We were two bachelor students from Malmö university travelling to Hiroshima, Japan in august 2017, Camilla Perming (to the left) and Ludmila Betina (to the right). We were starting our sixth and final semester after INU workshop in Safe Quality Patient Care at Hiroshima University.
I, Camilla, travelled to Japan a week earlier than the workshop started because I wanted to experience Japan since I had the opportunity. I took a shinkansen to Kyoto, the former capital of Japan and the more cultural and traditional city in Japan. I would highly recommend doing so to those who are thinking of applying to the INU workshop for next year. Both Ludmila and I took some extra days to spend a little time i Tokyo after the workshop and I’m so happy that I did. Tokyo is a great and fun city!
First day started with us meeting up with our fellow participant students from South Africa and Spain, we had met them briefly the evening before when we all arrived in Hiroshima. We took a train to Saijo where we met up with the rest of the students and had introductions and getting to know each other, followed by a lecture about LEAN theory held by representatives from Toyota. The reason for them inviting in Toyota was for us to learn about their high safety level and how we in health care can apply the same structures to avoid doing unnecessary work and to make our job working as a nurse more effective. In Sweden we learn about LEAN theory in our third semester in organisational theory but the focus was now on how applying Toyotas LEAN theory can increase patient safety.
Second day started early with us going to the Peace memorial museum. We took a bus to Hiroshima city and walked through Peace Memorial Park where we got the see The Atomic bomb Dome for the first time. We only had a few minutes to stay and take some pictures which i thought was a bit disappointing. The whole day was very stressful. When we got to the museum (a bit late) we only had an hour to walk around and it wasn’t enough time to see everything. The museum wasn’t that big but I would have liked to stay longer because it was a lot to take in. It covered the whole history from making the atomic bomb to after it detonated and the time after. After the museum tour we hurried to the International Conference Centre where Mrs Keiko Ogura, an atomic bomb survivor, told us about her experience being born and raised in Hiroshima and being only eight years old when the bomb detonated. It was incredible to listen to her story; how she remembered the day the bomb detonated and the time after and how it has shaped her and other survivors life afterwards. I learned about the discrimination people experienced in Japan for being from Hiroshima. It was very inspiring to listen to her, her way of viewing the world wasn’t bitter nor in anger. She just wanted to speak up and work for a nuclear free world.
The afternoon was spent in a Call Medical Clinic which was very interesting. At the Call Medical Clinic they had MP, nurses and other specialist professions going out to homes and treating people in need of care. They could offer advanced health care treatment in the patients homes. We also had a look around their base clinic and learn more about how elderly care was provided in Japan. Most lectures were held in Japanese but we had Yumi, who worked at Hiroshima University, to translate for us.
Early morning we took a bus to Peace Memorial Park where the University had reserved seats for us international students to take part of the Peace Memorial Ceremony. The Peace Memorial Ceremony is held each year on August 6th, the anniversary of the atomic bombing of Hiroshima. Some 50,000 local citizens and visitors, as well as ambassadors and dignitaries from around 70 countries, gather here to console the spirits of those killed by the atomic bomb and also to pray for lasting world peace. Japans prime minister Shinzo Abo delivered a speech, amongst other noteworthy figures like Hiroshima Mayor Kazumi Matsui and representative from the UN. A minute of silence was held 8.15, the same time as bomb dropped to remember the dead and a call to eliminate nuclear weapons.
It was a lot of people in the area and cameras and news teams with all their camera equipment. It was very hot even though it was early in the morning. Thankfully we were given headphones so that we could hear the translator throughout the ceremony. I had had a mental picture of how this day would be like before coming to Japan, I thought it would be a day to grieve and to mourn and remember the people that had died. And it was a day to remember the horrible consequences of the bomb but most of all it was a beautiful day with people coming from all over the world celebrating peace together. It was clear that Japan was proud over how quickly they had rebuild Hiroshima and now stood for the message that atomic bombs should never again be used. So I was surprised to see that it was such a happy day. Kids were playing and laughing everywhere and people were talking and enjoying themselves. It was a wonderful atmosphere to be in.
