Hari: 10 November 2023

Panduan Pubertas untuk Siswa SMP –Panduan Pubertas untuk Siswa SMP –

Pubertas adalah fase yang signifikan dalam kehidupan remaja. Ini adalah saat ketika tubuh mengalami banyak perubahan yang menarik sekaligus menakutkan bagi sebagian besar remaja. Perubahan fisik termasuk pertumbuhan tinggi badan, perkembangan payudara pada perempuan, pertumbuhan testis pada laki-laki, perubahan kulit, dan pertumbuhan rambut di berbagai bagian tubuh. Selain perubahan fisik, pubertas juga melibatkan perubahan mental dan emosional. Remaja mungkin mengalami fluktuasi suasana hati, pertanyaan tentang identitas diri, serta peningkatan minat dalam relasi sosial. Pemahaman tentang semua perubahan ini adalah kunci untuk membantu siswa SMP menghadapi periode pubertas mereka dengan lebih baik.

Divisi Endokrinologi, Departemen Ilmu Kesehatan Anak RSUD Dr. Soetomo – FK Unair memberikan edukasi tentang pubertas kepada siswa SMP Muhammadiyah 2 Taman pada tanggal 1 September 2023. Kegiatan ini mencakup pemaparan materi yang disampaikan oleh dr. Khairunnisa, Sp.A, M.Biomed dan dr. Rayi Kurnia Perrwitasari, Sp.A, M.Ked.Klin, yang dibagi menjadi sesi khusus untuk siswa SMP perempuan dan laki-laki.

Ketika sesi pemaparan materi tentang pubertas, siswa terlihat sangat antusias. Mereka aktif mendengarkan dan menunjukkan ketertarikan. Saat sesi tanya jawab, beberapa siswa terlihat malu-malu dan membisikkan pertanyaan mereka “Misalkan datang bulannya tidak teratur bagaimana? Bulan ini muncul, bulan depan tidak, normal tidak?” tanya seorang siswi. “Kalau datang bulan warnanya tidak merah, tetapi cokelat dan sedikit bagaimana?” tanya siswi yang lainnya. Respons ini mencerminkan juga ada kecemasan atas apa yang terjadi pada dirinya.

“Pada satu, dua tahun pertama, memang menstruasi biasanya belum teratur. Jadi semisal itu terjadi di usia kalian ini, masih termasuk normal.” Jawab dr. Khairunnisa, Sp.A, M.Biomed. “Sedangkan untuk darah datang bulan berwarna cokelat itu termasuk normal, memang biasanya warnanya bukan warna merah terang.” Lanjutnya.

Selain edukasi, para siswa juga mengikuti pretest dan posttest untuk mengukur pemahaman mereka tentang pubertas sebelum dan setelah pemaparan materi. Siswa juga diminta untuk melakukan pemeriksaan fisik mandiri melalui pengisian kuisioner yang telah disediakan.

Tujuan utama dari kegiatan ini adalah memberikan pengetahuan yang kuat tentang pubertas kepada siswa SMP. Pemahaman yang baik tentang tahapan dan perubahan yang terjadi selama pubertas akan membantu mereka menghadapi perubahan fisik dan emosional ini dengan lebih baik. Orang tua dan guru juga memiliki peran penting dalam memberikan dukungan selama masa pubertas ini.

Dengan pemahaman yang baik dan dukungan yang tepat, siswa SMP dapat menghadapi masa pubertas dengan percaya diri dan sehat secara fisik maupun mental. Masa pubertas adalah bagian alami dari pertumbuhan dan perkembangan, dan pemahaman yang baik tentang hal ini akan membantu siswa menjalani perjalanan ini dengan lebih baik.

Penulis: Calcarina Nira Pramesthi

Kolaborasi, Mahasiswa FK-FKG -FKH Adakan Pengmas di Panti Asuhan –Kolaborasi, Mahasiswa FK-FKG -FKH Adakan Pengmas di Panti Asuhan –

Organisasi Kerohanian Islam, Assalam Fakultas Kedokteran Universitas Airlangga (FK UNAIR) melakukan kegiatan pengabdian masyarakat di tiga panti asuhan di wilayah Surabaya, Sabtu dan minggu (26-27/08).

Dalam menyukseskan kegiatan ini mereka berkolaborasi bersama organisasi kerohanian Fakultas Kedokteran Gigi (FKG) dan Fakultas Kedokteran Hewan(FKH).

“Kami berkolaborasi bersama dengan tiga fakultas tersebut untuk menguatkan jalinan persaudaraan dan meningkatkan kerja sama, ujar Ketua Pelaksana, Alisia Nuwayyarotul Iftinan.

