Reflections on Sisu

So it’s now time for me to try to find the words to properly capture my experience this year, and I’m not entirely sure if I’m ready. Yet, it is May 29th, the day I planned to leave Turku and, in all honesty, a day I’ve waited for, and so I suppose this is as ready as I’ll ever be.

I started this year hoping that in my time here I would somehow find this magical sisu that all Finns are known for having. At the time, I would’ve liked to think that I was already pretty gritty, resilient, hardy, [fill in other insufficient sisu synonym here], and maybe I was, but I’m not sure that I’ve ever been tested to use these attributes so much in my life.

I would be lying if I said that this year was easy, but I would also be lying if I said that it was impossible. There were winter days that felt hard, and when reflecting on them I realize that they were even harder than I thought at the time. The darkness here is real, and while life continued to move on and sweep me along with it, it wasn’t until the sun started shining from 6am to 11pm that I realized how strong I was to have survived it. The winter here is empowering for sure, but ask me if I’d do it again come next November and I might have a different answer.

Just like the darkness, living abroad for this long isn’t necessarily easy. There were times that I would become exhausted just by the sheer difference I would encounter in a day, maybe even more so than when I’ve travelled to cultures that are far more different from the U.S. than Finland. On the other hand, there have been times when I’ve felt at home here and have been reassured by an unexpected self-confidence in my ability to navigate Finnish life. I suppose one can never live in a different culture this long and not experience a similar conflict. There will always be things that are just so different that they will never be easy, but then you wake up one day and feel surprised by the ways you’re suddenly feeling immersed.

And while Finns might be known for their more reserved nature, it is the Finnish people who really, in their own way, helped me feel immersed. I have always known that Finnish friendships are some of the truest one can find. I knew that in high school with my friend Juulia, and I continue to believe it today with all of the others I’ve met this year. While sometimes uncommunicated, these friendships are grounded in a sense of simplicity, trust, and loyalty. I feel this in my work relationships at TYKS just as much as I feel this with those at the Fulbright office and everyone I’ve met in between.

And so the conflicting feelings continue as I leave. In many ways, I feel that a weight has been lifted off of my shoulders knowing that I will soon be home where I can navigate life with ease. In others though, I am sad to know that the home I made here will never really exist in the same way again. There are people and places that I will miss in the meantime, but I know I will see them at some point in the future. But I will never recapture the time that I really lived here and called this place my temporary home.

There have been times when I’ve joked with friends that I would like to return my sisu — I thought I wanted it, but its just not as comfy and empowering as I hoped it might be. I’ve learned that sisu is something you must choose to embrace. The Finns choose to embrace sisu everyday, not only to cope with the climate, but also to overcome the small, ubiquitous challenges that life throws at them. If I’ve learned anything, it’s that we could all approach the challenges of life with the same enthusiasm, even if it sometimes must be coupled with a dark and sarcastic comment here or there. As the Finns would say: If you’re happy, hide it. Well somehow I’ve found myself pretty happy this year, even through the challenges, and I’m not so sure if I can hide it.

Growing Parents

This past week, Dr. Karol O’Brian, the physician who developed the “Family-Integrated Care” model of NICU care, visited our unit in Turku. This model of care is extremely similar to the Close Collaboration with Parents Training, although the difference between a model of care and a staff training is certainly noteworthy.

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Dr. O’Brian with the TYKS group on an archipelago dinner cruise. 

While I certainly learned a lot from Dr. O’Brian  and was fascinated to hear about her experience implementing a progressive family-centered care model in the North American context, one thing she said in her lecture stuck with me. She said that in neonatology we have the honor of “growing parents.” We have the privilege of seeing new parents in their most formative period and helping them overcome their first challenge — caring for their sick infant.

And she is right. Especially in North America, I think we refuse to fully address the liminality of birth, and instead funnel families in and out of labor and delivery as fast as possible without truly giving our full attention to the huge transition they are undergoing. While a NICU stay isn’t in anyone’s birth plan, the lengthened transition to parenthood that occurs there could in some ways have more benefits than we like to think about. This only holds true, though, when we are fully engaged in the effort of growing parents. When we allow the family to do everything in their ability to act as normally as possible with their sick infant and restrain some of our deepest held tendencies to gatekeep the baby, then we will be employed in an effort to support parents in their transition to parenthood that can rarely be found in other parts of medicine.

