Monthly Archives: March 2014

Home alone

I have been waiting for homesickness to kick in. This far it is nowhere to be found. There has been some grumpy days or more likely grumpy evenings, not even whole days yet. I have been wondering why is that.. Of course we are just three weeks in, so I really cant tell just yet. This far everything has been new and exciting, even the first week at the hospital. Even though I now know roughly how my everyday life here will be it isn’t yet that everydaily to me.

In addition to the all new things here, I think there is more to this than just wondering about new. Here I’m all the time surrounded by people. In dorm I have my roommates, at hospital there is usually other students along with the advisors and patients who are all communicating with me. Then there is my travel companion who goes to have lunch (and dinner) with me most of the days. On weekends there is usually some activity where I go somewhere with someone from Finland or some locals. To be honest, I’m more lonely in Finland than I am in here. It is not just the surroundings, I’m more social in here too. Maybe because I feel that I have to.

Now my Finnish roommate is moving to another city and I feel quite sad about it. It has been fun to have someone similar in here. Even though many times when we are home at the same time we sit back to back on our computers without talking that much. But it is not all about talking, it is the possibility to share my daily life with someone who understands my language and the cultural background I’m coming from. I will still have my travel companion, fortunately. Before I consideret it strange to hang out with people from the same country while abroad. Why would one want to do that when there is so great an opportunity to get to know some locals?!? Now I understand. If I was the only Finn here, I would feel much more alone and homesick.

SOAP and vinyle gloves

If someone was envious about our first two weeks, there is need for it anymore. My first week was quite busy. Usualy I was walking home after training day about 5.15-5.40 PM. After dinner I went to library to write some small assignements to one of my clinical instructors (yesterday I was there a bit less than 2 hours) who wanted to have them printed. I’ll be home around 7-8 PM and then I’ll go trough my notes if there is still something my teacher has asked me to find out. Some food, shower and to bed. It hasn’t even crossed my mind to go wander around the city or plan some travelling. Today I feel that I have started to adapt to the enviroment. I’m not that tired or hungry after hospital hours.

kyltti2

One of our departments.

I think that my favourite part at the moment is the bedside therapy. Maybe because it is a bit familiar to me beforehand. Still there is lots of differences. Here we use vinyle gloves every time when we see a patient and we wash hands after every patient too. It feels that it is more important here to wash hands after seeing the patient than before seeing them. Therapist is not the only one who is taking care of the exercises, because there is always a family member or a caregiver, so it is their responsibility to see that the exercise is done. That means that progress is faster. Because of the caregiver we can also stop the therapy when patient is able to ambulate intependently (even though walking might not be that good). There will always be someone to take care of them. Therapist will write initial notes and daily notes of patients. I think the daily note aka SOAP is much better than our writing down things. This is because in soap there is always progression and a plan.

In the clinic I have been a bit of confused. Everything seems so different. Thay use much modalitys here. First there is electricity or something similar combinet to heat packs to save time. Then maybe some manual therapy and short exercise teachng and then some more modalitys like ultra or traction. To understand why, you need to know a bit about the politics behind the health enviroment here. There is a common healt insurance that is really cheap and everybody can afford it. This insurance pays for some health care things you need to have, for example physical therapy. So the insurance pays the hospital to treat patients but the amount of money is not that much. Hospital wants to have enought money to pay all the salaries so they insist that terapists see many patients a day. It can be as much as 40 patients in one day. Because of this demand therapist may use only modalitys to treat some patients and then they take those who seem motivated enough to make some exercises. It is recognised that this is not as effective as manual therapy or exercise would be but there is just not enough time.

terapiatila

A therapy room. All the therapist will be here at the same time.

