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Laos Primary Health Care Team Activity Program
Laos Study Tour: Inter-Professional Education Program (IPE) at Keio University

The Laos study tour: Inter-professional Education Program is a joint overseas study tour program among three faculties in the medical sciences at Keio University: the School of Medicine, Faculty of Nursing and Medical Care, and Faculty of Pharmacy. In this program, students conduct fieldwork in Laos and participate in primary health care* practices as a team, which give them the opportunity to learn about team-based approaches to global health through firsthand experiences. Students from the Faculty of Nursing and Medical Care and Faculty of Pharmacy can take the Primary Health Care and Global Health II: Overseas Study Tour as part of their degree course, and School of Medicine students can participate in the program as part of their residency.

For their fieldwork in Laos, students go on excursions to learn about the health and medical work conducted by organizations such as the Japan International Cooperation Agency (JICA), UNICEF, and WHO, as well as visit local medical institutions. They also familiarize themselves with NGOs working with issues related to education and the environment, which gives them a comprehensive understanding of how primary health care is practiced in Laos. Additionally, students spend a day in a farming village and examine the health issues of the locals by learning about their lifestyle, customs, and culture.

The students visit a primary school in this rural village to teach the children about health care, such as the importance of washing their hands and brushing their teeth. Students also visit local educational institutions such as the University of Health Sciences in Lao PDR to meet other medical students and learn about human resource development in the medical field. Through these activities, the students are required to deepen their understanding of issues within the health care system in Laos, its health care policies, their culture and the way they live, and to think about sustainable measures of international aid and effective team-based approaches to health and medical care.
The Laos Primary Health Care Team Activity Program was launched as part of Keio's Design the Future Fund** scheme to support this experience-based education program in primary health care in Laos for Faculty of Nursing and Medical Care students, and was implemented in the 2009 and 2010 academic years with the aim to enhance learning activities in Asia at the undergraduate level. In 2011, it became the Inter-professional Education Program (IPE), an overseas study tour program for the three medical faculties: School of Medicine, Faculty of Nursing and Medical Care, and Faculty of Pharmacy. Since becoming a joint program, it has continued to grow and yield positive results with a total of 49 participants over the three years: 13 from the School of Medicine, 19 from the Faculty of Nursing and Medical Care, and 17 from the Faculty of Pharmacy.

Keio Global sat down with program coordinator and Associate Professor Tomoko Koike from the Faculty of Nursing and Medical Care to find out about the outcomes and achievements of the program so far.

Why was Laos chosen for this program?

Laos was chosen for the following three reasons:
(1) In terms of global health, there are many problems there that must be addressed. (E.g. The high rates of maternal mortality and mortality for children under the age of five.)
(2) The strong ties with Japan, and the deep friendship the two countries have fostered until now. (Laos is the first country that JICA provided with aid).
(3) Laos is a socially and politically stable country. (To ensure the safety of the students.)
Furthermore, in Laos there are insufficient medical resources such as facilities and equipment as well as medical professionals, which are all still in a developmental stage. It is a constant issue how best to maintain the well-being of the local residents with limited medical resources. For example, because of the lack of medical professionals in local communities which leads to local doctors and nurses dividing tasks, village health volunteers (VHV) from the community who have undertaken some training play a role in maintaining the health of their community. Learning about this kind of "task shifting", and being able to consider team-approach medicine (a theme for this program) from different viewpoints are defining characteristics of carrying out the training in Laos.

"Examining issues on a local, regional, and national level"

With regard to the objective of the program "sustainable measures of international aid and effective team-based approaches to health and medical care," what kind of results have you seen so far?

The students usually begin the program by asking themselves what they--as someone from a developed country--can do to help those in developing countries. Through this program they begin to think not just about the problems and what Laos and the surrounding areas lack or need, but also the positive aspects and what resources and assets are available. Students start to examine various issues from different angles, such as human resource development, provision of facilities and equipment, and financial aid. They question what it means to give highly sustainable support and what kind of developmental assistance is needed in order to give the people in the local areas the capacity to solve these problems on their own. This enables the students to examine these issues on a local, regional, and national level.

