It’s indeed a nostalgic feeling to write the last feedback report of my clinical fellowship training in the department of Plastic and Reconstructive surgery, TWMU as in exchange program between Dhaka Medical College Hospital and Tokyo Women’s Medical University Hospital. This feedback report had been the medium for expressing my splendid experience in clinical works in Hospital and cultural interaction in personal life in Japan.

Last month, I spent my most memorable month in Japan. I had an special invitation from very respectable Prof. Emeritus Motohiro Nozaki sensei on the eve of my finishing hour of training. At that dinner I also had scope to have interaction with Dr. Sheikh Aleemuzzaman about my training experience in Japan, my future plans and about the next candidates coming from Bangladesh.

19^th June, 2014 I made a presentation in the department about my training in TWMU and my stay in Japan in last 1 year which was followed by a small certificate giving ceremony. After that we went to an wonderful farewell party from everybody in “Kei Sei Geka” that was full of life, warmth, souvenirs, emotions and a strong desire of meet each other again either in Japan or in Bangladesh.

The day I applied for this scholarship I believed that it might be a life time opportunity for me and today I strongly realize, truly it was. As a young female plastic surgeon in Bangladesh after having this training completed, I feel “ KOKOROJASHI”; “ the Knight Heart”. I hope, I would be able to replicate the knowledge and skill I could earn in Japan and have scope to reproduce in Bangladesh.

During my farewell as Sakurai sensei wished , I would like to a “bridge between Japan and Bangladesh”. Because I genuinely wish to continue to be a part of the noble motive of Japan Bangladesh Medical Association (JBMA) to build medical expertise of Bangladeshi doctors in Japan as well as to ensure optimum health facilities to Japanese foreigners in Bangladesh. Last of all, I would like to say that I not only received skills, knowledge, wonderful teaching from my supervisor and senior doctors in department but also had lots of love and respect. I believe that my journey starts now.

My heartfelt gratitude towards JBMA and my supervisors of both Bangladesh and Japan.

By the end of May, 2014 I have to realize that I am leaving Tokyo Women’s Medical University soon as my training period is almost over. Simultaneously another thought comes to the mind, I should try to replicate the knowledge, professional commitment and academic attitude in Bangladesh that I experienced in Japan. So, In this month’s feedback report, I would like to highlight some perspectives that I really want to reproduce in Bangladesh in my Clinical Practice.
In spite of the fact that in one hand the management of each patient in TWMU is accomplished by judicial reconstructive procedure and advanced surgical technologies and equipments and on the other hand we have scarcity of resources, technologies to large extent; still there are many scopes of improvisation of practice in Plastic surgery in Bangladesh.

I found, “Cleanliness, Hygiene, Maintenance of sterility to a level of perfection” is one of the key of success in most challenging cases like burn, amputed toes- fingers for replantation, advanced grade bed sore, or notorious diabetic wounds and so on.

Documentation during pre-operative visits, immediately before operation planning and co-relating with investigations, using those information during operation, maintenance of a huge patient data-base and eventually revisiting the same patient’s records during successive revision surgery or similar challenging cases –these lessons I followed during last one year and I really looking forward to establish in our clinical practice. I am also grateful that I learnt some wonderful techniques of reading and translating CT images from Sakurai sensei and learnt way of diagrammatic illustrations of the OT procedures.

I was privileged to learn hand to hand fine surgical skills techniques, gentle handling of delicate tissue, microsurgical techniques and essential hand movements in details from the senior colleague both in operation theatre and dry lab. In this connection I would like to mention that, I strongly felt it’s the high time in Bangladesh we should start frequent practice of some advanced surgical approaches like microsurgical reconstructions, microsurgical replantations, VAC therapy and using electrical dermatome for harvesting STSG specially for burn patients.

I am highly motivated by training in TWMU about the research works and writing scientific papers about the distribution of different pattern plastic surgical cases and defining our limitations and achievement so far and goal in near future in Bangladesh.

My heartfelt gratitude to JBMA and my supervisors of both Bangladesh and Japan for giving this opportunity. ..

The months are now getting busier, actually now I have lots of tasks to finish, lots of friends to join, and getting lots more memories to cherish before I leave Japan. I am very happy and feel honored that JBMA made a beautiful way of sharing these experiences with others through “Feedback report".