Karena dari latar belakang yang berbeda, masing-masing Fakultas memiliki perannya masing-masing. Assalam memberikan sosialisasi terkait kesehatan secara umum. JMV (organisasi keislaman) FKH memberikan sosialisasi terkait kekerasan pada hewan. Dan SKI (organisasi keislaman) FKG memberikan permainan menarik terkait kesehatan gigi.

“Sasaran kali ini yakni pada anak setiap panti asuhan,” tambah Alisia.

Tak hanya itu, para mahasiswa juga memberikan pelayanan kesehatan gratis kepada warga sekitar panti asuhan. Meliputi tes asam urat, gula darah, dan tensi meter.

Selain itu di akhir kegiatan terdapat pemberian santunan dan pembagian bingkisan. Kegiatan pengmas ini dibagi menjadi dua hari dengan panti yang berbeda.Hari pertama dilaksanakan di panti asuhan Darul Hikmah, di Kecamatan Gubeng dan Panti Asuhan Rouhotul Jannah , di Kecamatan Mulyorejo. Pada hari kedua dilaksanakan di panti asuhan Ashabul Kahfi, di Kecamatan Mulyosari.

Tema yang diusung adalah Congruity form Humanity yang berarti kesetaraan antar sesama.

“Kami berharap dengan diadakannya baksos ini dapat meningkatkan pengetahuan dan kesadaran terkait pentingnya kekerasan terhadap hewan kepada anak-anak panti dari usia dini dan juga kedepannya kegiatan seperti ini dapat berlanjut sehingga terus mengalirkan manfaat bagi masyarakat,” tukasnya.

(Alisia/ Ism)

Hepatologi Anak FK UNAIR – RSUD Dr. Soetomo Ciptakan Kartu Warna Tinja Sebagai Alat Skrining Atresia Bilier pada Bayi –Hepatologi Anak FK UNAIR – RSUD Dr. Soetomo Ciptakan Kartu Warna Tinja Sebagai Alat Skrining Atresia Bilier pada Bayi –

Tim Divisi Hepatologi, Departemen Ilmu Kesehatan Anak, RSUD Dr. Soetomo – FK UNAIR, Surabaya yang terdiri dari Dr. dr. Bagus Setyoboedi, SpA(K), dr. Sjamsul Arief, MARS, SpA(K), dan dr. Rendi Aji Prihaningtyas, M.Ked.Klin, SpA membuat kartu warna tinja “lokal” untuk membantu mengidentifikasi warna tinja pada bayi kuning yang dapat menjadi awal tanda atresia bilier. Kartu warna tinja telah lama dikenal dan pertama kali diterbitkan di Taiwan lalu menyebar ke negara lain dengan bentuk yang berbeda-beda. Kartu warna tinja merupakan alat skrining yang efektif dalam mendeteksi atresia bilier, mudah dilakukan, tidak membutuhkan fasilitas tertentu, dan murah. Namun demikian, informasi “pentingnya mewaspadai bayi dengan prolonged jaundice (kuning lebih dari usia 2 minggu) dan evaluasi warna tinja pada bayi kuning” belum menyebar secara merata di Indonesia, baik pada tenaga kesehatan sehingga kasus keterlambatan berobat dan rujukan pada pasien atresia bilier masih cukup tinggi.

Kartu Warna Tinja yang dibuat oleh Tim Divisi Hepatologi, Departemen Ilmu Kesehatan Anak, RSUD Dr. Soetomo – FK UNAIR, Surabaya

Kartu warna tinja “lokal” yang diciptakan oleh tim dari RSUD Dr. Soetomo – FK UNAIR ini membagi warna tinja menjadi 3 kelompok, yaitu normal, waspada, dan tidak normal. Kategori “waspada” ditambahkan untuk meningkatkan kewaspadaan terhadap bayi kuning agar gejala/tanda atresia bilier dapat lebih dini ditemukan dan segera dilakukan rujukan ke fasilitas tersier. Jika didapatkan bayi kuning lebih dari usia 2 minggu (prolonged jaundice) atau bayi kuning disertai warna tinja yang semakin memudar (pada kategori warna tinja waspada dan tidak normal) maka evaluasi kadar bilirubin direk dan total sangat direkomendasikan untuk memastikan ada tidaknya kolestasis (peningkatan bilirubin direk) yang bisa menjadi tanda atresia bilier.

Kartu warna tinja “lokal” ini didapatkan dari pengalaman klinis selama menangani pasien dengan atresia bilier dan sudah disosialisasikan pada tenaga kesehatan, seperti dokter, bidan, dan perawat di fasilitas kesehatan primer (Puskesmas) dan masyarakat umum di wilayah Kabupaten Sidoarjo, Jombang, Magetan, Yogyakarta, dan harapannya dapat meluas ke seluruh Indonesia. Deteksi Dini Atresia Bilier pada Bayi, Menuju Indonesia Bebas Atresia Bilier!

