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I’m currently sitting at the Columbus airport waiting for the first leg of my flight back to Finland while enjoying my last taste of American pizza for the next few months. I initially thought I might write a bit more over the holidays, thinking maybe I would be ready to reflect on all that the first half of this adventure has held, but with only 12 days to see family and friends I was kept pretty busy. Thankfully, the new year and the inherent sentimentality induced by airports has finally given me the inspiration I need.

A very wise friend of mine loves to talk about how we often oversimplify our time abroad, feeling as if simply being in a different place engenders some sort of rare self-discovery. And she is right. Living in a different country provides a lot more questions than answers, especially about ourselves and some of our most strongly held beliefs. Over the past 4.5 months, I’ve been challenged in so many ways. There have been times when I’ve wondered if I will continue doing this work for the rest of my life or if I will change my path and land in a different area of medicine. I’ve endured interactions that have made me feel like I’m from a different planet and not just a different country, and left these interactions reminded of how hard communication can be sometimes. There have been times when I wasn’t sure if I really had this whole adulting thing down well enough to balance work, travel, and family and friends, all while living in a new country and adjusting to cultural changes. I’ve been made to wonder if there really is any perfect approach to healthcare, education, social services, etc., if even here there are things to improve upon. And finally, I’ve been forced to reconsider how I communicate, when I should stand up for myself, and when I can let some things go.

We definitely have some things to learn from the Finns, and they have a lot they could learn from us as well, but I think the beauty of being immersed in a new culture is that you have the chance to encounter and digest different perspectives in the places they are created, and eventually return home to decide if and how these perspectives may fit into your own. But you can’t really know this until you leave. Returning home, I’ve been reminded that our country is far too large and too diverse to discredit. Sure, we have a lot to improve upon, but it isn’t fair to forget about the sheer differences between our two nations. While there are days when I generally feel hopeless about the state of American healthcare, it is good to remember that we are doing pretty well given our history and culture. I’ve also decided that (surprise!) Americans are too loud, especially in public spaces, but Finns are still far too reserved for my taste. I can’t tell you how nice it felt to finally interact with strangers normally while back at home. When I smiled, people smiled back, and people were never visibly awkward when I asked them how they were doing. While this is the case, I’m really looking forward to the reliable peace and quiet of Finnish city streets.

Being home and finally getting to feel like my full self again was a much-needed reminder that 1.) I don’t stick out in the world as much as I might think I do in Finland, because in America I am at least a sort of normal human. And 2.) I am one of the luckiest people alive to be able to have this year to explore, learn, and grow even if it means I have to leave a lot of people and places I love back home. My day to day routine in Finland may sometimes feel monotonous and nearly everyday holds some sort of challenge, but when I really step back and think about this life I’m living right now, monotonous is the furthest thing from reality. Here’s to 4.5 more months living in this winter wonderland and doing the work I love.

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The Finnish Arctic (& why we should all care about climate change)

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After a beautiful weekend spent in Finland’s north, I’m beyond grateful that I had the opportunity to see the arctic in all its (slightly warmer, but still existent) glory. Our adventure to the north started with an overnight train from Turku to Rovaniemi, the largest city in Lapland just across the arctic circle. Sleeping on the top bunk in a cabin on a moving train didn’t make for the best night’s sleep, but nonetheless, we arrived in Rovaniemi the next morning ready to immerse ourselves in a winter wonderland.

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And that is thankfully what we found. Unlike the Brits who have recently been in the Finnish news for their coining of the term “Crapland”, we found Lapland at its finest: at least a foot of snow wherever we went, trees hanging heavy with snow and ice dangling from their branches, and sunrises and sunsets that can only be seen when one is so close to the earth’s poles.

And in the midst Lapland’s beauty, we also found the simplicities (and difficulties) associated with rural living. I was reminded of how hard it might be to live in small town Ohio as a foreigner, attempting to get around without a car and with minimal and/or unreliable public transportation. And because public transportation was nearly non-existent in Rovaniemi, a rarity in Europe for sure, we found ourselves walking in the dark a good bit. Although our cold treks might not have been super glamorous, I think these were my favorite moments of the trip, as this was when the air sparkled with snow  turned stardust and the sky was the clearest I’ve ever seen.

