Cut Off by COVID-19: Medical Students Bring the World Closer at Keio

International Medical Association (IMA)

School of Medicine

Apr. 30, 2021

The International Medical Association at the Keio University School of Medicine, commonly known as the IMA, is a student organization where sixth-year students spend their summer vacation engaging in medical activities and research in countries in South America, such as Brazil, to promote international exchange and cross-cultural understanding. The 43rd IMA delegation of 2020 became the first in more than forty years to be unable to travel abroad due to the COVID-19 pandemic. The delegation consisted of Hirokazu Matsushima (sixth-year medical student and student leader), Tatsuya Nakamura (sixth-year medical student and treasurer), and Tomokazu Kurahori (sixth-year medical student and liaison coordinator). Left to their own devices, the three of them created the International Medical Student Meeting on COVID-19, which gave medical students from eight countries around the world an opportunity to connect online and discuss their thoughts on coping with circumstances brought on by the coronavirus. Here they share the struggles of organizing an international conference during the pandemic.

The IMA was founded in 1978 when three medical students from Keio traveled to South America in their sixth year to see the world and broaden their perspectives before starting their careers as doctors. Since then, that same spirit has been passed down from one generation of medical students to the next, each following in the tradition of traveling to South America and Brazil on the other side of the globe. Going to Brazil allows students to broaden their points of view as it is home to places unknown to modern man, where indigenous populations still live today, as well as large cities like São Paulo, which has state-of-the-art medical care. One highlight of the program is cruising down the Amazon River on a patrol boat, equipped with only a stethoscope, to areas with few, if any, medical facilities available. It is a one-of-a-kind experience that provides food for thought on the "origins of medicine" for sixth-year students who are about to set out on their journey as doctors.

Members are recruited annually in the second half of their fourth year, and three to four members are chosen to participate after a round of interviews. Every year, a faculty member from the School of Medicine aids students as the leader of the delegation. This year, Prof. Masataka Yamazaki, assistant professor in the Division of Cardiovascular Surgery at the School of Medicine, served as the faculty leader of the 43rd IMA delegation. He himself visited Brazil as a student member of the 21st IMA delegation.

It is tradition for the students to decide the destinations and activities for their IMA trip, but according to Prof. Yamazaki, most students choose destinations in South America. Among the destinations, Brazil is something of a mecca for the IMA.

"Brazil is on the other side of the globe, where an unimaginable world awaits students from Japan. Of course, students learn a lot in the process, thanks to the local Mita-kai alumni association, which has long supported the IMA's activities over the years. I believe that the long history and strong bond between the IMA and the Mita-kai is a major factor in creating such a sacred place for students in Brazil."

Three students, yearning to participate in these activities abroad, joined the 43rd IMA delegation.

Matsushima, who served as the student director, is part of the swimming club of the Athletic Association at the School of Medicine. When he was in his first year, all he wanted to do was "live an exciting life," but after seeing a fellow student come back from their trip to Brazil as part of the IMA, he saw how much they had grown and wanted to follow in their footsteps. His desire to join the delegation only grew after hearing lectures and experiences from Prof. Yuko Kitagawa, Director General of Keio University hospital and fellow alumnus of the 8th IMA delegation.

Delegation treasurer Nakamura is also from the swimming club of the Athletic Association at the School of Medicine. He first became interested in the IMA when he found out how senior classmates and past delegation members had gone on to be successful in a variety of fields. "I want to come into contact with a wide range of values systems, which is one of the main reasons I decided to join. I also wondered how I should act as a doctor in places where advanced medical care is unavailable. I decided to join the IMA to learn what it really means to be a doctor." (Nakamura)

On the other hand, liaison coordinator Kurahori is a member of the Alpine Club of the Athletic Association at the School of Medicine. He has always had an interest in international health, such as multilateral cooperation in medical care and public health. When he was in his third year, he even visited India and the Democratic Republic of the Congo. These experiences taught him that "there are areas in the world where medical care is insufficient, and there are differences in the values that people place on life itself," he says. He wanted to join the IMA in order to further deepen his understanding.

By the time 2020 began, plans were already well underway. As the students started arranging their tickets and their dreams were about to come true, COVID-19 began to cast a shadow over the entire world, and the delegation was forced to abandon their plans.

Devastated by the outcome, the three students even discussed relinquishing their title of "43rd delegation" if they could not go to Brazil and instead bestowing it onto students the following year.

