The Life of Finnish College Students...

After my three weeks of Pubic Health Clinical, I headed back to the university (MAMK= Mikkeli University of Applied Sciences) this week for a final group presentation and a test. Yippee. I actually really missed being at the school. I really like the university and the system and all that comes with it. For example, Finnish students have a subsidized hot lunch that they can get for 2.60 euros, and since I'm an official student here, I get it too. It may seem like a lot to pay, but it's buffet style and all the food is made at the school each day. They even make their own homemade bread. I die for that stuff! And I missed it while I was away at clinical. It's the little things in life...

Clearly the bread is my favorite...it's the first thing I eat everytime :)

I ate it all. sorry not sorry. 

Finnish students also don't have to pay for their tuition fees. It comes from the taxes and education in universities for bachelors and masters degrees are entirely paid for. In the bachelor's programs, the students even get a monthly stipend to help pay for housing costs. The students say that it doesn't cover all their costs, but it's pretty close. Some do have part time jobs that they pick up, but in comparison to the thousands of dollars of student loans we take out in the US, that seems like nothing! I can't help but think about how nice it is do be a student here. I don't think I would be in any hurry to graduate actually :)

A fun thing we did this week was an event called "Jääice."

 It was a winter sports activity and party that the school puts on each year. There are different competitions, sled racing on the ice, broomball, curling.

Getting ready to race with my Hungarian friend, Zofie. 

Yay! :) 

 They also had ice skating that we tried out. Unfortunately it was sleeting so it was hard to skate on the ice, but we had lots of fun with the sleds and just being the crazy looking foreign students. (The Finnish students came for the broomball...we came to try everything so we really stood out!!) 

They also had the most amazing hot dog sausages. So good!

Yes yes I know...these helmets...

Let's just say we knew we were setting a fashion statement.

Another cool thing that's happening right now is that each year in February, Savonlinna hosts an ice sculpture festival at the castle. This week was the preparation week where they carve everything. I first noticed something was up when I saw the ice slide in the market square! The public was allowed to go early this week to meet the carvers and see what they are working on. I met an American who comes every year to the festival from Philadelphia. I was really excited to hear that there was an American here...I hope I didn't sound too excited when I just walked up and said "Hi, I hear you're from the States." What I meant was, "please talk to me" :) The carvers have this week to make their sculptures, and then they are judged on Saturday. They will stay at the castle on display until they melt, which may actually be very soon because the weather has not even been below freezing recently.

Here are the beginning stages:

Celebrating Savonlinna's 375th birthday!

Beginning stages of the competition

Lastly, we had our final exam today for my Community and International Nursing class. I was happy to note that my study habits haven't really changed much even when I'm thousands of miles away from home. I still find time to procrastinate as much as I possibly can (I started studying last night), getting distracted (this time by a new book that I'm reading), and staying up so late and waking up early to finish studying leaving me so tired. But the test actually was pretty easy for me because it was in my own language and because I've taken Community Nursing back at BYU. The other students thought it was more difficult because it was in a foreign language for them, and they actually got to do it in pairs. I had to do it alone...though I had lots of people say they would be my partner :)

Sirkka and Sirpa, our two nursing professors

Before the test we had a little party, just to celebrate and have an excuse to bring foods from all of our different countries. So many types of foods. Some delicious (like the berry cake) and some not (rye pudding).

During the party we sat and watched the olympics. It was very tense in the room when we watched Finland ski for their first gold medal! It was very exciting, and since US was in 8th place, I felt ok cheering Finland on. They deserved it :)

 I'm proud to say my chocolate chip cookies were a hit :)

There are lots of fun things coming up that I'm really excited to share. Tomorrow I'm giving a presentation in a Kerimäki high school about Mormons, and Sunday night I'm leaving for Lapland and the Santa Claus village for a few days! So stay posted :)

Wrapping up Public Health

In my last week of Public Health Rotations here, I spent my time at the Pediatric Clinic at the Savonlinna Health Center. I have explained that all preventative services are provided at these clinics. It's one big building that has many separate offices.

The Pediatric Clinic takes care of babies from the time they are born until they are 6 years old, getting ready to start pre-school. (Here their kindergarten is what we call pre-school and vice versa). Here is the break down of visists, if you are interested

2-3 weeks old
6 weeks (doctor)
2 months
4 months (doctor)
6 months
8 months (doctor)
10 months
12 months
1.5 years (doctor)
2 years
3 years
4 years (see the doctor and public health nurse)
5 years
6 years

This week I helped the nurse during these appointments. Mostly it was checking development, like rolling over, hearing, losing baby reflexes, ect. It is difficult when the parents feel uncomfortable speaking English, so then I end up spending the hour not understanding...sometimes it took all my concentration to stay awake!! But the nurse again was so wonderful and very passionate about her work. She told me at the end that before I came she was very nervous to have an international student, because she wasn't sure what I'd be like and she thought she would struggle with English. It's very humbling to be told something like that, and then hear that she really enjoyed her week, couldn't have asked for a better student (yay!), and to come back and visit her!