After first week I feel that studying in Finland is really lazy. Not that we don’t have much to study about, but we are not expected to know that much even after the courses. I feel that teachers hope that we will mainly learn in the practice periods. Still, when I was in my first practice period, I wasn’t expected to know much. I wasn’t even expected to find uot that much new stuff. Here, if I don’t know something teacher askes me to find out for next day. One time when I didn’t remember one abbreviation that teacher had told me the day before, she looked me a bit funny and said: “but I told you that yesterday.” More demandin enviroment suits me well. I’m a lazy person and if I feel that I can survive without making much effort I wont make any. Here I feel that if I want to do well, I need to make some effort and it feels great. Usually interns here are fourth year students so they do have more knowledge, but I think it is nice to be expected to know something. Learning is facinating when the enviroment is good. Even though my teachers seem to be quite strict and demanding they are also really nice and they give good feedback.

Any other things in my life at the moment? Nope. Haven’t had time..

kirjat

Study study study!

Ears full of Mandarin

Today it begun! My first real clinical practice day! I can admit, I was a bit nervous. My boyfriend will probably roll his eyes for this, because he needed to call me from Japan in the middle of the night because I was panicing. Just a bit.. Well, lets be honest, I might not have slept all night. In other hand, I must have slept some, othervise it wouldn’t have been possible to wake up so many times. I didn’t feel like the sharpest tool in the box when I started my walk forward the hospital in the morning.

kyltti

Our hospital!

sairaala

And the actual hospital too! That is the white building in the center of the pic.

Luckily just few meters before hospital door I met my good friend David (one of those local students who was in Finland last fall). He showed me where to change my clothes and kept me company for some day. Then other of my saviours arrived! James is one of the research students and he was my life line today.

We went to meet the first one of my six clinical advisors or teachers as they seem to call them here. My first expression was a bit shocked since this guy didn’t greet me, didn’t talk to me and as far as I could tell he didn’t even look at me. Just told James to show me the places. I was a bit confused and a bit scared. Would it be like this all the time? I am a person too you know.. But after the first four hours my impression was totally flipped. My teacher seemed like a really serious guy, but near the end he was smiling more and more all the time. Even thought he spoke only in Mandarin and James worked as a translater he started to aske me questions and I even got to do something small in my first hours there. I was told that since they usually have not that busy hour just before lunch, I can just tell them what I want to learn and they will provide me with lesson. My teacher also told me that my posture tells him that I might have some hip problems (and I do, my legs are not even) and that he likes to combine chinese medicine to the western way. This is a gold mine I tell you!

My first four hours were at orthopedical practice. It was a big room, full of tables and busy with physical therapists. One therapist had couple of patients at the same time and they used a lot of modalities like electricity and ultrasound. There were tables for cervical and lumbar tractio machines where patients were just put to the machine and then the therapist went to treat other patients while machine did the tractio. There were one other intern and some second year students as well. It was really nice to talk with other students and think about some problems we were given. I liked the athmosphere because it felt like people were discussing about treatments rather than just given one right solution from the teacher. James also praised my skills all the time, so what there is not to like??

sairaalanikkuna

View from the hospital window.

Other four hours were at orthopedic bedside. I felt familiar since my first clinical practice was at same kind of department in Finland. It was nice to notice that I had really learned something from my first training period and I had some selfconfidence about the treatments. I liked Matti’s teacher (mine had a meeting and wasn’t there today). She was really good at explaning everything and she provided enought info beforehand about conditions we didn’t know before.

In bedside department we discovered some unique features. All the patients we saw today had either a familymember or other caretaker at their bedside to take care of them sonce nurses didn’t have time for all of the patients all the time. And those familymembers really seemed to almost live there too! Well ofcourse it is a bit different here since they have different customs of taking care of parents and family. But I liked the feeling about it. Finland could use something like that..  Therapist used a lot of time to educate those familymembers about their relatives condition since they were the ones that were going to take care of them. They seemed to take it really seriously too. Two of them were taking pictures with their phones when the terapist showed some exercise stuff or how to for example sit down with a full hip replacement.

nohevat

Nohevat.