Nama penulis : Rendi Aji Prihaningtyas

Ajang SIlaturahmi hingga Menjaring Provider Deteksi Dini Atresia Bilier di Masyarakat –Ajang SIlaturahmi hingga Menjaring Provider Deteksi Dini Atresia Bilier di Masyarakat –

Baru-baru ini gathering orangtua dan pasien atresia bilier diadakan di Surabaya, 3 September 2023 oleh Divisi Hepatologi, Departemen Ilmu Kesehatan Anak, RSUD Dr. Soetomo – FK UNAIR, Surabaya. Pada acara gathering tersebut, puluhan pasien atresia bilier yang berasal dari Surabaya dan beberapa daerah di Jawa Timur lainnya, seperti Sidoarjo, Kediri, Bojonegoro, Blitar, Lamongan, Jombang, Mojokerto, Gresik dan dari Fak-Fak, Papua berkumpul. Sebagian besar dari mereka sudah dinyatakan sembuh dan beberapa masih dengan keluhan kuning. “Yang belum sembuh rata-rata karena baru datang berobat pada usia diatas 3 bulan”, ucap Dr. dr. Bagus Setyoboedi, SpA(K) selaku ahli gastrohepatologi anak yang sudah lama berkecimpung menangani pasien atresia bilier.

“Acara gathering ini diadakan untuk mempererat tali silaturahmi antar orang tua pasien, agar kita bisa saling kenal, sharing informasi, hingga melahirkan provider di masyarakat untuk sosialisasi deteksi dini atresia bilier di lingkungan sekitarnya. Saat ini pasien atresia bilier masih seringkali terlambat berobat padahal kuning sudah dialami oleh bayi sejak usia 2 minggu. Anggapan di masyarakat bahwa bayi kuning tidak apa-apa dijemur saja, kurang minum, dan nanti hilang sendiri harus diluruskan, karena tidak semua bayi yang masih kuning pada usia diatas 2 minggu adalah hal yang normal, ada kondisi-kondisi tertentu yang bisa menjadi gejala awal atresia bilier,” ujar Dr. dr. Bagus Setyoboedi, SpA(K)

Atresia bilier adalah penyakit dimana terdapat gangguan aliran empedu. Empedu yang tidak mengalir dengan baik dapat merusak hati. Jika penyakit ini berlangsung lama, maka akan terjadi kerusakan hati secara perlahan. Operasi Kasai pun tidak selalu memberikan hasil yang baik. Hal ini menyebabkan atresia bilier menjadi penyebab utama transplantasi hati pada anak. Dengan deteksi dini atresia bilier, diharapkan penanganan dapat dilakukan lebih awal sehingga menghindarkan bayi kerusakan hati yang ireversibel, bahkan dari atresia bilier itu sendiri. Pada acara gathering ini, selain mendapatkan informasi tentang kondisi anak, sosialisasi kewaspadaan prolonged jaundice dan kartu warna tinja diberikan kepada para orangtua sebagai provider deteksi dini atresia bilier di masyarakat sekitarnya. Dengan demikian, diharapkan angka keterlambatan berobat pada pasien atresia bilier dapat ditekan sekecil mungkin, mewujudkan Indonesia Bebas Atresia Bilier!.

Nama penulis : Rendi Aji Prihaningtyas

Pancreatic Carcinoma and Gastroenteroanastomosis –Pancreatic Carcinoma and Gastroenteroanastomosis –

In July 2023, I was given a great opportunity to attend an exchange program by the International Federation of Medical Students’ Associations (IFMSA). For the first time in my life, I went to Bratislava, Slovakia. For one full month, I attended a clerkship at Kramare Hospital Bratislava, specifically in the General Surgery department. There, I was lucky to attend many different surgeries, from hernia repairment to parathyroidectomy. In the middle of all those surgeries, one caught my attention, which was a gastroenteroanastomosis on a patient with inoperable pancreatic carcinoma.

Pancreatic cancer, specifically originating from the cells lining the pancreatic ducts, is referred to as pancreatic ductal carcinoma (Puckett and Garfield, 2022). This type of cancer stands as the fourth leading cause of cancer-related fatalities in the United States. The survival prospects for patients with pancreatic cancer are notably grim, with a 5-year survival rate ranging from just 5% to 15%, and an overall survival rate of a mere 6%. Currently, surgical removal of the tumour is the sole curative option available, although the unfortunate reality is that only 20% of pancreatic cancer cases are eligible for surgical resection at the time of diagnosis. Research on pancreatic carcinoma has provided crucial insights into its risk factors, genetic mutations, and potential therapeutic approaches (Ryan DP et al., 2014). Several factors increase the risk of developing pancreatic carcinoma, including age, smoking, obesity, chronic pancreatitis, and a family history of pancreatic cancer. In recent years, advancements in molecular profiling have identified specific genetic alterations associated with this cancer, such as mutations in the KRAS, TP53, and CDKN2A genes.