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No pictures can do it justice. PC: Michelle Paterick

Now, everyone knows I couldn’t write romantically about Finland’s arctic and not discuss the very real issue of climate change. While I’m certainly no expert, unlike several of my Fulbright Finland counterparts, climate change impacts my own research just as much as it impacts everything else. It may be something we like to sort of joke about in the U.S.– even as a scientist who wholeheartedly knows the reality of climate change and believes something needs to be done, I am still guilty of making jokes about global warming on extra cold days in the middle of winter– BUT in Finland, the effects of climate change are nothing to joke about.

Speaking with older Finns who remember what winter here was like in the 70s, 80s, and 90s, it is evident that the whole nation has continuously and very quickly warmed. The arctic circle recently experienced its hottest year since 1900Turku recently experienced the warmest May on record since the early 1980s. Finnish people speak about days when they would have to crawl out of their bedroom windows to escape their homes in the winter, as the snow would pile up too high to open the front door, but this “permanent snow” accumulation has steadily decreased with scientists predicting that Lapland will be the only place in the country with permanent snow accumulation by the end of the century. And the article about “Crapland” is even more evidence that climate change is greatly impacting Finland, but those nations particularly at fault for the problem are doing little about it and are instead simply complaining that their holiday was cancelled.

It is a sheer privilege to be able to see the arctic before it likely disappears forever, just as much as it is a privilege for some to complain about “Crapland” and not feel compelled to do anything about it. This is an issue at the forefront of climate change discussions, as just last week leaders from the U.S. and other developed nations were rightly criticized for shying away from taking steps to halt climate change at COP24. This is while less developed nations that have just begun urbanizing within the past 50 years instead find themselves at an additional disadvantage trying to crawl their way out of natural disaster after natural disaster. At the end of the day, the issue is just as much one of social justice and public health as it is one of the environment.

As a U.S. citizen seeing the impacts of climate change in Finland, it makes me sad that our federal government will not take the same steps that other global leaders are taking. We know we only have years left to change the direction of our planet, and while many individual states are ready to take steps, our nation as a whole, one of the biggest culprits of the problem, chooses to pretend that it is not real. While Trump’s promise to pull out of the Paris Agreement can’t officially be enacted until 2020, and our nation is now 1 of 190 to come to an agreement this past week at COP24, the general hesitancy prevalent in our national dialogue is concerning. For anyone who thinks climate change is fake news or crap science, I beg you to come see the arctic and decide what you think then. A place as beautiful as Lapland is worth taking steps to save even if you don’t believe there is a problem.

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When we told Santa that we all thought Finland was bit cold, he said “This is nothing.” Santa knows.

Hanging with Parliament

The Friday after Thanksgiving, all of the Fulbrighters were invited to have lunch at the Finnish Parliament in Helsinki. The lunch, which was arranged by Fulbright Finland and Finnish Fulbright alums who now work in parliament, was hosted by Hanna Sarkkinen and Mats Lofstrom, two members of parliament. MP Sarkkinen is from the leftist party, and MP Lofstrom is from the center party representing the Aland Islands. As you can imagine, this combination led to some fascinating conversations.

The lunch started with the members sharing their thoughts on hot topics in Finnish government and the items that would likely play an important role in the next election this coming spring. One issue of relevance that I’ve been following is the potential restructuring of the Finnish healthcare and social security systems. This restructuring would create an intermediate body between municipal regulation and federal regulation, allowing the provinces to play more of a role in the administration of these services. Although I’m not sure if I have a clear opinion on this issue, nor do I feel warranted to have one, it has been discussed with worry by some of the physicians at the hospital. While this is the case, the members of parliament seemed quite positive about it, suggesting it would decrease bureaucracy and increase flexibility in these systems.

