Overcoming my personal obstacles

This week has been already huge for me when it comes to personal growing. This Monday we had our first lesson of Chinese medicine and of course the topic was acupuncture. Some people might know that I don’t like needles. I hate going to the blood tests and I feel sick if I watch my friends using insuline. But I will tell more about that later, first some first expressions. I had thought that we would go to some back alley clinic. Somewhere small and cosy with strange decoration. Oh no, I was wrong. We went to this huge hospital that had many floors and there was one department for Chinese medicine, just like there is a department for pediatrics for example. In this department people were sitting in (kind of) orderly rows waiting for their turn just like in a normal clinic. This is when I came to realize that Chinese medicine is treated really differently here than it is in Finland. Of course.

tch

Hospital where we have our lessons.

More about the needles then! First thing we witnessed was acupuncture for stiff nose (after flu or something). The terapist just put two needles right besides the patients NOSE. He told us that he only puts them 1-2 deep because the patient is a bit scared. This was the first time I left the room feeling dizzy and a bit sick. We were told that usually the needles will be at place for 20-30 min, 1 hour if patient has time and doesn’t have any bad symptoms from them. It just happens to be that fainting is one of the most common symptoms. Ha..

acunukke

First lesson!

We had about 30 min long lecture about Chinese medicine and acupuncture and then we got to try it. Gah! But before this we went to see another treatment. This time it was renal dysfunction and he got 14 needles. And this was the second time I left the room. But this time it was a bit easier. I think that some part of my ill feeling came from not eating dinner, sleeping really badly and smelling the moxibustion stuff in the clinic. I didn’t want to get any needles to my skin, but I was brave enough to put one through our teachers skin. It wasn’t that bad actually. It is worse to look and to get the treatment. I also think that if I have tried the treatment myself it might not be that bad either, but considering my feeling of the day, maybe it was better this way.

neulamatti

Matti is so brave!

All in all it was really interesting evening! Our teacher categorised me as a heat (like not cold) person just by feeling my pulse and looking at my tongue. I cant wait for next Monday to get our second lecture. I wonder what will the topic be then..

Monday was also my first hydrotherapy day. When I first heard that we are going to have therapy in the water I was really horrified. I don’t like water. I feel that I can’t swim that well and I’m usually always a bit afraid of the water. Also, I can’t see without my glasses.. But as I have heard my classmate talk about his classes (his hydrotherapy started two weeks earlier) I started to wait for my turn quite eagerly. Our teacher is awesome! She is really into this water therapy thing and I can see that from all she does. My first class was nice. I got actually much praises for my swimming skills (not all people can swim here like in Finland) and I learned much new and interesting stuff! This will be great! From the new stuff I think Watsu is my favourite this far.

Hydro

My awesome hydrotherapy teacher.


Crazy crazy traffic

My local friends warned me that I need to be more careful while walking in Taipei than I am in Finland. Really soon I noticed that it is true. Even thought this is not the worst traffic I have seen there is some differences I should keep in mind.

1. Scooters!

In Jyväskylä people use bicycles to go everywhere. Here people use scooters. There is so many of those kamikaze-like drivers with their scooters here that I really need to keep my eyes (and ears) open every time I cross roads. With a scooter it is not that serious if you drive in orderly fashion or not. Scooters are small and they DO use it to their advantage. Too small for a car? No problem, scooter can go through. Not enought space to have two cars besides each other? No worreis, with scooter you can have three! I have seen whole familys on one scooter: Best this far is parents and two kids. On one scooter. Usually parents have helmets but kids don’t always have those. I have seen babyseat on scooter (you know the space where you would usually put your feet? It was there). I have seen people riding with their dogs ar with their work equipment. One day I saw a man riding a scooter with a ladder and some painting equipment. I don’t know how they do that.. 😀

skootteri

Some scooters waiting for their turn.

