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Standing Director and International Exchange Committee Member: Masanori Shibata
International Exchange Committee Member: Tomotaka Naramura
Tadayuki Kawasaki, Honorary Chairman of this association and Chairman of the International Foundation for the Promotion of Clinical Engineering

[Background and Objectives]

Similar to other Southeast Asian countries, the Philippines is experiencing a dramatic increase in dialysis patients due to rising national income and changes in lifestyle. However, a significant problem is that the average life expectancy of patients after starting dialysis treatment is currently extremely short, at only 3.2 years.表The following is data from 2015 compiled by the Philippine Society of Nephrology. A project has been underway for three years, supported by the Ministry of Health, Labour and Welfare, led by a group led by Shingo Yamane, Executive Director of the Matsuenkai Medical Foundation. This project aims to improve the quality of dialysis treatment, the quality of life for dialysis patients, and the prognosis in the Philippines by transferring dialysis fluid quality and purification management technology utilizing endotoxin capture filters (ETRF), a relatively easy-to-implement dialysis-related technology developed, refined, and clinically recognized in Japan over 40 years, along with introducing dialysis treatment know-how and, in the future, introducing Japanese technologies, products, and systems such as central dialysate delivery systems (CDDS). This project, spearheaded by a group led by Shingo Yamane, Executive Director of the Matsuenkai Medical Foundation, is scheduled to conclude this fiscal year. While some achievements can be considered within the three years, it is anticipated that the number of dialysis patients in the Philippines will continue to increase, and there is strong opinion in the field that further continuous cooperation and support should be provided to maintain and improve the level of technology. Currently, numerous problems remain, but it is judged that these can be resolved for the future. Therefore, there was a suggestion to designate the current time as a period for interim evaluation, to revise the ongoing program to reflect the current situation, and to use it as a step towards achieving even greater results. In a recent meeting between our Honorary Chairman, Tadayuki Kawasaki, and Kentaro Kishimoto, Director of the International Development Promotion Office at the Ministry of Economy, Trade and Industry, it became clear that the Ministry of Economy, Trade and Industry is currently working on a study group to establish medical device maintenance bases in emerging countries, and that within this context, the Philippines is also exploring measures to strengthen the competitiveness of Japanese medical devices.

In light of the above circumstances, a plan was proposed to establish a training center in Manila as the second step of the dialysis technology transfer project, with the aim of training technicians who can maintain and service Japanese medical equipment locally. Specifically, it was suggested that the first step should be to provide education and training to local Philippine technicians and hospital staff on the maintenance of dialysis-related equipment and the management of dialysate purification, and it was also proposed that the Japanese Association of Clinical Engineers (JACE) would be willing to cooperate as the main force in this effort. Therefore, our association proposes that we would like to discuss an educational process with the ultimate goal of establishing a Japanese-style Clinical Engineer (CE) system in the Philippines and improving the technical level of dialysis treatment.

Therefore, in order to gain the understanding and support of key figures in the field of dialysis medical care, from September 18th to 20th, 2017, we not only paid courtesy visits to Dr. Coralie Therese D. Dimacali, Associate Dean of the College of Medicine at the University of the Philippines in Manila, and Dr. Irmingarda P. Gueco of The Medical City (a JCI-accredited facility), but also toured related facilities operated by Magsaysay, one of the leading conglomerates in the Philippines, and met with its owner, Doris Magsaysay Ho. This report details our visit.

Table. Overview of Dialysis in the Philippines (2015) Source: "Philippine Renal Disease Registry 2016"

• Number of maintenance dialysis patients: 32,077
• New dialysis patients HD 17,958 PD 645
• Underlying disease: Diabetic nephropathy 43.28%
• Number of dialysis facilities: 562
• Total number of dialysis machines: 5626
• Age at dialysis initiation: 1-10 years old (35 people)
  11-20 320
  21-30 1,228
  31-40 1,845
  41-50 3,173
  51-60 4,773
  61-70 4,471
  71-80 2,053
  81-90 658
  >90 47
• Number of kidney transplant patients: 475

[Regarding courtesy visits to each facility]

1) Courtesy visit to Dr. Dimacali, Associate Dean of the University of the Philippines College of Medicine.

1. Date and Location: September 18, 2017 (Monday), Philippine General Hospital
2. Japanese side: Honorary Chairman Tadayuki Kawasaki, Committee Member Tomotaka Naramura, the author,
3. Dr. DimacaliPhoto 1) had a meeting.