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The perspectives of each member in attendance, while sometimes quite different, were always extremely cordial and straightforward. You could sense their respect for one another in their dialogue, each acknowledging the others’ background and its influence on their perspective. For instance, MP Lofstrom from Aland represents a very rural, sequestered (and completely Swedish speaking) part of Finland, and so his political values are quite different from that of MP Sarkkinen who comes from the very techie (and predominantly Finnish speaking) city of Tampere. In addition to their respectful manner, another thing that we all noticed immediately was their relatively young age. MP Sarkkinen is just 30 years old and was only 27 when she was elected (To put this into perspective, we have Fulbrighters who are 27 right now). MP Lofstrom, while a little bit older, is still under 40. Although not all members of parliament are this young, the average age of all Finnish MPs (44 years of age) is by far lower than in the US (58 years of age in the house, 62 years of age in the senate).

Eventually, we had time to ask the members of parliament some questions. Of course, many of us wanted to know what Finnish elections are typically like, and how these national elections fit into the greater scheme of things with the EU. Finnish elections typically don’t have the same level of political advertisements, and they are rarely characterized by negative ads. Additionally, there is no necessity to vote according to party due to the sheer number of political parties and the intentional focus on the individual candidate rather than the political institution. This system seems to succeed in putting the country, and not politics, first.

After lunch, we began our tour of the parliament building. We were able to sit in on a voting session and see the votes come in on various issues. The environment in the parliamentary room was, again, extremely respectful and light. There were even times when laughter ensued after a vote, with jokes across party lines keeping things friendly. While the light-hearted environment was fascinating, the thing that struck me the most was the statue at the front of the room. At the center, there is a statue of a mother holding a saluting child, all covered in gold. We asked our tour guide what the statue represents, and he said that it is there to remind the members of parliament of their true duty: to make Finland a better country for the next generation. While I think it must also help remind the MPs of the importance of mothers to a happy, healthy society (because the maternal and child health scholar in me can’t not think that), I believe the intended message is one that we all need to be reminded of, especially when it feels like our nation is continuously putting hostile politics before our children’s futures.

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A replica of the statue that stands in the middle of the parliamentary room. 

 

Hyvää Kiitospäivää

As you can probably imagine, this past week was a fairly weird one to be an American living abroad. To most people in the world, Finns included, the third week of November is just that– another week. But for Americans, its time to start thawing turkeys, baking pies, and beginning to make room in our stomachs for the yearly feast that is Thanksgiving.

Thanksgiving tends to be my favorite holiday of the year, mostly because it is just so simple, but also because I think everyone should take some time now and then to be grateful for whatever it is in our lives that makes them worth living. While the cooking may be time-consuming and the stress of traveling can be exhausting, the whole purpose of the holiday is to just eat and be with the people you love. I honestly can’t think of another holiday more wholesome than that.

While my enthusiasm for Thanksgiving is always well-received with my American peers, my excitement for this day landed on deaf ears here in Finland. The conversation at the hospital lunch table was not filled with discussion about what each person was cooking or what family members they would be visiting. My Finnish class did not use the opportune time to teach us new words pertaining to such a day (although we did discuss Black Friday, which is apparently just as much of a capitalistic monstrosity in Finland and other European countries as it is in the US). And my roommates continued to wonder why I was spending so much time stressing over my homemade noodles to be eaten at the Fulbright Thanksgiving feast. While this all made for a little bit of a gloomy beginning to the week, I couldn’t be more grateful for the Fulbright friends turned family that I was able to spend the day with.

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Before entering the “all you can eat” room at the Fazer chocolate factory

Fulbright Finland always has several Thanksgiving events for the American grantees during this time, likely because they realize that it really can be an isolating time to be abroad. They planned a tour of the Fazer chocolate factory for us all to start the holiday off right (by stuffing ourselves with an inordinate amount of chocolate). It was maybe not the best way to prepare for the Thanksgiving dinner to follow, but we all managed to rally. The potluck dinner held at the Fulbright Finland Bicentennial Chair’s apartment afterward was just as delicious as it was diverse. I’m not sure if there is a more beautiful way to spend the holiday than enjoying the diversity of foods we have in our country with people who are just as full of character as their dishes. We each shared some of our family Thanksgiving traditions with the Fulbright Finland staff, who all seemed just as excited to be experiencing Thanksgiving as we were.

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Yay food!!!

