Elective Course Report
In Medical Faculty of Kobe University

Imam Tongku Padesma
0906508150

Faculty of Medicine
Universitas Indonesia
20141

“One's destination is never a place, but a new way of seeing things.”― Henry Miller
The Arrival
Sunday, 4th May 2014, 07.00 A.M., I put my feet for the first time on the land ofJapan. I was full of joy and excitement that I couldn’t imagine what kind ofexperiences I would have ahead in a month. So, I said to myself to enjoy every secondof life here. Japan, I’m ready!
Afterlandedat

KansaiInternational Airport, my friends
and me went directly to ourlodging, the place called Nichii
Gakkan in Port Island, Kobe. We
were taking reserved big taxi that
could accommodate six people ofus. On the way there, I could tell
how

well

structured

is

the

development of the city in Japan.
Even this simple trip wasn't boring me at all, since the scenery around the road reallyamaze me, especially the view of the sea. After one hour, we finally arrived and I got
surprise one after another! Nichii Gakkan building looked very nice from the outside.
While putting up some luggage from the taxi, I really enjoyed the feeling of the freshand chill morning air of Kobe. The securities then greeted us quickly and hospitably.
After we entered, some securities explained about some inn’s regulation and showed
us some facilities that we could use on our stay, even though it was really hard tounderstand since they only speak Japanese. By the time I entered my room, I could
only say thay I didn't expect that Nichii Gakkan would be as luxury as fine stars hotel!
We had our luggage organized in our room and also a little rest before meeting new
friends at 11.00 AM. My deepest gratitude upon professor Kuno for giving us somestudents tutor. We met Saki-chan, Masahiko-kun, Kie-san, and Lisa-san in the lobby.
I was really happy to meet them, and to know that all of them were really nice andfriendly. Moreover, I also felt relieved since their English was great! At the lobby, wechatted happily while they were helping us making a registration card to use trains for2

school. After making the train’s pass in Sannomiya station, we continued our trip to
campus. Such a trip by walking around the town and taking trains really allured me alot. I enjoyed every step I take to the campus. As we arrived there, they gave us sort
kind of orientation in the campus, by showing every department’s office we would
enter, locker room, cafeteria, library, hospital and also Japanese class classroom. By
looking at those buildings, I could say that it was really supportive environment forstudy. They also showed us how to access the Wi-Fi in campus.

Next, we headed back to Sannomiya. We had so much laughter on the way there byjoking around and taking random photos. I thought we got closed quickly. In
Sannomiya, they showed us some good supermarket that could provide our dailyneeds. After having lunch together, we said bye in Sannomiya station. To have such agreat day on our first day, I can only be grateful.
First Elective Course – Cardiovascular Internal Medicine
My very first class had just started on Thursday due to one-week national holiday
called “golden week”. As schedule said, we were asked to come to the department at
10.00 AM. We met Sasaki Naoto sensei as our supervisor. He gave us an introduction
about the schedule on these 2 weeks and also a tour to Cardiology Ward in 7th floor of
Kobe University Hospital. In general, we had some lectures and clinical practices. We
had also much free time that we used to discuss our case reports.
31. Lectures
I had 6 lectures in total, that are Echocardiography, Diagnostic Imaging,Electrocardiogram, Arrhythmia, Cardiac Catheterization, and Heart Failure.
Most of the sensei was really excited to share their knowledge to us, since theyalso explained the lecture in English. Luckily, we also had met 5 students ofKobe Medical School since the beginning of the second week that was also in
Cardiovascular Internal Medicine rotation. They helped us translate someparts of the lecture too. In general, the way lectures were given to the student
wasn’t too different compare to the lecture in my university. One thing thatconcerned me a little was the lecture, if it wasn't rescheduled, was started andfinished precisely like the schedule had shown.
2. Clinical Practices
I was excited to attend every
schedule, especially the practiceclasses which were directly using
the devices. I saw that some further
examination,
angiography,

like
CT

Scan,

echo,
and

scintigraphy, were important to beunderstood by the students here,
since

many

diagnostics

wereestablished by those examination only. But on the contrary, Kobe students
didn’t get many opportunities to do history taking and physical examination
directly to the patients by themselves compare to the students in my country.
We had some practice classes, including echocardiography, cardiac sound,catheter ablation, and myocardial scintigraphy. In echo class, I was so excitedsince we were allowed to try the echo by ourselves. In cardiac sound class, we
practiced hearing the cardiac sound using sophisticated manikin. In catheter
ablation and myocardial scintigraphy classes, we were explained on how thedevices work while they were doing in on the real patient.

