(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!