My Exchange

● Dora Karmelić (University of Rijeka)

My name is Dora Karmelić and I am currently a 6th year medical student of University of Rijeka, Croatia. This summer I had the amazing opportunity to spend a whole month in Japan, as a part of student exchange program between Hyogo College of Medicine in Nishinomiya, Hyogo Prefecture, and School of Medicine, University of Rijeka, Croatia. I have applied to train in the shoni geka – Pediatric Surgery Department. I came with motivation to meet and gain understanding of Japanese culture, history, people and medicine, but returned to Croatia with so much more.

The official part of the exchange took place during working days. My schedule was different every day, reflecting the dynamics of pediatric surgery department and motivation of my mentors to provide me with the most experience possible in these four weeks of my stay in Nishinomiya. Usually I would go to hospital around 9 AM, either to outpatient clinic, or to operation rooms. My mentor was prof. Okuyama. He would let me scrub in and assist during surgeries (even though my assistance consisted of occasional passing of the scissors), which was a very exciting experience, being so close to the heart of the action and having surgeons explain to me what was happening. Most of the operations were laparoscopic reparations of inguinal hernias. Since the operations are done here using modern techniques not yet practiced in Croatia, it was an invaluable experience. However, due to the timing of the exchange (just as school year had started), little other operations were performed in my department. With that in mind, my mentors organized for me to see other operations involving pediatric patients in Urology and Plastic surgery department, so I have observed a hypospadic repair, orchidopexy and repair of haelioschisis. Since we don’t have such technology in our hospital, prof. Okuyama organized for me to witness a 5-hour long laparoscopic prostatectomy using Da Vinci robot to achieve high precision, least invasive operation method and fastest reconvalescent time possible; to properly follow the operation we were using 3D glasses and watched the 3D screen as the operator himself was seeing. I have also talked with the anaesthesiologists, who showed me new approaches in pediatric anaesthesiology. From all the operations I have seen I have concluded that Japanese operators approach their patients with great care and knowledge, allowing themselves as much time as necessary to perform scarless surgery, with best possible functional and aesthetic result and relying on team work always showing maximal respect towards all the department staff and patient’s family.

Besides operations, I have spent time in outpatient clinic shadowing prof. Okuyama. This gave me the opportunity to witness different pathologies in pediatric patients as well as monitor their postoperative recovery.

During my stay in Pediatric surgery I have also participated in some of the other activities in the department: morning rounds, imaging in TV center, ICU, radiology conference, and Sunago rounds with handicapped patients. I was impressed by attitude of Japanese medical staff towards handicapped, and how they continue to take care of the patients even after, chronologically, they don’t still fit in the pediatric patients group, and how they give their best effort to assure the best quality of life for them by, for example, placing gastrostomy when the patient has problem swallowing food, or swallows too much air. With sadness I have remarked that in Croatia there is no institution with such level of care for handicapped patients, but I hope that it might change in the future.

Besides my training in Hyogo College of Medicine, my mentors also organized for me to visit neighboring pediatric hospitals in Kobe and Osaka. I was impressed by advanced and difficult operations they perform in both hospitals, as well as approach to children, so they would not feel afraid: in Osaka Center for Child and Maternal Health they have converted waiting room in a huge playground, and in Kobe Children’s Hospital a music therapist plays child’s favorite tune when child arrives to the operation room. The neonatal intensive care unit in Osaka was impressive for the sheer number of pre-term children they take care of until they are big enough to come out of the incubator, while in Kobe I had the opportunity to see some rare cases of neonatal deformities.

The most fun I had in endoscopy simulator room, and during medical sewing course. In endoscopy simulator room, I have learned to place stitches endoscopically, and practices some other basic skills using special computer program designed for medical students and young doctors. In the end, I was able to perform simulated cholecystectomy. Sewing course was organized in cooperation with a medical equipment selling company who gave lecture on the sewing technique and brought special pig skins with no smell me and other medical students could practice on. During the course, all the doctors form the Department came to give us advice and help through difficult parts, and I feel my skills have advanced through the course. In the end, if the pig was still alive, it would have an almost invisible scar.

Even though I have spent a lot of time in the hospital, there were also a lot of other things outside the official program of the exchange which made this experience special, such as trips to nearby cities, spending time with Japanese students, meeting medical staff from other departments in a less formal surroundings, tasting all kinds of Japanese food and learning how to use chopsticks, observing and internalizing different social norms and morale. In our trips, we visited Tokyo, Nara, Kyoto, Osaka, Kobe and Ashai. Despite typhoon on the weekends, thanks to great enthusiasm and hospitality of Japanese students and staff of Department of Dentistry and Maxillofacial surgery, with whom we have become good friends, as well as Emergency Medicine and Critical Care Department, we had a great time exploring the Nara park, Kyoto’s many temples and shrines, trying to catch a glimpse of a geisha passing by, trying different foods most of which I have never learned the names of, walking along the port of Kobe or exploring nightlife in Osaka city center. We have also participated in a tea ceremony, giving us understanding of rich Japanese history, traditions and connection to nature.

I was surprised by the attitude of professors and senior doctors towards me, a foreign student. Instead of feeling like I was getting in the way or that I don’t know much about the topics, I was made part of the medical team and learned more and more every day in interaction with my mentors and the patients. I did not expect for such busy doctors to find time to spend with me outside hospital, but I was wrong – one of best meals I have tried in Japan (if not the best) was on a dinner with professors Nose and Okuyama, where we tried to introduce to each other our countries and customs. I felt all the staff was very approachable and friendly, despite high academic titles. I feel proud to have been surrounded by such amazing people. I will definitely use this approach when I will be a physician interacting with medical students.

With me to Croatia I bring happy memories of an amazing country with kind and respectful people, and hopefully some new skills, personal qualities – punctuality, respect, compassion and understanding towards others, many new friendships, and longing to come back to Japan once more.

兵庫医科大学 〒663-8501 兵庫県西宮市武庫川町1番1号 TEL:0798-45-6111 (代)

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