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  2. 2. WASHINGTON REGIONAL HOSPITAL VISIT  Last Thursday, April 18th, we visited the Cath lab at Washington Regional Hospital in Fayetteville AR. Before going I honestly was pretty clueless as to what a Cath lab was. Once I Googled it however, I found out that it was in the cardiology department and used for diagnostics and treatments of heart conditions. I expected to learn how these things were done and some information about the equipment. I also anticipated seeing somebody maybe getting a catheter put in first hand, which would have been pretty awesome.  Once we arrived in the lab I figured we where not going to be watching any catheter action today but what we did in fact learn was equally as interesting. The lab had a lot machines and a big monitor hanging from the ceiling. The two Ladies there showed us a little about how they would insert a catheter, and what the other equipment there could tell us about the heart. One of the things I found most interesting was how much all of these things cost. There is millions of dollars to be managed so every penny spent on any single item counts. We learned about the negotiations that must take place between hospitals and medical sales reps in order for the patient to receive the car they need.  The other topic we covered was health insurance and lifestyles of medical professionals. The differences between the US and Sweden are large but are becoming less and less with the implementation of health care reform. A very large problem in our county is peoples inability to pay for the health care they need and insurance companies making it difficult for them to get that coverage, as well as making it difficult for certain doctors and hospitals to do their jobs. It causes a bad chain reaction when a patient is not able to pay for the medical services that they needed because it causes the hospital to pick up the slack using the some of the money from the patients that could pay. This leaves the hospital in a bind because this money could have been used to go toward stocking the hospital with necessary supplies and equipment that is need to help future patients.  Problems like these are mainly affecting public hospitals like Washington Regional as opposed to specialty clinics because they rely on more federal funding. It is clear that there is a lot of frustration with the system that we have been operating on. I am excited to see if these problems have been solved under the Swedish system and what new problems their system is creating.
  3. 3. DR. HERSHEY GARNER  This past Saturday we had the opportunity to here Dr. Hershey Garner come speak about the current problems and future benefits of health care reform in America. Dr. Hershey Garner has a strong background in law, finance and medicine and frequently has an input in state and federal government. I expected to have a clearer understanding of the new heath care system and realize what current problems have made it necessary. One thing people might be surprised to learn is that we are not even in the top 20 of medical care in the world. Many people go without being able to afford or be eligible for health insurance or. Also, with insurance tied to employment, many people have had to go without if they have lost their job or some benefits in the recent recession.  One of the things I was most interested to hear about is how corrupt the lawmakers can be. It is clear that certain parties have an agenda that does not include helping the majority of Americans but instead getting their own issues across and to be reelected by mislead Americans. This also leads to importance of a unbiased news source, which can be very hard to come by these days. One example of this is a lawmaker having the idea to put funding for end of life care into the new bill. This same lawmaker, after getting his idea written into the bill, went around warning people of “death panels” and President Obama wanting kill your grandmother. Clearly this is just an example of dirty politics. Because of such strong opposing agendas, the bill may have many flaws, though it is better than nothing. Dr. Garner works in hospice and Oncology so he knows the importance of funding for such medical necessities even for the less privileged. Like he said, it is kind of ironic that we have the right to own a gun but not the right to health care.  Another main point of the talk was the emphasis of preventative care. If more people are allowed to visit the doctor regularly for check ups, very expensive problems such as a stroke or cancer can be avoided more cheaply and easily. I was also happy to hear that the bill will open up even more positions in the medical field and make use of all health care professionals talents such as using nurse practitioners to do examine patients so more can be seen faster. All in all I am very happy about the incoming changes to the health care industry and hope that the progress will be expanded. There may be many flaws but hopefully lawmakers and citizens can find some common ground for the good of the country.
  4. 4. SIM LAB AND SPEECH AND HEARING CLINIC  Last Thursday we had the opportunity to visit the Simulation Lab in the new Donna Epley Nursing Center. Before going I was very excited because I knew that we would be seeing where the nursing students do their training on manikins and was very interested in seeing them as well as the new building. The first thing we did once we arrived was tour the bottom half of the building with Dr. Hagstrom. This area dealt with communication disorders in youth. There were many different rooms for each age group where evaluations and studies are done on children’s speech, hearing, and swallowing. It is hear where children get cochlear implants to enable them to hear and can be helped with other communication problems. The center can also be a great help to adults as well. If an adult is diagnosed with a diseased such as ALS, they may consult the center to gain communication skills even after their ability to speak is gone.  The second part of the center we toured was the nursing education center. This was my favorite part of the tour. We where shown numerous rooms used to simulate a hospital or a clinic. One room was just full of hospital examination beds where the students could practice on themselves. The next room contained many beds each with a manikin. These where the basic manikins, they could not speak or breath but some in there could open their mouths and even store some bodily fluids. The next set of manikins we saw where very high speed. One could breath, talk, and even had a pulse. The most surprising thing to me was how much theses things cost. Even the basic dummies where about 5 to 7 thousand dollars and the more advanced ones could be more than $60,000. Clearly these tools are expense, albeit necessary to medical education.
