Exchange program 2014Indonesia Airlangga University
2014.4.7 – 2014.5.2	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 Kobe University School of Medicine 6th grade
Fuminori Taniguchi	 	 	 1. Introduction
I did my clinical clerkship at Dr.Soetomo hospital in Surabaya ,Indonesia from April 7th to May 2nd2014.
Dr.Soetomo hospital which belongs to Airlangga University School ofMedicine has 3000 beds.
This hospital is the largest hospital in east Indonesia .
The building of Emergency and ICU was founded with the support fromJapan. Other buildings were founded with the support from Netherlands.
The role of this hospital is providing a low income patients with medical
treatment and education.

2. Schedule
I spent first two weeks in the internal medicine ward and outpatients department, 3rd week in ITD,
and last week in emergency department.
Time schedule
8:00 Morning report
9:00 Patient’s care in the ward or outpatient department
11:00 Case presentation
12:00 Lunch
13:00 Patient’s care in the ward

3. Education

Tuberculosis	 ward	 ①	  Night shift and morning report
The student of Indonesia graduates in 5 years. 4th grade students join night shift.
In night shift, students play a role equivalent to Japanese resident doctor. Students study thedifference between reality and a textbook from night shift.
Students joined Night shift make a presentation on nextmorning in front of their classmate, and receives indication fromtheir advising doctor.	 
The number of the patients is an average of ten for two students.
Students were growing by receiving indication from anadvising doctor and sharing the experienced case with classmate.
The difference from Japanese students was having carried out
training which considers a given dose and the amount of infusion concretely.

Morning	 report	 ②	  Outpatient department	  In the internal medicine outpatient department, the student interviews a patient and examines
and writes a medical record. They reports it to a doctor. The student receives feedback from thespecialist. Japanese students does not have such a practical education. I felt that this was the bigdifferences between Indonesian student and Japanese student. Dr.Soetomo hospital is a core hospitalin east Indonesia and is the educational institution which handles a great many cases. there is a great
deal of number of the doctors in Dr.Soetomo hospital. I felt that this made very good education
environment. The difference in national charactor is one of the factors, too. The interest in health of thecitizen who is lower than middle class people is low and the knowledge for the disease is poor.
Therefore there are many patients who do not have a medical examination when the situation is not sosevere.So many seriously patients come to this hospital.
I feel that it is difficult to perform similar practical education in a university hospital of Japan.
However, it was useful for education in Japan to refer to this.

4. Internal medicine ward and outpatient department
The internal medicine outpatient department is divided into nephrology, internal secretion, generalinternal medicine, collagen disease.The number of outpatients is 250people a day.There is an air-conditioner in the department but patients
wait outside.There are many patients of CKD in nephrology.
I watched a malaria patient in the general medicine.There is littlemalaria in Java. The patient traveled in Papua and Kalimantan Islandand had malariathere. It is common case in this hospital.
I learned to see many cases in the outpatient department

The internal medicine ward is divided into woman's ward, man's ward,cardiology, tropical disease.The bed has three grade by an amount of moneythat a patient pays.There was the ward which a cat walked, and it was notable to be said that hygiene environment was good.
I was able to learn the case that had not looked in Japan.
(SJS,TEN, Kussmaul's respiration and so on)

5. ITD
Institute of Tropical Disease(ITD) is a base in Indonesia of the new revival infectious disease study,
and is divided into the following laboratories.
1.Malaria 	  2.Dengue 	  3.Entomology 	  4.Diarrhea 	  5.human genetics 	  6.Herbal medicine
7.Leprosy 	  8.Tuberculosis 	  9.Hepatitis 	  10.Stem cell 	  11.Molecular oncology 	  12.HIV/AIDS	 
13.Influenza 	  14.BEE	 

15.Proteomic

I did clinical clerkship as a member of Influenza study group. This group research Avian flu.Themembers are professor Shimizu and four Indonesian researchers. ITD has a BSL-3 laboratory. They getavian flu virus in this room from a bird which they bought in a market. In the market, H5 type isfound in one of 200 of the bird which is sold. They have a connection with Dr.Soetomo hospital andmake the system that they check the sample which is got from a suspicious patient.

6. Emergency department	  The emergency department was built in 1995 by support from Japan. The department is crowdedwith severe patients who are sent from public hospital. The number of patients is 250 a day. I hear 400
patients have come in one night. On the other hand, the number of ambulance is six a day. The
Indonesian ambulance belongs to a hospital. So, It is necessary for the patient to pay money to use it.
The emergency part is divided into pediatrics room, trauma room, resuscitation room. There are about
10 beds in each room. Because there was much number of patients, many patients were not able toenter those rooms. At first doctor distributes a patient to blue, red, yellow, green depending on theseverity in triage room. Blue is the most severe patient. These code blue patient is committed inresuscitation room. Resuscitation room has six beds. About seven doctors and five nurses worked there.
Indonesian doctor does not use a monitor to check the vital sign for not so severe patient. The monitor
is put on only Code blue patient.

The cases were dengue hemorrhagic fever and hyperkalemia, cerebral hemorrhage, burn injury,
meconium aspiration syndrome, flail chest and hemothorax, tension pneumothorax. Many patients,from a baby to an elderly person, come to the room. The doctor of the emergency part examine all thepatients.

The director of emergency department came for rounds, and lectured in the resuscitation room.

In emergency department, students make a diagnosis and think about the treatment plan. They canconsult to a doctor immediately there. I felt that it was the adequate environment for education.

7. Daily life
①	  Dormitory
During the clinical clerkship, I stayed in a dormitory of Airlangga University campus C. I went tohospital by taxi every morning. It took approximately ten minutes(250 yen) to the hospital. I think thatyou should be able to speak basic Indonesian because the taxi driver cannot speak English.
You can buy a cold drink at the daytime in the first floor of dormitory. There is a shopping mall about
15 minutes from dormitory by walk. I did not feel that the public peace was bad. However, I
recommend that you do not go out at night. Because there is not the sidewalk, and there is much traffic.
There is not an air conditioner in the room. So, I went out on the weekend. There was terrible noise in
the dormitory. But, I had good experience.

②	  Weekend and Sightseeing
We went to Jakarta and Bali island to play by air on every weekend. And,I participated in a game andan exercise of the basketball club with medical students.
All of Indonesians we met were kindness, We spent very happily.

8. Conclusion	  The purpose in this clinical clerkship was to understand the difference of medical situation between
Indonesia and Japan, and to know the strong point and weak point about the Japanese medical
environment and education. To experience both healthcare settings, I was able to get an opportunity tothink about what was necessary for better medical care and education in Japan.	  Many medical textbooks in Indonesia use english. They were going to perform the conference inEnglish positively. Many young doctors are good at English. On the other hand, Japanese medical
students learn English depending on an effort and interest of each person. I think that it is necessary totouch medical english routinely by using english textbook and lecture in Japan. In addition, I felt theability that could explain the Japanese medical situation and a certain disease in simple English wasimportant to take a communication. I want to make use of these experience in my future doctor life.

9. Acknowledgements
Lastly, I would like to express my deepest gratitude to all the people who helped me to have such a
wonderful experience, especially Prof.Kuno, Ms.Kikuhara who coordinated this project, Prof.Shimizu
who taught me their research at ITD, Prof.Kuntaman, Dr.Rizki, Dr.Lutfy who coordinated this projectin suravaya and taught us many things about Indonesia, my supervisors: Dr.Awalia, and Indonesian
medical students and doctors who helped me in Dr.Soetomo hospital.