As I’m nearing my time to return home, I am honored to be a researcher in an area of medicine that not only helps our patients, but also helps their families. While we still have a long way to go in the latter effort, I am extremely excited to see how advances in care like Close Collaboration training and the Family-Integrated Care model will change the field. Neonatology is already excellent at growing babies, and it’s about time we expect the same excellence out of our effort to grow parents.

Small Towns, Handcrafts, and Resilience

Sometimes there are moments when Finland feels eerily like home. Of course, Turku and Helsinki are really nothing like home. Even if Turku is considered a small, quiet city, it is still far larger and more bustling than my hometown of Zanesville, Ohio, and that’s not even taking into account the nearby village of Dresden where I spent most of my childhood.

But this weekend was different. I decided to join the Fulbright-ASLA alumni association on a day trip to the small village of Nuutajarvi. Nuutajarvi is a historic glass-making village and is home to some of the earliest innovations in Finnish glass. While I didn’t expect to be hit with a pang of nostalgia during the trip, I couldn’t help but compare Nuutajarvi to Dresden, where the art of basket making used to flourish in the same way that glass making did here.

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Our tour guide, Jenni Sorsa. Jenni is also a glass artist and produces/sells her work in the village.

Finnish glass making has a strong history, and much of it began in Nuutajarvi. Glass making started in the region in 1793 due to the practically endless amount of lumber that could be used to heat the furnaces full of sand. The factory ran for nearly 220 years, belonging to locally run companies until Iittala bought it at the turn of the century.

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Some examples of traditional Finnish glass in the museum in Nuutajarvi. 

Iittala is at the heart of what is typically understood to be “Finnish glass.” The company is a mass producer of Nordic design, with much of its glass having a contemporary art deco feel. Some would argue that a Finnish home is incomplete without a few pieces of Iittala glassware, and many young people receive Iittala glass as gifts for graduations and weddings.

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Examples of early Finnish glass. The bottom piece is a glass baby bottle!

While Iittala is the big name of Finnish glass, the artists left in Nuutajarvi might argue that the company isn’t very supportive of local glassmakers. Iittala closed the Nuutajarvi factory in 2014, and the ways this has impacted this small community are evident. What used to be a village of row homes filled with families of glassblowers is now essentially a tourist town. While the village has been lucky enough to find funding from various sources in order to continue supporting local artists and the local glassblowing school, it is apparent that the village is nothing like it was. And even with Iittala gone, the people of Nuutajarvi don’t have to look far to be reminded of the company’s near omnipresence, as there is an Iittala outlet directly next to the small store where the local artists sell their art.

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There is a Fulbright Finland scholar living and working in Nuutajarvi. Jonathan Capps is a glass artist from Ohio State University who has been collaborating with artists in the area all year. He hosted a glassblowing session for us in the hot shop and shared his projects from this year. In speaking with him about the ways Iittala first supported and then deserted the area, it is apparent that Iittala has chosen the market over art. The artists of Nuutajarvi represent true, current Finnish glass design. What Iittala makes, while beautiful and iconic, merely represents Finnish glass history.

In reflecting on the day, I couldn’t help but see the similarities between Nuutajarvi and Dresden. While likely not on the radar of many people under the age of 50, the Longaberger Basket Company was once the Iittala of Dresden. It wouldn’t be an exaggeration to say that most people in the area had at least one basket weaver in their family when the company was thriving. Longaberger has long been out of business though, leaving only a handful of dedicated weavers and collectors attempting to sell their work in the few shops left in town.

While there are many similarities between Dresden and Nuutajarvi, there is one prominent difference. The artists of Nuutajarvi had the safety-net of the Finnish social welfare system to fall back on when Iittala left, and they still have access to it if it’s needed as they continue making their art. When a community’s wellbeing can be insured, traditionally “unprofitable,” but critically important fields are able to survive. It is no surprise that people from my hometown have had to find other ways to make a living since Longaberger closed, but I do wonder what the village would be like now if some of the basketweavers had a steady income to continue pursuing their work even without the company’s presence.

As a person from a small town, I understand the power of a shifting economy. While my community will continue to suffer from losing the handcraft that supported it for so long, I can only hope that one day there will be a way for villages like Dresden to find a way to conserve their history in the same way that Nuutajarvi has. If Finland has shown me anything, it is that resilience can be found in even the most unlikely places, so long as there is a support system to catch us when we fall.