4

3. Discussion
We had been introduced to Nakayama Kazuhiko sensei on our very first day.
Nakayama sensei acted as mentors for our case reports. He gave us twopatients, each a case of CTEPH and PPS. I was personally working on the PPS
patient. We had discussed about 4-5 times. We usually discussed in 7th floor of
hospital since we needed to see medical records in the computer. He explained
many things about the cases, start from the definition of the diseases to theexamination and treatment for the patient. Sometimes he took us around theward to examine some patients. He also gave some tips on our case report.
Unfortunately, there was no definite schedule for discussion. We usuallycontacted Nakayama sensei directly and asked for his time. If he was busy thattime, we usually tried to find Mori Shunpei sensei.
Fortunately, we had encountered Mori sensei in diagnostic lecture. Morisensei was the supervisor of the previous Indonesian’s elective student. Since
he had already known the academic needs of elective students, he also helped
us to learn about our case report in our private time. Moreover, we had to use
special access card to be able to see our patients’ data. But unfortunately, we
hadn’t been given the card, so we had to ask for help to the staff every time wewanted to learn about our patients.
4. Ward Round
We had ward round every Thursday at
01.00 PM, led by Hirata Kenichi sensei
as the head of the department. Nakayama
sensei and Sasaki sensei always helped
us in the ward round. That was such agreat experience to be able to see thepatient’s care environment that is very
different than I had ever seen inIndonesia. To find the patients were notin their bed were common here because
the patients could walk freely around theward as they like. Some of the nurse maybe accompanied them, but sometimes

5

we could find them were walking alone, carrying their IV pole themselves. I
was more surprise that I found some patients from 7th floor was walking by
themselves to the 1st floor to buy some meals in Family Mart! Every patient,
especially the critical one, was using portable monitor that connected to themonitor in doctor and nurse’s room. So, they could find out if there issomething bad happen suddenly to the patient quickly. Moreover, the nurses
here looked very closed to the patients. On the second round, we were given astethoscope that connected to our sensei’s stethoscope that was used to
examine the patients.
5. The conference
In department’s conference, the staff discussed some of difficult cases. Ourfriends from Kobe also had presented their task about some patient on thatday.

Overall, I really had a great time here since I saw some cases that I had never seen inIndonesia. Some of them even categorized as rare case. The opportunities to see manykind of examination, even allowed to try some of it personally, made me feel reallygrateful. Thank you to Sasaki sensei, Nakayama sensei, and Mori sensei for yourwillingness to help my study here. Thanks for all your kindness and hospitality.

6Second Elective Course – Cardio Surgery
I enrolled the new rotation on my third week in Japan. I entered Cardio Surgery
Department for my last two weeks. Different from my previous rotation, I was asingle fighter on this department, until my Kobe friends from previous rotation joined
me on my second week here. On my first day here, I was asked to come at 8.00 in themorning. I met my supervisor, named Sakamoto Torihito sensei. He asked me to joinmorning conference in advance before explaining about the schedule. I was
introducing myself in front of everyone in the class after the conference. Everybody
looked very welcoming and very nice. The Head of the Department, Okita Yukata
sensei, also greeted me personally. After that, Sakamoto sensei continued his
explanation in the outline of schedule. I was a little bit startled at the beginning to seea very different schedule to Cardiovascular Internal Medicine. I had to come every
morning at 7.00 AM for morning round. It was said that this department maybe had
the earliest morning schedule in the Faculty. Thankfully, I had used to wake up early
since the schedule was pretty similar to the usual schedule in my University.
Generally, I had schedules for morning round, morning conference, observing theoperation, and lectures.
1. Morning RoundThe

morning

roundstarted at 7.00 everyday.
We toured from the ICU
to 7th floor to check every
patient’s condition. Every
morning, the round wasalways lead by Okita
sensei or Okada sensei,
thedepartment’s

Vice

Head. They would ask thepatients about their condition at that time. Some residences usually reported
their patients’ condition and problems. They also checked patients’ stitches
scar and changed their bandage. The round usually finished after 30 minutes. I
used the time before the morning conference to join Kobe students to study
about their private patient.

72. Morning Conference
Morning conference was held at 8.00 in the office room. It was usually started
with journal reading. After that, they discussed about all of the patients inyesterday and tomorrow’s surgery. For the tomorrow surgery, they made surethat everything was ready before the surgery was performed. While foryesterday surgery, the residence that was involved in the operation shouldpresent on how the operation was done. I was impressed to see that every
operation’s reports had to be presented by hand drawing in the paper.
Furthermore, their all draws were really great.

