Fulbright Forum & The Beginning of the End

It doesn’t seem possible that I am already nearing the last few months of my Fulbright term, especially when I think about the work I still have to finish. Yet this past week we had our final full group event of the year – Fulbright Forum – to present, at least on some level, our work over the past six months. 

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Terhi addressing the audience on the first day of Fulbright Forum.

The first day of the forum was focused exclusively on education. Some of the Fulbright Distinguished Awards in Teaching fellows presented the innovative teaching methods they use in their U.S. classrooms and the ways that Finnish education incorporates similar methods. Others, like Michelle and Jules, who have been studying the Finnish education system all year, presented on both the strengths and weaknesses of Finnish education. While I’m certainly not a pedagogue and a lot of the terms these scholars use went over my head, I was still able to make connections to my own experiences in education and to my own work.

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My awesome education friends, Michelle and Jules, killing it with their interactive presentation.

For example, I couldn’t help but think about the ways that education and health are so intertwined. Whenever someone mentioned the equal footing that all Finnish children find themselves on as they walk into primary school, my mind automatically went to early childhood, infancy, and prenatal care. The Finnish neuvola system is the reason for this success, and education and health scholars alike are big fans. Do a quick GoogleScholar search for it and you’ll see what I mean. The word neuvola literally translates to “A place for advice,” and that’s what these families get in addition to basic care. Mothers receive prenatal care from these regional public health clinics, and after birth, their children receive pediatric care in these same clinics. The neuvola system also includes parenting training, psychosocial support for the family, and assistance with nutrition, behavioral problems, and learning. In many ways, the success of the education system in Finland is directly related to the success of their public healthcare system. In the same way, the healthcare system benefits from the education system by producing well-educated students who become healthcare professionals and scientists, in addition to producing a generally health literate patient population. It is no wonder that both of these institutions are well regarded throughout the world. 

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Presentation by Stef and Kate on the eco-apocalypse.

The final day of the forum was dedicated to the arts and sciences. Topics ranged from the algae and parasite eco-apocalypse to socially conscious engineering, and social justice approaches to law, humanitarian aid, and the armed forces. I was able to present my work and received good feedback from some of the social science scholars in the audience. While it is always fun to see your friends present on their passions, and to present on your own, I think my favorite part of the conference was finding the small ways our work connected. Whether it’s the way that breastfeeding could contribute to saving our environment or how educational pedagogy aimed at improving language development could be utilized with children who were once preterm infants, I always learn something when listening to my amazingly intelligent Fulbright peers. 

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Me describing the importance of an exclusively human milk based diet for neonates. 🙂

As the conference came to a close and we began to say our goodbyes, I couldn’t help but feel grateful for all the ups and downs my time here has brought and the people who came along for the ride. Both the Fulbright Finland team and the American grantees I’ve met throughout my grant term have helped me grow in my scholarship and in my understanding of the connectedness of our world. We all endured the winter, embraced some awkward Finnish moments, and found joy in the differences and similarities between Finnish and American life. Although I have a lot left to accomplish in the only 70 days (eep!) I have left here, I know that this is only the beginning of a lifelong connection to Finland, its people, and the Fulbright Finland community. 

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A Different Approach to Care

With the support of the Lois-Roth Endowment, I travelled to Riga, Latvia this week to observe and assist with the initial implementation phase of the Close Collaboration with Parents Training Program in the Children’s Clinical University Hospital NICU there. I’ve written about Close Collaboration in a previous post, and I am still just as excited about the potential this program has to create culture change in NICUs throughout the world. I was lucky enough to receive the Roth-Thomson Award through the Lois-Roth Endowment to support an extension of my original Fulbright project and allow me to travel to different hospitals in Finland and abroad to see the program implemented in these units.

My time spent in Riga definitely revealed a unique approach to neonatal care that I had never considered. In some ways, the structure of their care is quite advanced. While their intensive care unit is an open bay structure, meaning that there are several babies in one room, their step-down unit has more single family rooms than the NICU at TYKS. At first glance, this seems very family friendly, but upon a closer look I found that the care culture is actually extremely challenging for families.

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Sari & Hannele introducing Phase 1 to the Riga NICU staff

Latvia is of course a post-Soviet nation, and remnants of that time still live in the hospital there. The hospital building and the surrounding areas are perhaps the most obvious example of this. The signs of poverty in the neighborhoods around the hospital are evident. Driving onto hospital grounds, the buildings look as if little has changed since the country gained its independence in 1991. Yet, they’ve found ways to make the buildings work, connecting each free-standing building with tunnels and corridors, and filling the insides with very modern facilities. This is similar to the approach many Latvians seem to take when asked about the history, as it is something they must aknowledge and remember, but also move forward from as best they can.