  5. 5. QULTURUM  Before going to Qulturum I honesty had now clue what to expect. I thought that it might be some sort of clinic or research hospital and that Qulturum was just the Swedish term for Doctor’s Office, who knows.  I was actually quite surprised to see what Qulturum actually was. Apparently they did not practice medicine at all. When we arrived a woman named Agata Rukat gave us a short tour and told us about an average day at work there and their responsibilities and goals. After the tour we where taken to a room where Agata and the director of qualtorm gave us a presentation about the facilities goals and what they have done to improve hospital, health professional and patient relations. Also they talked about how they are changing the way medicine in practiced in general to help both doctor and patient.  One of the things I found most interesting was the video about self dialysis. Dialysis is a very time consuming process for people battling kidney disease and awaiting a transplant. At Jonkoping there has been instituted on of the first “DIY” dialysis clinics. This is much more convenient for the patient who can now go get treatment on their own time and feel more involved in their care. Also a great thing is how they focus on health more than care in practicing health care. In order to promote health Qulturum puts together programs such as Passion for Life, which gives healthy living tips to an aging population. This information will be very useful in the future. Hopefully as a physician I will not only think about how effective the care I’m giving is, but how the care makes the patient feel. By assessing the culture of medicine Qulturum is helping both doctor and patient toward a higher quality of life.
  6. 6. SWEDISH SOCIAL INSURANCE  This Monday we paid a visit to the Social Security Office in Jonkoping. Before going I expected to learn more about Sweden’s tax system and benefits for its citizens. I had been learning in my time here that Sweden had some pretty high taxes but some very large government benefits as well.  When we arrived at the office soaking wet, Klas Rydell, who worked at the office, took us to a conference room. Mr. Rydell was very nice and funny as well as a very engaging speaker. He showed us a power point that included fact and statistics about Sweden’s population, income, and lifespan. He told us a lot about all of Sweden’s government benefits, which include health care, housing, extremely long maternity leaves.  What I learned about the Sweden’s social security made me realize why their high taxies are so worth it. What as just amazing to me was that not only health care, but also all schooling, including college and graduate school, is completely free to Sweden’s residents. I also learned that Sweden is very geared toward equality and the promotion of families. The basis of the social security system is that the young support the old. With people living longer and longer lives and with smaller family sizes, this is becoming difficult to do with the number of elderly people unable to support themselves exceeds the limit that can be supported by the working. One way they are trying to solve this problem is by offering more incentives for having children such as long maternity leaves – about two years per child- and by giving a monthly child fee to the family that can go towards day care or other needs.  I found this information incredibly interesting. Knowing this I can better understand the reasoning behinds Sweden’s financial policies. This can be applied to the health care system very easily because it is a person’s social security in Sweden that provides them with the care they need. In the future I plan to learn a little more about Americas social security system so I can better compare them and ask questions accordingly.
  7. 7. SWEDISH HEALTH CARE SYSTEM  Ingalill Gimbler gave our fist official lecture over the Swedish Health Care System. Going into the lecture I prepared by having my fourth cup of Swedish coffee for the day and had expected to learn more detail on how the Swedes operate their medical system from someone who knew first hand.  Ingalill was a nurse anesthetist who had lots of experience working in the Swedish as well as American health care system. She gave us a PowerPoint presentation not only talking about the health care system but also giving lots of statistical information on Sweden as well as the rest of the world. We also got to hear a few interesting Swedish facts and see pictures of grandchildren along the way.  I still cannot fully wrap my head around northern Sweden being dark 24/7 in the winter and light in the summer but according to Ingalill it was very depressing. One of the first things she mentioned was how high the suicide rate was in the Swedish city of Kiruna, way far north. Also Sweden is very sparsely populated with only 9.4 million inhabitants. Because Sweden has always been on the lower side as far as population count, the government started very early in trying to prolong the longevity of its residents. Acts to promote clean water and sewage as well as bans on alcohol were all put in place to make a population healthier. I would say this has been very successful seeing as the average lifespan is around 82 years and an infant mortality rate of 2 per 100 live births. Another thing that was mentioned was the high use of midwives in Sweden and how it may contribute to this low mortality rate. I believe preventative measures such as regular checkups and promotion of healthy lifestyle is part of what makes their health care so successful.  The thing I will take away from this talk the most will be the focus on preventative care. If people spend more time taking care of themselves they are more likely to avoid a more life threatening and costly illness. In the future I will ask more questions about how Sweden’s preventative care measures compare with those in the United States.