I think I speak for all of the Fulbrighters when I say that the people of Fulbright Finland are what make this program so successful here, and I know that I have them to thank for the experiences I’ve had and the friendships I’ve made. The other Fulbrighters and the Fulbright Finland team have really become my family away from family and it was a joy to spend the holiday with them. With a full tummy, I left Thanksgiving that evening beyond grateful for this amazing opportunity, the people I’ve met because of it, and our beautiful, if sometimes flawed, world. Thanksgiving may be a predominantly American holiday (sorry Canada?), but the purpose of the day is universal: to be grateful for those around us, the things we’ve been blessed with, and the lives we are honored to live.

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Just some happy people with full tummies and full hearts.

Am I really qualified to give a guest lecture?

*I wrote this way back in September and never got around to posting it, but reading it now was a much needed energy boost during data collection. Qualitative data collection is always a slow process, and there are so many days that I now spend just waiting for eligible families to consent to my study, but this reminded me that it is so worth it no matter the time it takes. 

Ehh, maybe? Maybe not. I’m not really sure, but this week I found myself speaking to 15 masters of nursing students at the University of Turku who were all part of a qualitative methods class. So maybe, just maybe I do know enough about that.

Hannakaisa, one of the professors in the research group I’m a part of, asked me to come speak about my previous research at Elon and to give a student’s perspective on coding interviews and developing larger themes. While I definitely don’t consider myself an expert on the topic of qualitative research, I have done it enough to have some tips to share, and so I went in hoping to impart at least a little research wisdom.

Qualitative research can be quite tricky, and we discovered through my presentation and the discussion that followed that many of these difficulties exist across cultures. For instance, what happens when you’re already an “insider” of the environment you wish to study? How do you mediate your biases when you may be, say a nurse, wanting to study your own patients qualitatively? Or most tricky of all, how do you ensure that your data truly represents the human experience you want to study, while also allowing room for the variability that qualitative research is so good at providing?

All of these questions and more came up as we spoke about our own experiences with this work. I provided the students with a sample transcript from my previous research to let them try their hand at coding. After revealing to them how I coded it, we of course each had different ideas about what codes were appropriate. Even more, one of the students asked how to focus on just the topic of study, and not all of the other interesting things captured in the transcript. I was reminded of Dr. Fair’s mentorship during the midst of my own coding process when she told me to “take note, but ignore the shiny, pretty things for now.” The first goal is always to answer the intended question. The second goal (and maybe one a few years down the line) is to explore the shiny things.

Really, this is why I believe qualitative research can be so beautiful. There are always infinite answers to the question, and even once you feel you’ve answered it, you can always find another question to ask. I left the guest lecture (read: super chill nerd discussion) reminded of the importance of documenting the human experience with words and emotion. Numbers may be objective, but there is so much more beauty in utilizing our personal stories to create knowledge.

Learning to Trust Parents

A few weeks ago, Dr. Lehtonen and her colleague Sari Ahlqvist-Bjorkroth invited me to participate and help with an information session for the Close Collaboration with Parents training program. This was held for several interested physicians and nurses from countries like Israel, Estonia, and the Czech Republic. I’ve already discussed a little bit about the program in one previous post, but I now have a better understanding of all that the program entails. The information seminar lasted two days, with the first spent discussing why the program is important and some of the research findings related to its success, and the second day showing how it is executed in the unit in Turku. Of course, most of my time here has been spent seeing how the program has been executed in the unit, even if I didn’t realize it, but it was still wonderful to get a glimpse of how the magic that the staff in the NICU create begins.

It was fascinating to hear the questions that many of the participants raised during the information session. Before seeing the unit and understanding the ways they do things here, I probably would’ve asked similar questions. How do you minimize infections if you allow siblings to visit? Do families actually give you a good description of how their infant is doing? So babies sit in rooms alone if nurses or family members aren’t there? It does sound impossible to implement this type of care when you come from units that barely have any parental presence, never allow siblings, and have 10+ babies in one room with several nurses caring for them all. But slowly, as the participants watched videos and saw the unit, they began to see that it really is possible. By understanding that it is a step by step process that doesn’t happen overnight, but requires slow, intentional steps toward family-friendliness, replicating the care culture that the unit in Turku has built doesn’t seem so far off.