"[The 43rd delegation] was on the verge of disappearing into thin air," Prof. Yamazaki reflects. But he never goaded or chastised them and instead resigned himself to watching how they might react.

"We live in a world where many people feel emptiness and regret when things don't go as planned. In fact, many people get sick, both physically and mentally, so I thought it was only natural for them to be demotivated and demoralized due to their predicament. I continued to think about how we could keep them going as the 43rd IMA delegation."

Prof. Yamazaki reflected on his own IMA experiences, where he felt that "the allure of IMA was the connection between people."

"When I was a resident, I was impressed to see Prof. Masahiro Ogami, a founding member of the IMA, always so curious about new things and excited about his work. My encounter with him is what led me to my decision to become a surgeon. When I was a member of the IMA, Prof. Toshihiko Ueda was the faculty leader, and for me, he is really the father of cardiac surgery. There is no doubt that I am where I am today because of similar encounters I had with many other people, and I can trace them all back to IMA. I suspect that these students will only come to realize what participation in this organization really meant in around 10 or 20 years' time."

With no way for them to know what Prof. Yamazaki was thinking, the three students were unable to come up with a Plan B between April and May. Radio silence ensued.

Then, with the declaration of a state of emergency, there was a drastic change in the students' usual academic environment. Even at the Keio School of Medicine, students attended online classes from morning to night. Unable to visit the operating theater, students supplemented their studies with videos of surgery.

That's when it suddenly hit them: "How are other medical students around the world experiencing the pandemic now?" There had been reports that in some countries, even medical students were treating COVID-19 patients. These IMA students thought that by learning about different situations worldwide, they might learn how medical students can help during an emergency like the current pandemic. They came up with the idea of an online summit called the "International Medical Student Meeting on COVID-19."

Of course, it's no easy task to build something out of nothing. "The hardest part was getting medical students from overseas involved. We were fortunate to have had contact with a university in Brazil, but we had to rely on faculty and friends to reach out to medical students from other countries." (Nakamura)

After a series of trial and error, medical students from a total of eight countries—including Japan, Brazil, the United States, Italy, Spain, Thailand, China, and South Korea—gathered for presentations and discussions over a two-day period on July 25 and 26, 2020.

Despite the limitations of an online meeting, there was still plenty to learn from the candid opinions of fellow medical students from around the world. "With restrictions on classes and clinical training, many people were just as frustrated as we were. Among them, I was especially impressed by the passion that one Thai medical student showed when talking about wanting to contribute to student-led PR activities since they were unable to do anything hands-on." (Kurahori)

"Many medical students outside Japan said that even with the restrictions, they thought they could give back to society somehow. It made us realize that we'd been doing nothing here in Japan."

"Sometimes in life, there are things that don't pay off no matter how hard you try, and it's not all about getting the results you expected or being praised by someone else for a job well done. But you can't regret not being rewarded or blame others for something not paying off. After all, one privilege of youth is an infinite source of energy. Even if things don't turn out the way you wanted, the experience of giving something your everything will prove useful in the future. That's why I'm proud to see these three students struggle through an unprecedented situation like this and end up creating the International Medical Student Meeting on COVID-19." (Yamazaki)

Nakamura explains, "There were so many struggles along the way and plenty of times when I wanted to give up. But the harder I worked, the more I became motivated to make sure that the meeting succeeded." He attests to the importance of getting things done. Kurahori also added, "I understood that even in difficult situations like today, there are things that can be done. I just want to say that I encourage our younger classmates to always try and never give up."

At the end of January 2021, the 44th IMA delegation held the 2nd International Medical Student Meeting on COVID-19. This meeting, which was launched by the three students of the 43rd IMA delegation, may continue far into the future, with conferences in person once international travel opens up again.

Matsushima says that the IMA is "an organization that allows its members to thoroughly pursue the 'origin of medicine' as individuals." He went on to describe his own experiences: "I think it would have been a wasted opportunity if I had just settled by saying, 'There's nothing we can do because of COVID-19.' Instead, I was able to think about what was exciting to me—what it was that I really want to achieve—without being swept up in the hysteria or trends of the times. Through the IMA, I was able to find the courage to take a leap of faith and heighten my awareness. I don't know when, but someday I'll definitely go to the Amazon I don't know when, but someday I’ll definitely go to the Amazon as a former IMA member."

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