Hui Aric Josun (香港)
Hello… My name is Hui Aric Josun and I am an Associate Consultant at the Alice Ho Miu Ling Nethersole Hospital in Hong Kong as well as an Honorary Assistant Professor at the Chinese University of Hong Kong. I am indebted to Professor Tetsuo Arakawa for the tremendous privilege to be attached to the Osaka City University (OCU) Endoscopy center from September to December 2013. The purpose of my attachment was to acquire both the principles and practical techniques of endoscopic submucosal dissection (ESD) for which Japanese doctors are world-renowned for.
I was most impressed by the high level of endoscopic expertise that I had witnessed day-to-day at the OCU Endoscopy center. I had gained a much clearer understanding of how to use magnifying chromoendoscopy to assess lesions prior to ESD and the principles and practical details of ESD techniques. All the most widely accepted classifications for magnifying endoscopy such as Kudo pit pattern and Sano capillary pattern originated from Japan and having a local expert explain them to you was far superior to trying to understand them from a review article. This also applies to the acquisition of an advanced endoscopic technique such as ESD. In addition to observation, I had some hands-on training on a pig model and performed ESD on patients under careful supervision. Aside from endoscopy, I had the pleasure of participating in many of the grand rounds led by Professor Arakawa or Professor Tominaga and attend many of the clinical research meetings.
During my stay, I have gained a deep appreciation of the Japanese system which provides great emphasis on careful assessment of mucosal lesions, detailed photo documentation and the teaching of the next generation of endoscopists. During the endoscopy sessions, trainees performed the duties of an endoscopy assistant to the more senior doctors. This allowed them to observe the techniques of their seniors who often explained in great detail what they were doing and how they tackled difficult cases. When trainees perform endoscopy they were closely supervised and had ready access to assistance from their seniors. The senior doctors would carefully go through the hundreds of pictures taken by the trainees during the day to teach and ensure the correct diagnosis and management had been provided. This happened three times a week during the doctor’s lunch break and often resulted in the endoscopists only having a few minutes to actually eat. This dedication to provide the highest level of care to patients and to ensure the trainees were educated to the highest standards is the secret behind Japan’s world leading position in endoscopy. Having witnessed this, I was often left thoughtful about how I can contribute to improving both the training and service in my home country.
After work, I had ample time to enjoy the city of Osaka which has the well-deserved reputation as being the gastronomic heaven of Japan. Furthermore, Osaka is conveniently located to many cultural treasures and I had greatly enjoyed my forays to Kyoto, Kobe and Himeji. The weather was very comfortable during my stay. Interestingly, my deepest memories were not of a famous temple or castle but rather of the time spent sitting on the bank of one of the many rivers that run through Osaka during sunset and watching the children play baseball.
On a more personal note, looking back at these 3 months spent in Osaka, I am overwhelmed by the generosity of spirit displayed by all the members of the OCU Gastroenterology division. All the medical staff was unfailingly kind and patient towards a stranger who could not speak Japanese. Professor Arakawa, thanks again for this great opportunity and for the useful handbook on endoscopic techniques. Dr. Tanigawa, you have been a perfect host and I am grateful for all the assistance you provided. I would also like to thank all the members of the “ESD/treatment” team with whom I had spent the most time and whom had spent the most effort trying to explain what they were doing. Dr. Nagami and Dr. Fukunaga, I am in awe of your technical expertise in performing ESD and will treasure all the tips and techniques that you have taught me. Dr. Ominami, Dr. Maruyama and Dr. Okamoto, I am impressed by your enthusiasm at work and also grateful for your friendship. Whenever I have Mentaiko udon with raw egg, I will always remember you guys. Professor Tominaga and all the young doctors, I am thankful for your company and the great food during my farewell dinner. I will always treasure the time I was attached to the OCU and Osaka will always be special to me.
Ebby George Simon (インド)
I am Ebby George Simon, currently working as an Associate Professor in the Department of GI Sciences at Christian Medical College (CMC), Vellore, a major teaching hospital in South India. I have always admired the rich contributions of Japan towards the field of gastrointestinal endoscopy and have eagerly looked for a chance to learn from Japanese experts. Fortunately for me, the Japanese Society of Gastroenterology (JSGE) has made it possible for young Asian gastroenterologists to have training opportunities in Japan by means of its Research Fellowship programs granted every year. This year (2010) I was selected along with 3 other applicants and I was allotted to the Osaka City University (OCU) Graduate School of Medicine, my course director being Professor Tetsuo Arakawa. I was keen to learn about enteroscopy (both single and double balloon), EUS and also about EMR and ESD procedures. I also wanted to know about the Japanese approach to endoscopic techniques and endoscopic training.