Last month, I could join those reconstructive surgeries that always challenges plastic surgeons; like reconstruction of lacrimal apperatus, nasal sinuses, tissue defects after resection of cancer, electric burn injury to the fingers, Avulsion injuries and facial bone fractures following road traffic accident and recurrent decubitus ulcers in debilitated patients. Specially, I could observe laparoscopic harvesting of jejunal flap for free tissue transfer for the first time.

March had been a month of diverse academic experiences. Sakurai sensei is recently teaching me details about statistical calculations, interpretation and presentation of data for research purposes which surely gives me an insight to my academic knowledge. On 29th of this month, I could attend his memorial Lecture on “The 50th Meeting of TWMU on Breast Cancer”. I had a privilege to visit Nihon University School of Medicine- Emergency department for one day and could acquire experiences on prompt coordinated team effort with advanced equipments while managing emergency patients. Nevertheless, I felt honored, when I was asked to illustrate the surgeries as a representative of the department to the foreign medical students from United States of America and Korea.

Professor Emeritus Nozaki sensei closed his outpatient clinic in TWMU this month , on that occasion I could share some wonderful moment with Sensei at the “Operation Record Room” which preserves the glorious heritage of Plastic Surgery department of TWMU.

By the end of this month Dr. Nora finished her training and before she left Japan we could have some beautiful memories to cherish while visiting Tokyo Disneyland, Traditional Japanese Tea ceremony, Suntory Museum of Art at Roppongi and of course the refreshing Cherry blossom.

After finishing the last month's training period , I realize, that I not only finished 2/3rd of my training but actually by this time I have achieved "The lifestyle of a young plastic surgeon at TWMU".

The most overwhelming event in my training so far, happened last month on 8th February at 22nd Japanese Society for Burn Injuries; Kanto Region Meeting , when I got the oppurtunity to present paper on paediatric burn. Senior Plastic Surgeons encouraged me doing further research reports on epidemiology and pattern of domestic burn cases in Bangladesh and try to establish prevention strategies.

Last month, I was fortunate enough to experience joining; couple of advanced reconstructive surgeries for Cranial synostosis in collaboration with neurosurgery team, mandibular reconstruction done for mandibular setback and buccal mucosa and gum reconstruction by radial forearm free flap. Moreover,my supervisor and senior surgeons guided and help me in gradually advancing my level of participation during operation.

On February, nature has bestowed her best snowfall to Tokyo in last 13 years. I was fascinated to see snowfall first time in my life, while my friends in Japan said, "Humayra is too excited to feel cold".

On 21st of February, I got a holiday to celebrate "International mother language day"near the "Shahid Minar" Monument, Ikebukoro,then at Bangladesh Embassy in Japan and Tokyo university of Foreign Languages ;with other Bangladeshies in Japan.Therfore, I want to finish my report, on a thanking note to Sakurai senei who always been kind to let me live myself in Japan.

Although in January I did not have a tight operative schedules, I enjoyed being busy in social interaction in Japan having a long holiday during the first week. I am very glad that each and every day, I am taking one footstep forward regarding my plastic and reconstructive surgery as well as practicing microsurgery. Gradually, I can appreciate the importance of staged surgery, secondary reconstruction and revision surgeries.

This was the month when JBMA received another doctor, Dr. Nora Khan from Bangladesh to the Diabetic centre of TWMU. I was very happy and feel privileged to have her while staying in Japan. Prof. Sakurai generously gave a warm welcome to Dr. Nora to Japan through a dinner invitation in a traditional Japanese restaurant; we had enjoyed Japanese cuisine “Shabu Shabu”and “Sukiyaki.” I felt like home in Japan and as a host as well, while I went along with Dr. Nora and her mother Prof. Sayeda to Tokyo tower, around Tokyo and Yokohama.

Entering into a new year in Japan, my supervisor Prof. Sakurai gave me the opportunity to submit an abstract about paediatric burn in Burn Unit of Dhaka medical College Hospital and right now, I am preparing for presentation of the paper at 22nd Japanese Society for Burn Injuries; Kanto Region Meeting to be held on 8th February. I think, it will be a great experience for me and also a scope to point up incidence and pattern of burns existing in Bangladesh to Japanese doctors and health professionals dealing with burn.

