Clinical clerkship in Oulu
Week 4/4
Let me continue with more interesting facts about the system. I have broken it into two parts (part one is here), there really is a lot to talk about.
Accidents and emergency
I had an option to visit A&E. A friendly resident showed me a little bit around.
The first thing I noticed was:
IT IS MUCH MUCH EMPTY than at home!
Just to imagine, this is the waiting room in Oulu Accidents & Emergencies.
There is a person here and there sitting, but mostly it is empty. Usually people go through the primary care physician to get a referral and only then come to seek emergency care. There is no horde of people rushing in at all times like at home. It really shows that primary care is the king of the public health system, if one can take care of patients at the GP level, everything else works better. It is important to put a lot of money and effort into a working primary care level.
The system is basically the same as we have it at home. You have a (1) surgical and (2) internal medicine parts, all in the same location under the same roof. There is also an (3) acute doctor (EMS specialist) to help with the most urgent cases. They also have a (4) GP for non-urgent cases (slo. Hitri pregledi). The surgery is then further divided by specialties, you have a OBGYN, urologist, traumatologist, etc. There is a doctor in each one, ready to take the patients as they come.
The shifts in emergency rooms are covered usually by residents. Once you become a specialist you do not need to do night shifts (depends on the speciality). You work 8 hrs from 8 AM to 4 PM, afterwards if it is your turn, you are on call and you have to come inside 2 hours if summoned and answer all consults you might get on the phone from your younger colleagues. Sometimes it might just be resident seeking a second opinion before taking a decision.
The emergency room was built around 2007, making it look a bit less modern than the one we have in our university hospital in Maribor. Bellow are some comparisons, pictures in Oulu were taken with permission and under supervision and from Slovenia are taken from the internet and personal archive (thanks Andrej!).
The waiting rooms are shown bellow side by side. In Maribor they are usually full, with people standing in line and waiting. Sometimes more than 300 patients seek emergency care in a single day.
We are very proud in Maribor on how modern our emergency center looks. Here are some more pictures.
Here are reanimation rooms compared to each other. It seems like there was a lot of aftermarket modifications done in Oulu, but this is all being updated with a new hospital being built as we speak. Some of the departments are already doing some work from there. But the functionality is basically the same, you can see the same machines in both of the pictures. The care for the patients is on the similar level, which is way more important than the looks.
And to finish things off a hallway.
The facilities
I find everything here comparable to what we have at home. I recognise most of the machines they use here and we have the same at home. The brands are really international and omnipresent.
What was really different to me was the layout of operating theatres. We have quite different protocol than the one here.
Let me explain. In Finland they do not change clothes to get into ORs. They get fresh white coat, scrubs and socks every morning. The clogs they use are their own, the open Birkenstocks are really popular here.
To get into OR they put on a hat and a mask, that’s it. Scrubbing in is usually done only with the disinfectant for 3 min, not the actual scrubbing with soap or iodine. The disinfectant is really nice to your skin, I have done it 5 days a week for the last 4 weeks and my hands are still silky smooth.
In Slovenia (see the picture bellow) to get in you first need to go through the "filter,” there you change into new scrubs, change socks and change your shoes for clogs. Then you go to the OR, in front of it there is a little room where you scrub your hands, only then can you scrub in on a surgery. We also use disinfectant, but usually you start your day by scrubbing.
Another thing that is getting more and more popular is RAS (robot assisted surgery). I have seen the Da Vinci at work and it is AWESOME! It looks so cool and it has a lot of benefits over the traditional VAS (video assisted surgery). It is less invasive and has a lower rate of complications (I am told).
They have also just recently purchased a 15 mio. EUR robot for orthopaedic surgery, but I did not manage to see it.
Private sector
Doctors that work in private sector need to declare it. Employer can make it so that if there is a conflict of interst they won’t allow it. The doctors I talked to, do not know a case of that ever happening. Your free time is yours to spend. This differs from the political debate in Slovenia with some parties wanting to make it illegal for doctors to work both public and private. What is sad, that some of the ideas are also crossing the borders and emerging here. I was told by one doctor that a lot of hospital leadership is also thinking in this way.
