By Dr Nina Lau Lee Jing
Specialist, Obstetrician and Gynaecologist
Sarawak General Hospital

(Published in OGSM CONNECT Newsletter December 2023, Issue 1, Council 2023/2024)

The COVID-19 pandemic has led to the shutdown of many countries around the world, therefore, the plan of running a Caesarean Section Masterclass in Japan in 2020 was cancelled. However, it did not extinguish the fire of desire and passion to improve the maternal care among the ICOE and J-CIMELS team. The ICOE team, in collaboration with the Japan Council for Implementation of Maternal Emergency Life-saving System (J-CIMELS) and Asia Medical Support Organisation (AMSO), has successfully organised the Masterclass in Caesarean Section in Tokyo, Japan on the 13th of May 2023 in conjunction with the 75th Annual Congress of the Japan Society of Obstetrics and Gynaecology (JSOG 2023).

The Malaysian team consisted of 4 trainers – Dr Gunasegaran (ICOE team leader), Dr Thaneemalai, Dr Muniswaran and Dr Nina Lau. We met at KLIA International Airport at 9 pm, on the 11th of May 2023. As usual, Mr Baskeran (the ICOE admin liaison) has packed, pre-weighed and securely wrapped all the necessary mannequins, equipment and ICOE handbooks. Our check-in and immigration clearance went smoothly and we boarded the midnight plane to Tokyo. After a 7 hours flight, we finally arrived at Narita International Airport. We met Dr Mayumi, one of the Japanese trainers for this masterclass, who also just arrived at Tokyo. Dr Mayumi is one of the J-CIMELS trainers and has been our important translator and liaison between the Japanese and ICOE team throughout the planning and preparation processes.
Coming from Malaysia with months of scorching heat waves, we were all delighted with the cold morning and gentle drizzle outside the airport terminal. The beautiful Tokyo spring breeze and refreshing zephyr swept away my grogginess from the overnight plane ride. After some paddy field and greenery, unending skyscrapers soon loomed into view. I was exhilarated watching the driver effortlessly navigate through the most complicated multilayered highway lines. After an hour ride, we finally reached the centre of the Tokyo metropolitan. We dropped off the mannequins and equipment at the Tokyo International Forum. The J-CMELS maternal life-support course was held in the same venue on that day so we could not set up the equipment for the masterclass. We had some free time to explore Nihonbashi while waiting for the J-CMELS team.

Nihonbashi is a very distinctive place, offering traditional and historical charm combined with ultra-modern architecture. We walked across Nihonbashi bridge and “Zero Milestone of Japan”- the starting point of the five major roads across Japan. The picture scroll of Kidai Shoran in the underground passage in Misukoshimae station was amazing and offered a glimpse of Japanese history during the Edo era. There were shrines and historic department stores, such as Nihonbashi Mitsukoshi Main Store and Nihonbashi Takashimaya S.C, in the midst of modern skyscrapers. Every corner of Tokyo city was filled with various beautiful blossoms of Nemophila and Rhododendrons, such as Azalea and Kalmia Latifolia, signifying the beauty of spring.

The unending skyscrapers and sophisticated railway lines in Tokyo Metropolitan

The beautiful city view with colourful blossoms in springThe beautiful city view with colourful blossoms in spring

At around 6 pm, we met the J-CMELS team, Dr Hashii Koji (the founder of J-CMELS) and Dr Mayumi and Dr Hikaru (the trainers of J-CMELS). We had a dinner talk prepared by the EmerSim team at the meeting room of the Japanese Association of Obstetrics and Gynaecology (JAOG). They introduced the Penguin System and their new EmerSim program. EmerSim has evolved into a cloud-based vital signs monitor simulator and scenario management that allows on-site, remote and hybrid medical training. We were amazed that the EmerSim system directly connects to any mobile or tablet devices and requires neither special mannequins nor software installations. The trainer can adjust the vital sign values in real time based on the trainees’ responses during the simulation. It was extremely useful, especially during the pandemic since it allowed training to continue remotely. With a mobile phone or tablet in hand, simulation training can be conducted easily anywhere, anytime and with anyone, both in the hospital and outside on the field. It is definitely a must-have system for future ICOE training. The program can immediately begin upon subscription. The brainstorming on the clinical scenario for the Masterclass in Caesarean Section was fuelled by the enthusiasm to incorporate EmerSim into the simulation. Within half an hour, the entire scenario with multiple obstetric emergencies was drafted and completed.

The J-CMELS team shared a new invention by Kyoto University – a dedicated blunt straight needle and sutures for uterine compressive sutures. Dr Hashii has generously provided us with some samples for the hands-on session during the Caesarean Section Masterclass. I personally found it extremely useful for Hayman sutures. We were excited to observe another intelligent innovation – the Japanese water pillow Caesarean Section model. We were privileged to have Dr Junko Nakayama, the inventor, to personally demonstrate her model to us. The rubber hot water bottle, known as water pillow in Japan, is creatively used to mimic the uterus. The bottle is cut on one side and the baby mannequin can be placed inside the water bottle to mimic abnormal lie during Caesarean section. This model allows the trainee to practice cutting the uterus model and learn how to deliver the baby during difficult Caesarean section. It is economical and easily reproducible. Dr Guna and Dr Munis shared some ideas and suggestions on how to improve this water pillow model. The participants for the masterclass were lucky to be the first group of people to try this water pillow model.

For the intraoperative maternal collapse workshop, we suggested to cover postpartum haemorrhage, maternal collapse, amniotic fluid embolism and resuscitative hysterotomy. We planned a role play by both the Malaysian and Japanese team, each with different roles. We drafted the script and discussed the essential points for debriefing and feedback. Dr Mayumi and Dr Hikaru also discussed the healthcare system and ambulance and transport systems available as well as the common challenges they faced in Japan and Tokyo. This topic was very relevant for my talk about patient transfer. We were so engaged with the conversation that we did not realise how time flew by. Everyone was very pleased with the fruitful pre-masterclass discussion.