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国際保健協力フィールドワークフェローシップ冊子発行にあたって
WHO西太平洋地域事務局長
尾身 茂
国際保健協力フィールドワークフェローシップが開始されて、2005年で12回を数えられたと聞いており、関係者の皆様のこの事業に対する熱意とご尽力に改めて敬意を表します。
先日ある機会に、このプログラムでマニラを訪問したことのある卒業生にお会いしました。既に立派な社会人になっていましたが、私に次のように言われまれました。「我々学生がWHO西太平洋地域事務局（WPRO）を訪問した時、先生は、『1日1時間で良いから10年継続して英語を勉強すれば、将来国際機関で働けるような英語力がつく』とアドバイスされました。私は今日までそれを実行してきました。お陰で英語力に自信を持つことができました。ありがとうございました。」
実は、当時WPROの感染症部長として皆様の前で話したとのことでしたが、大変失礼ながら、そのような話をしたのかどうか私自身忘れていました。しかし、この話のような例があるので、感受性の強い真摯な若い学生の方々の前で話す際には、できるだけ私の正直な気持ちを話すよう常に心がけています。
私自身も高校時代にアメリカのニューヨーク州にAmerican Field Service（AFS）交換留学生として1年間留学しました。当時の私にとってはすべてが新しい体験で、世界各国の留学生と友達になるような楽しい毎日でした。このときの経験だけは、今でも天然色で思い返されます。その後、自治医科大学の1期生として大学に入学し、僻地医療に携わり、都立病院や救命救急センター勤務など様々な経験をしましたが、その高校時代の留学の際に経験した国際関係のダイナミズムが忘れられず、回り道はしましたが、現在の国際機関で働く選択をしました。私のように、若い頃の経験は、時に人生の上で大きな意味合いを持つことがあります。このプログラムに参加された多くの方々が、その後、国際保健の仕事に携われているとの話も聞いております。また、現在は携わっていなくても、私のように、今後、学生時代の記憶を呼び覚ます方がいないとも限りません。
国際機関で働く立場からみますと、更に複雑になる国際社会の中で、昨今、日本の指導力がやや翳りを見せている印象を拭えません。例えば、世界の保健関係の指導者がお互い携帯電話等で連絡を取り合う中、情報戦で必ずしも優位に立てずに行動が出遅れてしまった例や、マレーシアやタイなどの新興国が国際社会での力をつけ始め、日本より先んじて国際会議を開催するなどリーダーシップを発揮した例など、これまでのような日本の国際社会での存在感が揺らいでいる印象を受けています。こうした中、国際保健で活躍する優れた人材の育成が日本で急務であることは論を待ちません。国際保健で活躍する次世代の育成に着目し、継続して運営されている笹川記念保健協力財団及び関係者の方々の慧眼に改めて敬意を表します。
毎年夏、このプログラムの参加者は、ハンセン病を取扱うフィリピンの病院等で研修を行う中、我がWHO西太平洋地域事務局を訪問し、国際保健についての講義を1日かけて受講されます。私自身も、他の予定が極力入らないよう、学生さんが訪問される日を早くから手帳に書き込んでいます。
今後も国際保健協力フィールドワークフェローシップが発展し、わが国の国際保健の人材が一層充実するよう、関係各位の更なるご支援を願ってやみません。
International Health Cooperation Fieldwork Fellowship - Something I am truly proud of - Sumana Barua
Medical Officer, Stop TB and Leprosy
WHO/WPRO
Thinking about the Fieldwork Fellowship Programme, I was wondering how I could sum up its role and how I could state its place in shaping the future career of the participants. It has been challenging for me as I have seen this Programme since its inception and having seen each year’s participants so closely for the past 12 years.
These are what I thought, and this is what came to my mind:
With this Fellowship Programme, Japan puts the best foot forward in regard to Health Human Resource Development through 'early exposure'. It may serve as a Japanese model of multi-sectoral as well as governmental and nongovernmental (rather public-private) collaboration in this field.