What else.. All the info we saw about the patients were on paper. Thay had one file per a patient and everything was put there. I don’t even know if they have files on computer. We also had to use masks all the time when we were with patients. This was more strict at the bedside than at the other department. Before this day we were also told that we should put neat clothes on (some local students even wear suits to make a good expression when they visit hospital), have shoes that don’t show toes (no sandals!) and we were given a white jackets to wear. I feel like a doctor when I’m wearing those! Our days are 9 hours long because between our two 4 hour periods we have 1 hour lunch brake that is not included to the hour count. There is no other breaks than that. So 4 hours straight without a break is a rough work I tell you.

All in all, I’m really happy about my placement at the moment. I have no doubt that this will be challenging couple of months, but it will be worth it. Even though would be easier if I could speak chinese. Today only one of the patients spoke English with me..

First ending

This first two weeks has been amazing. We have had a lot of time to get used to the country and these habits here. This far we have only had some lessons at university and next Monday our actual clinical training begins. It is exciting and at the same time a bit sad. We have met many students here and some teachers as well and all of them have been really friendly and nice to us. It is sad to think that some of those I have met last time now. It makes me think about the time when I will leave here and see all of this last time. But maybe this is not a time for that!

In these two weeks I have learned some new skills! This week we tried pilates torture machine. It might have had another name too, but I don’t remember it at the moment. It was actually really interesting machine and I started to think how could I make on of those for myself. It is funny how much different exercise machines people have made and there is no end to it..

pilates

Using the torture machine.

pilates2

Actually this wasn’t that bad..

pilates3

It was even slightly fun!

We also tried some gyrokinesis. It seems quite okay. We only had one lesson so I cant say much about it, but it seemed interesting and worth trying some more. That also has some kind of a torture machine but we didn’t see that one. In addition to these we have dug into our brains trying to solve some case assignments and I already opened my Magee to check out couple of things. (Magee is a really heavy book about musculosceletal assessment.)

häkkyrä

One can measure muscle strenght with this “häkkyrä”. I forgot the name..

Our Chinese improves all the time. I get small learning experiences almost every day. I still have no idea what these people are talking about..

chinese

Trying to learn new words. This is difficult because locals know their marks better and writing something we will understand takes some time usually.

I have also learned that I get really tired if I try to go out every day and do something awsome. But I get really bored if I just sit in front of my computer. Maybe I need to learn to do something a bit less awesome but still active. I guess I will be in best shape of my life when I leave here. I have decided that in the end of the exchange period I will run these stairs up. 😀 I have improved really well these two weeks I have stamped those stairs. Every. Day.

portaat2

Small portion of my everyday stairs. Okay, maybe half of them if I go up only once.

From Ginger Duck to Bubbletea

There is some huge differences when it comes to eating and drinking. To it feels like people eat about everything. We have had this soup thingy called ginger duck where they put everything from the duck in the pot. There is head and feet but also the heart, stomack and intestine and almost everything you can imagine. Oh, and duck blood. It is like a pudding, a wobbly thing.. Last night my classmate brought me some chicken hearts and pigs ears for late dinner. And the list goes on. They have special tofu called stinky tofu and you can order chiken feet from a teahouse.

gingerduck

Gingerduck.

From the places I have been visiting there is two kinds of places: First is the places where you get a glass of tea first thing you sit to the table. From these places some even fill your cup entire time you spend there. The other kind of places don’t have drinks at all. Or then I just don’t know they have any. To this second series of eating places is included the famous nightmarket. In there locals sell almost every food you can imagine they have from small booths at the street. For me it was funny to notice that many times people have their kitchen on the street and customers go inside to eat (or they take their food with them).

michelin

A table full of food in a famous dumpling restaurant.

