right: Hearing requests for training content from local medical staff

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TENKAI Project News vol.2 ｜ March 2022

Left: Online overview of blood transfusion medicine in Japan | Right: Online/mobile phone hybrid conference

impact of the COVID-19 pandemic forced changes in plans; training and symposiums were held
online using teaching material videos.
For the teaching material video, the project recorded Burmese audio for the benefit of the
trainees. The English translation was translated to Burmese by a translator, and a Myanmar
engineer working for Daido Industries played an active role in checking the language. For
example, the English word “serious” was translated as “resulting in death.” Engineers asked
experts whether an adverse event resulted in death, and the engineers received an explanationin Japanese and English on the concept of “serious.” Thus, the translation used suitable termsby accounting for the detailed nuances.
Additionally, in the video production for the local technical guidance training for the standard
blood transfusion procedure, experts first made an image video in Japan. They showed it tolocal doctors and nurses, conveyed the content, and filmed various scenes reproduced at the
local nursing college to complete the project.
Shortly before the online symposium was held, a coup d'état occurred. Internet services were
cut off the day before the symposium. Myanmar engineers made phone calls to various offices
and managed to connect to the mobile phone of the director of the National Blood Center, andthe meeting was held as an online/mobile phone hybrid conference.
Toward improving the standard of blood transfusion medical care in Myanmar
Responding flexibly to unexpected events such as the COVID-19 pandemic and coups, theone-year project completed the training of 32 multidisciplinary medical staff (17 doctors, 13
nurses, and 2 technicians). In Myanmar, where smartphones are widely used, it is possible
to repeat learning on demand. Daido Industries believes that combining on-site training andlive streaming to deliver the live discussion of Japanese experts will provide effective training
opportunities. To improve the standard of blood transfusion medical care in Myanmar, Daido
Industries hopes that the system built in the Yangon area will be expanded to other cities. It is
expected that the COVID-19 pandemic will be over at the earliest and that the company canwork with the National Blood Center again.
(Cooperation: Shinsuke Ohgiri, Daido Industries, Inc.)[Implementing country] Republic of the Union of Myanmar [Project name] “The project for sustainable safer blood transfusion in
Myanmar” (2021) [Implementing body] Daido Industries, Inc., http://www.daido-ind.co.jp

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31

GOOD PRACTICE FILE

No.09

Enhancing hospital quality management and patient
safety in Vietnam during COVID-19 pandemic| Vietnam | Bureau of International Health Cooperation, NCGM
Photo: Online training at Vinh Phuc General Hospital

Working with the Ministry of Health Vietnam to Enhancing hospital quality management
and patient safety
Medical malpractice occurs in every country and can lead to serious accidents and evendeath. In Japan, the national government, academic societies, professional organizations, andother bodies have established medical safety systems at hospitals against the backdrop ofserious medical accidents that occurred in 1999 and the 2000s. In Vietnam, medical accidents
have been reported in the newspaper and social media in recent years, and people’s interestin medical safety is increasing. The Vietnamese government has established laws on medical
safety, and hospital audits are conducted annually. Under such circumstances, the Bureau
of International Health Cooperation of the NCGM is working on the Project for Improving
Patient Safety Through Strengthening In-hospital Systems in Vietnam.
For seven years since its predecessor project started in 2015, the project has been
providing Vietnamese medical staff with training to improve hospital quality management
skills and the quality and safety of medical care. Thus far, 44 trainees from across Vietnam
have visited NCGM and learned through lectures and active discussions. The trainees
continue to keep in touch even after the training ended. The NCGM also supports the
Medical Quality and Patient Safety Forum in Vietnam and they share many case studies
with other Vietnamese hospitals.
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TENKAI Project News vol.2 ｜ March 2022

Implementation training at NCGM

2015

Hospital quality and patient safety forum in Vietnam

2015: Bac Mai Hospital2017

2017: Ba Ria Hospital

2019
2016

Copyright © 2021 National Center for Global Health and Medicine. All rights reserved.

2019: Hung Vuong Hospital

2018

1

2016: Da Nang Hospitalfor Women and Children

2018: Duc Giang Hospital

Copyright © 2021 National Center for Global Health and Medicine. All rights reserved.

2

Activities during the COVID-19 pandemic
In 2020, the Japanese experts could not contact the counterparts in Vietnam because of
the COVID-19 pandemic. The planned flight was also canceled, and the Japanese experts
had to reconsider next steps.
In August 2020, owing to the successful government-led early response—Vietnam had
been recognized worldwide as a country that had succeeded in controlling the COVID-19 our project had restarted. With online discussion between the Ministry of Health Vietnam
and NCGM, the Vietnamese side requested to strengthen the capacity of the quality
control department, which is responsible for the quality and safety of medical care at
hospitals including COVID-19 measures.
Online training between Vietnam and JapanThe Vinh Phuc Hospital in Vietnam is famous for its success in controlling COVID-19. The
director and medical staff of Vinh Phuc General Hospital, who had been trainees of the
project, isolated the village and coordinated with the hospital. Therefore, the Bureau ofInternational Health Cooperation collaborated with Vinh Phuc General Hospital to hold an
online training session that included knowledge sharing on COVID-19. Utilizing an online
conference system, more participants from various locations could access the training.
39 medical staff working in hospital quality management department and clinicaldepartment from 19 hospitals attended the venue at Vinh Phuc Province, and 197
participants attended lectures online. Some attendees listened to the lectures on theirsmartphones, while others participated in classes as a continuing training program at
hospitals.
The trainees discussed the introduction of the surgical safety checklist, 5S (Sort, Set, Shine,Standardize, Sustain), in-hospital networks, how to implement medical safety training, andformulate action plans.
TENKAI Project News vol.2 ｜ March 2022

