Aim and Future Perspectives of the Tropical Medicine Association of Juntendo University Through the Activity of the 53 rd South East Asia Research Group

about medicine in Thailand and Singapore. Ten students in their second to fifth years of university were accompanied by professors from Juntendo and studied the valuable experience of learning about foreign healthcare systems. We hope this experience will inspire future members of TMAJU on their next trip in March 2018.


TMAJU Principles
TMAJU was founded on the basis of two principles. First, students are here to learn "beyond"the textbook by studying and actually visiting facilities abroad. Students involved in the TMAJU are expected to learn about medicine from countries all over the world. Today, we live in a world where globalization is constantly increasing its presence, and as future doctors, we must try to nurture a global mindset and acquire an unbiased, wide perspective. Second, the TMAJU aims to create new international ties and become a"bridge" between medical students abroad. We have been achieving these goals annually through our study abroad programs, gaining friends in Thailand and Singapore and other South East Asia countries. These friendships may turn into something more professional in the future.

History
The TMAJU is a student club established in 1959 by many of medical students including chief executive officer (CEO) of Juntendo University, Figure-1 The location of the facilities that we visited in Thailand Prof. Hideoki Ogawa, nearly 60 years ago. Since the establishment of the Juntendo University International Center (JUIC) in 2009, it has been receiving support for its activities. Our main activity is our annual study abroad trip to South East Asia. We learn about diseases such as leprosy, HIV/AIDS, tuberculosis (TB) and malaria. We also regularly visit the Institute of Dermatology to learn about international contributions and collaboration through the diploma course of Dermatology and Dermatosurgery established by Prof. Hideoki Ogawa. Nearly 1,000 medical specialists have participated in this course. In addition, we also hold regular study sessions, sometimes involving visits to institutions in Japan.

Our study tour
Singapore A. National University of Singapore Thailand ( Figure-1 At the National University of Singapore, we were very fortunate to experience a homestay with the students there, which gave us insight in the lives of Singaporean medical students. While the medical education there was technically advanced, we were also able to appreciate our learning environment in Japan. In Singapore students learn the anatomy through textbooks and preserved specimens as there are not enough donated bodies. At Chulalongkorn University, we visited a surgical training room equipped with many cadavers for surgeons to practice on. This training room is so popular that they even receive surgeons from as far away as Korea. We also attended a lecture on malaria. At Mahidol University, we visited the pediatric wards, where we learned how they control infections between patients. We also attended a creative lecture on microbiology, where the lecturers characterized each bacterium so that students could better identify these bacteria. The RPSI is a hospital specializing in the treatment of leprosy patients. We had the opportunity to meet actual patients with leprosy, which was a very valuable experience, as this disease is relatively rare in Japan. The BIDI is a hospital run by the Department of Disease Control and treats many patients that are infected with HIV. They focus on the mental healthcare of the patients here, as there is still a stigma attached to the disease. At BIDI we were presented with many statistics on HIV/AIDS in Thailand over the past couple of decades. We were able to see their progress in reducing infections not only from improvements in treatment, but also owing to the establishment of strategic policies. The IOD is a Thailand-based institute that runs a hospital specializing in dermatology. Its history dates back to 1972, when it was initially founded by Dr. Hideoki Ogawa in the hopes of promoting research and education on dermatology. It has become a prestigious hospital and research institute, providing training courses for dermatologists from all over the world. Indeed, nearly 1,000 doctors completed the diploma course of Dermatology and Dermatosurgery. Dr. Hideoki Ogawa kindly invited us to the graduation ceremony, where we were fortunate to hear about his passion for the future of IOD (Figure-2).
In northern Thailand, our group was split into two. The first group visited the Mae Sot area, where healthcare is provided for refugees from Myanmar. During our stay we met a Japanese volunteer nurse who described the difficulties of working in the area. We also visited SMRU and had the opportunity to hear about their recent research on malaria. We also visited the hospital there, where many foreign doctors were providing healthcare for both Thai citizens and Burmese refugees.
The second group visited the Chiang Rai district. The group visited the TB/HIV Research foundation, which is a government organization that has been conducting multi-disciplinary research on tuberculosis and HIV since 1992. We also visited the Chiang Rai Pracchanukroh Hospital, which initially opened with only one physician. Today it has become a hospital that is relied on by many villages in the area, including the local prison. Pracchanikroh is also unique for sending physicians to correction facilities to provide healthcare for inmates there. We also learned with visiting students from Chaingmai University about the hospitalʼ s approach to tuberculosis treatment and prevention of pandemics.

Future prospect
TMAJU mainly focuses on infectious diseases that affect tropical areas in the world. This year, we continued with our studies on leprosy, tuberculosis, HIV/AIDS, and malaria. Visiting institutions that provide healthcare for these diseases caused us to consider our activity policies concerning leprosy, tuberculosis, HIV/AIDS and malaria. An isolation policy towards leprosy was adopted after the Second World War in Japan, eventually ballooning into a major human rights violation. At present, there are few new leprosy patients in Japan, and awareness of the disease is gradually diminishing. To avoid making the same mistakes again, we must consider how to respond when new diseases become prevalent. The lack of national-scale policies towards tuberculosis and HIV/AIDS despite the increasing number of patients is also of concern. Of note, however, leprosy is decreasing in prevalence due to the implementation of a severe isolation policy.
The prevalence of tuberculosis in Japan is still high compared to that of other Organisation for Economic Co-operation and Development (OECD) countries. In addition, the number of patients with HIV/AIDS is also increasing, especially among young adults in their 20s. When discussing how to deal with these diseases in the future, it is necessary to first compare the routes of infections, treatments and methods of prevention both in Japan and Thailand.
Malaria differs from tuberculosis and HIV/AIDS in that it is not prevalent in Japan at present. However, we cannot rule out the possibility of an outbreak in Japan in the future, since we live in a globalized age where not only humans but also numerous items and animals are crossing borders every day. This sort of globalized society underscores the importance of taking measures to prevent an outbreak. Learning how to diagnose and treat malaria patients is also of great important, as travelers may develop symptoms while visiting Japan. This study tour will aid in such endeavors.
Although most of our members have not experienced clinical training yet, we aim to consider these matters from a studentʼs perspective and also aspire to actively spread knowledge and experience that we have gathered through club activities. Furthermore, our club (TMAJU)ʼs ultimate objective is to increase the number of members who are able to build on their present experiences when they actually start to work as doctors in the future. TMAJU members feel that the presence of Juntendo University is growing in these Asian universities owing to the existence of annual study tours. According to students from NUS, the Juntendo program is very competitive, and they feel it is a privilege for them to be able to visit Japan. It was also inspiring to see older students, that we had previously met several years previously, now working hard as doctors and thereby positively contributing to their countryʼ s public health. We hope that we can therefore be an inspiration to future students from abroad.