Another thing I was interested in is the differences in vaccination recommendations. In the US the routine is to give Hep B at birth before leaving the hospital, unless parents decide not to have it. They only give it here if there is a high risk factor for the baby getting the disease. They also don't immunize against Chicken Pox at all. The government pays for all the childhood vaccinations and decided that the HPV vaccine was more of a priority than the Chicken Pox. Of course if the parents want it they can pay to have it. They also have to pay to get Hep A/B. So that's one big downside of this kind of healthcare. The government has to prioritize the importance of immunizations. But I have noticed that there is excellent continuity in healthcare. They have good interdisciplinary teams and the pediatric nurse works closely with the school nurse so as the child transitions in life, there is an easy transition to those changes in healthcare. They don't have to fill out so many forms every time they go somewhere. It is all in the system :)

The pediatric clinic was probably my favorite place to be. There is no language barrier with babies and children. :) I loved making faces and playing with them in my broken Finnish. I did notice that in cultural and language boundaries one of the most important things is nonverbal communication: how you sit, how you pay attention to how they are speaking, your facial expressions, ect. I made a point to introduce myself and greet in Finnish. I could understand the nurse introducing me, so I was able to talk to them at that point a little in Finnish and English. I noticed that playing with their kids and seeming at the same time like I was listening is what warmed the parents up to me and to speaking English to me. They were able to see that I was interested in them and their child's healthcare, and because I had to make the extra effort to go out of my way to talk to them and interact with them, they were very willing to let me be an active part of the appointment. I really appreciated that! I know that sometimes I can be an introvert and it would have been easy just to sit there the whole time. But nursing school has put me in very uncomfortable situations before where I have had to be an active voice and make myself a participant. That has served me well and prepared me for being here. I had to make an extra effort here to learn and participate, and in a way that makes me feel like it is that much harder and probably that much more rewarding for me, too.

So all in all my three weeks of public health nursing have been very eye-opening. I've learned that people like their healthcare here (they hate the huge taxes and cost of it), but enjoy the benefits and services that they see as the government taking care of them. I've met really fantastic nurses who have a passion for teaching and sharing their knowledge. I've improved my Finnish :) This week is a wrapup final group presentation and exam at the university. Then I'm off to my Winter Ski Holiday!

We were good buddies :)

Frosty the Finnish Snowman

Today I made my first snowman in many many years! This afternoon,  we went out to the summer cottage on the lake (frozen lake now) and spent some time with the extended family. Mostly we were watching the kids skate and play hockey on the lake. I didn't bring skates, but I got some hockey practice in :)

The temperature has been a little warmer here today, so the snow melted a little bit, making this perfect snowman snow. I felt like a little kid again rolling around on my hands and knees getting so excited about snow!

I even donated my scarf for the cause

And the snowman is in the perfect location. At the end of the platform leading out to the sauna. You can see it from the door of the house. :)

(Rural) Women's Health Nursing

This week I did my clinicals about 30km out of Savonlinna, in the area of Kerimäki. I thought Savonlinna was small, but this town makes Savonlinna look like a major city! There are about 30,000 people living in and around Savonlinna. Kerimäki has about 6,000 and that includes towns about 10km around it. It's pretty rural. (They are proud of their 40 new babies each year haha). Even so, it was really interesting to see the differences and similarities. Because it's all part of the public healthcare, things ran pretty much the same as in Savonlinna. This health center basically is a branch of the main one in Savonlinna.

But I'm getting ahead of myself. The day started every morning at 6:30 (or 6:35 if I felt like running late). I had to leave the house at 7 to walk to the bus stop to catch the 7:15 bus. I sat on the bus until about 7:50ish and then made it to the health center just in time for it to open at 8. Oh and it cost me 6 euros one way. I loved the bus ride actually because it took me through woods and small villages in the area. It was so beautiful.

The very tiny bench only bus station. 