The patient who experienced this condition was a 79-year-old male patient. He got hospitalised due to vomiting and pressure pains in the epigastrium and below the oblique ribs. Before this admission, he was admitted with arterial hypertension in 2021. Currently, the patient also suffers from Type 2 Diabetes Mellitus with peripheral artery disease and has been treated for it as well. On physical examination, the patient’s chest is symmetrical and has regular movement of the heart. The breathing of the patient is symmetrical, soft, and graspable. The chest is also diffusely painless on palpitation and palpation. On ultrasonography (USG) examination, there is a significant distended stomach due to gastroparesis suspension. Peristalsis is detected as weakened. There are scars after APE and CHE. The liver and spleen are non-palpable.

Surgical intervention was performed for the patient, as evidenced by both histological examination and CT imaging. This tumor was causing obstruction in the duodenum. The surgery was conducted under general anesthesia with the patient in the supine position, following appropriate preoperative preparations.

To access the abdominal cavity, a median laparotomy was performed. Upon exploration, it was observed that the stomach was not dilated, and the liver appeared normal without any notable changes. The tumor was found to have infiltrated the head of the pancreas and extended into the processus uncinatus, further infiltrating the radix of the mesentery. Although the tumor exhibited some mobility relative to its base, the extent of infiltration into the mesentery, coupled with the patient’s overall medical condition, rendered the tumor medically inoperable with curative intent.

During the surgical procedure, a notably firm lymph node was identified along the hepatoduodenal ligament. The ligamentum gastrocolicum was interrupted, and a thorough examination of the bursa omentalis was conducted, revealing no signs of carcinomatosis. Adhesions surrounding the gallbladder were released, and after cholecystoenterostomy (CHE), the hepatoduodenal ligament was revised. A dilated common bile duct (choledochus) was identified. Given the situation, a palliative approach was decided upon.

The surgical technique involved creating a segment of intestine measuring 40 cm using the Treitz ligament, followed by anastomosis to the choledochus using a lateral-lateral technique with Maxon 4-0 sutures. Further downstream, approximately 15 cm from this anastomosis site, a gastroenteroanastomosis was performed in two layers using Maxon 4-0 sutures. This anastomosis was connected to a Y-shaped intestinal loop fashioned according to the Roux-en-Y method. To facilitate bile drainage outside the gastrointestinal tract, an EEA (end-to-end anastomosis) according to Braun was added 10 cm before and after the gastroenteroanastomosis site.

To ensure the integrity and patency of the anastomoses, rigorous checks were conducted. During an attempt to biopsy the tumor through the duodenal window, significant venous bleeding occurred. The bleeding was managed locally by applying a hemostatic patch. Given the risk of severe bleeding, subsequent biopsy attempts were deferred, and instead, endoscopic biopsies were pursued. Hemostasis was carefully assessed and confirmed.

Post-surgery, a Penrose drain was placed in the vicinity of the choledochojejunostomy anastomosis and extended toward the head of the pancreas, directed to the right. After confirming all surgical materials and drapes were in order, the peritoneum and fascia were sutured using a continuous loop of PDS (polydioxanone) sutures. The wound was secured using surgical clips.

In conclusion, this experience in Bratislava allowed me to witness firsthand the complexities and challenges involved in the treatment of pancreatic carcinoma. It highlighted the critical importance of interdisciplinary collaboration, advanced surgical techniques, and the unwavering dedication of healthcare professionals in providing the best possible care for patients facing this formidable disease. My time in Bratislava has left a lasting impression on me, reinforcing my commitment to the field of medicine and the pursuit of innovative solutions to improve the lives of those affected by such challenging conditions.

References:

Puckett Y, Garfield K. Pancreatic cancer – statpearls – NCBI bookshelf. Available at: https://www.ncbi.nlm.nih.gov/books/NBK518996/ (Accessed: 07 September 2023).

Ryan DP, Hong TS, Bardeesy N. Pancreatic adenocarcinoma. N Engl J Med.

2014;371(11):1039-1049. doi:10.1056/NEJMra1404198 (Accessed: 07 September 2023).

Scientific Article by Gifta Marshanda Qanitah H. (Student FK UNAIR – 012011133063)

30 Days In Sweden –30 Days In Sweden –

Hi! I am Made Ayu Rheina Putri, but my friends usually call me Rheina. I am a fourth year medical student in Universitas Airlangga and most importantly, I am a member of CIMSA FK UNAIR. This July, I got a chance to experience a wonderful journey to the country on a different side of the world, more than 10.000 km away from Indonesia, Sweden. Through this article, I’m going to summarize my whole one month exchange story.