The training program has already been implemented in 11 international NICUs and has shown great success in all of these different cultures and healthcare structures. Generally, the units go through an iterative training process, where part of the unit is trained and then those staff members become the trainers for the rest of the team. It is an extremely holistic approach, with leadership, physicians, nurses, and therapists necessarily involved for the curriculum to work. While it hasn’t been implemented in any U.S. units, the program could finally help us actually implement real family-centered care. Clearly, even Europeans have hesitations about letting go and fully trusting parents, but if they can do it, so can we.

A Little Piece of Home

*Disclaimer: I’m posting this weeks late because life. I wrote it just a few days after my dad and Suze left town, but didn’t get a chance to edit it until now so please forgive the messed up timeline.  🙂

A little bit of Ohio came to visit me this week! My dad and step-mom, Susan, came all the way to Turku with American snacks, winter necessities, and lots of hugs for me in tow. They have been planning lots of trips around my time here in Turku, and this is the first of two visits they plan to make to Finland while I’m here. Of course they weren’t pleased when I asked them to bring half my closet and half the grocery store across the Atlantic, but they made it happen and I couldn’t have been more grateful.

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I met them Tuesday evening at the Helsinki airport, taking the train from Turku to Vantaa and then directly back again. They were jet-lagged and wide-eyed, but nonetheless ecstatic to see me when I found them at the airport train station. I had booked a dinning car table on the train back to Turku, so we were able to eat and catch up all at once. We were, as expected, the only people talking on the train, and my dad and Susan couldn’t get over how quiet nearly all public spaces here are. I remember the peace and quiet being a difference I noticed immediately as well, but have since gotten used to it I guess. It’s funny how you forget those small differences once you’re here for a while, but noticing them again makes me appreciate them even more.

Although my parents were only here for four days, we packed them with Turku’s famous sights, lots of nature, and heartfelt meetings with some of my favorite people here. The castle and cathedral were some of my dad’s favorites, while Suze loved the Fazer chocolate cafe and Marimekko. They also got to stop by the NICU one morning to see where I work and compare the unit to the one they experienced back home in North Carolina. The preterm birth of my twin niece and nephew almost 5 years ago was a huge moment in all of my family members’ lives, and its the inspiration for why I do what I do. My dad and Susan spent hours with my sister and her husband in the NICU, and so they have a good idea of what the NICU is like in the U.S. The unit here is so strikingly different that it is sometimes hard for me to believe its real, and they felt the same way when they visited.

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Our evenings were filled with meeting my friends and mentors here over good food. We had dinner Wednesday night with my good friend Michelle, another Fulbrighter living in Turku. On their final night here, Liisa, the physician I work with, made us the most lovely dinner full of traditional Finnish dishes–Smoked salmon and rye appetizers, reindeer and potatoes, and Glogi for desert. Although it’s always nice to have your family meet your friends and mentors, these meetings felt particularly joyful, and I think it left my parents feeling a little more at peace.

Although I haven’t really missed home all that much outside of the occasional cravings for certain foods or the intermittent FOMO I have for Elon events or family gatherings, words can’t describe how nice it was to have people who really know me be here. People always talk about “discovering yourself” while abroad, but that paints an oversimplified picture. Of course, the suggested self-discovery of travel results from the experience of truly being an outsider in a new place, but I’m not sure if this experience is ever fully translated to normal life once you return. The person you were at home and the person you become out of necessity while abroad are very hard to congeal. I’m not sure I’ve ever been able to fully integrate these two versions of myself after any of my travels, and maybe that will change because I’m actually living in Finland, but I still feel that there is this huge difference between the Sarah I know and the Sarah those in Finland perceive me to be. Be it the language barrier or the cultural differences, it can be hard to feel like I’m ever fully portraying myself accurately in my actions and words, but with my family here a little bit of that dissonance subsided.

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We said goodbye for now on Friday evening, and they successfully caught the train to the airport early that next morning. It was hard to break our hugs when I left, but I will see them (and the rest of my family) at Christmas. Overall, it is always a good feeling to have your family fall in love with the places and people you’re falling in love with, and I’m already looking forward to the next time they visit.