I'm getting really good at taking selfies :)

I've explained a little about the healthcare, but basically, any preventative services are provided at one office: the health center. So, there you can find the pediatric clinic, the maternity clinic, the clinic for older adults, the diabetic nurse, the mental health nurse, the social worker, the dentist, ect. These clinics are all run by nurses, but several days a week, there is a doctor on hand. Since Kerimäki is very small, there is only one women's health nurse that meets with all the women in the area for prenatal, family planning, vaccinations, and things like pap smears. One nurse takes care of all the women! They see the doctor only if they need to start a new contraceptive or to put in an IUD or something that the nurse can't resolve on her own or if the patient requests it. Again, public health nurses here have a lot of responsibility and do so much in taking care of the day to day things. I've noticed they seem to be between a Registered Nurse and a Nurse Practitioner, like we would like of it.

The Public Health Nurse sets and runs her own appointments and works very independently

The public health nurse in the women's health side takes care of all the prenatal appointments for women, about 9 times. They also visit the doctor at the clinic once, and the doctor at unit at the hospital twice. They are never sure which doctor is going to be there, but since Savonlinna Hospital and healthcenters are small, usually they are the same ones. At their regular appointments, the nurse measures basic weight, hemoglobin, tests urine, measures fundal height of the baby, finds the heartbeat, can do the 10 week ultrasound, ect. She is the one to notice rising glucose levels or high blood pressure, after which she can make recommendations and refer the patient to the specialists, who work at the hospital.

I thought this poster was so cute!

In Finland, women get maternity leave for 9 months and men can get it for 3 weeks. After the mom goes back to work (if she has to), the father can get another 1 month leave. After the 156th day of the pregnancy, women can apply to get a maternity package. Basically, it has outfits and supplies for the baby for the first several months. You can opt out and get money instead (140euros), but it sounds like most people get the package. This is free for them from their national health insurance called Kela, it comes out of all the taxes that they pay. Expecting parents also get a free dental visit, basically a chance to learn more about taking care of their teeth and how to do that for their kids. I don't think dental is included in their free healthcare. After the baby is born, the Public Health Nurse makes a home visit within 10 days to check on the mom and the baby.

Maternity Package (if you're interested in seeing what comes in the package)

This week I spent a lot of time with the nurse doing these prenatal visits. It was really hard not speaking the language, but most understood English if it was spoken, so I was able to say some things. They all let me feel the baby and find the heartbeat, and do that fun stuff. I just loved seeing how happy these women were! It felt like we were doing something good. We also did preventative care, such a pap smears and health checks for older women, updating vaccinations (such as TDAP or HPV), counseling for contraceptives, and today we did a home visit for an new baby.

Feeling very official :)

As a side note, I really like the idea of at least one home visit for new babies. We spent about an hour and a half there, taking care of the mom, making sure she wasn't bleeding as much, checking her hemoglobin and BP, counseling with her about changes in her life and how she's adjusting and coping. We also talked about diet and contraceptives. Then we measured the baby's weight, did an assessment of growing and reflexes, and watched how he was breastfeeding. It was a comprehensive visit to make sure mom and baby (and the dad!) were recovering well. It was so personalized, and the family really welcomed us and respected the nurse's input. I really prefer this to our system. I know that there is a "class" often given at the hospital that talks about these same things and then the baby goes for his first appointment a week or so later. I think having the nurse come to the house is a really good idea. The mom is still recovering, but you get a better glimpse of family life and the way things look. The mom is more comfortable opening up. You can observe, is the house a mess? Is the mom put together? Are there other kids preventing mom from recovering? It is a good holistic way to help mom and baby.

The public health nurse has so much information around her office that she can share. She has info about contraceptives, agencies for social services, products to use for different complaints, where to get extra help, classes on how to eat right and feed the baby well, info for new dads so they don't feel left out of the pregnancy process ect. ect.

This cabinet was only hiding the massive amount of pamphlets she had on hand!

It was another good week with a great nurse to work with. She and I laughed so hard so often, we got very distracted from work! When she found out that I love the Finnish piirakkas (rice pudding pie/pastry), she brought one in for me, just because. I have found so far that the Finnish nurses are very compassionate, caring and passionate about what they do and eager to share it with others!

Runebergintortut

On February 5th, Johan Runeberg, one of the most famous Swedish-Finnish poets was born. Runeberg wrote all kinds of poetry about Finland, rural life, and the war with Russia (after which Finland become a Grand Duchy of Russia until 1917). One of his poems later became the Finnish National Anthem.

Each February, Finns celebrate Runeberg's birthday with a traditional Runebergintortu, a cake made with almonds inside, raspberry jam on top, and a circle of vanilla frosting. According to the story, Runeberg's "Lady Wife" as Leena called her, used to make this every morning for her husband's breakfast. So in honor of him, we enjoyed this:

Most people just buy these cakes because they are kind of difficult to make, but you can only buy them in January and February. The nurse I was working with last week found a recipe for me, so you can bet I'll be attempting to make these once I get home :)

Skates and Frozen Lakes

This weekend I had my first outdoor sports in Finland. It was so exciting! 

