Yoshioka: 45 years ago, Keio University School of Medicine student Masahiro Ogami wondered whether he could truly become a doctor without understanding the world at large, leading him to found the student-led International Medical Association (IMA). The future doctor and his colleagues ventured to medically underdeveloped regions of South America to experience firsthand the “building blocks of medicine” and to focus on international exchange efforts in medical science and treatment. The IMA’s aspirations have continued ever since at the Keio University School of Medicine, where the association celebrates its 45th anniversary in 2022.
At the heart of the group’s activities is participation in international medical activities abroad—primarily in Central and South America—for about 40 days during the summer holidays. The group includes three sixth-year students who are supported by three fifth-year students. One thing that sets the IMA apart is the fact that members plan each trip themselves, determining their destinations and activities in addition to the necessary fundraising.
Why did you decide to join the IMA?
Yoshioka: I was on the baseball team with Mr. Sato and heard about the IMA through him. I didn't feel like I was good enough to join after reading about the great things the older students were doing. I wanted to be like them and thought the program would be a great opportunity for me to grow as a person.
Sakai: I'd grown up in the Keio system since kindergarten, so once I finished my career at the Keio Medicine Track & Field club, I decided to spend my last two years at Keio doing something unique that I could only do while a student. The IMA offered precisely that, and I thought it would be an excellent opportunity to test myself, so I looked into joining.
Yoshioka: Having Prof. Yamagishi as our advisor was incredibly encouraging. As we shifted our focus inward, he was very flexible and accommodating of all the changes we made. It's a shame we couldn't travel to Brazil together, but thanks to Prof. Yamagishi, we were still afforded many rewarding opportunities. As a member of the 44th delegation, I am sincerely grateful for all that he contributed to our team.
After Hamamatsu, you visited the city of Tsushima in Nagasaki Prefecture. What did you do during your week on the island?
Sakai: Tsushima is a large remote island city covering 708 square kilometers in Nagasaki Prefecture, and for many years, the city has developed its own remote island medical care system. On the island, we had the opportunity to engage in practical training at a remote core hospital and several remote clinics from July 25 to 31.
Tsushima Hospital, the island's core hospital, is so big I almost forgot how remote it is. With a rehabilitation facility and a home-visit nursing station located next to the hospital, residents can receive all of their medical care on the island, save cardiovascular and neurosurgical treatments. It was amazing to see the level of comprehensive care that these doctors provide, with surgical specialists performing things like dermatological treatments for their patients.
Yoshioka: I will never forget one patient who came to Tsushima Hospital complaining of a headache. When we first examined him, we thought the cause of the headache might be tight shoulders, but the doctor decided to do a CT scan just to be sure. The CT scan revealed that there was blood collecting on the surface of his brain, a condition known as chronic subdural hematoma (SDH), and the patient was rushed by helicopter to a hospital in Nagasaki. It was a testament to the importance of being able to provide thorough examinations and a sobering reminder of how lax my assessment of the patient had been.
Sato: In Tsushima, we learned the vital role core hospitals and clinics play in this kind of remote area. The city of Tsushima runs north to south with quite uneven terrain, making it time-consuming to travel by car. For this reason, the city has established several remote clinics staffed with doctors from Tsushima Hospital and other facilities to treat nearby residents suffering from chronic diseases. The system the city has established to allow seamless collaboration between Tsushima Hospital and other facilities was impressive.
Sakai: In Tsushima, I experienced how the government plays a critical role in properly allocating medical resources, including human resources and medical equipment, and shifting the overall direction of medical care on the island. I learned a lot by seeing this remote medical care system with my own eyes. I would not have been able to gain this perspective in the classroom or through practical training at the university alone. As I embark upon my career as a physician, I’m considering a career in government as one way to help steer the future of healthcare in Japan.
The Aguni Clinic is responsible for seeing all 700 islanders and is operated by a three-person team: a doctor, nurse, and office staff. We witnessed how dedicated the doctors were when they rushed to help when the phone rang in the middle of the night. We also saw the difficulty of making an accurate diagnosis with limited resources available. When transporting a patient to a hospital on the Okinawa mainland for an emergency, doctors must decide whether to wait for the once-a-day ferry or call for a medical transport helicopter or the Self-Defense Forces for help.
Yoshioka: You often hear people talk about “patient engagement,” but it wasn't until my 20-day stay on Aguni Island that I truly understood what the phrase meant. Patients can end up spending a long time at the clinic. It was impressive to see how attentively the doctor listened to their stories and gave detailed explanations of their diagnoses to put them at ease. During home visits, I was surprised how much there was for doctors to learn about other aspects of patients’ lives, like their daily diet, room temperature, and hygiene, which they could never have found out at the clinic. You only see one aspect of the patients’ lives at the clinic, so I felt that we need to make more of an effort to get to know them.
At the hospital where I work now, I hope to connect more deeply with patients by cooperating with nurses, physical therapists, and other healthcare professionals. I’m glad I encountered these flexible ways of thinking as a student before I become too set in my ways.
Prof. Yamagishi, you later joined the students on Aguni Island. How was it?
Prof. Yamagishi: First, let me say how grateful I am to Dr. Takamitsu Miyake of the Aguni Clinic and to the people of Aguni Island for welcoming us so graciously. In fact, I myself once spent several months on a remote island when I was young, so I thought I knew the realities of remote island medical care. But having experienced so many years of so-called “urban practice” at Keio University Hospital, I once again realized the differences between rural and urban care, which has helped me deepen my understanding of the issues.
Understanding the reality of such remote island medical care will be a great asset to students no matter where they end up in the future. Of course, Keio University Hospital and other hospitals provide exceptional medical care, but on remote islands, you have to rely more heavily on medical examination and diagnosis. Patients may have to be transported by boat or helicopter for a single test. Students need to know the weight of such decisions, and I believe this experience has been eye-opening in that respect.
Sakai: Among the 38 days of activities, the days I spent with Prof. Yamagishi on Aguni Island were extraordinary. He always had little nuggets of wisdom for us. One such insight was his take on what professionalism means as a physician. He taught me that true professionalism means becoming close to the patient without becoming emotionally involved and giving the best possible care as a physician while remaining neutral. That was something missing from my practice, and it has stuck with me ever since. There are many other little words of wisdom, but I will refrain from mentioning them since they may not be as appropriate. [laughs] Among the many experiences unique to the IMA, I think one of the most valuable was the opportunity to spend a lot of time with a beloved faculty member whom I both respect and admire.
Prof. Yamagishi: The lessons you learn in the classroom only really stick after you experience them in the field. As a professor, I am in a position to teach young people, but it isn’t always easy to talk with students in such intimate settings during lectures. As a physician and researcher, it was good for me to be able to share my life experiences, including my own reflections. It was certainly tiring [laughs], but I really enjoyed it.
Yoshioka: Never stop moving forward, even when things don't go your way. Take it one step at a time. It’s times like these when you can gain a whole new outlook on life. I am sure that I will face many difficulties in my career as a doctor, but I believe the lessons I've learned through the IMA will provide me with emotional support.