Report on Elective Course in
Kobe University
Department of Medicine

by Shabrina Narasati
Faculty of Medicine, University of Indonesia
May 2014

Part I: Clinical Rotation

First Rotation: Dermatology
I’m really interested in dermatology since my pre-clinical year and I was reallyexcited when I heard that I can do my elective course in dermatology department ofKobe University. In here, I had learned so many new things and gained a lot ofknowledge and memorable experience. These are my activities during the rotation:
1. Outpatient Clinic
In outpatient clinic, I observed sensei (the doctors in Japanese) doing the anamnesis,
physical examination, and also the treatment. Although the conversation of doctorspatients in Japanese, sensei always translate and teach us in English before the patientcome or after the patient leaving the examination room. Doctors also allow us to see
the lesion, touch the skin’s lesion, and see the its histopathology.

Picture 1. Examine the Histopathology in Outpatient Clinic

I found that most common disease in here are immunologic disease like atopic
dermatitis and psoriasis; different from Indonesia.

Some of interesting cases that I found in outpatient clinic are the treatment ofpsoriasis, treatment of Alopecia Areata, and the treatment of urticaria cholinergic
because there are some differences between treatment in Indonesia. I’m alsointerested in phototheraphy treatment by using the narrow band UVB or UVA to treat
many dermatology cases such as proriasis, alopecia areata, and also atopic dermatitis
in some patients.

Picture 2. Skin Prick Test

In here, all of the medical records are in the computer including the picture of theskin’s lesion so we can easily see the picture of the lesion before and after treatment.

Picture 3. Examination Room; Picture 4. Camera in Outpatient Clinic to Capture the Skin Lesion

Besides the medical knowledge I also learn about Japanese Culture. My sensei toldthat in Japan, the eyes of doctors and patients have to be in parallel, so both patientand doctor seat in the same height, including the medical student who observe theoutpatient activities.
2. Conference
I’m attending the clinical and pathological conference every Tuesday. In here, we
discussed about the current patient in ward and also the patients that have beenplanned to undergo the surgery. Although the conference is in Japanese, my sensei
seats next to me and translate all of the discussion in English.  On the second week,
we finished the conference at 19.30 then attended the pharmacy presentation and got
the bento for dinner.
3. Operation
I observed the operation every Wednesday. On the first week, I observed the excisionof the nevus pigmentous that was suspected with melanoma maligna. On the secondweek, I observed the operation of Extramammary’s Paget Disease, nevus excision,and skin graft that using the equipment to separate the epidermis. In my clinicalrotation in Indonesia, I saw a lot of skin graft in plastic surgery department and inJapan, many skin graft and other dermatology operation has been done bydermatologist and that's very interesting for me.

In the operating room, my sensei always teaches me and guides me about thecondition of the operation.

Picture 5. Activities in the Operating Room

3. Ward
I also attending the ward round and observing dermatology ward activities.

Picture 6. Dermatology Ward Round

4. Discussion
My sensei also gave me the lecture, homeworks, and discussion. The lecture wasabout histopathology of the Graft vs Host Disease and Dermatomyocitis. The
discussions were about; (1) the dermoscopy and how to differenciate between themelanoma maligna and nevus pigmentous by looking its pattern; (2) alopecia areata;(3) psoriasis; (4) extramammary paget’s disease.

Picture 7. Histopathology LecureThat was my activities during my first rotation in dermatology. But besides all ofthem, I also found new friends, and learn many other things like Japanese culture. All
people in here are very nice and kind and I really glad and feel lucky to be here. Thisis one of the best unforgettable and memorable experiences in my life  I thank to
my supervisor Nagai Sensei, Professor Nishigori, Kunisada Sensei, and Fukunaga
Sensei and all of the Department of Dermatology Kobe University Hospital for taking
care of me and letting me learn about anything in here. I hope I can come back here in
the future 

Second Rotation: Obstetrics and Gynecology
I’m also interested in Obstetrics and Gynecology since I was in pre clinical year andgetting more interested when I passed the clinical module. These are my activities
during the rotation:
1. Conference
Every Thursday, the department has a gynecology conference in the morning andobstetrics conference in the afternoon. We discuss about the patients currently staying
at ward, surgical patients, and also delivery patients.
2. Discussion
In my activities during gynecology and obstetrics ward, I always discuss about thepatients who will undergo the surgery or new patients in the ward with my sensei. I
also learned about CTG, observed Fetal Echocardiograph to detect the AV block,observed the chronic villi sampling, paracentesis, and some clinical examination.