This 'early exposure' ― being one of the main features of the Programme ― provides the participants with an initial opportunity to widen their horizon and to deepen their vision as future health care providers who, in due course, either work in Japan or abroad.
The participants ― the real indicators of the Programme's success ― prove that their hearts are in the right places through their flexibility, adjustability and adaptability. Their openness to change is admirable during the Programme and thereafter, which enhanced their dedication and commitment to the service of the people in parallel with the technical health care skills. These have been in line with the Programme goals.
Having said the above, I wish to explain further to outline my observations:
The beginning of the Fellowship Programme:
The Programme is the brainchild of Dr. Fujio Otani (Ex Director General of Health, MHLW) and Prof. Kenzo Kiikuni (Chair, Sasakawa Memorial Health Foundation). Since the 1970s and 1980s, Japan's collaboration has been in an increasing trend for improving health care of the developing countries, through governments as well as international organizations (e.g. WHO and UNICEF). In parallel to this trend, there has been a crucial growing need of Japanese experts in implementing governmental and nongovernmental agencies supported health programmes in such countries. Dr. Otani and Prof. Kiikuni realized these needs and addressed the challenge of developing human resources in Japan for international health collaboration overseas. One of their top priorities in realizing this challenge was the 'early-exposure' of medical students to this field, and this indeed bore fruit.
Under the leadership of Dr. Otani, the Programme started its journey through the active involvement of a number of concerned experts, a few to mention of who are: Dr. Hideo Shinozaki (Director, Institute of Public Health, MHLW) Dr. Hiroshi Nakajima (DG Emeritus, WHO HQ), Dr. Shigeru Omi (RD, WPRO), Prof. Kiikuni and others.
It would be appropriate to mention the enthusiastic support of Dr. S. T. Han (RD Emeritus, WPRO) in response to Prof. Kiikuni's proposal to have the WHO Western Pacific Regional Office act as the focal counterpart in Manila for the implementation of the Programme.
The partners of the Programme:
a) Sasakawa Memorial Health Foundation (SMHF): The main organizer. As such, I should neither overemphasize on the financial support that SMHF has been providing, nor should I repeat the already available statistics. However, I shall simply assert with great confidence, and the record clearly shows, the vital role that the SMHF has been playing in the overall coordination with other partners for the actual implementation of the Programme annually. The foresight of the SMHF to involve various organizations and institutions, mentioned below, is absolutely commendable.
b) Ministry of Health, Labour and Welfare of Japan (MLHW): Representatives of several autonomous institutions within the Ministry, serve as members of the Programme's Planning Committee. The Ministry also supports the programme in providing venues at the International Medical Centre-Japan, followed by site visits to the National Sanatorium Tama Zensho-en and the Tuberculosis Research Centre in Tokyo suburb, where students have two days of lectures on international health cooperation from experts from various fields. During these two days, the participants are also given the opportunity to become acquainted with each other and decide on how to share areas of responsibilities during the Programme and thereafter.
c) Japan International Cooperation Agency (JICA): Their representative also serve as a Planning Committee member. During the orientation in Tokyo, an overview on health related JICA projects in various developing countries is presented. The participants get first-hand information on the utilization of overseas development assistance (ODA) and the personal experiences shared by the lecturer in those countries. In Manila, JICA-Philippines officials give briefings on their activities in the country, and also support the arrangement of field visits to one of their project sites. The field visits include exposure to rural health centres in order to observe the daily activities of the basic health staff.
d) Various universities in Japan: Application guidelines of the Programme are sent to each Medical School in Japan each year. From there mainly, the students become aware of the availability of the Programme. Endorsement/recommendation from academic advisors/professors of the applicants are highly appreciated and are undoubtedly essential in screening appropriate and deserving participants. This in return contributes the success of the Programme.