My trip to Sweden began at July 30th 2023. I took 4 flights in total, which are flight from Surabaya to Jakarta, Jakarta to Dubai, Dubai to Stockholm, and Stockholm to Umeå. I have to spend more than 24 hours in total until I arrived at Umeå airport. I took the flight from Surabaya to Jakarta with my parents and I had to say goodbye to them at Soekarno-Hatta airport in Jakarta. My flight to Umeå was indeed lonely, but also interesting at the same time because it was my first “alone” international flight, so it was pretty good to call it as a “me time”. But, my flight from Stockholm to Umeå unfortunately got delayed for about one hour. As I arrive at Umeå, I was picked up by two students whose currently studying as medical students at Umeå. They also drove me to my apartment.

On the first day of my exchange, I met the department’s administrator to manage my access card at the hospital and my locker. After everything was settled, she took me to join the morning meeting and introduce me to the staff of anesthesia department, which I was assigned to for my exchange. Then, she took me to meet my supervisor. Thankfully, my supervisor was very kind and generous to teach me lots of things and translate to me about everything that everyone talked about since they always talk to each other in Swedish. After he took me to walk around every room at the anesthesia department, he assigned me to join a surgery. It was a laparascopic cholesystectomy. My supervisor asked me to join him to do the pre-operative assessment for the cholesystectomy patient. After everything was clear and settled, the patient went to the OR and the anesthesia staff will put him under general anesthesia. After the anesthesia staff were done with every pre-operative procedures, the surgeons start the surgery. After it ends, the anesthesia staff will perform procedures to wake up the patient and send him to the post-operative ward. That was basically everything that I did everyday during my exchange program. But, of course, everyday was a totally different and interesting case.

The most satisfying and memorable surgery that I joined was a robotic surgery. This type of surgery was done with the robotic machine that acted similar as the surgeon’s hands. This technology mimics the laparascopic surgery. With this machine, the surgeon is able to do the surgery by controlling the machine’s “console” that is away from the patient. With this technology, the effectiveness of the surgery will be improved and the risk of complications for the patient will be lowered. At Norrlands University Hospital where I was assigned for my exchange, they use the robotic surgery for a few different surgery cases, which are hysterectomy, pancreastectomy, prostatectomy, rectum resection, and liver resection. I was very grateful for the chance to join every surgery that is done by using the robotic machine because I never got to see that kind of technology in real life.

During my exchange program, it is not just the hospital life that is worth to be written in this article. The social programs are also played a big role! Every medical students who are part of the IFMSA arranged lots of exciting activities during our stay. On the first day of our exchange, they invited us to the welcoming dinner that was held in one of the student’s house. It was a simple yet lovely evening. On the other day, they asked us to join them to the city tour, national food and drink party, barbeque night at the lake, and so on. Not just randomly sitting and eating together, they also arranged some sports activites that are perfect to do in summer. They were hiking, beach volleyball, and the Swedish game: Brännboll.

My time that I spent in Sweden was very great and worth the long hours of flights. Everyone I met during my stay was very kind and warm. It was definitely an amazing once in a lifetime experience for me to travel that far north of the Earth and to learn such a different culture and medical system.

An Exchange Story in Universitair Ziekenhuis Brussels –An Exchange Story in Universitair Ziekenhuis Brussels –

Hello! I am Arsya Auliya, a medical student at Universitas Airlangga. I got a great opportunity to be a CIMSA-IFMSA Medical Exchange’s outgoing in Universitair Ziekenhuis Brussels, Belgium. On February 2023, I got an acceptance letter that invited me to participate in a medical exchange program in Brussels, Belgium. This program aimed to foster cross-cultural understanding and knowledge sharing among medical professionals from around the world. I had always dreamed of expanding my medical knowledge beyond the familiar walls of the hospital in my hometown.

Arriving in Brussels, I was immediately mesmerized by this city’s stunning architecture, amazing history, and vibrant atmosphere. Brussels is the capital city of Belgium. It lies in the north-central part of Belgium, that has two different region which are Flemish Brussel and Wallonian Brussel. This country is a bilingual-speaking country in French and Dutch. English is spoken as well as those languages. It has many variative cuisine, beautiful historical and architectural landmarks, and attractive traditions. One of Brussels’ famous landmark is The Royal Palace of Brussels. The King’s administrative residence and primary workplace is the Royal Palace of Brussels, where he meets daily with his staff. The King welcomes leaders of political organizations, foreign guests (heads of state, ambassadors), and other guests at his office at the Royal Palace of Brussels.