The Small World of Neonatal Research

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All the attendees of the 2019 Turku-Uppsala meeting

This past weekend, I had the pleasure of attending one of the semi-regular research meetings between the Turku and Uppsala NICU teams. While I was excited to both see a bit more of Sweden and present my current research to a predominantly Nordic and Scandinavian audience, I had no idea that I would be joining such a rich community of neonatal researchers.

The Turku-Uppsala NICU meetings have been happening since the late 70s, beginning with just a few pediatric neurologists talking about current neonatal problems over coffee. Eventually, the meetings grew larger and larger as the field of neonatology began to expand. The meetings have been held in several locations, but generally they switch between Finland and Sweden each time, mostly being held in Tällberg, Sweden and Seili, Finland. The meetings have always been friendly, predominantly being a space where younger researchers could practice their presentation skills while sharing their work and receiving feedback.

This year, the meeting was held in Tällberg, Sweden, which happens to be extremely difficult to get to. Seili, Finland, the other location these meetings are often held, is also quite remote. (I’m not sure if this is unintentional, or if there is a method to the madness of making these meetings inescapable). Our journey started with a quick flight from Turku to Stockholm, followed by a 30 minute train to Uppsala where we spent the day exploring before taking a bus to Tällberg.

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The Turku team in the main auditorium at Uppsala University

The city of Uppsala has an extremely rich academic history. About the same size as Turku, it carries a simple Scandinavian elegance. Uppsala University was initially founded in 1477 and was the first university in Scandinavia. We had a private tour of the main buildings on campus, some of which are still originals from the university’s first years. The tour included discussions about some of the famous scholars who either worked or visited Uppsala, the most famous of which was Descartes. There is also a rich medical history in Uppsala, evidenced by the remaining anatomical theatre leftover from the mid 17th century.

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The anatomical theatre, used for educational autopsies as early as 1663. Autopsies were also open to the public for a viewing fee.

After a day of exploring, we boarded the bus with the Uppsala NICU team to Tällberg. Three hours later, we arrived at Åkerblads Hotel and Spa, where we would stay in small red wooden cottages and indulge in delicious Scandinavian foods. Tällberg is a small town in the Dalarna region famous for its cute red wooden houses, wooden Dalarna horses, and Lake Silijan. It is a very quaint part of the country and reminded me of Ohio’s Amish country in some ways.

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Katrzyna and I in front of one of the typcial Tällberg homes.

Our time in Tällberg was full of learning, relaxation, and good food. Both Katazryna and I presented our work, along with several other young researchers from Turku and Uppsala. I was able to hear about the ways in which Uppsala’s care culture influenced Turku’s care culture, and how the collaboration continues to help push the boundaries for family-centered care. The Uppsala team is beginning to use the term “zero separation” to describe what they mean by family-centered care, which feels far more tangible and easier to understand than the vague terms we’re used to throwing around about family friendly care cultures.

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My presentation (after recovering from severe technological difficulties).

After the weekend was over and I was able to reflect, the conference really truly reminded me how small the neonatal research world is, and how lucky I am to be a part it. Way back in June of 2017, I emailed Dr. Uwe Ewald, a Swedish neonatologist from Uppsala whom I had met at the Academy of Breastfeeding Medicine annual meeting in the fall of 2016. Eventually, Uwe put me in touch with Liisa, who supported my successful Fulbright application and wrote my letter of affiliation. Coming full circle and meeting the Uppsala team after spending so much time in Turku working with Liisa and her team was so rewarding. And then we can’t forget the ways that these two units are connected to the first NICU I ever saw – Nationwide Children’s in Columbus, Ohio – and the doctor who showed me the first patient I had ever seen with necrotizing enterocolitis, Dr. Leif Nelin.

Moral of the story: The world of neonatal research is small. So is our world in general. Somehow I’ve been lucky enough to find myself in the middle of this community, and I couldn’t be more grateful for the way things worked out.

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Statue of a breastfeeding infant in the central building at Uppsala University.

Finland & Fake News

Recently, it’s been hard to keep the idea of false realities or fake news off of my mind. This might be partially due to the Fulbright Finland workshop I attended after Fulbright Forum, but is definitely also influenced by the mounting wave of media surrounding the 2020 elections, the questions my Finnish colleagues are asking me about it, and how medicare-for-all will play a huge part.

