I’m Tallinn you what…

Being in Tallinn, Estonia for the weekend was wonderful. It was the first of what I hope will be many spontaneous travel adventures with friends over the next nine months. A group of Fulbrighters decided to hop on the ferry (cruise ship?) from Helsinki to Tallinn for a few days of exploring. Although we were in the country for less than 48 hours, we saw so much and all left in awe.

IMG_9400
Post ferry breakfast outside.

Mihkel, one of the Fulbright Finland interns, is actually from Tallinn, and he joined us as well, serving as our local tour guide for a few days. It was beyond kind of him to show us his city, and we all loved getting an insider’s take on its history. Estonia is a very young nation, just gaining its independence from the Soviet Union in 1991. Estonian culture is quite ancient though, and so this unique history produces a nation with interesting juxtapositions of old Europe and Soviet influences.

The “ferry” to Tallinn left early in the morning, and so we were able to have almost all day Saturday to explore. We started our day at the Tallinn TV tower where we were able to enjoy views of the whole city and also explore the “There are no bananas: Time Travel to Soviet Daily Life” museum. The TV tower in Tallinn has had an important role over the past 30 years, as Estonian nationalists chained themselves to the tower to maintain the nation’s connection to western culture during the nation’s fight for independence. The museum attached to the TV tower gave us a striking insight into what life was like for Estonians less than 30 years ago. Its name is indicative of some of the items that many Estonians lived without during the communist occupation.

IMG_3219
The TV tower
IMG_3255
Part of the Victims of the Communist Occupation memorial. When you look through the gunshot holes you see the image of a fallen Estonian soldier.

We followed the TV tower with a visit to the Victims of the Communist Occupation memorial, which just opened this year. The memorial begins with an upward climb lined with marble walls called The Journey and ends in an open field entitled the Home Garden. The 22,000 names of those who went missing or were murdered during the occupation are inscribed on the walls which lead up to the garden full of apple trees. The design of the memorial reminded me a lot of the Vietnam War memorial in DC, and was just as humbling to walk through.

After finishing our tour of Soviet Tallinn, we headed toward Old Town, which is the Gothic part of Tallinn and is a UNESCO world heritage site. Old Town was the first time I experienced what I had always imagined old European cities to be like: cobble stone roads, colorful buildings with terraces full of flowers, and old churches with tall bell towers on every turn. It was stunning. We spent the evening and next morning just wandering the streets of Old Town until we finally had to get back on the “ferry” home.

IMG_3271
Old Town
IMG_3291
Some of the eerie statues around town

IMG_3295IMG_3299IMG_3300

5d15601d-ab6f-45fe-9af2-69d08c76ca50
The view from the balcony of our air bnb. Literally stunning.

 

Advertisements

A Proper Finnish Welcome

Fulbright Finland definitely knows how to welcome their American grantees. I’ve just finished a wonderful week of orientation in Helsinki where I was finally able to meet the other grantees, learn more about Finnish culture, and see the energetic Fulbright Finland team in action.

Fulbright Finland is fairly unique in terms of the work it does to support both American and Finnish grantees. As a Fulbright commission country, rather than a Fulbright consulate country, Finland has really put energy into creating a strong bilateral program that allows for innovation and free trade of ideas between our nations. The long history of exchange between our nations began even before Finland joined the Fulbright program in 1952.

In order to make us feel welcome and learn as much about Finland as we possibly could in 4 jam-packed days, we had speakers from various Finnish ministries and U.S. departments. A representative of the Ministry of Education and Culture and two higher education representatives came to discuss the Finnish education system. The Ministry of Foreign Affairs coordinated discussions on Finnish international relations and the Finnish economy. There, I got my first in-person glimpse of a Finnish baby box, and pure joy obviously ensued.

Screen Shot 2018-09-05 at 8.57.57 PM.png
Image from the Finnish Ministry of Education and Culture
IMG_3128
The baby box!

We also had some time to engage in Finnish culture this past week. Our first evening in Helsinki was spent at a Finnish cultural center on the island of Hanasaari learning how to properly sauna, ice swim, and play Molkky. Sauna and ice swimming were quite invigorating, although I don’t know how the Finns cope with the cold water once winter comes. With the air temperature currently less than 60 F in the evenings, the water is already cold enough to knock the wind out you. Molkky is a traditional Finnish yard game that requires tossing a wooden mallet at pins labeled with numbers. I would describe it as a mix of corn hole and bowling.