After the peace memorial ceremony we went on a trip to Miyajima. Miyajima is an island outside Hiroshima and the island is known for its torii gate and Itsukushima shrine which is UNESCO World Heritage classed. I learned a lot of interesting and fascinating facts about Japan’s two biggest religions which are Shinto and Buddhism. Most people in Japan embrace both religions, or both religions are practised in the same family. The Japanese people were encouraged to have two religions when buddhism grew popular in Japan so there wouldn’t be fights within families or between religions. So many of the shrines in Japan is a combination between shinto and buddhism. But there are some distinctions that can show which religion is most influenced in that shrine. We got to visit two shrines, one which was mostly Shinto and another that was mostly Buddhism.
On the island there are wild deers living that has gotten accustomed to people so they are walking around harassing tourists for food. They tried to open our bags nibbling on almost everything so you had to be careful. I found them absolutely adorable and they were so friendly, you just had to gently push them away when they got to close.
The island was breathtaking, Ludmila and I took a walk on the beach down to the torii, it was low tide so we could walk underneath it. And while we were walking back we took a moment to ourselves and appreciated being in Japan and getting all these experiences. It was a beautiful day and we were halfway around the world with wonderful people, getting to take part of unique experiences and we felt so blessed. If you ask me if I thought it was worth all the effort, the extra costs and the trouble of arranging and flying for that many hours I will promise you that it is! I loved every minute, even after eating all that damn rise! 😉
From the boat we could see how the mountains shaped a head with a crack in the mountains where there was a waterfall and the crack formed the eye of the head. We were told that it was one of the reasons why many japanese thought of the island as spiritual and holy place. On the picture you can see the face, it starts with the forehead to the left and then the “eye”, nose and lips. The face is looking up to the sky. In front of it is the torii.
We didn’t have that much time on the island though, we wanted to get back in time for the lantern ceremony. While back in Hiroshima we walked to the atomic bomb dome where we could color and make our own lanterns.
It was nice watching the lanterns with the word like “peace” or “love” written or painted on them. Some lanterns drowned but after awhile the lake started getting filled with lanterns. We didn’t stay long enough for it to become very dark since we had another full day of workshop the day after. The days were long and so hot so you got pretty tired. The apartment where we stayed were really nice though, this day we had to go the the spanish girls apartment to use the wifi to finish our presentation about swedish health care and send it in.
It was time for our student presentations. It was interesting and nerve wrecking. I don’t enjoy giving presentations but we pushed through it. We also got to listen to the other students presentations on how their health care system work in their countries.
After the student presentations we transferred to Mazda museum. This day was rainy and windy which was welcoming, the other days had been so extremely hot. We got a guided tour learning more about their cars and how they worked. Unfortunately we were not allowed to take any pictures where they worked putting the cars together. That was the most interesting part to me, watching them work and seeing how a car is put together. Then we listened to a representative from Mazda who talked about their safety work.
The pre-noon was spent listening to lecturer Gwen Sherwood explaining about QSEN – quality and safety education for nurses, which was a great and inspiring lecture. She has been working to improve nursing education to improve safe quality patient care and by telling us the story of Lewis, a 12 year old boy who died as a result of improper treatment lacking several patient safety measures and she made most of us cry. I was very affected by Lewis mother’s story whom Gwen worked alongside to improve patient safety in health care. The Lewis story was used as a case study that we based our group presentation on. We were divided into four groups with students with different nationalities. We were given three key words, transparency, culture and error reporting and we were given free hands in how we wanted to present these key patient safety factors implementing them into the Lewis story.
Afternoon was spent visiting Hiroshima University Hospital were we learned how japanese nurses worked from a patient safety perspective. It was very interesting and we also got to see patients rooms, nursing station and different equipment that the nurses used.
The visit was followed by another lecture in patient safety and risk management and then by a cultural activity where we were given the opportunity to try Ikebana, japanese flower arrangement. It was harder than it looked and who knew there were so many rules in how to make Ikebana?
Directly after we were taken to Ai Ai restaurant to eat Okonomiyaki, soul food of Hiroshima. The food was great and the entertainment equally so! Two brave students got up the to grill table to learn how to make Okonomiyaki and it was hilarious, first up was Raquel from Spain and then my partner in crime Ludmila from Sweden. Fun way to end a great and long day.