Savonlinna is almost completely surrounded by lakes, and this time of year, they are finally frozen over enough to ski and ice skate. I've had my fair share of ice skating, but it's never been on a lake! So Leena and I packed up the two kiddos along with a neighbor friend to enjoy some time in the Finnish sunshine.

The original plan was to skate the 2km to the other side, have some warm pancakes and then skate back. We probably only made it 1km with the kiddos :) 

Now, even though I lived in Utah for the past five years, close to the "Best snow on Earth", I have never been skiing. Cross-country or downhill. It's really a shame...and a little embarassing. That's ok, though, because I'm definitely getting that experience here!

I started off trying the cross-country skiing. Let me tell you, I definitiely underestimated how hard it is! I only did it for about 5 minutes before I awkwardly fell down. I know I looked like a foreigner for sure because the kids here learn how to ski in elementary school. Good thing there are no picture of those few minutes. But Pekka here was patient, and even though he speaks no English and I speak little Finnish, he was very helpful :)

I haven't given up on skiing! But ice skating is more up my alley. 

The weather was really nice, and skating on the frozen lakes through the beautiful woods of Finland was such a cool experience! I mean, just look at it!

Even though we didn't make it all the way we wanted to, we had a great time together with friends and family. I will definitely make the trip over to this place again sometime soon

I love my Finnish mother :)

School Health Nursing

Disclaimer: long post ahead!

As I've mentioned, I spent my first clinical week following a public health nurse at two different elementary schools, Normaalikoulu and Kellarpellon koulu.

See this unassuming field?
They teach the kids how to ski and ice skate starting in 1st grade!

Public health nurses have additional education beyond a nurse and work somewhat independently in this healthcare system. They make their own appointments and manage the health of school age children, looking out for diseases such as diabetes type 1, eyesight problems, hearing, or vaccination needs.

In this public system, nobody falls through cracks. From the time the child is born, they are part of the child clinic that follows up until school age, then the school health care, then student university healthcare, then occupational care, and if needed, maternity care. As the people move up in age, their "primary care" is offered at these clinics. For the school age children, this clinic is at school.  Some of those primary healthcare services that are provided include yearly health checks by nurses, and physical exams by physicians every few years. Public health nurses manage these clinics and perform a lot of services for families. When the family goes to the doctor for a physical, they see their nurse, who remains the same, but they cannot pick their physician. The nurse may spend 40-60minutes doing a health check and interview, the doctor usually only gets 20 if it's a healthy child. In these elementary schools, the doctor visits once a week, and that's when the school nurse can discuss any concerns about specific children needing appointments or referrals to a specialist.

In this system, public health nurses are very well respected and needed. Parents call them first for child illnesses, and in school health, she is the most visible healthcare provider. If they feel ill at home (and it's non emergent) they call the school health nurse. She then assesses and advises them on what to do, and if needed, makes an appointment with the school physician. Those appointments take place usually at school. Basically, the healthcare for the school age child is provided at the elementary school level.

The office...

This week at school, I helped the nurse perform health checks. In grades 1,5, and 9, they have a physical with the doctor as well. Our health checks included interviewing them about their stage in life, their hobbies, interests, family life, and stressors. We took height, weight, hearing, vision, BP, and hemoglobin levels. We talked about alcohol and tobacco use and eating healthy. For these kids, I was able to talk to them on a basic level in english. The nurse translated for me for other times. We also gave vaccinations as needed (many of those are free to students through their healthcare) and washed out many ears :) A useful skill. Of course, there were kids that got hurt at gym or felt ill. We assessed them as needed. We also checked blood sugars and were watching out for symptoms of diabetes. We had meetings to attend with the interdisciplinary team: principal, teachers, social worker, special education teacher, and school psychologist if needed. The school health nurse provides teaching as needed for these members about different illnesses and is the person responsible for catching changes in health and promoting it.


I think that having health care in the schools makes the public health nurse visible to students. I noticed that the kids all knew her by name and came to her with their concerns. Because anytime they are sick or for their yearly health checks they come to her, they know her and trust her. When I think back to the school nurses I had, I don't remember them. Because they weren't really visible. Yes, they performed eye or ear checks. They check for scoliosis.  But these school nurses are part of the primary health care system, and do the work we would think of in our doctor's offices.

Sirkku, the nurse I worked with was so kind and compassionate to these kids. She has a gentle voice and a calm demeanor that puts the kids to ease at once. I was nervous, too, haha but she made me feel so welcome! She answered my millions of questions so patiently. She is a gem :)

I'm also a giant when you compare height!