In addition to the buildings, perhaps a more hidden way you can still feel a Soviet tinge in the hospital is through their approach to nursing care. Hannele, one of the nurses on the Close Collaboration team who travelled with us to serve as an interpreter for Russian speakers, talked about her time living in the Soviet Union. She remembered times when she had friends in the hospital, and how a support person of some sort always had to be there to do things that we would now consider part of a nurse’s job. She recalled bringing food to sick friends, bathing them, and moving them in their beds to prevent bedsores. These things simply wouldn’t have happened had she not been there.

This approach to care still exists in some ways in the NICU in Riga, as once the infant is stabilized and parents are able to care for them, that is their full-time job. I spoke with several mothers while helping with the baseline family centered care measurements that are always taken at hospitals receiving the Close Collaboration training, and many of them communicated that they were overwhelmed by the sheer amount of care they had to provide their very fragile infant. These mothers received little, if any education about the best ways to move, hold, and feed their infant. When asked how pumping was going, they told me with frustration that there was just one electric pump for the whole unit to share, and that they had instead bought a hand pump for themselves so they could adhere to the suggested 3-hour pumping schedule. A solution, certainly, but entirely less effective.

One may argue this approach to care is necessitated by a shortage of nurses and funds, but I would argue it is also an example of the way culture really permeates healthcare. If a parent genuinely couldn’t be present in the unit, I am positive that the nurses would pick up the slack. Nonetheless, the parents are there, trying their best, and without sufficient support. This challenge is quite different from the one the Close Collaboration team usually faces. Generally, NICUs throughout the world are notorious for limiting the ways parents are allowed to care for their sick infants. The regular thought is that parents don’t know how to prevent infection, aren’t able to measure their feeds appropriately, and may accidentally dislodge critical wires and tubes when transporting the infant. Close Collaboration is usually able to help NICU staff reflect on these beliefs and lead them to understand that parents can in fact do these things when they receive the proper support.

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The Turku Close Collaboration team with some members of the Riga NICU staff.

In Riga, however, it will be a challenge to help the staff see that while its great that parents can be engaged in care (or are practically required to be involved in care), they need more education and support. And although this will be a different and difficult task, I am nearly positive that Close Collaboration will succeed there. Because the program is designed to be exclusively driven by members of the unit and not by unknowing outsiders, the team in Riga will be able to develop better ways to support parents using their own cultural knowledge. This in itself captures my wholhearted belief in the Close Collaboration program: it is the epitome of a successful applied anthropological approach to care culture change.

My Finnish Home

While many people probably think my desire to go to Finland was exclusively motivated by my research, that is not exactly the case. Of course, it worked out well that Finland is a great place to study what I study, but my selection of this country in particular was partially fueled by my long time friendship with Juulia, and this weekend we were finally reunited in her home country.

I met Juulia in the fall of my senior year of high school. I was called to the guidance office early one morning during the first week of class, and when I got there, my guidance counselor introduced me to this tall blonde girl from Finland who would be spending the year at our school. At the time, I knew that Finland was in Northern Europe, but I really couldn’t have told you anything else about it. I probably couldn’t even have identified its flag. But throughout that first week of guiding Juulia to her classes, introducing her to her new teachers, and inviting her to have lunch with my friends and me, I began to build my understanding of what it meant to be a Finn.

Juulia and I became fast friends that year for many reasons. She played tennis, and so she decided to join the girls tennis team and eventually became my doubles partner that season. Our team was small and didn’t have funding for busses, so we spent many hours traveling to and from matches in my mother’s car while talking about the quirks of our small region of America, her life in Finland, and the travels she had experienced previously. Now, I knew that being placed in Zanesville, Ohio probably wasn’t her dream American experience, and I think she would say it definitely had its difficulties, but I believe our friendship is one of the best things we both got out of that year. Since then, we’ve both gone off to college (or university as the Finns call it), she’s come back to the US to visit a few times, and now I’m finally in her country to visit her.

But of course, life couldn’t be that simple for either of us. Always the avid traveller, Juulia spent a semester in Mexico last fall. So while I was packing up to come to Europe in August, she was preparing to head to North America once again. This left me to figure out Finland on my own for the first few months, but now that she’s back from her sunny, taco-filled adventure, we have lots of Finnish experiences to catch up on.