I was in the department of Gastroenterology and Hepatology, OCU from August to October 2010. On reaching the department, I was welcomed by Professor Arakawa and briefed about its functioning and my schedule for the next 3 months. I was fortunate to receive an endoscopic manual for trainees, which was an in house publication but translated into English. Dr Tominaga was helpful in handling most of my paperwork. Two young faculty, Dr Hosomi and Dr Otani were entrusted to assist me in getting my bearings both within and outside the department and they did a marvelous job. The faculty did their best to teach me despite their busy schedule. I am grateful for the excellent accommodation provided by the university Guesthouse at Sugimotocho. The OCU medical library and the e-resources were of immense help. I was amazed by the division of the faculty into specific focus groups, the involvement of many clinicians into basic research and the large number of abstracts being sent to DDW annually from the department.
I gained quite a lot during my tenure at OCU. I was able to witness some of the fine qualities of the Japanese people namely punctuality, politeness and hard work in day to day life. Since there was relatively no dearth of doctors or equipment when compared to many other countries, I could see that the endoscopic training was meticulous, organized and well supervised and that there were endoscopists who were specialized for certain advanced procedures. I learnt about the identification of early luminal malignancies by chromoendoscopy, magnification endoscopy and narrow band imaging and their subsequent management by EMR and ESD. Dr Machida, the expert in ESD made it possible for me to attend a hands-on ESD seminar on porcine models held at Kobe. Although I was already doing EUS in my country, I could learn more about submucosal lesions, pancreatic cystic lesions, intraductal EUS and about doing on site Diffquick staining. I had hands-on exposure to double balloon enteroscopy and mechanical clipping. On Friday afternoons, I could attend case presentations by the trainees in English followed by Grand Rounds. I was also exposed to some basic research techniques namely immunohistochemistry, Western blot and flow cytometry. The research fellowship also made it possible for me to attend the JDDW at Kanagawa where I could see the endoscopic experience from other centres in Japan. Last but not the least, I was able to have some excellent Japanese colleagues as friends.
I hope that I would be able to replicate what I saw at OCU to some measure in my centre and pass on the wisdom I gained to my colleagues and students back in India. I also hope that this visit would pave the way for future collaboration between CMC and OCU. Finally, I would like to express my sincere gratitude to the JSGE who made this fellowship possible and to Professor Arakawa and his team for their hospitality and contribution to my training.
Ahmad El-Allawy (ドイツ)
August 13, 2010 : Report Experience Japan
Please let me introduce me to you first. My name is Ahmad El-Allawy a 23-year-old medical Student from Germany, Hamburg with Egyptian background. I am in 8th semester and like in Japan Medical School in Germany includes 12 semesters, so 6 years in total. Now after I returned back to Germany I can conclude that my decision to go abroad to a new and modern Asian country like Japan and gathering experience there not only in the fields of medical gastroenterology but also in cultural innovations was an invaluable and unforgettable time for me.
When I decided to come to Japan, it was a decision based on the fact that I would like to have an entirely new experience in a to me new country and culture. I didn’t know what is expecting me and I was really very much looking forward to that journey and training. Actually at the time of my departure to Japan my knowledge about this country and my skills in Japanese language were very restricted. But after 1 month I am happy to say that the time in Japan has widened my view of other people and countries in a positive way tremendously.
Arriving in Japan I had my first contact with the very positive, kind, fresh and friendly way of Japanese people. Actually during my whole stay I was always supported by many students, doctors and all other people working in university and hospital. They helped me to find my way through problems and also to fill my time with interesting studies and examinations and that also included my free time in Japan. Most of my time I have been situated at the Endoscopy Center and there I have been taught together with the other Japanese students in a really nice atmosphere. Everyone was very keen to explain to us the procedures even if they were a bit in stress due to their clinical activity. They took their time to show us around and to answer questions. The kind way one was welcomed every morning encouraged you to come every day with a happy feeling again. My schedule was fixed for the 4 weeks and I had the opportunity to have a look into several areas of Gastroenterology. So I was also allowed to visit surgery and I have seen interesting procedures together with a very kind surgery team that explained you the operation in details and even let me wash in sterile to stand with them at the table at the first time of my visit to a Japanese Operation Room. This was an amazing experience where I have learned a lot and also many different methods that are not so common in Germany.
Every second week at the end of the visiting of the department my Japanese student-colleagues were invited by the directors of the department for lunch. Actually and in one sentence: I was overwhelmed by this. I think it is a very nice gesture of the Professors to show the students that they are not only interested in them as medical students and their knowledge-base but also in the persons who stand behind these students. How they live, which interests, what hobbies or other out of school activities they have. It makes the distance between the lecturers and learners much smaller and fills it with a lot of empathy giving students the feeling of being heard. I was always very happy and grateful to have the opportunity to share this experience. From my point of view, it was anexcellent opportunity to get to know the students and to take part in their lives. And also giving the students the feeling to be imported, being taken seriously and also being respected.