In light of the ways that media and manipulated realities influence our modern lives, Fulbright Finland organized a workshop entitled “Truth Matters” that was open to the public, but also included Fulbrighters from Finland and other Nordic, Scandinavian, and Baltic countries. While I don’t consider myself the biggest fan of communications “stuff” (sorry Elon), I believe that this issue is critical to the conservation of human rights and will only become more and more relevant as time goes on. The conference included a keynote from Farida Vis, the director of the Visual Social Media Lab at Manchester University, who gave us a tool for decoding media, its intentions, its audience, and its impact on our own biases. There was also a panel with several Finnish communications and political figures, as well as the U.S. director of NewseumEd. The day was filled with examples of misused media, manipulated images and ideas, and tools that could be used for fact checking.

And while fact checking and media literacy are nice phrases we like to throw around, I left the seminar feeling that they are not and will never be enough to combat this change in our society. The time we live in might be fascinating to study and discuss from a sociological perspective, but until we are able to find a way to underline the truth without putting limitations on free speech, I (at least currently) am feeling pretty hopeless about this issue.

To make things worse, just a few days after the conference a Fulbright Finland alum shared an article on Facebook filled with fake news about the recent Finnish government resignations. He was condemning the article, as it completely mischaracterized this event in order to use it as an argument against medicare for all. This was followed by tweets from Nikki Haley in response to Bernie Sanders’ statement about the low cost of childbirth in Finland. Her tweets also mischaracterized Finland’s healthcare system, and so now I feel compelled to provide some back story and discuss how reality has been manipulated in both of these cases.

The recent Finnish government resignations are a reaction to the inability of the current government to pass a reform of the Finnish healthcare system. I’ve talked a little bit about this in a previous post, but essentially this reform would move the administration of health services from the city to the state level in the hope to cut down on costs and increase efficiency. While this doesn’t seem like it would be very contentious, Finns that I’ve spoken with have argued that people generally identify more with the city administration than with state administration. Additionally, some argue that this is a fairly irrelevant policy proposal, and that it actually hides more conservative leaning policies that would result in less funding for the healthcare system. This seems to hold true, as the reform would have also allowed more market space for private healthcare companies, thereby reducing funding to the public healthcare system.

When this reform didn’t pass the parliament, it seemed that there was no more policy work to do, and so the Prime Minister and his government “resigned” for the term. The word “resigned” is quite strong here though, as in reality, the government is still functioning in an administrative capacity and the resignation came just a few days before the parliamentary term ended. The article posted on Facebook actually said that the Finnish government “collapsed,” which is the furthest thing from the truth.

The Finnish elections are in less than a month, and many journalists argue that this resignation simply provided the parties with more time to campaign in light of a failed reform. While the article on Facebook makes it sound like Finland is currently under its own version of Trump’s shutdown earlier this year, in reality the government is still doing things like balancing the budget, funding social welfare, and ensuring that citizens’ lives go on. The only thing that has taken a momentary pause is further policy discussion. It may sound strange, especially in light of our recent history with government standstills, but Finland’s government did not desert its people for political gain.

So while the article mentioned above was incorrect in its characterization of the resignations, there is still another issue at hand. Not only is the Finnish government not in a state of ruin, as the article would have you believe, but Finns are generally happy with their healthcare system even if it requires a good bit of tax money. This is where Nikki Haley’s tweets come in.

It is a well-known fact that a public healthcare system costs money. Finns know that just as well as Americans. The difference is that Finns, for the most part, are extremely willing to pay for it and are pleased with the results. And studies actually show that, in the long run, these systems save money and produce better health outcomes. Even if the Finnish system needs reformed because of some inefficiencies and high costs, this is not a problem exclusive to Nordic and Scandinavian countries with generous social welfare policies. The problem is inherently one of longer lifespans and lower birth rates. We have this problem is the U.S with social security as well, and while we certainly need to find a solution to this generation gap, it does not give us permission to ignore every human’s right to accessible and affordable healthcare.

I’m not trying to argue that the U.S. should immediately transition to a system exactly like Finland. I am too practical to think that all of the private parties that play a role in our healthcare system will just suddenly disappear. But I do think we can find a happy medium that brings us closer to ensuring every person’s right to healthcare. Medicare for All will likely not be perfect, just as the Affordable Care Act isn’t perfect, and just like the Finnish healthcare system isn’t perfect. But after observing Finnish healthcare for nearly 7 months, I cannot stand idle and watch someone misconstrue the reality of the issue at hand. Finns are happier and healthier than us, and there must be a reason. It’s about time we start taking steps in their direction to find out why.

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. 

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.