DSC_0156_1
Find me to the left bracing myself… 
DSC_0229_1
Post-sauna and swim Molkky. Clearly its an intense game…

The week ended with a celebration of our achievements (although we all know that there are lots more to come before the year ends). Meeting my fellow Fulbrighters was exactly the energy-boost I needed to start my research. It was good to be in a group of people just as passionate about the work they are doing as I am about my own. Even though many of us are in different cities throughout the country, it is nice to know that there are people going through a similar process, and that we will all see each other soon. Until then, it’s time to get to work!

DSC_10397.jpg

The Transformative Power of Trust (and Other Really Wonderful Things about the Hospital)

IMG_3023
“Department of Pediatrics”

My first week at the hospital was spent mostly shadowing and getting to know the unit and their practices, and it has already exceeded my expectations. I’ve mostly been spending my time rounding with the attendings and residents, and even though I can’t understand much of what they discuss because they round mostly in Finnish or Swedish, I can already tell the difference in the care here. Much of this difference has to do with a culture of trust. 

One of my first observations was that the parents are nearly always present during rounds (and at other points of the day), and they don’t appear frazzled or stressed to be there. This is quite different from the parents that I’ve observed at home, many of whom have either slept poorly in a chair at the bedside or have woken up very early to make it to the hospital before the doctors begin discussing their baby. Here, many of the parents sleep in a hospital bed next to their infant and are able to shower, cook, and do laundry in the parent facilities just down the hall. This, to say the least, allows the parents to be present at rounds, but also provides some much needed normalcy to this very hectic time in their lives. 

I shadowed a nurse for a day, following just one mother and baby. This mother, like many of the other mothers and fathers in the unit, stays every night in the unit and is extremely involved in her infant’s day to day care. She is provided opportunities to participate in nearly everything–from changing diapers and picking out clothes to holding/kangarooing her infant and filling the feeding tube with her milk. She and her infant were always first encourage to attempt breastfeeding before her expressed breastmilk was put through her infant’s feeding tube, and even then the milk that the baby received was usually unfortified, unrefrigerated breastmilk. This is an important distinction to make because breastmilk looses some of its benefits when it is refrigerated/frozen, pasteurized, or fortified. We scientifically understand this nutritional difference, but U.S. policies don’t allow for the same flexibility of breastmilk use as exists here. 

One of the most amazing things I’ve seen has occurred during conversations between parents and physicians on rounds. The first thing the physicians do when rounding is ask the parents what they think about their infant’s health. We say we do this in the U.S., but I’ve seen rounds where parents are an afterthought, only being asked once labs and prescriptions are ordered and the team is on its way to the next baby. Even when we do ask at home, I’ve always felt that parents aren’t really sharing their true thoughts, but are instead saying what they think the physicians want to hear. Here in Finland, the families already feel supported by the NICU staff in so many ways that they aren’t afraid to share what they think. They know the physicians genuinely want to hear from them because, while they may not have much medical knowledge, they do have an instinctive understanding of their baby. These instincts exist partially because they are genetically related to the infant, but also because the physicians trust them to get to know their infant extremely well by providing direct care. 

Although I knew the NICU here was very advanced in its family-centered care and support of breastfeeding, I am still stunned that it can actually exist. The inherent trust that exists between families and clinicians here makes a world of difference. When we trust that parents know what is best for their infants and are motivated to take action on that, then physicians and nurses can spend their time practicing medicine for the infant instead of trying to exert control over the family. 

Ruissalo

On Sunday, Dr. Lehtonen invited me to join her for a walk and lunch on Ruissalo, one of the closest islands on the Finnish archipelago. I met her at her home in Turku and we drove from there across a bridge to the island. We began walking along the coast of the river that leads to the Baltic Sea and past many old Finnish homes and summer cottages. I have come to really love Nordic architecture, and the summer cottages are beautiful examples of it. They all have intricate woodwork lining the windows and roof, and are brightly colored so that they pop out of the green forest.

img_3004

While walking, Dr. Lehtonen points out several oak trees and says they are quite rare to see in Finland. The island may be one of the only places they grow because there is just enough rain in this region of Finland to support them. There were even several signs that talked about their rarity on our walk, and I couldn’t help but think of Elon when we were reading them. I told Dr. Lehtonen about our acorn to oak tradition and my oak sapling which she found funny. I’m now sort of regretting leaving my sapling behind (even though customs probably wouldn’t have been happy), because Ruissalo would have been the perfect place to plant it!