e) Nongovernmental organizations (NGOs) in Tokyo: Every year, a health-related NGO based in Tokyo (example SHARE) is invited to give a lecture on their activities in various developing countries. This enables the participants to understand the mechanism of NGO collaboration and its similarities and differences from the governmental approach in international collaboration.
f) WHO-Western Pacific Regional Office (WPRO): As the Regional Director puts much emphasis on Health Human Resource Development through 'early exposure,' the participants enjoy the luxury of 2-3 hours of his lecture covering a wide range of issues including sharing of his life experiences. In addition, there are orientation-lectures on the contribution of WHO in various aspects of health, non communicable and communicable diseases in the Region.
g) Department (Ministry) of Health (DOH)-Philippines: The DOH arranges the observation-visit to the City Health Office and to urban health facilities within Manila and in nearby provinces such as Tarlac. This enables the participants to learn about the urban as well as rural health facilities in the Philippines in comparison with that in Japan, as well as the overall health service system in the country. They are also given the chance to visit leprosy sanatoria in Manila or Cebu, which is under the government administration where they learn about the history of the disease in the country, in comparison to that of Japan.
h) Local nongovernmental organizations (NGOs) in Manila: Each year, a local NGO is requested to bring participants to one of the slum areas near or within Manila, such as the Smokey Mountain where they are exposed to the people's lives. The experience could be a 'culture shock' to many of those who are visiting an Asian country for the first time, but it also helps them better understand the reality as well as the importance of support, and what kind of support is in actual need and how the local NGOs are aiding them.
i) College of Medicine, The University of the Philippines-Manila: The participants get a half-day orientation and tour to familiarize them on the Philippine medical education system. They are divided into small sub-groups, which include Filipino medical students, and they visit the State University Hospital then meet again for a sharing session. Above all, long-lasting friendships are established among many of them.
Why do I enjoy this programme?
Since early 1980s, I have been involved in the 'community-exposure' and 'home-stay' programmes of Japanese students and young professionals in Leyte, Philippines as well as in Bangladesh. All through the years, the undertaking did not make me rich financially but has made me richer than many others with 'self-satisfaction' as I can no longer keep record of the participants though many of them still come to greet me recalling the past.
At the time of the Fellowship Programme's initial discussion, I was engaged in my post-graduate studies at the University of Tokyo. I was also involved in a number of extra curricular activities together with a group of my esteemed Japanese friends, mainly, continuing support of Japanese students and young professionals for their exposure to the health realities of the developing countries.
The Planning Committee of the Programme decided to enrich me with further 'self-satisfaction'.
Let me give you a few examples of what I enjoy about this programme:
・At the Tama Zensho-en dormitory, during the earlier years, as the course adviser, I enjoyed observing until late evening the way each participant started with their self-introduction, gradually leading them towards team building for the field visit to the Philippines and thereafter as alumni of the Programme.
・Those who maintain friendships with the Filipino medical students have visited the Philippines months or years after the programme, while others attend each other's weddings in Japan or in the Philippines.
・Many of the participants frequently visited my house to enjoy the Bangladeshi-curry during weekends, and at times, some came with their parents.
・I could support many of them who wanted to have more exposures to other developing countries, for them to give voluntary services before becoming doctors.
・Many of them still write me asking suggestions in selecting their post-graduate research areas in order to pursue higher studies.
・I am pleased to acknowledge that the participants have been giving me opportunities to practice the saying, "life means sharing...".
Conclusions:
In conclusion, I must confess that there are many things which I have done during my life which neither I nor anyone else will ever remember. There are a number of things that I in fact regret, and would rectify if I could. However, there are very, very few things about which I am truly proud of. My involvement in this Fellowship Programme is one of them.
Lastly, I am ever so grateful for this opportunity to serve the younger generation in shaping up their own future career through this Fellowship Programme. It has been a life-long learning process that I wish to nurture all through my life.
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