OKINAWA: UH’s contining training role, and why faculty should check it out, by Dr. Ken Sumida

by Dr. Ken Sumida
Internal Medicine Residency Program Newsletter

After World War II and the devastation of Okinawa, a small government hospital was constructed in central Okinawa. Staffing was a problem as few physicians moved from mainland Japan to the U.S.-controlled Okinawa. Students from Okinawa enrolled in medical schools in Japan and most did not return to Okinawa. In 1952, the old “Koza” hospital was constructed to replace the central Okinawa hospital, but again, was understaffed. By the 1960s, it was apparent that measures were needed to increase the physician pool in Okinawa. Collaboration between the United States Civil Administration of the Ryukyu Islands and the University of Hawai`i (UH) School of Medicine resulted in a training program being established in 1967, at a newly constructed hospital in central Okinawa, the current Okinawa Chubu Hospital (OCH). In those days, the University of Hawai`i provided full-time faculty, including directors of the program, who typically ran the program for two-year terms. As the program became self-sustaining, fewer faculty members committed to the UH-sponsored program such that currently, OCH welcomes up to 12 visiting professors per year. On occasion, consultants will spend two to three-month stretches in Okinawa. The activities remain coordinated through the International Medicine program at the UH John A. Burns School of Medicine (JABSOM), headed by Dr. Satoru Izutsu.

Chubu Hospital in Okinawa.

Chubu Hospital in Okinawa.

With this background, I committed to spend a week at OCH as a visiting professor in March of this year. To be succinct, the experience was great. Traveling to Okinawa is time consuming and with the time zones, I started on a Saturday in mid day and arrived at 9:00pm on Sunday. I quickly learned that OCH is not in Chubu (Chubu is “central” and the city is Uruma City) and that not all cab drivers speak English well. But with minimal inconvenience, I was able to make my way to a modest hotel and prepare for the week’s events. I chose the Kasuga Hotel because of the proximity to the hospital, a quick 5-10 minute walk. A humorous anecdote: I asked about non-smoking rooms and was graciously welcomed to smoke in any room that I chose. Needless to say, there were no non-smoking rooms. Okinawa is amazingly similar to Hawai`i in foliage and weather, at least during the month of March. However, I quickly learned that a 5-10 minute walk could result in a drenching during an unexpected downpour or agonizing sweating in the humid weather. I learned to instead take 10-20 minutes to walk the short distance to keep myself cool. The sightseeing was brief, but I had a chance to see a number of interesting areas, including an Awamori brewery. I think my host guessed my interests. Of course the taste test was mandatory. It’s kind of like Sake.

The OCH was a welcomed site. Opened in September 2001, the hospital is functional, easy to navigate and full of helpful staff. It reminded me of Kuakini Medical Center. This is a 550-bed hospital, but remarkably, hospital rooms consisted of four to six beds per room. Private rooms were rare. Drapes were abundant. Technology was not lacking, and each nursing unit had the latest computer equipment for medication dispensing and electronic order entry. Interestingly, just like Kuakini Medical Center, medical record documentation was done by hand in paper charts, no Electronic Medical Record based progress notes, no inadvertent “cut and pasting” of attending notes into intern notes. Radiology review equipment (PACS) stations were present at all nursing stations and the physicians were accessible through short distance radio-frequency devices, basically limited range cellphones. There were no problems with communication between “attendings” (attending physicians) and residents (MD trainees). The training program consists of PGY 1-3 in the hospital while PGY 4 or 5 are sent to public clinics run by the Okinawa government in neighboring islands. Some residents return to continue with training at OCH or to take staff positions. Work and attending rounds are conducted in the morning and afternoon. The residents also rotate through the emergency room a few weeks at a time throughout the year, admitting patients and transferring them to the ward teams the following day. There is a move towards observing ACGME (Accreditation Council for Graduate Medical Education) work rules, but not for the immediate future. Currently, residents have no specified days off and have no limitation in hours per day nor time between shifts. And they truly reside at the hospital in comfortable dormitory facilities. I suspect scheduling rotations is easy, a chief residents delight.

My personal experience as a consultant was enjoyable and interesting. Dress for the occasion was similar to Hawai`i. Not many ties, lots of scrubs and white coats. Many of the “attendings” wore ties, so I did too. Morning report was very similar to ours at the UH Internal Medical Residency Program. Case presentations were followed by didactic presentations. It was requested that I lead the discussion and query (i.e. “pimp”, in student lingo) the residents in English. Unfortunately, the responses were often subdued and many times the attending staff and subspecialty consultants “came to the rescue.” On the other hand, the residents were gracious and apologetic if they failed to distinguish themselves. They and the staff were eager to hear from a U.S.-trained physician, and to experience the teaching techniques that we employ. I was also asked to meet with various subspecialties to review interesting Oncology or Hematology cases and provide opinions on diagnostic work up and therapeutics. In Japan, the gastroenterologists take care of colon cancer, pulmonologists take care of lung cancer, gynecologists take care of ovarian cancer and so on. The specialty of Oncology is in its infancy.

Finally, the food was wonderful. Not all raw and not mysterious, especially for those accustomed to the local fare we have in Hawai`i. Obviously, the preponderance is Japanese with ramen and udon easy to come by. Even the “hospital food” was quite good, including the food in the gift shops. I had a great time and hope all faculty and residents have an opportunity for a similar experience. You should go!

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