2. Busses..

Okay. You might think that it is scary if someone offers you a ride with a scooter. I have mainly declined from those, but I tried once and actually it felt a lot safer than some bussrides I have had. There is quite a many people living in here, so when you take a buss usually somebody else is taking it too. There is some seats so if you are lucky you can get one. Of course trying to be polite and offer the seats for the older people. After that there is some hook thingies coming from the roof that you can hold on to. And after the bus is full you really don’t need to hold on to anything because there is so many people that you wouldn’t move anyways. Yeah, well it is not that nice to have some sweaty fat old man leaning to you even when it is not neccessary. And prepare yourself for lining up on the buss stop. Even though the first buss might not have enough room for you.

3. Trains.

Everybody in Finland always says bad things about VR (our railwaycompany). It is true that trains are too costly and thay are sometimes late. Before this trip I never thought that being late could be from something good. For example here, if you have lined up fot train and you haven’t even got to the train yet but train needs to leave. Then you just need to wait for the next train. In Finland trains wait for people. No wonder they are sometimes late.. With seats trains are the same as busses. You can get a seat if you pay more or are fast enough. Othervise you will stand. There are some trains that you need to buy the seat ticket, but for the slower ones you don’t need to.

juna

Insides of a moving train.

junakartta

Trainroute map.

4. MRT!

Mass rapid transit aka metro or subway or whatever. Really convenient! Goes almost everywhere and you don’t need to wait for long tome to get one. Just remember that it is not allowed to eat, drink or chew gum in the MRT. I will really mis this one when I get back to Finland.

portti

Don’t jump under the train gate and waiting line. Oh yes, you need to line up!

kielto

Don’t do this!

All this is quite easy, because there is EasyCard. It is kind of travel card where you can load money on it and use it to pay for MRT, train (some of them), busses and Ubikes (rent a bike).

Bu the way. I have noticed that people think you are strange if you want to walk somewhere. Or climb stairs.

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Honeymoon is over!

That was fast! After all the great feeling about my clinical practise last week, I had some not so good ones this week. For starters I had my first patients in the clinic. Practice patients only, they were my tutors, but the way this is done here came to me as a bit of a shock. When intern here has his/her first patients there is no teacher to help. Student is expected to do the treatment from the beginning to the end by his-/herself and if there is something they don’t know, then they discuss about it with the teacher afterwards or go to check it out by themselfs (if they are afraid of asking the teacher). This includes taking the history, observing the patient, assessment, treatment and home exercise. In finland we have the teacher standing by our side and helping every time when we don’t know something or don’t know how to do something and they can also prevent us to do any harm to the patient. I have had two of these situations now and they are highly stressful and I don’t have any confidence to my level of knowledge. There is good sides too. I’m forced to think about the situations myself and try to connect all the symptoms and see through the secondary ones to the one that is really causing everything. Still, for me this is extremely difficult and I get a huge rise of my stresslevel in these situations. Again, there is also good sides. After the second one (that went a bit better than the first one) I got a huge feeling of success because I have had some effect to the symptoms. Only with my thinking and performing some treatment. Ha!

Other PT’s sometimes ask me to do some small tasks to help them out. This is really nice! I can do some simple things I know how to perform, not only stand around and watch.

In addition there is my bedside practise. Oh, how I love the bedside. I know how to perform treatment and I feel that I learn every day something. I can be relatively independent in some of the tasks and my teacher is amazing! She is also really strict and asks me to write a lot of patient data. Which is a good thing and I learn a lot, but it takes so much time! This week I have been to the library after the clinical training every day at least for an hour and yesterday I had to wake up a bit earlier so that I had time to finish my assignments. Trying to concentrate to learn over 10 hours a day is really challenging and doesn’t work out for a long period of time. At least not for me. So when my last day on the bedside was over yesterday, I felt both sad and relieved.

If I would neet to study here for the whole 4 years I think I would have a heart attack. Or a peptic ulcer. Or a panic disorder. Or all of them.. I don’t cope well with stress.

Even thought this week has been.. challenging.. I think I’m still learning a lot and I’m still enjoying my time here.

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Too. Tired. To. Write.

Örglbörgl, zzZZzz…!

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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.