Then there is the drinkshops. This is different from the cafes and other places like that. It is a small shop usually selling tea (a lot of different kinds of tea!), bubble tea, juices and maybe coffelike products. From there you can byt a drink o go with you and they pack it to a sealed plastic container that has a film over the top. They have special packing machines in every shop. Then they put it in a small bag, give you a straw to take with you and tadaa! There is the drink you have been missing in the restaurant. 😀

tee

Bubbletea without bubbles.

Taiwanese speciality in drinks is the bubbletea. It is tea that includes small pearls made of sweetpotato starch powder. It is like a pearlporrige in Finland (if you have tried any). That is made from pearls of potato starch. And there is a ton of different types of bubble tea. Every small drinkshop seems to have their speciality. Other distinctive feature in Taiwanese drinks is that they are really sweet usually. I mean really really sweet! And I like sugar. Today I ordered honey green tea and watched horrifiedly when the girl behind the counter added three huge spoonfulls of honey to my cup. Many times you can choose how much you want sugar in your drink. You can also decide how much you want ice in your drink.. Too many options. 😀

chocobubble

Chocolate bubbletea (or something like that), you can see the pearls in the bottom.

hunajatee

Amazingly sweet honeytea.

When you go to eat with locals it is customary to order table full of food and then everyone eats everything and price is divided evenly for the whole group. I like this, because I get to try all different kinds of food. Big dinner groups are quite common here also. Especially in weekends. Oh and don’t even think of making food yourself, it is not worth it! It is much cheaper and easier to go out to eat.

jälkkäri

These people put beans into their dessert!

Cha Cha Cha!

Cha is mandarin chinese and means tea. Yesterday we two physiotherapists and one Finnish nurse (my roommate) went to Maokong hill. The trip there was simply amazing. First we took a gondola elevator which went quite fast. First it felt like being in a rollercoaster but after while I got used to it. The view was great. We could see part of the Taipei city and surrounding “hills” (Finn would call them mountains).

gondola

The view from the gondola. Maokong hill stop was about 300 m high.

After we got up there we were a bit hungry so we decided to find a teahouse, since the area is known for its tea. We picked one place at random because it seemed to have a nice terrace facing the cityview. It was just perfect! First we were a bit hesitating because we didn’t need to pay only for tea and snacks but also for the seats at the terrace. I glad we decided that it was worth it because it totally was. And in the end it was only about 370 NTD (about 9 €) per person.

parvekenäkymä

A set to prepare tea and some snacks at the terrace.

Our waitress showed us how to prepare tea properly and after that we just sat there for 3 hours drinking tea. We must have made at least 15 teapotfulls of that tea. We decided to stay to see sunset, because the view was just too great and we left after the citylights went on only to find out that there was a full moon at the other side of the gongola station. The expression on my travel companions face was great when he saw the moon: “wait a minute.. One shining ball just went down there, what is that?!?”

On our way down we admired the citylights on the other side and the fullmoon on the other riding the cabin in almost complete darkness just listening the silent hurring sound of the elevator and chirping (?) of the insects and birds from the forest we were crossing over. Just perfect I tell you!

How to prepare cha: (My tealoving friends, you must not judge me if I don’t remember everything correctly)

huuhtelu

Pour boilig water to the pot and over it to warm the pot.

kuppihuuht

Pour that same water to the teacups to warm them up.

kaato

Pour that water out using wooden pinching thingy so that you don’t burn your fingers.

teentäyttö

Add tealeaves to the pot filling it to 1/4 and add water. Leave it be for about 15-20 s.

kannuun kaato

Pour this first set of tea to another pot through a strainer.

1haudutus

Pour the tea to the cups and then pour it away since you don’t drink the first brewing.

kuppi

Fill the pot again and wait for 20 s. Pour the tea as explained before and then you have your first cup of tea you can actually drink according to all fine rules of tea brewing.

tyhjennys

You can use the same tealeaves for about 6-7 brewing. Then just take out used leaves and start from the beginning.

Adventurer! ..to be?