A lot of doctors work privately. The working conditions are "worse” in private, but you get higher sallary. You treat much more simple cases and a lot of them. I hear that also patients in private practice are more picky and demanding. They really want perfectionism, but a wise surgeon once told me:
That the only surgeon with a perfect record is the that never did surgeries.
There is also a private sector work around, as the wages have caps on them if you sign a contract with a public employer. If the hospital signs a contract with you LLC, there is no cap as they pay for service.
Learning from mistakes
Mistakes here are taken as opportunities for improvement and not something to destroy a doctors’ life over. For the patient to get compensated he does not have to prove medical negligence in court, rather the doctor apologises and refers him to an office worker who helps the patient get compensated.
This is quite different than in Slovenia. In Slovenia for a patient to get money after something went wrong, the patient has to go to court and show that doctor knew what he was doing and did it wrong anyways. And it is tragic what this process does to both sides.
What is more your attending does not scream and shout when you do something wrong, nor does he throw things at a wall. It is expected that you are not perfect and mistakes do happen. Shouting at you does not help moving past the mistake and addressing it efficiently and safely for the patient. This used to be the culture about 30–40 years ago, but not anymore. I admire the professionalism employees here show and only hope that I will be able to see this when developing my career.
This is not to say that this is a rule in Slovenia, but I have definitely seen it happen once or twice.
I like the culture of facing problems professionally and empathetically, you should always imagine what the person that made the mistake is living through. Probably they are judging themselves much more than you are anyway. It is smart and healthy to help them get through it. We are all in the same boat after all.
Day 23 (Monday)
Monday brought nothing very special in the hospital, just the usual day of watching surgeries.
In the evening we had decided to have a national tasting party, it is where everybody that came on an exchange meets and makes/brings their own food.
I wanted to make Šmorn (actually Austrian dish), but then was convinced by my very talented girlfriend to do Štrudl. I have never done it from scratch so it was quite a learning experience. I followed this recepie from Instagram. Some notes to myself: always use a damp cloth bellow, it is so hard to roll it otherwise. And ofc do not forget sugar, vanilla Skyr and blueberries are not enough.
I also brought cherry liquor from Berryshka in Slovenia, it got some good feedback for which I am thankful.
There was so much food! And it was all amazing! We tried a lot of different tastes from all around the world.
I think I liked the most the olive spread from France, salami from Portugal, pastries from Finland and beer from Belgium. Everything else was also delicious and I am grateful to taste it.
Day 24 (Tuesday)
We played volleyball! It was so fun. The game was played into a beautiful sunset.
We took a lot of pictures.
We then went to the supermarket and had a midnight dinner.
Day 25 (Wednesday)
The Wednseday was in the shadow of preparation for the evening Sitsit party. It is a concept that we do not have at home. Everybody wore a bed sheet like a toga and every sitsit is different (they usually have 1 per school month, so we were lucky to come here in August). To participate you buy a 20 EUR ticket, this gets you in and will get you a shot, Jalovina 1⭐️, 3 small cans of alcohol, some snacks and a little dinner — we got some chips with cheese and salsa dip. Usually people bring also their own alcohol (alcohol is really expensive and for 20 EUR you really cannot expect a lot).
There are a lot of rules (they differ from city to city), so much that I do not really remember them all. Here is a little taste.
- You can go to the toilet only when they say so, usually it is a 15 min break every hour.
- To cheer, men touch glasses with their right, then left, then front neighbour. Women do it left, right, front.
- You do not applaud, but hit the table with your hand.
- You shouldn’t eat when someone is speaking/singing.
- You should always sing the song for the drink, before you open it. So for beer there is a song, same goes for long drinks* and wine.
- You musn’t sit down before you are allowed in the begining.
- To make a speech the toast master must allow it. You do it like that: Say [kili koli] — meaning cheers, stand up on your chair and the toast master will say if it is ok or not.
- The first question when making a speech is always "are you single?”, and when you say no you get a boo, so it is aimed more at single people to identify themselves.
*Long drinks are a type of beverage that are sold in Finland and very popular.
A lot of effort is put into these kind of parties and it really shows. As a guest you can just sit back and enjoy. For our team it was very nice, even though we did not understand a word in Finnish. There was a very friendly student who decided to help us fit in and translated everything.
