My clinical exchange experience in Japan

Authors: Karim Moutchou

Institution: Medical Student, Fez Faculty of Medicine and Pharmacy

Juntendo university hospital

From the 6th to 11th of August 2019, I participated in a surgical internship program at the department of urology at the Juntendo University in Tokyo. There, I had an opportunity to observe urological surgeries operated with the latest medical technologies in the world.

Juntendo hospital was founded in 1838 and was the first Japanese hospital in history to adopt modernized medicine. When I was walking around the hospital while being guided by residents of Juntendo hospital, it felt to me like I was in an institution from science fiction movies. This was my first time to see the latest and far advanced models of medical devices such as EKGs, ultrasonography, and MRIs.

Besides that, at the hospital, I was shocked to find out medical, and paramedical hospital employees worked more hours than in my hospital. They told me that their work starts typically no later than 8:00AM, and some doctors and nurses stay at the hospital more than 12hours per day. In contrast, the working hours of hospitals in Moroccan is much shorter, usually from 8:30AM to 3PM. The day started with the morning staff meeting. Residents and professor were discussing the planned surgeries in the details and the evaluation of patients at the department. I could not understand the language, but residents who were able to speak English explained everything for me for the whole time.

First of all, I was fascinated by the sanitation level of the Japanese hospital. The operating room looked much cleaner and better organized than all the hospitals I have seen in Morocco. In Moroccan hospital, nosocomial infections are one of the most common causes of death. Furthermore, the Floor of the operating rooms are usually covered with blood, aeration systems are broken, walls are dirty, and insects or even cats and rats are also everywhere. Poor hospital infection control and access to sanitation make it very difficult for physicians to cure patients or even to provide appropriate medical service as most bacteria acquired in hospitals are resistant to the usual antibiotics or can rapidly develop resistance.

On the other hand, the hygiene level of Juntendo university hospital was in contrast to that of Moroccan Hospitals; the floors, as well as the walls and tables, were unspotted. The air conditioner and aeration systems were working flawlessly, and patients' beds were impeccable. Automatic doors and water sinks were minimizing the contact with dirty surfaces, and the ER was only accessible to authorize persona who have electronic badges.

Secondly, surgeries assisted by Davinci Xi and Davinci Si were one of the greatest experiences had in Japan. This type of technology is not yet available in Morocco. I attended da Vinci surgeries on prostatic carcinomas and other urinary tract cancers. Professors and residents explained to me that through small incisions, a 360degrees-3D camera is inserted inside the patient, with the robots' arms. The surgeons then use the external console to move the robot while he's getting a very realistic image from the camera on the console's glasses. Other physicians and nurses are next to the patient to make sure everything is in its right position.

During the operation, the physician explained the benefits of da Vinci System surgeries to me. It minimizes the risk of infections and post-operations complications significantly. It gives a much better view of the inside of the abdomen then the standard laparotomy or laparoscopy thanks to the 3d camera. And lastly and probably, more importantly, it gives the surgeon more dexterity and control to perform tasks that used to be too hard or inaccessible by the old methods.

I also had a chance to discuss a wide range of topics with Dr. Shigeo, the head of the urology department, including medical, cultural, and historical subjects. Dr. Shigeo presented the kind of wisdom from decades of experience and willingness to teach soon-to-be doctors. We compared healthcare indicators between our two countries, mainly the percentage of uninsured people, the prevalent diseases, technology, and robots in hospitals, and the relationship between pharmaceutical companies and doctors.

Dr. Shigeo explained to me that the super-aging of the Japanese population has become a significant public policy concern in the Japanese healthcare system. On the other side, my country still suffers from infectious diseases that are distinct or extremely rare in Japan, such as tuberculosis or rheumatic fever. We also discussed the importance of doctors staying up to date about new technological discoveries. Robots and computer science can help medicine develop beyond its classical limits, reaching regions of the body that couldn't be reached before, and taking images of the smallest organs without a cut. Dr. Shigeo also encouraged me to learn new skills. Dr. Shigeo specifically mentioned Python, a programming language, that is now considered as one of the most important languages to learn for the future.

Riding the Shinkansen

While most of the time traveling from one city to another can be pretty boring and time-consuming, my trip to Kobe from Tokyo was another unique experience that I dreamed of for a long time; I got to ride the Shinkansen for the first time. It felt as amazing as I imagined. I still get asked by my Moroccan friends about my experience with Shinkansen. Exploring Japan's technology was one of my goals, and the Shinkansen was on the top of the list.

On the other hand, although Morocco has bullet train since 2018 most of Morocco's railway system is old and has not evolved so much since the colonization period. There are only 2 train routes in Morocco, and they only cover major cities and therefore do not cover most of the cities and villages.

The bullet trains in Europe are also slower than the Shinkansen, and this is the reason why Shinkansen is so special and admired globally. I have also experienced the highspeed trains in Germany, France, Italy, the Netherlands, and Spain. By comparison, the Japanese trains are more punctual and better organized, although they are more expensive, the quality of the seat and the wagon are superior than any bullet trains I have taken before.

Kobe City Medical Center General Hospital:

Kobe City Medical Center General Hospital offered me lodging for the week, and I shadowed Dr. Kaji every day. I learned from him and his resident medical skills and cardiology principles, which were far different from Moroccan ones. By the end of the week, I had enough knowledge to interoperate an angiography image, understand stent implant procedures, and percutaneous valve treatments.

Residents presented during morning staff meetings the cases admitted during previous' nightshift. The hospital receives many of the patients presenting cardiac symptoms in Kobe. After that, small groups took over one of the tasks such as angiography, stress EKG, pace maker transplantation, etc. Every day I was assigned to follow one of the groups. Every team had at least one English speaker to help me understand.

Doctors supervised all tasks and procedures that residents performed. Most interventions, such as angiography, pacemaker, stents, were conducted by interns and residents. However, there were some advanced procedures limited to professors and doctors with more xperiences, such as catheter ablation of Arrhythmias and cardiac MRI interpretation.

Medical students and residents in Morocco don't usually have access to developed diagnosis methods, including in cardiology. While first-year residents in Kobe's hospital can perform Angiography and stent implants, most of the residents in my country never get to learn that, even after they become specialists. Access to these procedures and others is usually limited to professors, and Cath-labs exist only in university hospitals.

This situation obligates patient to travel for several hours to the closest Cath-Lab, just to be on long waiting lists. This sad reality made me realize even more how much my country can learn from Japan, and I felt luckier than the others to have observed those procedures and others when most of my peers couldn't.