Internship Japanese Style

It’s not uncommon for college students to participate in an internship-type program prior to graduation. However, it is highly uncommon to experience that internship with one of the leading experts in your field of study. But that’s exactly what happened to Yuko Gilbert, an international student from Tokyo, Japan, during her senior year of nursing studies at Alfred State College in Alfred, N.Y.

Gilbert, who like all other nursing seniors was required to do a pediatric observation sometime during the final semester of the two-year program, decided she would like to lighten her obligations by doing the observation during a holiday break. Other students had done this in the past, says Linda Panter, associate professor of nursing and Gilbert’s lead teacher for her final semester at Alfred State, but the observations are usually done in the United States. Gilbert wanted to do hers at home, in Japan.

Gilbert & KawasakGilbert & Kawasak

Well, why not? Once the school had determined that there really was no reason not to allow an out-of-state observation–or in this case, out-of-country–then it was simply a matter of finding the right place in Japan to do it.

Gilbert, the daughter of a Japanese mother and American father, began by asking her mother, her friends and her mother’s friends if any of them had a personal connection to someone back home who specialized in pediatrics. After a flurry of phone calls and emails, the husband of a friend came forward. He was a full-time translator who had worked with Dr. Tomisaku Kawasaki in the past. Kawasaki, a pediatrician, is world renowned for his 1967 discovery of a childhood disease, known as Kawasaki disease or syndrome. Would Yuko like to do her observation with Dr. Kawasaki?

Following another flurry of letter writing and emails, it was all set. Gilbert had an appointment with the famous doctor, now 78 years old, on December 29, 2003, at the Kawasaki Research Center.

Meeting the Master

As she made her way over to the research center, Gilbert was “a little nervous,” even though the family friend and her husband, the translator, accompanied her. When they arrived, Dr. Kawasaki opened the door himself and they shook hands. They spoke in Japanese, she says, “about everyday things.”

What surprised Gilbert the most was how patient, relaxed and down-to-earth he was. “The interview went very well,” she recalls. “We talked a lot.” The young nursing student had not expected the doctor to be such a humble and modest gentleman. “I was impressed with how he went over case studies and reports,” she says. And if she needed a copy, “he walked over and made the copy himself.”

When it was time to leave, Dr. Kawasaki handed Gilbert a handwritten note. She was scheduled for her observation with him on January 6, 2004. “I was so delighted,” she says.

Gilbert & KawasakiGilbert & Kawasaki

On the scheduled day, she met Dr. Kawasaki at the Ushiku train station. Together they continued on to Tokyo Hospital, where they first stopped at the cafeteria for two cups of coffee; the doctor had sandwiches in a bag. Gilbert offered to pay. Dr. Kawasaki said she could buy him a cup of coffee when he visits New York.

Gilbert remembers that day well. “I knew he was very famous and I guess I was expecting someone arrogant or reserved,” she says. “But he was like a grandfather–gentle, very kind.” He was the same during interactions with his patients, she adds. The only difference was that he wore a white doctor’s coat. He shook each patient’s hand.

She observed how Dr. Kawasaki interacted with a mother and her son. He asked the boy to take a deep breath, then told him what a good job he had done. He calmed the mother, who was anxious.

Gilbert explains that the medical system in Japan is set up so that anyone gets to see a doctor, inexpensively. But that system leads to a lot of “abuse” in that sometimes a doctor’s visit isn’t really necessary. She estimates that Dr. Kawasaki saw 25 to 30 patients from 2-5:30 p.m. and sometimes his caseload reaches 60 patients in a single afternoon.

Dr. Kawasaki’s professional motto, Gilbert learned, is: “Medical Treatment with Warmth and Compassion. Medical Science with Discipline and Strictness.” She interprets this as meaning that the medical field is like a lifelong boot camp where you work very hard training, studying and polishing your skills. Then, when you are ready to implement that knowledge, it should be done with warmth and compassion.

“I asked Dr. Kawasaki what nurses meant to him,” Gilbert adds. “He replied, ‘They are my trusted partners.’”