After walking a while, we came to the botanical garden that is run by the University of Turku, and stopped to eat lunch at the cafe there. Dr. Lehtonen told me that she often spends her summer Sundays this way, and loves the cafe’s Sunday special — Salmon soup. She is surprised when I say that we don’t have Salmon soup at home (at least I’ve never had it), but it resembles clam chowder, with potatoes and a cream base. We eat it with sweet rye bread, which is really one of the only types of bread they have here. Ruissalo actually has the Finnish word for rye — Ruis — in its name. It makes sense that rye is so common here since it is hard for wheat to grow in cold places, but I definitely didn’t expect it.

img_3005
Salmon soup and rye bread

We finish our afternoon with a walk to the seaside where I officially get my first close-up with the Baltic. We sit on the cliffs for a while, sometimes talking but mostly sitting in typical Finnish silence, and watch boats go by. Nearly every Finn I meet tells me that they are trying to “build up energy” for the winter, and I think a day like this one is exactly what they mean. I don’t blame them for wanting to spend the little warm time they have this way, especially when there is so much natural beauty to take in.

img_3002
The Baltic Sea

A Finnish Defense

On Friday afternoon, Dr. Lehtonen, my research mentor here, invited me to her PhD student’s dissertation defense. Although I’ve never been to an American dissertation defense, I have been to my own undergraduate thesis defense, and this was starkly different from that. With that being said though, I think a Finnish PhD defense is unique nonetheless.

In Finland, PhD defenses are formal affairs. The student and committee all wear black tie, which for men means a tux with a tail and for women means a floor length black gown. Everyone else wears business attire.

Dr. Raiskila making his statement (in Finnish)

The defense begins when the student and committee walk into the room and all of those in attendance stand up as they proceed in. Then there is a short statement from the student, which in this case was in Finnish so I understood none of it. Then the opponent, or the visiting scholar appointed to provide criticism, gives a statement about the overall thesis and then follows with questions to the student regarding the dissertation. Luckily for me, the opponent did all of this in English so I could understand.

Discussion between Dr. Nelin (the opponent) and Dr. Raiskila

The topic of the dissertation is actually exactly what I will be studying while in Finland. The student, Dr. Simo Raiskila, studies family-centered care and separation and closeness in the NICU. He is predominantly a quantitative researcher, and so it was interesting to hear the statistics behind the very subjective narratives that I study. His work is quite relevant in the field, as he has taken the first steps toward standardizing and quantifying family-centered care.

While Dr. Raiskila’s research has made strides in measuring family-centered care in a meaningful way, the discussion that ensued between he and the opponent got me thinking about family-centered care and its intangible definition. While as an anthropologist I understand that many perceptions of “good healthcare” exist throughout the world, I think it is difficult to know where the line between evidence-based care and cultural practice lies. Maybe in Finland, family-centered care means having parents in the room 24/7 and engaging in direct infant care, but maybe that is not what it means culturally for the U.S. While there are clearly many social differences between Finland and the U.S. (paid family leave time, racial and socioeconomic inequities, etc), these are certainly not the only factors at play. It is always easy to underestimate the power of culture, and the discussion was a great reminder that change cannot occur without taking culture into account.

After the defense, there is a celebration with cake, coffee, and champagne. During this time I was finally able to meet Dr. Lehtonen in person. Additionally, I got to reconnect with Dr. Nelin who served as the opponent of the defense. I have actually shadowed Dr. Nelin at Nationwide Children’s in their NICU, and so it was really cool to catch up, talk with him about my own research, as well as the work that I will be doing while in Finland. I can’t understate how nice it was to have someone from near home to speak with, even just a few days in. It may be cliche, but it really is such a small world!

Arrival

I’m here!

After a few days full of catching up on sleep, exploring, and running errands, I finally feel like I’m getting settled. My flight and travels to Turku were actually fairly easy–so much so that I didn’t even realize I had gone through customs when I did. The flight from Chicago to Stockholm flew by and the very short flight to Turku after that was filled with beautiful views of the Finnish archipelago.