<Summary of remarks>

• Our medical school had just begun considering the establishment of a course to train biomedical engineers, so JACE's offer of cooperation is of great interest to us.
• I would like you to introduce the JACE training curriculum (in English) implemented in Japan and other countries. I would like to review it along with the video you provided to consider what kind of course structure would be appropriate for our region. I would also like to have a concrete discussion when the Japanese side returns to the Philippines in December.
• The Philippine Society of Nephrology (PSN) conducts a training course for biomedical engineers around November each year, and it is possible to integrate the JACE training subjects into this course. For specific details, please consult with Dr. Gueco.

Photo 1.Third from the right: Dr. Dimacali

2) Dr. Gueco, Director of the Dialysis Center at The Medical CityPhoto 2A courtesy visit to ).

1. Date and Location: Tuesday, September 19, 2017, The Medical City Hospital
2. Japanese side: Honorary Chairman Kawasaki, Committee Member Naramura, Author
3. I met with Dr. Gueco.

<Summary of remarks>

• I am extremely grateful for the opportunity to learn about Japan's cutting-edge medical technology. I am also very thankful for JACE's proposal.
• Medical City has a five-year contract with B Braun to install dialysis equipment, and entrusts them with maintenance and repairs. However, it would be extremely helpful to have a technician who can respond immediately if there is a problem with the equipment. The hospital has a medical engineer, but they are in charge of examinations and other tasks, and are not responsible for the maintenance and servicing of medical equipment.
• I would very much like to study JACE's training curriculum. Furthermore, I would like to discuss with JACE and our hospital's staff (doctors, nurses, and technicians) what specific actions we can take together in the future.
• It might be a good idea to introduce Japan's Clinical Engineer system to the Technical Education and Skills Development Authority (TESDA).

Photo 2.Dr. Gueco (front right) intently examines the endotoxin quantification results obtained during a courtesy visit to The Medical City.

3) Visit to facilities related to Magsaysay

1. Date and time: Wednesday, September 20, 2017

(1) Seafarers Training Facility (Times Plaza Building)
(2) Medical testing clinic
(3) Japanese language school (Photo 3）

2. Discussions were held with the Magsaysay conglomerate owner and other executives.Photo 4）。

• Japanese side: Honorary Chairman Kawasaki, Committee Member Naramura, Author
• Representatives from the other party: Doris Magsaysay Ho (Owner), Edouard Manesse (Chairman of the Board), Jay (Head of Business Development), Alexander Querol (Director of Training Center)

<Outline of discussion>

• From JACE, the mission of JACE and図The proposed plan for a medical technology training center was explained.
  I explained that the proposed plan is currently just a preliminary draft, and that it will be necessary to examine the needs of the Philippines in more detail and consider a training scheme that addresses them. I also explained that financial support from the Japanese government and equipment support from manufacturers are prerequisites.
• Mr. Ho expressed his gratitude for JACE's excellent social role as an educational institution, its educational activities in various countries, and its willingness to cooperate for the Philippines. He emphasized that Magsaysay's vocational training policy focuses on acquiring skills that can be immediately applied in practice, and expressed his desire to cooperate with this project concept. He also stated that, as a future plan, he would discuss with Dr. Gueco what specific needs exist in the Philippines and develop a more concrete training plan. Furthermore, he expressed his desire to explore collaboration with universities and vocational schools, taking into account the government's new policies that are leading to the consideration of establishing new Biomedical Engineer programs at institutions such as the University of the Philippines.
• JACE promised to provide the Philippines with an English-language curriculum outline and an overview of its activities in each country as reference materials.

Photo 3.In a classroom at Magsaysay Japanese Language School

Photo 4.Doris Magsaysay Ho (center in the photo), owner of Magsaysay.

[Regarding the future]

In the Philippines, the majority of personal dialysis consoles are manufactured by B. Broun and Fresenius, and actual maintenance and repair work is considered the responsibility of the manufacturers. The Ministry of Economy, Trade and Industry has long been exploring the possibility of Japanese companies jointly establishing and operating medical equipment maintenance centers in emerging countries. The plan is to train personnel to perform standardized tasks such as daily inspections at the center, as well as personnel to maintain and manage equipment within medical institutions. There is also a suggestion to introduce a call center-like system where personnel capable of triaging whether repairs are necessary are stationed at the center, and manufacturers take the lead in handling actual repairs.

If educational courses on dialysis medical equipment are to be established at vocational schools in the Philippines in the future, recruiting trainees and arranging employment (placement) after the training will become one of the tasks, and cooperation between Japanese and Philippine manufacturers will also be important. Do dialysis physicians in the Philippines want treatment outcomes comparable to those in Japan? To what extent do they want to introduce sophisticated Japanese dialysis technology? What level of dialysis technicians do they desire? Mutual understanding and awareness regarding these points must be established first.

In the future, we hope to have many more clinical engineers participate and spread the Japanese style of clinical engineering to the world.