She then asked what advice he would give to her nursing class. “A little teary-eyed, he replied, ‘Love…and then the medical skills to back this up. Get your hands dirty, don’t just observe but do. Seeing is believing, but doing is what will give you the needed skills and experience.’”

Discovering an Asian Health Disparity

What exactly is this Kawasaki disease that led to the doctor’s fame? Although the illness had probably existed for a long time, it was Dr. Kawasaki who singled it out as a separate entity. It is a children’s disease characterized by fever, rash, swelling of the hands and feet, irritation and redness of the whites of the eyes, swollen lymph glands in the neck, and irritation and inflammation of the mouth, lips and throat. The condition may also affect the linings of blood vessels and the heart muscle, possibly leading to aneurysms and heart attack. Damage to the coronary arteries in childhood may increase the risk of heart attack in adulthood.

The incidence of Kawasaki disease is higher in Japan than in any other country. In the United States, it is more frequent among children of Asian-American background but can occur in any racial or ethnic group. The disease is relatively common, and in the U.S. it is a major cause of heart disease in children. Kawasaki disease almost always affects youngsters; most patients are under five years old, and the average age is about two years. Boys develop the illness almost twice as often as girls.

The cause of Kawasaki disease is unknown. It does not appear to be hereditary or contagious. Because the illness frequently occurs in outbreaks, it is believed that an infectious agent, such as a virus, is the likely cause.

Building Bridges Between East and West

Panter says Gilbert’s unique pediatric clinical observation went very well and resulted in a wealth of information and networking opportunities, which the nursing professor plans on using at Alfred State College in the future. For example, she and Gilbert are investigating the possibility of videoconferencing and long-distance lectures through universities and other institutions in Japan.

“Yuko is going to climb the professional ladder quickly, and without doubt she will be making outstanding contributions to a profession she cares deeply about,” Panter adds.

Gilbert’s precedent-setting internship in Japan has also opened the doors for other international nursing students at the college to do clinical observation assignments in their homelands.

“This [meeting with Dr. Kawasaki] would not have happened if Yuko had not mentioned she wanted to do the assignment over break but did not think it was possible,” says Panter. “It started out as an idea, a wish she thought would never have come true–but it did! Implementing the dream only took encouragement and a nursing student who had the ability and energy to follow through.”

“Never did I think this interview with Dr. Kawasaki would become a reality,” Gilbert agrees. “I thank all the people who were involved in making this wonderful encounter happen.”

What will she remember most about the whole experience? “Dr. Kawasaki is a great doctor with immense knowledge and experience,” she says, “but he is also a person with compassion, warmth, wit, empathy, modesty and love for people–all the things I hope to embody as a nurse.”

The future for Gilbert is bright, combining both the Eastern and Western sides of her cultural heritage. “My father was originally from Hornell, N.Y. [near Alfred], and my favorite aunt and uncle both live near the area. I’ve always loved the United States and I have been blessed with growing up in two very different heritages. [After spending my early years in Japan], I hope to spend the next half of my life in my father’s county, pursuing nursing as my second, lifelong career.” She had previously been working in the computer industry, involved in legal service contract management.

Gilbert graduated from Alfred State College in May 2004 and received the Loretta M. Smith Verbal and Written Scholarship in Nursing at the college’s honors convocation. In early summer, she studied for the NCLEX-RN® exam, which she passed. She then returned to Japan to reapply for a new student visa. The process took months. Gilbert returned to New York State in mid October and has since interviewed for several nursing jobs, ranging from a large facility in Buffalo, N.Y. to a small rural hospital in Pennsylvania.

Several days prior to her return to the U.S., Gilbert visited her “friend,” Dr. Kawasaki, conversing for some two hours. “I thanked him for my past interview/observation and reported about my graduation from the nursing program and passing the boards.”

Both Gilbert and Panter hope to someday welcome Dr. Kawasaki to the Alfred State College campus where he could share his years of wisdom with the medical community and aspiring medical specialists. And Yuko Gilbert would finally get her chance to buy him that cup of coffee.

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