33

An online training venue in Vietnam

Japanese experts delivering lectures from Japan

Delivering online training to remote areas
In the FY 2021 project, four Vietnamese model hospitals were nominated for training in
2020. With themes such as “Correct patient identification,” “Surgery safety (WHO surgicalsafety checklist),” and “Safe blood transfusion,” training is being conducted for doctors,
nurses, and pharmacists in the clinical departments of the hospitals. The online training
has been delivered to 924 people (as of December 23, 2021).
Human resource development utilizing the online solution is becoming more widespreadthan ever in the face of the health crisis of the COVID-19 pandemic. Although some aspects
are difficult to implement online, such as practical training and deep discussion with muchparticipants, the project team from the Bureau of International Health Cooperation of the
NCGM continues the project for many medical staff directly across the distance.
(Cooperation: Jun Moriyama / Tomoo Ito / Masahiko Doi / Kaori Seino,
Bureau of International Health Cooperation, NCGM)[Implementing country] Socialist Republic of Vietnam [Project name] “Quality management of healthcare program” (2015) “Strengthening
the management capability for quality and safety in healthcare” (2016, 2017) “Strengthening the management capability of nurses for quality
and safety in healthcare to accelerate hospital-wide cooperation in Vietnamese hospitals” (2018) “Strengthening the management capabilityof medical staff for quality and safety in healthcare to accelerate hospital-wide cooperation in Vietnamese hospitals” (2019) “Project for
improving patient safety through strengthening in-hospital systems in Vietnam” (2020, 2021) [Implementing body] Bureau of International
Health Cooperation, NCGM, National Research and Development Agency, https://kyokuhp.ncgm.go.jp/index.html

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TENKAI Project News vol.2 ｜ March 2022

Six tips on the international expansion of
medical care in the future
From the good practices of the Project of Global Extension of Medical Technologies, thefollowing indicate the future of the international expansion of medical care, which will
be a win–win situation for Japan and its partner countries.
Creatinga system tonurture people
who use medical
products
Creating a system for nurturing
medical personnel will lead tocontinuous product sales.
As this will take time,
manufacturers will consider theuse of business plans and funds
for multiple fiscal years.

Includinga managerial
perspective intraining contents
High-quality medical services
require training, including
medical safety, infection control,and quality control. Adding suchadministrative aspects would
make linking guidelines andinsurance inclusion easier in thepartner country.

Business
design for fundacquisition
Companies and medical
professionals, and domestic andlocal staff, will complement one
another in collaboration initiatives.
Those in charge of overseas
expansion strategy, development,
and market development should
first visit the medical sites of thepartner country.

Establishinga training base

Establishing a training center
locally or within a major
hospital will serve as a base fortraining, which is effective for
expanding to domestic regions
and neighboring countries.

Partneringwith academic
societies
As the institutions responsible
for continuing education,such as expert certification,
academic societies shouldseek early involvement in thepartner country as a shortcut
to creating a framework forhuman resource development
and ensuring continuity.

Price andmaintenanceJapanese products haveissues of high prices and strict
maintenance. Manufacturers will
create opportunities for partners
to experience the merits ofour products during training byusing demonstration machines
and samples. The objective isto reduce the maintenance loadby narrowing it down to theminimum necessary functions.

Through 234 projects in the seven years since the start of this overarching project, Japanese
medical products, technologies, and services have been continuously procured in partnercountries and used in medical settings, leading to improved health for many people. The
sharing and collaboration with industries, governments, and academia will secure thecontinuous international development of Japanese medicine that contributes to global health.
TENKAI Project News vol.2 ｜ March 2022

35

Bringing
Japan's
Health Careto the WorldFor inquiries and applications, please visit the website.

| 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 | https://kyokuhp.ncgm.go.jp/activity/open/index.html

TENKAI Project News
(English Edition) vol.2
Published
March, 2022
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
https://kyokuhp.ncgm.go.jp/©National Center for Global Health and Medicine ALL RIGHTS RESERVED.

TENKAI Project News vol. 2 2022 Published March, 2022 ISSN 2436-1968 Secretariat of the Projects for Global Extension of Medical Technologies, Natioonal Center for Global Health and Medicine

Ministry of Health, Labour and Welfare
Fiscal 2022 Projects for Global Extensionof Medical Technologies