IMG_2961
The Finnish archipelago from the plane

I arrived at my new home around 4pm Finnish time, and was (eventually) let in by my landlord’s son. My landlord originally planned to pick me up from the airport, but was called in to work, and so I took a taxi to the house. I am staying in a room in my landlord’s family home, and there are several other international students staying here as well. There are also a few cats that live here, which my allergies don’t love, but I’m hoping my body will adjust quickly and it will be motivation to keep my room as clean (and fur free) as possible. My room is quite spacious with ample closet space (for everything that I overpacked) and a nice fireplace that I can’t wait to use once it gets cold.

img_2994.jpg
The house I’m staying in– a traditional wooden Finnish home. There aren’t very many of them left in the city.
img_2984
My fireplace!

Speaking of weather, it feels like a nice Ohio fall on most days. My Fulbright Buddy, Ilkka says it will likely stay this way for about another month before beginning to get cold. Ilkka has been a lifesaver in helping me get all the administrative stuff about moving to a new country out of the way. He showed me around the university and the city, and helped me register with the magistrate, where I got my Finnish ID number that allows me to do things like get mail and open a bank account.

Turku is really a gorgeous city and is very easy to navigate. The Aura river runs right through the center and makes for a scenic walk. Turku is also famous for its cathedral, which I’m planning to visit soon, and of course the castle. While I haven’t made it all the way to the coast to see the castle yet, I’m hoping I might be able to wander that way this weekend. I’ve also explored the city center a bit, which is only a 10 minute bus ride away from my house.

IMG_2982
View of the Turku Cathedral
IMG_2978
Fruit stands in the city center
IMG_2980
So many berries!

Overall, everyone has been kind and helpful. Finnish people are often stereotyped as being quiet and distant, but of course this is only because of their preference for personal space and different value for language. Public spaces are definitely more quiet than in the U.S., and it is fairly uncommon for people to smile back at me as I walk past them, but the quiet tends to be quite peaceful and if I approach someone to ask a question they are always immediately warm and welcoming. It will definitely take some getting used to, but as an introverted person myself I can totally respect their preference for some time alone in one’s head.

The days to come will be filled with more exploring, meeting people, and starting work at the hospital. If the rest of my time in Finland is anything like these first few days though, I think I’ll be happy here.

Here we go!

Today I am boarding a flight to Finland, suitcase(s) full of warm clothes, books, and American snacks in tow, to begin my nine month journey as a Fulbright scholar. This summer as I’ve prepared for my grant period to begin, I must admit that it never truly felt real. Between seeing family and friends, making some money on the side, and gathering everything I would need to move across the ocean, I don’t know that I ever let myself think about what it would actualy be like to step on this plane.

Yet, here I am.

fullsizeoutput_1524

My year in Finland will predominantly be spent doing two of my favorite things. Formally, it is my next step in understanding the complex needs of new families thrown into one of modern medicine’s most liminal environments. The neonatal intensive care unit (NICU) is a space where what it means to be human comes into question every day, and where many parents’ expectations of the first few weeks/months/years of parenthood will likely become tainted. My undergraduate honors thesis at Elon University, entitled “’I pumped, I didn’t breastfeed’: Toward a More Family-Centered Care Culture for our NICUs and Donor Human Milk Banking System” examined the infant feeding narratives of U.S. mothers with infants in the NICU. The analyses of these narratives revealed that U.S. neonatal clinicians and scholars have much to improve upon in terms of providing family-friendly and breastfeeding-friendly care.

But…

In Finnish NICUs, achieving normalcy for families isn’t quite as difficult. In these NICUs, families become integrated into the care team, live in the unit 24/7 if they choose, and are encouraged to provide human milk and/or breastfeed as soon as the mother and infant are ready. There are many factors that play into this unique family-centered care culture, some of which I already understand minimally, and others of which I know lie in my observations and interviews to come. Maternal and child healthcare is world-renowned in Finland, and so who better to learn from than neonatal scholars who endlessly invest in practices that encourage the use of human milk, support the mother-infant dyad, and seamlessly blend vulnerable families with the medical environment?

Informally, this will be a year full of cultural immersion, learning, and exploration. As an anthropologist at heart, the thought of having nearly endless time to simply watch people, learn from them, and share with them ignites my soul. I have always been interested in the small things we all have within us that make us human–our shared human experience– and have continuously sought these things in books, conversations, art, and in moments of service. Our shared human experience is why I do what I do: why I document the stories of vulnerable families, why I hope to one day enter medicine myself, and why I continue to have faith in the future of our world.

So, here’s to a year of searching for just what makes Finnish people (and families) so gritty– a year in search of sisu.

fullsizeoutput_1528.jpeg
Clearly overpacked whoops