As I have told you earlier, I’m a boring person who likes to follow rules and routines. I have noticed that I feel a bit uncomfortable here when I can’t read all the signs, so I can’t know if there is something I’m not supposed to do. In Finland I usually read most of the signs and I’m well aware what is expected behaviour. If I’m not, I might not even attend an event. I like to watch and learn before trying things myself. I want to know I’m doing things right before I do them.

I kind of thought that by coming here, I would become an adventurer. Just by changing the environment I could change myself. Weeeelll.. Not quite. I just noticed yesterday that me and my classmate are completely different with this. He is asking everything when I’m just trying to figure out myself just by looking. He is going to shops that clearly don’t operate in english and just trying to comminucate in some language when I’m just avoiding places where I think people don’t speak english. Soon, he might even know more chinese than me because he is always asking how can you say this and that while I just observe. Noticing this difference was a bit of shock to me, because I was thinking myself as a curious and outgoing person and I noticed that I’m still more of an observer than a doer.

paitateksti

I even bought a shirt to remind me not to make all these excuses and just do things.

It took me a while to accept the situation and to decide that it is okay to be like this. At first I thought that I can’t be adventurer if I’m like this, but later I just decided to change the concept of adventurer in my head. Because I’m different from what I hoped to be doesn’t mean it is wrong. I can also change the way I act when I pay attention to it and try to not to be so overly cautious about everything.

First week accomplished!

I left from Finland about a week ago. How I feel? Confused.. I have been having this vacation feeling because we don’t have that many classes at the moment. We have had time to see stuff, hike, walk, eat, adventure.. You know, the basic holiday stuff. Today I realized that after couple of weeks this feeling will probably go away. When the real deal starts. It is a bit scary.. It means that I have to accept that I’ll have my boring weekday routine, just like home. Actually I don’t know.. This is all just a bit confusing at the moment. I feel like I don’t want to have a routine and basic weekday stuff, but having everyday adventure for 3 monts will be a hard task to accomplish.

panda

Chiang Kai-Shek Memoriall Hall entrygate.

Am I energetic enought to change my daily routine from what I have at home? I hope so. I’m boring at home. But maybe I’m demanding a bit too much from myself. If I continue this, I will just stress about having fun. Sounds reasonable right? 😀 Well, that is me. Usually I have one or two things I stress about, without any real reason.

maisema

“the Battleship” rock from Mt. Junjianyan.

It will be interesting to see what happens!

Studying..

Yeah. Well.. We are having quite a slow start to the studies here. For the first two weeks we only have 2-3 hours of lessons and only for 4 days. Most of the students here have been wondering why we have so few classes. Well, that will change since after our clinical practise starts, we will have 9 hours of practice 4 days a week and 4 hours on Friday. So no 4 day working week like we had thought. It is actually a bit confusing. I have no idea who has picked these courses for us. I don’t remember that anybody had asked from us what we want. Neither has anyone said that we can has a say to what we study here. That was the case in Finland. And in here it seems to me that everyone is expecting that these courses are our choices. To be frank, I would have wanted to have more influence for my studies here. But maybe I would have had to ask these things directly from Yi-Fen.

kerroskuusi

This is where we study!

Our first classes were easy. Just some reminding about ROM (range of motion) measurements. We also took part for one suspensio system lab class on Wednesday. It was really interesting and I would like to try more with that thing. We have had some pilates lessons in addition to these two. Those I really like! They are quite challenging, but also rewarding afterwards.  About the classes.. Well, there is somethings that differ from Finland. The class contains about 40 students, so the class is full. When using the “plintti”, research table, they don’t use paper (since it is cleaned weekly). And we have had our pilates classes ON the tables (since there is no room on the floor. Also other students are usually already in class when it is time for the class to start, when in Finland we usually go to class at the moment it is about to start. It takes about 10 min from our classes every time. Something to learn here I think.. What else.. Teacher is using a microfone, also those students who are presenting something are using the microphone.

suspensio

The Suspensio System. At the end of our class, one boy was hanging from this with his ankles and doing knee flexion combined with abdominal squeeze. It looked crazy!