For example, even if you were to provide expensive, high-performance medical equipment, if it breaks down and can't be repaired it will simply remain unused. These are the kind of things that you cannot know unless you actually go there. It is vital to apprehend what kind of health and medical measures are truly needed in that local area to avoid indiscriminately sending supplies from Japan.
By living together with local people during their time in Laos and by observing all levels of care, from primary to tertiary, students can understand what kind of aid is necessary at each stage. These experiences will form a solid foundation for students who are aiming to be medical practitioners active in international fields, and I believe that this program will be greatly beneficial to all those who participate.

"Many of our students go with the intention to teach but find out they are the ones who end up being taught."

Furthermore, it will be an experience that will shake their sense of values, as they will witness, for example, a vastly different concept of wealth than what they may have known in Japan. For in Laos, solidarity in family and community makes up for an underdeveloped health care system. When it becomes necessary for Laotians to be admitted to hospital, it is a family affair; the whole family takes time off work to stay with them and provide meals while they are in hospital.

Laotians don't consider this to be a restriction or a burden. It is simply a matter of course for family members to be close to the patient. Seeing the pure family bond and the spirit of helping each other is a moving experience for the students. Despite the prevalent problems of poverty or poor health, Laotians are always friendly and help each other, and suicide is very rare. What really is the true meaning of "wealth" and "happiness"? Many of our students go with the intention to teach, but find out they are the ones who end up being taught.

One more characteristic of this program is that participation does not end upon returning to Japan. Participants from the previous year share the results and experiences from their training with the next group, allowing for the handing over of unresolved issues from the previous year so that the next group can work on the solutions. An example of this is when our students teach health education at a primary school in the village we go to every year. Even if they teach the children how to wash their hands and brush their teeth in the short time they are there, it is difficult to turn it into a habit.

Together, the former and future participants search for new ways to tackle the problem in the following year, such as informing the elementary school teachers about the most effective health education methods, and then teaching the children together. In this way, as the years add up, sustainable new ideas are born and we build on the activities in the local areas, which I think has a great impact on the effectiveness of the program.

"Students from different specialties complement each other."

What are some of the benefits of implementing a joint program between the School of Medicine, the Faculty of Nursing and Medical Care, and the Faculty of Pharmacy rather than a program for just one?

I would have to say that a major benefit would be that students from different specialties complement each other, and they learn to approach health issues from various sides despite the vast differences between their respective programs. When looking at the same phenomenon, sometimes it takes three different perspectives to identify something that one specialist's viewpoint may not pick up on.

When investigating the health issues of people from the villages, it is possible to grasp the problem structurally not just by looking at the physical condition from a medical standpoint. It can be equally important to also apprehend the effect certain habits and cultural behavior has on the body such as herbal medicine, smoking water pipes, etc., and their lifestyle such as food preparation and how children are looked after. Furthermore, at the hospital inspection, students from the Faculty of Nursing and Medical Care relayed their thoughts about measures to prevent patients falling due to the height of the bed not suiting the patients, which offered a new perspective for the pharmacy and medical students.

Students from the Faculty of Pharmacy pointed out that drugs that should require prescriptions were available over the counter at the town pharmacy, something that would go unnoticed by the medical and nursing students. In this way, they are able to gain a greater appreciation for each other's specializations. It is essential for an effective team approach to have an understanding and respect for one another based on communication. The synergism of students from three different fields is the source of various ideas to solve complex problems.

After finishing the program, some students have gone back to these medical sites in Laos on their own initiative. A number of students gain a better idea about what they want to do in the future by observing the activities and meeting and talking directly with the people working in organizations that operate in Laos, such as JICA, and international organizations such as WHO and UNICEF, as well as various NGOs. Some students have reported that sharing their passion and dedication to international aid with other students in the program was a deeply moving experience. As Associate Professor Koike explains, "This program is the students' first step onto the international stage, allowing them to develop their skills and talents to become professionals who can work hand-in-hand with people from around the world and together design the future."

* Primary Health Care: http://phci.jp/ (Japanese only)
** Design the Future Fund: http://www.dff.keio.ac.jp/ (Japanese only)

Associate Professor Tomoko Koike
Video about the Program (YouTube)

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