Beside this I was also given the opportunity to see into every day’s clinical life how students learn, doctors and of course all other hospital employees work and how the patients feel and are being treated during their hospital stay. And for sure and most important how all these different groups manage to work together and handle their interpersonal behaviors to keep this whole enormous health system work in a proper way. In my opinion although a Japanese hospital is very busy and has a lot to do and many patients to treat however I had always the feeling that there was a warm and effective climate to manage it to work very well. I think a major fact for this is beside the very well-equipped hospitals with the newest technologies moreover the nice and friendly atmosphere that was created to work within the department. And this nice working together and respectful way is also very much related to the Japanese culture and education, I believe. I appreciated it very much during my whole stay and I think it was also reflected in the streets.
Beside my stay and experience in hospital within the week, the weekends I tried to use to visit and learn more about Japanese cities and culture as tourist. Kindly Osaka Medical School Students gave me the possibility to show me several cities and take me out to several occasions which gave us and both sides the chance to learn in many and very interesting conversations from everyone’s other culture to see and understand differences but also to see many similarities. I really enjoyed spending this time with my Japanese colleagues a lot.
In the final analysis and after I returned back to Germany and to my family I have felt like that I have just experienced something that will forever be in my mind and that will have a big influence on my way of thinking and feeling due to that great experience. All in all I can conclude my internship in Japan as student as very fruitful and absolutely recommendable for everyone who is interested in learning in medical fields as well as in cultural aspects.
Finally please allow me to thank all my Japanese friends and everyone who supported me during my stay for their great help and always kind way. This is something that will be unforgettable.
Mahmoud Kamal Elsamman (エジプト)
I’m Mahmoud Kamal Elsamman, Assistant lecturer of Internal Medicine from Egypt. My country offered me a scholarship for two years to study and enhance my skill in the field of endoscopy and endoscopic ultrasonography.? Among different European and Asian countries, I preferred to come to Japan, which is famous in this field.
Department of Gastroenterology, Osaka City University Graduate School of Medicine, offered me a unique chance to achieve my target. The friendship between my Egyptian professor and the Japanese one had an important role in providing me an initial good impression about study in Japan. Japanese Medical School is different from the European and American one and I didn’t have an idea about Japanese language. I have to make a choice between studying and enhancing my skills in Japan and studying in European / Western country and enhancing my English language. I decided to go to Japan and my decision proved to be the correct one.
In Japan, I was lucky to find several staff members in different fields of gastroenterology. Most of these staff members have long and high experience in basic research, clinical and technical aspects. One of the characteristic features of the gastroentrology department, where I was, is the balance and complementary role between clinical and basic researches. In addition, the endoscopic description of the lesions in gastroentrology in detailed. Actually, many Japanese classifications in gastroenterology are unique and informative. These points could be deficient in some other Medical Schools. Moreover, the endoscopy unit, they have, is organized, well equipped and supported by updated digital system for recording endoscopic examination and patients’ data. I have been impressed by the Japanese technique and I found several endoscopists feel and breathe what they are doing. The co-operative Japanese doctors and ensoscopists were keen to help me to acquire good skills and understand well what I’m doing and this is reflected significantly on my skills and attitude.
During my scholarship, I had a good chance to participate in building up a good scientific article in the field of endoscopic ultrasonography. I was lucky to have co-operative and expert staff members in this field. Although they were busy all the time, they were concerned by work and my search.
Before I came to Japan, I knew little about the Japanese culture. The traditional Japanese picture was Samurai, but when I arrived Japan, that image was changed and became more clear. The good behavior, co-operation and active attitude are clear features when you come in contact with Japanese. Moreover, I discovered several common aspects between the Japanese culture and Egyptian one. The soul of each seems to be similar. I built up good relationship with many Japanese friends and we participated in some beautiful Japanese festivals. My wife accompanied me in Japan and she did her best to support me and to provide me the suitable environment to build up my career. My first baby was born in Japan and the process of delivery was an interesting, unique and valuable one.?
Although I’m from Egypt which is famous for ancient traces, I have been impressed by several Japanese traces and by Osaka-Jokoen in particular. Moreover, I feel much happiness when I see Japanese mountains which are covered by green tree all the time.
When I backed home, I have felt the significant impact of this scholarship on my skill, knowledge and attitude. I think that, being a good staff member in gastroenterology was not possible for me without this scholarship in this wonderful department. When my friend in Egypt asking me about the country where they can study gastroenterology, I recommend Japan all the time. Our department in Sohag Faculty of Medicine, Sohag University, Egypt, currently includes several staff members who have learned in different countries including Japan. I think that presence of variety of staff members, belonging to different Medical Schools, will have a significant impact on the rapid progress of this unit in the future and this will be reflected significantly on our researches and the management of our patients.
My scholarship in Japan is an interesting, informative and impressive one and I think Japan could be the country where one can study and enjoy life at the same time.
Elsamman MK, Fujiwara Y, et al. Predictive Factors of Worsening of Esophageal Varices After Balloon-Occluded Retrograde Transvenous Obliteration in Patients With Gastric Varices. Am J Gastroenterol. 2009 Mar 24.