I noticed that when we were doing our ROM measurements, the teacher was not as demanding than in Finland. We made the measurements clothes on and we could add the goniometer after making the full movement. It feels a bit weird.. I’m usually by-the-book person and I have always had difficulties to apply theory to the real world. It just seems a bit weird to me that we don’t for example demand to take the measurements from the skin (clothes off). That would be more accurate. The teacher told us that most of the clients don’t want to take their clothes of for assesments. Maybe because it is cold here even indoors or maybe it is not expected. But while in rome do as the romans do. Even in the Finish hospitals everything is not done right according to the book. I just need to get used to it and adapt.

Our pilates classes is teached by one of the major students. Most of the students we are dealing with are major students. That means they are studying research thingies. Unlike in Finland, here people study 4 years of basic studies to become physical therapists ( in Finland it is 3,5 years). From these 4 years they have the last year fully clinical practice. In Finland we have first year studying, then rest of the years we have a cycle of couple month of studies and couple months of practice. After completing the 4 years of basic studies people here apply for master program. In National Yang Ming University there is a lot of more research students than the basic ones. That is because this university is a research university. In Finland (if I remember correctly) after the 3,5 years we go to worklife for couple of years before we can apply for the research studies in university. Also we are learning the basic stuff in University of applied sciences and then we apply for the “normal” university for the research part. Here it is all in the same place.

Studying here is not free for the locals like studying in Finland is for us. It costs about 1500 € per year and this is why many of the students here have a part time jobs. Well.. Many of the students at home have a part time jobs too, but that is because it is so expensive to live in Finland. For a school cafeteria meal here it is about 1-2 € and if you go to a restaurant it might go up to 5-8 €. In Finland, school cafeteria meal is 2,60 € and if you go to a restaurant it is usually more than 15 €. Here it is cheaper to go to restaurant than to make food yourself.. And that is just food! But one can’t just compare prizes, because these things are more difficult than that. There is politics and stuff, so I don’t talk about this more this time, because I know nothing about politics..

tee

Bubble teaish stuff, without bubbles, 1 €.

ruoka

Meal from Uni cafeteria: 1-2 €!

jugu

Frozen youghurt = expensive! About 3,5 €

Weather

We have had a really odd winter in Finland this year. Usually we have nicely snow and long times of cold weather. Now it is March and it feels like the end of April. Almost all of the snow have melted and we haven’t had any proper cold days in weeks. I have seen GREEN! Usually it is not until maybe end of this month when one can see some liveliness in nature.

maisema

The end of the January in Finland 2014

talvi 2013

Winter 2013 was more like a normal one.

In Taiwan at the moment we have about 15-20 degrees of celcius and humidity is something between 60-95%. In a month this place will be a sauna. I felt a bit stupid when I packed some long sleeved shirts with me. “Come on, 15 degrees! It won’t need any of this stuff!” Then I came here and realized that humidity makes a world of difference. I have almost as much clothes on as in Finland when there is -10 degrees.. I’m not joking!

While walking and being on the move it’s not that bad, but when you slow down, or worse, stop! Then the cold creeps in. This humidity takes cold to the skin and sometimes I feel that it’s in my bones too. I have even have some thoughts about buying more warm clothes.

portaat

This doesn’t look that cold does it?

In addition it raind all the time here. Well, not all the time, but a lot. Actually so much that is can be seen on the architecture. In Taipei they have rainsheds over the sidewalks. Only time you need your umberella is when you cross the street. I already broke my umberella a bit because I was opening and closing it so much while walking.

sadekatos

There are the rainsheds supported by the pillars.

Right now we have a rain season here. I heard it is called the plumrains. It should end this month. After that other rain season will start. So I went to the one place where the weather is worse than in Finland? Lucky me..