While I was sighing that, what an spectacular last year I have just finished! I am also hopeful that may be next year is going to be full of even more wonderful and exciting experiences in Japan . December is the month of celebration for Victory for Bangladesh, so it’s very close to my heart, as well as I enjoyed the Japanese style of celebrating winter by sending souvenirs and greetings.On the eve of Christmas and new year the entire city was decorated with beutiful lightings.

Winter is getting cooler day by day and wondering about snowfall weather forecast is very joyfull and exciting as well.

Actually, December had been so busy a month that I found, it was finished very quickly. This month was a kind of “Perfect training month” as I could join some wonderful head and neck reconstruction surgeries, i.e. reconstruction of tongue, floor of mouth, pharynx by free ALT flap, free Jejunal flap, free VRAM flap; some important pedicle based flaps in PRS, i.e. VRAM for chest wound dehiscence, posterior thigh flap for ischial sore, V-Y advancement for sacral sore and more. Finally ,this month I could follow the management of a severe flame burn case from the emergency department to the ward then to sequential surgeries and rehabilitation.

After gaining some basic concept of of microsurgery in TWMU , this month I have started to practice the dry lab practicing Microsurgery which is being supervised by Prof. Sakurai as well as other micro surgeons of the department; which is very precious part of my training. I have also started to work on a research about venous pressure monitoring regarding breast reconstruction with Prof. Sakurai ; I believe those are advance step in my training in Japan at TWMU.

"The year ending party" was one of the events that I enjoyed most in Japan because actually I participated in an act with my colleagues, I liked the tradition of rejoining together; could meet Prof. Hirayama once again, I could share momements with very senior and honored Japanese Plastic surgeons at the same time had fun moments with young plastic surgeons.

Thank you and happy New Year to everyone connected to JBMA

With the chilling breeze of winter and Changing color of enchanting beautiful Maple leaves my training days in Japan are also flourishing; every day I get an exciting learning experience which I enjoy most. Actually last month, Japan looked even more colorful to me, as my husband had a trip here for 10days. Prof. Sakurai was so generous that he not only granted me a long vacation but also invited both of us to Dinner at Tempura Restaurant at Roppongi with his lovely wife.

Last month, I could participate in some of plastic surgery emergency managements such as , accidental amputation of thumb, Cut injury of nerve by electrical machinery trauma and couple of acute burn case also. Both the issues are important in Bangladesh context and I was really excited to learn the replantation surgery from one of my senior colleague.

In our country burn cases are so numerous specially in Burn unit of Dhaka Medical College Hospital, The number of burn cases are really scanty here, But still I get the chance to follow many burn cases, some burn scar contracture cases who have undergone wonderful reconstructions such as, rotation flap following tissue expansion of scalp for facial reconstruction, free SIEA and SCIA (combined) flap for axillary contracture, and also use of artificial dermis for some cases and I realize how a reconstructive surgery can improve quality of life.

In November, My Training took a new turn when my Supervisor Prof. Sakurai offered me the visit to Nihon University School of Medicine for one week. It was really an wonderful experience to work with Prof. Hiroaki Nakazawa and his team who work in harmony and organized manner. I got the scope　to see some skin cancer management in face and breast reconstruction case, specially a case of reduction mammoplasty.

At the end of this month, while starting to write feedback report I realize that I have just passed one-third of my training period. This particular month was a great learning experience regarding my advanced plastic surgical training in TWMU.

This month fortunately, I could participate in 4 Post-mastectomy Immediate breast reconstructive surgeries; which is an area of my special interest. Each of them was unique in their own way. From those operations I could learn not only the interpretation and implication of MDCT mapping in Planning of Surgery, the techniques about reconstructing breast of symmetrical size, shape and ptosis but also realized the essence of multidisciplinary approach and team work. I also learnt about some advanced microsurgical concepts; superchrger arterial and venous anastomoses. My Supervisor Prof. Sakurai has been always very kind to explain me about the pros and cons about all my queries about breast reconstruction operations and others.

I also learnt about some new techniques regarding post-operative flap monitoring by measuring venous pressure and post-operative venography through the catheter in situ.

This month I got the opportunity to introduce myself in an august forum of Plastic Surgeons of Tokyo Women’s Medical University and Other university namely Nihon University School of Medicine in a conference held in Hotel Metropoliton Edmont, Tokyo . I had the honor to meet Prof. Isago and Prof. Nakazawa there.