We spent this past weekend at her family’s home in Rauma, Finland. Old Rauma is one of Finland’s seven UNESCO World Heritage Sites, as it is one of the few places in the country where the old wooden city centers never burned down. Her father actually grew up in Rauma, and so he gave us a local tour of the city. I felt right at home with her family who very kindly made Finnish specialties for dinner and even translated all of the questions in Finnish Trivial Pursuit so that I could participate. At the end of the weekend, I left with a better understanding of what life in rural Finland is like and feeling even more grateful for this international friendship.

Sometimes Finland can be hard. Turku is the part of Finland that is most notorious for its quite, distant nature, and I often feel like I’m always way too much for Finns to handle in nearly every situation. But with Juulia and her family, I was just me. They spoke English to me, let me practice my very poor Finnish, and welcomed me like I was their own. So while Fulbright and my research have definitely given me a love and deep respect for this country, challenging as it sometimes may be, this friendship has reminded me that at the end of the day good people are good people. I think my life just happens to be full of a lot of them.

If I could build a theory…

I recently had a particularly interesting interview with a mother in the NICU at TYKS, and it inspired me to continue digging deeper into the questions I ask. When I first came to this family’s room at our scheduled interview time, I found two nurses helping the mother get positioned with both of her babies. She asked that I come back in a few minutes, as this was the first time she was attempting to take her infants to breast. I left, more than happy to allow the nurses to have her full attention during this important moment, and when I returned, I couldn’t withhold my excitement at the sight.

Her twins, wedged between her own arms and the chair’s, were practicing the ever important rhythm of “suck, swallow, and breath,” even while still on respiratory support. The mother reclined in the worn leather hospital chair, her hands full of babies and breasts, while we began to chat. If I looked directly at the mother, I would’ve thought that she was breastfeeding healthy babies, that they were actually getting nutrition from her breasts, and that they had been born at term. In reality, her due date is still a while away, and when taking in the whole picture, I couldn’t ignore the arms of the ventilators hanging like cranes over her infant’s tiny bodies and the tubes of expressed breast milk using gravity to push milk through their noses and down into their stomachs. The dichotomy of these two images is exactly why the NICU is such a fascinating place.

Technology is a given in the NICU. It’s the only way to keep these babies alive, after all, and in some cases, it has been present in the life of the family since conception. From the potential use of IVF and prenatal genetic testing to weeks of fetal monitoring while on bedrest and the eventual, often traumatizing assisted birth (via c-section or other methods), technology follows these families from the beginnings of pregnancy and into early parenthood. And while resuscitation and intubation of the infant immediately after birth might seem like the big finale, it’s really just the start of a long line of technological interventions that will be used by both mother and baby before they return home. That is, if they go home with just an infant and not a parade of medical devices.

Although technology is clearly necessary in the NICU, when compared to the ways we normally speak about early motherhood, its presence can be quite shocking for new moms. The quintessential image of a new mother peacefully lying in bed at home with her baby on her chest is very far from the image of these twins squeezed in their mother’s arms with wires and tubes shooting off their faces and limbs in all directions. Even more, the baby isn’t the only one constantly attached to technology. Many mothers, both in the US and Finland, have suggested to me that they spend less time with their babies because they are either using the breast pump, cleaning the breast pump, or moving pumped bresat milk from one fridge to the next. With the necessarily strict pumping schedules these women must keep to, in addition to their desire to be with their infants as much as possible, it is no wonder the pump seems to feel more like a leash than a tool.

Davis-Floyd has described the way technology has been integrated into the maternity ward, suggesting that America’s birthing methods have become “technocratic”. Her theory of the technocratic birth is foundational in feminist healthcare literature, as it begins to unravel the ways the female body has historically been misunderstood, misrepresented, and often mistreated by the male physician. My opinion, which was previously elaborated on in my honors thesis, is that a refined version of her theory could and should be translated to the NICU. The culmination of my observations and conversations with families suggests that there is a uniquely medicalized form of motherhood that takes place in the NICU, and therefore, more work should be done to understand what it means to become a mother exclusively via the help of machines.

Now, I certainly don’t believe that I have enough data to assert this theory on my own. It is simply something that I often think about when speaking with mothers. But one day, my work and others’ work on this topic may just culminate into something along these lines. I can only hope that if and when that day comes, we can do justice by the stories of mothers who have undergone this struggle in the past while providing a new knowledge-based for those that may experience this form of motherhood in the future.

Home

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.

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.