3. Observing The Operation
The preparation for the operation was started exactly after morning conference
was finished, usually around 9 AM. By the time, me and other students also
immediately went to operation room to see the procedures since the very
beginning. Observing the operation was the part of the activities that I
anticipated the most, since I hadn’t any chance to see any cardio operation
before. In fact, I was very lucky to
see Okita sensei’s operation that wassaid to be one of the best cardio
surgeons in Japan, especially foraortic management.
I was amazed when I attended myfirst observation. They maintain thesterility and hygiene of all procedureand equipment flawlessly. I also
noticed many assistants in the room
were ready to help the surgeon. Since
the operations often used Cardio
Pulmonary Pump (CPP), there weresome assistants specifically took careof that machine. That was also myfirst time to see the surgeon using8

surgical glasses in their operation, I really thought it was pretty cool.
Even though all of the activities in the schedule were done in Japanese,
Sakamoto sensei or another sensei would accompany me alternately to explain
it in English. This maybe the reason why I had known more sensei here
compare to my first department. They explained so many things on theoperation room, like how the operation was done and how some of the tools
worked. The presence of the camera on the surgeon surgical glasses and above
the patient, and also the complete medical record on the computer inside theoperation room, supported the explanation from the sensei. We easily
understood their explanation. Besides that, the presence of Kobe students alsoenhanced the excitement of observing the operation, since we could discussmany things about it.
As for the cases, I had seen so many aortic replacements. Sakamoto sensei told
me that maybe it was due to the high life expectancy of the Japanese thatmight reach around 70 years old. Besides that, I had also observed CABG
surgery, EVAR, and valve repair surgery. I also had a chance to see someemergency surgery. It was also my first time to see four surgeons doing theoperation at once, I was really impressed.
4. Lectures
We had lectures on Wednesday in my second week. There are 4 lectures intotal. Since all of it was in Japanese, I got help from my friend to understandit.

At my last day, I had my farewell to the class. I was really surprised that professor
Okita asked me to come back there in the future to study Cardio surgery. I was very
grateful to hear that. Thank you to everyone in the department, especially Professor
Okita, Sakamoto sensei, Inoue sensei, Matsumori sensei, and also Okada sensei.
Thank you so much for everything you had given to me in the class. I was also
grateful to get their email that I could still contact them until now. I hope I can get theopportunity to go back there someday.

9The Japanese ClassI really loved this class. Not only to mention that I could learn my Japanese here, but I
also get so many new information about Japanese cultures and traditions. Even
thought it was only held every Thursday for 2 hours, this class had a deep impression
for me. Thank you to Satoshi Terao sensei and Yun Hiruko sensei for making thisclass felt very fun. ありがとうございました！Thanks also for accompanying us to
go to Kobe Rokko Campus. It was a great time!

10The Friends and The Sensei!
I felt it very necessary to write
down this part since this factor
was one of the reasons I reallyenjoyed to live in Kobe! Thankyou to professor Kuno for yourwillingness to accept me in thisprogram. It was truly an honor
to be able to enroll thisprogram. Thanks for being kind,
hospitable, and funny. I reallyenjoyed having a talk about thehealth system in Japan and the health condition of the Japanese with you. Thanks also
for giving us many student tutors that was really helpful to us. Not to forget, thankyou to Kato-san for your help since the preparation of our program until we had comeback to Jakarta. I am really waiting for your arrival in Jakarta next August.
Also very big thanks for all of student tutors who was being such a good friends forme. Thanks to Saki-chan, Masahiko-kun, Midori-senpai, Mizuki-senpai, Kie-san,Ryouhei-senpai, and Lisa-san. We had made so many stories! I am going to missevery moment we had passed together in Kobe. Thank you so much for everything. It

11would be a really long paragraph if I should write down all of your assistances. I
would never forget that. Good luck with your study ahead! I hope I can see you guys
again in the future.

To my rotation friends, Fujisan, Okhubo-san, Takehirosan, and Yumi-san, thank you
for your help in my daily
lives in campus. It would be
difficult to do the rotation
without you guys. Good luckwith your study here. I am
going to miss having lunchwith you guys!

Thanks to futsal team of Kobe Med School for allowing me to join you guys in every
week practice. I was really having fun to play with you guys. Good luck for the team!

ほんとうにありがとうございました、またいつか！

12