During my stay in Japan, I met doctors of different countries like China, Taiwan, Nepal; staying in the same apartment (Flex Stay Inn) and came for training in Tokyo women Medical University in different departments. It is always a beautiful experience meeting doctors of different countries, sharing views and making new friends.

This is the third month of my training in Japan at TWMU ,which was actually like proceeding one step forward regarding my clinical participations and experiences. Near the beginning of this month I received the special ID card as a Foreign Medical Practitioner (Certificate of Permission of Advanced Clinical Training) issued by Minister of Health, Labour and Welfare.

I express my heartfelt gratitude to My Supervisor Prof. Sakurai, the office staff of TWMU and special thanks to JBMA who supported financially during the official procedures.

During the month I got the Opportunity to participate numbers of interesting and challenging reconstructive surgeries like Free flaps (namely, SCIA flap, Groin flap,) Post- mastectomy large wound reconstruction by VRAM flap , couple of tissue expander and Breast implant insertion surgeries also.

With few of my colleague and Hospital staffs I attended the Conference on Burn at Shinjuku Burn Forum , Tokyo where I could gather knowledge from Japanese Burn Surgeons from different Hospitals and shared the views and experience about burn case management scopes and limitations in Bangladesh.

Lastly I would like to mention that this month I had the pleasure and honor to meet the General Manager of JBMA Ms. Izumi Iwata and had a frank discussions about my stay and facilities during my training in Japan.

The second month of my training in Japan at TWMU was like speeding up of an aircraft in the runway as it was eventful for me both clinically and socially. Gradually I become acquainted with the daily routine of a resident in Plastic Surgery department starting from morning conference, round in the ward, interacting with the patients, attending the ambulatory care centre, joining operations & proper documentations and so on.

This month I could participate in different categories of Plastic & Reconstructive Surgery like Latissimus dorsi free flap for coverage of leg ulcer (Microsurgery), maxillofacial reconstructive surgery for craniofacial deformity, NAC reconstruction, tissue expander insertion procedures etc.

In the morning conferences, I could gather knowledge of some interesting techniques of Plastic surgery like demonstration of Doppler ultra sonogram, Nipple areolar complex Tattooing kits with their uses.　Besides the operative procedure, I have learnt from Prof. Sakurai about the pre-operative mapping of vascular anatomy which is very vital for performing a successful Breast reconstruction by DIEP flap.

It was a honor for me that, the department waited until the month of Ramadan finished and after that arranged a Welcome Dinner Party at a Bangladeshi Restaurant at Akasaka in Tokyuo . On 20th August , 2013 I was overwhelmed to meet the respected Prof. Takeshi Hirayama at his Clinic, where shared his views about Bangladesh and gave me advices about my career.

Japan, the land of sunrise came up with a new sunny chapter in my professional life when I arrived at Tokyo on 7th of July, 2013. The reception on my arrival in Tokyo at Haneda International Airport was very warm by respectable Professor Hiroyuki Sakurai and Mrs. Sakurai which was followed by a welcome dinner at a traditional Japanese Restaurant with variety of Japanese foods.

Also, I am very much thankful to JBMA for arrangement of my accommodation in an apartment that is accomplished by all the facilities of daily needs; especially 24 hour accessible free broadband internet connection that helped me to keep in touch with my family. There are convenient transport systems available around the area so that a newcomer like me can easily go to the University as well as other places.

However, Tokyo Women’s Medical University is an overwhelming experience for me. The friendly attitude from the administrative staffs, warm hearted welcome in the department of Plastic & Reconstructive Surgery by Senior & Junior colleagues and co-operations of nursing staffs in the operation theatres was really appreciable. Participating as a member of surgical team in an Operation Theatre with all advanced medical technologies is like a dream come true for me.

Last week I was honored to meet Professor emeritus Motohiro Nozaki which was enthusiastic for me as a young plastic Surgeon. In The month of Holy Ramadan as a Muslim woman, even in a foreign land; I feel no hesitation performing my prayers only because of the kind cooperation of my colleagues.

Finally, I specially thank Professor Hiroyuki Sakurai and JBMA from bottom of my heart as I realize that this scholarship will not only enrich my knowledge & experiences but also open a new scope of exchange of views and experiences between Japan & Bangladesh.