The hospital located in Jette municipality. When I was arrived, a local student welcomed me and guided me to my dorm. Luckily, it’s pretty and clean. I attended Upon Arrival Training in one of the incoming’s dorm and they explained all of the things that we have to learn about this city, hospital administration, public transportation, also how to laundry and many food recommendation. The exchange program had participants from various countries, which are Malta, Lithuania and Turkey. Each of them bringing their own medical expertise and stories. I was paired with Dr. Janssens, a passionate Belgian abdominal surgeon known for his advance techniques in minimally invasive procedures. I accepted in General Surgery department and attended various surgery cases in a month.

I observed about 3-4 surgeries each day. There were many interesting cases that rarely found in Indonesia, such as nissen fundoplication procedure in GERD patients and laparoscopic hernia repair in patients with complications. The Nissen fundoplication wrap normally appears as a large fundal mass with a smooth contour and surface. A partial fundoplication is created with the fundus partially enveloping the distal esophagus, enabling a reduction in postoperative dysphagia and gas-related side effect. That was my very first time assisting in real surgery to the patient, so they teached me how to do aseptic techniques such as hand hygine, how to use sterile gowns, and how to works in the operating room during a surgical procedure. I assisted in 7 surgeries, which are nissen fundoplication, hysterectomy, and five circumcision patients. I also performed urinary catheterization in pre-operative patient. I also observed robotic surgery for a few abdominal cases. It was very interesting because I haven’t seen it in my pre-clinical term. Every week, I attended 6-8 hours per day. Every doctors and nurses welcomed me kindly and taught me steps in surgeries. I learned a lot from them.

On weekends, I explored Belgium from one city to another one. Belgium is a small country, so it’s possible to go to each city for one day trip. I went to Antwerp, Bruges, and Leuven. My favorite one was Bruges, it’s a pretty city with many tourist attractions. I also went to the other country in Western Europe such as Netherlands, Germany, and Switzerland with other exchange incomings from Universitas Airlangga.

In the end, my medical exchange in Brussels not only broadened my professional capacity as a medical student but also highlighted my power of unity in diversity. Through shared knowledge and experiences, I had learned that regardless of borders, languages, or backgrounds, healthcare professionals around the world were united by their commitment to healing and compassion.

Gaining Comprehension in the Czech Republic –Gaining Comprehension in the Czech Republic –

Ahoj! That means hello in Czech. I would like to introduce myself. My name is Lukiteswari Dyah Tri Hapsari. Most people call me Luki. I am a fourth-year medical student at the Faculty of Medicine, Universitas Airlangga. Such an honor, I got the opportunity to take part in the SCOPE exchange program by the International Federation of Medical Students Associations (IFMSA) that was held for a month in the Czech Republic. As a clerk student, I was placed at the Department of Plastic Surgery, Olomouc University Hospital, Palacky University. Through this article, I’m going to give my summary of this wonderful journey.

My journey began in August 2023. To get to Olomouc, I have to land at Václav Havel Airport in Prague. It takes 3 flights to Prague, from Surabaya to Changi, Changi to Doha, and Doha to Prague, in total estimated more than 22 hours. Also, I need to take a train or bus from Prague to Olomouc for almost 3 hours. But it is worth the long hours of journey! Olomouc is very beautiful, especially each building’s architecture. The city has an abundance of historical buildings. All architectural styles, from the Romanesque style to modern, are represented in its urban landscape.

The next day, we were escorted to the Department of Plastic Surgery. There, I met MUDr Bohumil Zálěsák as chief of the Department of Plastic Surgery, at Palacky University and supervisor during the program. He gave a warm celebration and invited me to immediately follow the department’s ongoing schedule of activities. I was allowed to observe any operations and procedures in this department. They have a clinic schedule (or they can call an ambulance) every weekday and a total of around one to eleven surgery schedules in one day starting from 07.00 am—03.00 pm. For its facilities, this department is facilitated by two ambulance rooms and two operating rooms (OR). The ambulance room is used to handle patient screening, patient handling, surgery planning, and postoperative control. Meanwhile, OR is used to handle operations that are distinguished again based on how big the case is. The first OR room, namely Opech. The room is usually used for minor operations so only local anesthesia is used. The second OR room, namely COS03. The room is usually used for major operations so general anesthesia is used. I was informed about the SOP that applies in this hospital. Starting from, when you come you must wear a white scrub uniform with white professional indoor shoes too. In addition, when entering the operating room, Opech is required to change clothes by wearing green OP clothing, head coverings, and masks. Whereas for the COS03 operating room, it is required to wear disposable blue OP clothing, head coverings, and masks.

