Clinical Exchange in Japan

It is with a heavy heart that I am packing my bags at the end of my elective here at Nagoya University. My experience here has completely exceeded all expectations and there will be many pleasant memories that I will be taking with me back to the UK.

Many people have asked me, why Japan? Well, even before I started planning my electives, I knew I wanted to have an experience in a first world country - ideally in a ‘non-Western’ healthcare system, having just spent 5 years training in the UK. As I was interested in Japanese culture, I decided to take a leap of faith and applied to Nagoya University Hospital despite my reservations regarding the language barrier and being in a completely foreign country. It wasn’t a completely random choice by the way, I applied there as it had favourable reports online from previous elective students, plus it was supposedly one of the top places in Japan for Haematology – which you can now tell I am clearly interested in.

Before coming over, I did my best to prepare as much as I could by attending a 16 week Japanese language course offered by my university, plus various attempts at self-study hampered by the fact that I had fairly major exams before my elective. Needless to say, my grasp of Japanese was hardly fluent by the time I had to fly over to Japan! It was with great relief when I found out that most of the doctors could speak at least some English (you’re never sure how much to trust online reports!). I will touch on this again later, but allow me to say this here and now – don’t let a lack of Japanese knowledge discourage you from applying to Japan! It certainly is immensely helpful to be able to understand the language – all the consultations and team meetings are conducted in Japanese, but more often than not, there will be a helpful someone who will be happy to translate for you. I do highly recommend learning some Japanese though! It is a great ice-breaker – most people are generally quite pleased that you have at least tried to learn their language, plus it helps to be able to pick up the rough gist of the conversation.

My elective was for a total of 4 weeks – 2 weeks each in Paediatrics and Haematology, both of which were immensely satisfying. Typically, each day would start around 8.30am and finish around 5pm, later if there was a case conference (where they discuss and decide on a plan for all the patients on the ward). Almost all the doctors here were incredibly friendly and helpful, often translating for me as well as giving me 1 to 1 teaching sessions, and also recommending fun things to do and eat in Nagoya. They really made me feel a part of the team and I got to know them quite well over the course of my few weeks here. While they could speak English, I would often try to practice speaking in Japanese which really helped my language skills to improve tremendously. About halfway through my elective I was even able to have (slightly-stilted) conversations with some patients and the non-English speaking doctors in a mix of broken Japanese and English – and it is a great feeling when manage to get someone to understand what you are trying to say!

As a tertiary centre, the hospital sees a wide array of medical illnesses which presents a great learning opportunity. I learnt a great many things over the course of my 4 weeks here, with especial emphasis on the diagnosis and management of various paediatric and haematological malignancies, plus a few bonus conditions such as Cockayne syndrome, Castleman syndrome and moyamoya disease! I got to observe both inpatient and outpatient treatment, as well as some ICU management and a bit of surgery. There is a very strong research emphasis here, and I managed to observe some of the clinical trials happening here as well as some of the lab work involved in preparing a haematological specimen – fascinating stuff! The epidemiology of various diseases is also rather different – for example, adult T cell lymphoma is relatively common here compared to Western countries so they screen regularly for HTLV1 infections. It was also very interesting to compare the differences between the Japanese healthcare system and the National Health Services in the UK – both have their advantages and disadvantages, and a common problem seems to be the lack of funding for an increasingly aging population. Although it was difficult to glean information directly from patients or during consultations, the doctors would often sit down with me afterwards to run through the patients’ notes, patiently explaining the details of what had just happened. I should also add that I did not have any unsupervised contact with patients, which would normally be quite unfortunate, but considering the language barrier, I was quite happy to just tag along with the doctors on their rounds and learn what I could directly from them.

At the end of my paediatrics block, I had the great privilege of taking part in the end of term concert for the paediatric patients on the ward. The concert was led by the hospital elementary school students (who were long term patients on the ward and attended classes in the hospital itself) and their school teachers. They were all incredibly enthusiastic and excited about the event, having practised very hard over the past few months. The team was super nice and even let me accompany them with the guitar for one of the songs! We sang some popular Japanese songs (I did my best to join in!) and I was super touched to find out that one of the kids had written her own version of the lyrics describing her experiences in hospital. It was a message of hope and friendship - even the unpleasant experiences of chemo and medical interventions were not enough to dampen her spirit. By far one of the highlights of my elective.

Needless to say, an elective experience is not complete without a chance to explore and experience the local culture. Japan is a fantastic place for this! Eating out here is incredibly affordable and, in the typical Japanese attention to quality, almost always delicious – even cheap convenience store bento sets are really tasty. Travelling around is not an issue as everything is well connected through the subway and train lines. I made it a point to try to visit as many of the local sights and markets as possible as well as trying the local specialities. Although it’s been 4 weeks here, I’ve barely scratched the surface – and I haven’t even visited the other prefectures yet! Suffice to say, if you are looking for an elective experience that combines both modern medicine and amazing culture, then Japan is the place to go!