Picture 8. Chronic Villi Sampling3. Obstetric Ward, Gynecology Ward, and Perinatology (NICU and GCU)
Every Thursday, the head professor, Yamada Sensei would perform the weekly roundon the entire patient currently staying in the Gynecology Ward and Obstetric Ward.
All of sensei, resident, intern, and also medical student join the ward round together.
The ward round was in Japanese but the sensei would always translate the ward rounddiscussion or conversation in English. In addition, the professor often teaches us in
English so that's very helpful for me Before I came to Japan, I heard that in Japan, 300 grams baby can survive. So I asked
to my sensei about it and she said yes about the fact. She brought me to the NICU tosee the small baby and finally I saw 500-grams-baby girl who delivered from momwith HELLP Sydrome and I feel so sad because the operation went on the night so I
didn't have the chance to see it. But, I saw the baby and she was the smallest baby
I’ve ever seen.

Picture 9. NICU

4. Operation
I observed many operations in this rotation. The first rotation was myomectomy bylaparoscopy. I surprised because the myom’s size is big (around 9x15 cm) and can bedone by laparoscopy by using the disposable myom-cutter so they can get out fromthe laparoscopy device. This is the first time I saw the procedure and device. The
other operation was caesarian section. The difference from the SC in Indonesia are:(1) in here, the operating room temperature is set to warm temperature for the baby
until the baby has been delivered and getting out from the operation room; (2) they
suture the skin with the staples to make the scar looks good and did the drainage. I

also see other operation such as hysterectomy and myomectomy by abdominal
insicion. In the operating room, sensei always teaches me and tell me about thecondition so that was very helpful and good for me.

Picture 10. Gynecology Operation

Picture 11. Laparoscopic Device

5. Delivery RoomThe perinatology, obstetric ward, and delivery room are in the same floor. And I got
chance to observed the vaginal delivery once.
That’s all my activities during my second rotation. I’m really happy to be here
because all of the staff in the obstetrics and gynecology department were very
welcoming and friendly. I had lunch with my sensei almost everyday and I had many
new information of everything about Japan, both medical and non medical context. I
thank to my supervisor, Miyahara Sensei and all of staff in Obstetrics and Gynecology
Department of Kobe University Hospital. I hope I can come back and meet all of themin the future Picture 12. With staff in Department of Obstetrics and Gynecology of Kobe University HospitalPicture 13. Miyahara Sensei (My Supervisor) and Morita Sensei

Part II: Other Activities During My Elective Program
Kendo ClubI also had chance to see the university club activities such as Kendo, one of traditional
Japanese martial arts.

Picture 14. Kobe University Kendo Club

Activites with Students Tutor from Kobe University
I thank to all of the students tutor from Kobe University for taking care of us since thefirst day and until the last day of our elective program. They brought us to the hospitalon the first day, sightseeing around Kobe on the weekend, and also help us ineverything during our stay in Kobe. 

Picture 15. My Students Tutor from Kobe University HospitalJapanese Class
Every thrusday, we learned about Japanese Language and Japanese Culture. We
learned about daily basic Japanese language conversation, writing Hiragana, and also
Japanese Culture. Thanks to Terao Sensei and Yun Sensei for teaching us about
Japanese Language and Culture.

Picture 16. Visiting Kobe University Main Campus at Mount Rokko with Terao Sensei and Yun
Sensei (My Japanese Class Teacher)I also thank to Professor Kuno as our benefactor for this program and giving us theopportunity to do our elective program in Kobe University. I also thank to Kato
Sensei and Ms. Kimi for taking care of us Picture 17. Dinner with Professor Kuno, Kato Sensei, and Kimi

That's all my activities during this elective program. Thanks to Fakultas Kedokteran
Universitas Indonesia for letting me enroll my elective program in Japan. I really gladand feel lucky to be here. This will be one of the best experience in my life. 