Every day, I take part in clerkship activities according to the operating schedule given. I make observations and sometimes become a doctor’s assistant. The most common case in this department is suspected skin cancer so excision surgery is performed with the aim of biopsy. Other cases are lipografting, liposuction, mastectomy, and circumstance malformation. The doctors explain the procedures and management of disease in patients. Not infrequently, the doctors give quizzes and invite discussions about disease cases. It was a very extraordinary experience for me, especially because I felt I could gain knowledge and be involved too.

Through this exchange program, I had the opportunity to meet other incomings from various countries in the world. To be honest, at first, I was worried that the atmosphere would be awkward. But it was not! We exchanged stories ranging from stories about our respective cultures and traditions to personal stories. They are very friendly, kind, and tolerant. We respect each other’s differences of opinion. We often spend time together. We usually go to parks and visit historical places, such as the Old Town, the Astronomical Clock, and the Churches, also towers. The National Food & Drink Party activities held by IFMSA in Hradec were also very impressive. We, who are from Indonesia, cooked rendang and instant fried noodles. Surprisingly, it was gone in 10 minutes. They said they liked it. We also tried other food from Portugal, Spain, France, Egypt, Kenya, Morocco, and more! It was a wonderful opportunity to get to know the cultures and traditions of another country.

By Lukiteswari Dyah Tri Hapsari

Clinical Clerkship Program in CHU de Caen, France –Clinical Clerkship Program in CHU de Caen, France –

In order to undergo the Kuliah Kerja Nyata (KKN) block, the Faculty of Medicine, Universitas Airlangga (FK UNAIR), gives its students the option to undergo this activity in the form of KKN Penyetaraan, a program that is offered for students to carry out student exchange activities abroad as a form of KKN.

This July, I joined the professional exchange program or often referred to as clinical clerkship offered by the Center for Indonesian Medical Student Activities (CIMSA) Universitas Airlangga for the class of 2020. This activity was held in Caen, France starting for the period  of July 3rd to the 28th,  and became an important activity in the framework of the implementation of clinical clerkship program hosted by The International Federation of Medical Students Associations (IFMSA) with the Association Nationale des Etudiants en Médecine de France (ANEMF).

The Professional Exchange Program is a full education program that offers internships to medical students abroad. Each year, around 13.000 students from more than 90 countries travel around the world to discover new health systems, new cultures, and promote global health and cross-cultural understanding.

Center Hospitalier Universitaire (CHU) de Caen, also known as Caen University Hospital, is a large public hospital located in Caen, Normandy, France. This hospital is one of the largest and leading medical facilities in the region and serves as both a teaching hospital and a general hospital. CHU de Caen offers patients a variety of medical services and specialty services. These services include emergency care, surgery, oncology, cardiology, neurology, pediatrics, obstetrics, psychiatry, and many other medical and surgical disciplines. As a university hospital, it is also involved in medical research and innovation. As a university hospital, CHU de Caen plays an important role in medical education and training. The hospital is affiliated with the University of Caen Normandy, and medical students, as well as resident doctors, receive practical training and hands-on experience in various hospital departments.

The first day of my internship at the hospital, I was placed in the Orthopedic Surgery and Traumatology department. The hospital itself is very big, but fortunately there were no language difficulties as the majority of the hospital staff could speak English. All doctors, residents and nurses are also very kind and friendly. Every day I was invited to participate in various activities at the hospital, from attending doctor’s consultations with patients to observing emergency surgeries.

Almost every day the orthopedic surgery department always holds a staff meeting which was attended by all department staff, from the head of the department, the junior doctor on duty, interns to senior chiefs. On this occasion, several doctors had their turn to present their cases to the head of the department and discuss them starting with the chief complaint of the patient, the diagnosis, to the management of therapy. This meeting  usually lasts around 30 minutes – 1 hour, depending on the number of doctors presenting that day. After finishing, then the doctors and other staff continue their activities on that day and usually after that I can join the doctor’s activities.

Furthermore, during my study in Caen I had learned a lot about the French healthcare system, with it being one of the most highly regarded healthcare system in the world. France runs a statutory health insurance (SHI) program that offers all inhabitants access to coverage. Employee and employer contributions, as well as a rising amount of specified taxes on a variety of income, are used to fund the system. The two main programs that offer SHI have the same coverage and benefit policies and are both focused on the agriculture industry. At the national level, funds are consolidated with the potential for program-to-program subsidies. A significant part is also played by voluntary, supplemental private health insurance (VHI). Nearly 95% of people have access to VHI, with 10.5% of people receiving means-tested subsidies and 8% of lower-income people receiving full subsidies. Around 83% of overall health spending is covered by SHI, with the remaining 17% coming from private insurance and out-of-pocket (OOP) expenses. France offers a wide range of benefits and has modest OOP costs. However, some products, such as dental and optical equipment, are not covered by SHI due to cost constraints. SHI pays for over 90% of hospital care expenses, but just 44% of ambulatory (outpatient) care expenses for non-pharmaceutical medical supplies.