  8. 8. RYHOV HOSPITAL  One thing I was very excited about Monday was to visit the Ryhov hospital in Sweden. Having already been to a hospital and cath lab in the US I was pretty sure what to expect. But I was also interested to see inside a Swedish hospital to compare it with our tour of Washington Regional back at home in Arkansas.  When we arrived we ate lunch in the hospital restaurant and then walk back down to the main lobby to wait for the cardiologist. Once he arrived he led us down stairs and through the cardiac wing to a conference room where he gave us a talk that included some facts about the hospital as well as about the patients they treat there. Next a nurse Annika took us on a tour to the cath lab and then to the nurse’s station in the ICU. We finished our tour with a look through the emergency room before returning back to the lobby where we found ice cream.  My favorite part of the hospital was just seeing around inside of it and lunch. I found it interesting how the hospital was made to be apart of the community. It had lots of art, which is provided by the state, and even a library and coffee shop. It was much more relaxed feeling than many other hospitals I’ve been to and had more people just walking around then laying in their rooms. Annika told us about how the patients who are able to are made to come out of their rooms for meals and socialize, which I thought was pretty cool. Another thing I noticed was while there was a lot of art and people, the hospital itself seem a little outdated. Compared to the Washington regional lab, the Sweden Cath lab was much less high tech. One of the most noticeable things in Washington regionals lab was the huge television monitor that hung from the ceiling. These supplies cost them millions each year. Sweden’s lab was definitively less modern looking but costs less and based on the figures from the PowerPoint, delivered just as good of care.  One thing I wish I had done differently before this lecture would have been to have a large cup of coffee. It was a long and rainy day so I was honestly dragging by the time we made it to this stop. Despite wanting to lay down in a hospital bed, I really enjoyed the hospital and will try to see the them as part of the community as opposed to a separate place only sick people need to go to out of necessity.
  9. 9. MATCH MUSEUM  This Tuesday we visited the Jonkoping’s Safety Match Museum. I planned to learn what exactly a safety match was since I did not know there was a totally safe match. Also I was excited to see how matches were made so long ago and what effect it had on the development of Jonkoping’s.  When we arrived I saw that the museum was actually in one of the original match factories, which was a two story white building. When we first arrived we watched a video that explained about the safety match and about the factory origins and work conditions. After the video we made our way around the museum, which contained lots of information (unfortunately all written in Swedish) about the tools and the procedures used all those years ago to create the safety match.  Even though I could not read any of the informational signs I did in fact learn a lot about the safety match and about life in Jonkoping all those years ago. Ironically the match was not safe at all. The video told about the horrible working conditions that the factory created. The factory was primary employed by women and children because their small hands where better for handling the tiny matches. This was very sad because many of them died or became horribly ill. We also learned about the living conditions of the workers. Apartments were provided to a family if all of the members were employed in the factory. We were able to see a model of these homes and learn about the many safety and health risks came with factory work.  I found this museum very interesting and it gave me a good insight into the city’s history. In the future I plan to look into more small local museums like this because it helps you see what makes a city unique.
  10. 10. DINNER WITH THE SWEDES  We had the opportunity to go have dinner with Fran’s good friends the Junefelts, at their home near Stockholm. I expected to see what a typical Swedish house was like and to have some great Swedish food (looking forward to fish).  I did in fact have a great meal complete with reindeer rolls and yep you guessed it, fish. No complaining here. Our night was rounded off with good conversation and a game of charades.  Besides the food, my favorite part of the dinner was our party games. Of course we had the obligatory deck of cards and with the help of John Flannigin’s two little girls we took part in a riveting game of charades. The little girls taught me that you could in fact be a food item (such as a waffle) in this game. As much as I would like to say I delved even deeper into the world of Swedish health care I have to be honest and tell you my time was pretty occupied by acting out movies and deciding if a little girl laying on the floor was a chicken nugget or a pancake.  In the future I plan on inviting myself into more European households because I am sure they would have great food stories. So if any of you have to bail me out of a Swedish jail for breaking and entering you can be sure I only had the motive of dinner and party games in mind.
  11. 11. THE VASA  One our first full day in Stockholm the HTA group set out for a trip to the Vasa Museum. I really did not know what to expect partly because I had no clue where we were going and will blindly follow pretty much anybody.  Once at the museum we spent the next hour exploring the 400 year old Vasa which sunk in the 1600’s on its inaugural sail.  I learned a lot about sea travel in the old days of Sweden. I got a new appreciation for their handywork looking at all of the fine details that went into the ship. It was unfortunate that they did not spend a little more time thinking about the mechanics of the ship instead of the looks. The ship was to tall and narrow to float and sunk about a mile out killing everyone on board. The ship and its passengers remained in the port until it was brought up and restored in the early 1900s.  From the Vasa people today learn a lot about the lives and priorities of those early people. They clearly had a passion for fine detail that was ultimately their downfall.
  12. 12. ABBA  Our last full day in Sweden we got up bright and early to head to Sweden’s Music Hall of Fame and ABBA Museum. I expected to expand my knowledge of ABBA beyond the movie Momma Mia and hopefully get down with my bad self to some rockin’ 70s’ tunes.  As for what we did, please refer to the next slide.  What I learned from this experience was that ABBA was a BIG deal. I also learned that Dr. Allison makes a great dance partner. Unfortunately I do not have video evidence of this, your just going to have to take my word for it.  In the future I will use this new found knowledge of Swedish music to grow on my iTunes library and jam out in my bedroom.