We had a lecture by the American lecturers in system thinking, safety impacts, basic TeamStepps, team work communication and an interprofessional exercise. The lecturers drew a parallel from an NASA incident where a space crew were killed when NASA made a critical mistake than can be applied to nursing environment. The lesson learned from the NASA incident was how group culture can affect patient safety outcomes and it was relevant to the Lewis story. We got to do team exercises aswell and time to work on our presentations.
After the group work we transferred to a nursing home. The woman that ran the nursing home was very motivated to improve elderly care and I was very impressed with their different ways to stimulate the day to day live of an elderly patient living in the home. One part of their services was that they had a chef to special make the food so that it was easy to eat for the patients whom couldn’t chew but still contained the same taste and flavour as regular food. They demonstrated this with preparing a wonderful meal, we felt pretty spoiled.
After that we had an optional cultural activity to learn Kendo but unfortunately I skipped it for being very tired.
We continued the lectures on QSEN qualities concentrating teach back as a method and SBAR communication model. Teach back as a communication strategy is used to make sure a patient understands the information that is being given to them. We had a team exercise that was a kind of domino game structured to enhanced the importance of communication and the different ways of communication strategies that we have. The exercise was to put domino bricks exactly as a picture but only one team member could see the picture and then having to direct the others in placing them as the picture.
We got time to prepare our group presentation and the cultural activity where we got to participate in a traditional tea ceremony that is called Ocha. Me and two other students got dressed up in Kimonos and photographed like models, because we were so pretty 😉 The tea ceremony was more complicated than I though, it’s not just drinking tea with a neighbour, it’s a whole process with bowing, kneeling and eating. It was fun to try. The tea is called matcha and its green and thick tea, tasted a little bitter.
Then we visited another kind of health service that helps patients with diabetes with information about preventative measures to reduce the use for dialysis, which is very common in Japan. They educate about food and other diabetes related health tips and the patients can call for information. After that we went to visit a hospice where we met nurses working with palliative care in a house that is privately owned. They didn’t make any profit and worked and lived in the same home. They were very inspiring people.
We ended the evening with a home party at one of the Japanese professors with sparklers outside. We sang and danced and ate good food and enjoyed ourselves. It was remarkable how well we got to know each other after such a short time. We were all living in a little bubble where we were all family.
Day started with group exercises in SBAR, teach back and patient simulation practise, it was a great opportunity to practise what we had learned in lectures in the previous days. It was good to practise because it is harder than it sounds and the lecture demonstrated how using teach back as a method is very effective to make sure adherence with the patient is achieved. SBAR was new to many of the other students so it was a great opportunity to shine like a star 😉 We were also being subjected to a patient simulation exercise where the Lewis case was the background story and it was a way for us to feel how it feels to be unprepared and fail.
We had lunch at a traditional japanese lunch at a tofu restaurant and the rest of the day was spent filming for our group presentation and going shopping in central Hiroshima. We had so much fun this day, i laughed so much that i probably worked up some abs. We were beginning to realise that our experience were closing into an end and we started to mentally prepare ourselves for the sad day when we had to say goodbye.
It was time for our group presentations and in my group we were very excited to present. We had lunch in the conference hall and we got our certificates. Some of us were already saying goodbye that day and we started getting a little bit sad that it was now coming to and end, the workshop had just gone by so quickly.
So the japanese students took us into central Hiroshima again to do some last shopping and we went to a restaurant where we grilled our food on the table. We had lots of ice cream and took pictures in one of those japanese gaming hall were we all crammed into a photobooth and took pictures that we were able to draw on and design before printing out. It was so much fun. We also played for stuffed animals at the game hall and I won a pokemon teddybear and we all won at least one each that we carried around under our arms in Hiroshima while laughing and joking, it was the perfect end to a great week and a half. We cried while saying our goodbyes and promised to stay in touch.
To sum up the workshop was a great rewarding experience and if you love meeting new people from different parts of the world, learning more about other cultures and traveling around Japan you should definitely apply for a scholarship.