I am very grateful for the opportunity given to join the SCOPE exchange program in CHU de Caen, France. I gained a lot of experience and knowledge while at CHU. Before joining this program, there were still many things I didn’t know about like hands-on clinical skills and knowledge. However, after joining this program, I got a lot of guidance and more knowledge that I will bring and apply when I become a young doctor. I also realized that through this program a lot of knowledge about different applications of the national health system in France and Indonesia and also about the various medical cultures that exist there. Also new understandings like intercultural learning and also exchanging culture, thoughts, and language with the other incomings or exchange students while I was there. After completing this program, I feel more motivated to learn and to be able to develop myself to become a better doctor and improve my teamwork skills for the future.

Sources:

  • Professional exchanges (scope) (2023) IFMSA. Available at: https://ifmsa.org/standing-committees/professional-exchanges/ (Accessed: 07 September 2023).
  • Chu Caen Normandie – centre hospitalier universitaire caen normandie (no date) CHU Caen Normandie – Centre Hospitalier Universitaire Caen Normandie. Available at: https://www.chu-caen.fr/ (Accessed: 07 September 2023).
  • France Health System Information (no date) World Health Organization. Available at: https://eurohealthobservatory.who.int/countries/france (Accessed: 07 September 2023).

By: Indriani Putri Paramitha

Clinical Clerkship in the Cardiothoracic Surgery Department at CHU de Caen Normandie, France –Clinical Clerkship in the Cardiothoracic Surgery Department at CHU de Caen Normandie, France –

In July 2023, I had the honour of participating in a clinical clerkship in a French port city named Caen, courtesy of the esteemed International Federation of Medical Students’ Associations (IFMSA) program. This month-long educational endeavour gave me the privilege of immersing myself in the cardiothoracic surgery at the CHU de Caen, Normandie. This educational experience has expanded my medical knowledge and skill set while also receiving a broader perspective on the intricacies of modern healthcare.

CHU de Caen, Normandie is one of the largest public health organisations in the Normandy region, France. The hospital, located on the Côte de Nacre street, is a 23-story monoblock tower built by Henry Bernard in the 1970s and started operating in 1975 in response to a lack of patient accommodation at other hospitals in the city of Caen. It is a referral hospital and the centre for teaching, innovation, and research, CHU de Caen is responsible for serving the 3 million people in the region. As a teaching hospital, CHU de Caen accommodates 4,135 prospective doctors, nurses, and caregivers from Université de Caen Normandie. The hospital is also a training centre for emergency care.

In France, as in many parts of the world, coronary heart disease (CHD) has consistently maintained its standing as a leading cause of mortality. In 2019, the World Health Organization (WHO) reported that CHD ranked as the primary cause of death for males and the second most prevalent cause of death for females. Alarming statistics have revealed that, at present, one individual falls to a cardiovascular event every four seconds. Perhaps even more concerning is the observation that these cardiovascular events are increasingly affecting the younger demographic, as reported by Fondation de France in 2021. These statistics have propelled the field of cardiothoracic surgery to the front line of healthcare in France. Due to the high prevalence of CHD, the predominant surgical procedure that filled the operating rooms throughout the month of July was the Coronary Artery Bypass Graft (CABG). Additionally, several patients underwent heart valve replacement surgeries or the Bentall procedure, all of which represented the complexity of cardiothoracic surgery. These surgical interventions represented the cutting edge of cardiothoracic surgery, demonstrating the hospital’s commitment to provide its patients the highest standard of care.

Beyond the operating rooms, the educational component of my clerkship was equally enlightening. One memorable highlight was a comprehensive lecture delivered by one of the esteemed doctors on Acute Aortic Dissection (ADD) and other related diseases. This lecture deepened my understanding of these critical conditions and served as a testament to the hospital’s dedication to knowledge dissemination and continuous medical education.

In conclusion, the month-long clinical clerkship at CHU de Caen stands as a defining moment in my medical journey. The experience not only offered a glimpse of cardiothoracic surgery but also provided a profound understanding of the challenges posed by cardiovascular diseases in society. I am immensely grateful for the privilege of learning medicine in the heart of Normandy, France.

Reference:

data.who.int. (n.d.). France data | World Health Organization. [online] Available at: https://data.who.int/countries/250.

Fondation de France. (2021). Cardiovascular Disease. [online] Available at: https://www.fondationdefrance.org/en/cardiovascular-disease#:~:text=Cardiovascular%20diseases%3A%20a%20major%20public%20health%20challenge [Accessed 19 Sep. 2023].

Article Arranged by : Faiza Khansa Tsabita Zulkarnaen (FK UNAIR, 012011133064)