The student club also has a guild house. It is a big place, they own and upkeep. They have a sauna and a hot tube, a big dance floor and it is located in the middle of nowhere, so you really can do a lot of events and don’t need to worry about the neighbours. I am really thankful that I had the opportunity to join and live this experience.
We had so much fun, and I hope that a party like that also comes to Slovenia.
Trip to Ruka
(there will be a lot of pictures)
Ruka is a hill in Finland, just 3h with a bus north of Oulu. It is famous for the skiing village and beautiful surroundings. We were very fortunate to get invited by Elina and Tomi to join them on their getaway from the city in a small cottage by the lake. This is probably the most stereotypical Finnish experience I could have ever wish for. It is so peaceful and quiet here. The wooden cottage is a beautiful piece of classical Finnish architecture and built traditionally. The nature is so quiet and offers the most beautiful views I have seen on my trip here. We also had a wooden sauna, which is obviously much better than the electrical one (this is something the locals always argue about) and a wood-run hot tub.
There is nothing better than going to sauna, then dipping in ice cold lake and enjoying the rest of the evening in a 40 ºC hot tub. We talk for hours and get to know the people we are with and the cultural environment we are submerged in and embracing fully.
Day 27 (Thursday)
We took a bus from Oulu to get here. It was about 28 EUR for one way.
First we went to the store and bought some groceries. It was an interesting experience, because Tomi and Elina are vegan, and I have not really tried a few continuous days of that kind of diet before. But it seems fun and the food is really good. The options for this kind of diet are diverse and usually tasty.
First we went to the ski center Ruka.
Second we took a little walk around the area to see some other houses and farms in the area.
I think that what I liked the most was the boat trip across the lake in front of our cabin. It was so peaceful, literally no sounds but ours.
And the sunset was immaculate.
We then retired to a sauna and hot tub.
Day 28 (Friday)
The next morning we set off to hike the little bear trail (the big one takes 4–5 days and is 80 km long).
It is quite flat, but it is well kept and accessible. You have everything you need, at almost all times. The nature is still in pristine condition, the air is fresh and the ground is soft to walk on.
And the team.
What is interesting to me is, that they have very well kept places for taking a short break. There is always a covered fireplace, a refuge to sleep in and these metal sticks to put your sausages on fire.
A reindeer crossed our path, this is quite common here.
It was Arianes’ last day in Ruka so after the hike and before giving her a lift back to the bus station we went to do summer sledding in the ski centre. I have never done it before and I expected it to be very steep, but it was a nice and comfortable ride down.
We then said our goodbyes to Ariane and left back to the cottage.
The view was once again immaculate.
It was even prettier when it got dark.
Day 29 (Saturday)
The last active day in Ruka…
We decided to do some little walks around the beautiful area.
First, it was the Ruka ski centre (from the other side now), they actually have snow stored from the last season!
They will be opening the ski season within next 4 weeks (I am writing this on 30th of August). Actually it is already getting quite cold here.
Then we went on another walk. The nature is really beautiful here, so there will be some more pictures, for better or for worse.
The views are really nice all around.
Imagine all of the pictures above in white, oh must it be nice when it snows!
We then went on the one last hike. There we found this little fella, wanting to walk on the fancy trail and not in-between the trees.
When we reached the peak we took a picture together with a nice view of the lakes.
Going down the forest was untouched, in some areas of natural reserves they do nothing to the trees. Once one falls, it stays there forever.
The evening was fun, we talked a lot and I really appreciate it. A lot of things that I did not know before and am happy to have knowledge of now (will write about it in the next blog, at least what I’ll remember). Elina also made a tasty cake (original recipe here).
Day 30 (Sunday)
Sunday was very slow. We woke up and ate breakfast and everything that stayed from the day before. Tomi and Elina took us to the bus station and we left Ruka. I was sad to go, but obviously content that it even happened!
Driving home we saw a lot of reindeers. Crazy animals, get off the road😂
I continued my day with a short run after getting home. I found a nice trail with stunning views here in Oulu.
We then met to say our goodbyes to Mohamed. We were talking about how fortunate our experience is here, how only a few get a chance to come here and experience this truly nice way of living life.
I have done more of these “blogs”. If you are interested you can also read about:
