Exchange report - incoming students
Home university: Universidad del Azuay
Study programme: Medicine
Exchange programme: INK
Semester: Autumn semester 2016/2017
Name: Ana Isabel Cordero Guillen
Email address: isacorderog@hotmail.com

Arrival and registration

My program started on the last days of September and I arrived four days before so I could not attend the introduction day, but I received the general information from my international coordinator, and she answered the questions that we had.

I want to thank the opportunity to the international students to contact KI student that helps us when we arrive. Honestly, I did not know what I would have done without her help. We arrived at 6:00 in the afternoon, and with the difference in the time, another language and another currency we were lost at the airport. Here, is where the KI student told us what to do and led us to our accommodation. She gave us all the information that we need to know how to buy the public transportation card, where we can buy the groceries near home, and in the building where the kitchen was, how to book the laundry room, and where were our rooms .

We were asked to visit the health center as soon as we arrived, because some tests were required like MRSA test. I went to Solna, there the nurse who took care of me was very kind and gave me information of how to contact the health center in the future if was needed. 

Acommendation


As a student that comes from so far away, for me it was very important to have a place to stay while I studied in Stockholm. We have read that finding a place in Sweden was very difficult, because of the amount of students and people there. Luckly for us we received an offer from KI Housing, for my point of view the offer was a little bit late in time, I would prefer to receive it sooner, because of the amount of papers that I have to arrange before going to Sweden ( The permissions, certificates, aplying for a visa, etc). I found the cost very accesible, taking in mind all the things that are included as electricity, internet, water, water heater, heating and in addition the other services like kitchen and laundry room. The location was also important because I needed to be near the public transportation, and in my case it was just three blocks away from the train station, so I was very happy. 

When I arrived to my bedroom it was perfectly clean, so I had a good impression on that, but honestly, I can not say the same thing about the kitchen of my floor. I know that is the responsibility of each of the tenants to keep the kitchen as clean as possible, but mine was a disaster. I have read that we have a schedule for each tenant to take care of the garbage disposal but I suggest that there should be control. Between the time that I spent in my accomodation, it was impossible for me to eat in the kitchen because it was always garbage in the table, the dishes, cutlery and glasses were always dirty, and I did not feel safe to use them.

About the laundry room, while I was there the machines were okay, but a couple of them broke twice, and unfortunately it was on the weekend so we had to wait so long for them to be fixed. 

Beside that, I did not have problems there, and I think that is an excellent option for students like me that do not have a contact or a place to stay. 

Leisure time and social activities

While I was at Karolinska, I was able to participate in a couple of social activities. I think that the people that organized this things were always thinking in the diversity of students that they had at KI. They knew how to get people interest in any activity that they were planning, from cultural activites as visiting museums to social parties just to have fun and meet other students.

I went to a couple of different activities and I always found them very interesting. First, I went to Salsa&Bachata Thursdays, I think that was a really good idea, because as a Latin American girl, it felt good to have something similar to home in the other part od the world. There also I was able to meet other Latin American students that were in KI. There were 2 levels, and both of them were very good for beginners and also for advanced dancers. It was free for the MF students and it costed 10 crowns for the no registered students, so also de price was very accesible.

Second, I went to a trip in Cruise to Riga. Everything was very well organized, we were able to get for some spots and the price was very cheap. As foreign students, we got lost when we were going to the boat (we took the wrong bus), but luckly we were able to catched the ship before it left.  We had a really good time in the boat and also at Latvia. Although we were going in the cheapest cabins, we were able to visit every place as the bars, discos, the pool, etc. We were able to interact with other students from the medical programm and also the other courses that KI was offering, and that was amazing. We also had an excellent breakfast when we arrived to Riga with many typical swedish and latvian dishes. The whole day we were able to walk through the city and visit places that we thought were interesting and between 4:30 and 5:00 pm we had to go back to the ship to begin our  way back to Stockholm. It was a short weekend trip but for a very low price we visited other country across the baltic sea and also had a party with a lot of international and swedish students.

We also went to a dinner and party in a boat called Patricia. Eventhough we were not able to catch spots for the dinner because for that time we were not registered members, but they allowed us to go to the party and we had a really good time. Between other activities we went to Fotografiska, a museum of photographies, the exposition was of an artist from Siria that showed what was happeing in that area throuh pictures inspired in children, it was marvelous.

I suggest that as interational students, especially in few time courses, should attempt to go to every activity that they can because they are very good and let us knew as much of the new cultures as we could in the short time that we had free!

Pre-departure



I chose to go on exchange because I think that living in another country with a different culture, customs and traditions let you learn things to make you grow as a human, besides giving you knowledge about your career, in my case, Medicine. 
I live in a small country in South America, as you may know, the majority of the countries there, are very poor and do not have advanced technology. I think that this was one of the most important reasons why I chose to go to Karolinska Institutet in Stockholm, Sweden. The idea of studying in a place where I can truly see what I have read just in books, made me got interested in this specific programm. I really love where I live, but they train us in different situations, and we develop different ways of abording a patient, so i believe that in any career is better if you can combine the knowledge of both sides and know how to act in any circumstance. 


For our students, the exchange in Sweden was new, in the early 2016 the agreement with KI was just signed, and was the first time that we heard that we had the opportunity to study in a university in the other side of the world. Honestly, we did not have to much informarion about Karolinska before coming. I remembered tha two people from Karolinska visited us, and gave us general information about Sweden and let us know that we could apply for an exchange, but it was not until few weeks before the deadline of the applications that we received the call for the people that was interested in going. We did an interview in our university, and after the authorities evaluate many parameters they chose two students, my classmate and I. We had just one day to prepare the papers and sent the application. I think that this issue was caused because, as I said before, is the first year that my home university sent students to KI, I truly believe that this will change between the next years, when they get experience and understand how this programm works. 

Vaccination or certificates were not needed for us, and this really surprised me.  

Courses during the exchange period

ELA005 : Internal Medicine 1
Internal Medicine was my first course. I started with two weeks at Gastroenterology, at Karolinska, Solna. As my first time studying in another country, with a different system and language, I was very shy to ask some questions at the beginning. My supervisor was very kind with me and tried to explain me as much as he could, but it was difficult, for example during the rounds because they spoke in swedish and I was not able to understand anything, but I was really interested in learning about the different patologies that the people from the nordic places had. Eventhough I was not able to understand what the patient was saying, my supervisor took care that I had at my disposal reading material about the different things that we saw everyday, so I can say that I learned a lot about diseases that are uncommon in my country, as Crohn's disease and Ulcerative Colitis. I also saw how they did some procedures as gastroscopies and colonoscopies, and the doctors there were always very kind and explained me everything, so I was able to learn a lot in every case. During the outpatient clinic, eventhough they spoke in swedish,before each patient the doctor took some time to explain me the backgrounds, what he knew about the patient, the treatment, the stage of the disease, between other things. And also, after each patient, he explained everything that had happened, every word that was said during the interview was explained to me, and I was free to ask if I did not understand something. After saying how amazing were this two weeks, I have to comment that during this specific rotation there were a few times that I felt left behind, and I know that the majority of the time was not the doctor's fault, but it was the language as a barrier, because sometimes they forgot that I did not spoke swedish. The next 2 weeks of internal medicine, I spent at the Emergency department in the Internal Medicine's desks. The rotation here was incredible, I learned a lot during this weeks. I was asigned everyday a different tutor and I followed him/her the whole day. There were amazing tutors, that explained to me everything about the patient and let me do many things as examine the patient, talk to the patient, take some gasometries, do some sutures, read EKG, and let me participate in any situation that came. During the emergencies, I was able to go into the acute room, and saw what they were doing, after the patient was stabilized I was explained everything and I had the time to ask what I wanted to know. As there were some good tutors, there were a few that I felt that they did not wanted to have me following them, or were too stressed to be able to explain to me what was happening with the patient. I really had this feeling a couple of times, and those days I felt that I did not learned as much as I would like to, but I was always welcome to use the computers there, so if they did not explained me something I always could read about it.
ELAXX6 : Surgery 1
Surgery was my second course, but my first one in Sodersjukhuset. Honestly I have to say that I felt very welcome in this hospital. A week before my rotation there started, I received an email from a group of the students there, that were very kind offering us their help if we needed something during our rotation there. This really made me feel good and very excited to to go to this hospital. From the first day and until the last day, everyone treated us very nicely, it is not that I am saying that in the other place they treated us bad, but here I felt something different in the enviroment. During this rotation, I had the impression that they are used to have students, and specifically international students, that do not speak swedish. Everything was very organized, before the rotation we received our own schedule of what we were going to do everyday of every week there. I enjoyed also the fact of having other exchange students with me, even though we were with different tutors everyday, we could spent sometime during the lunch. I had two weeks in General Surgery, one of those, in Hernia and Acute Department, I really liked this week, because the resident and also de specialist were very nice people that included me in everything. Here is were I chose my case for my final presentation, my supervisor told me that he was going to do an uncommon surgery and after telling him that I was interested he let me met the patient before the surgery, be the first assistant in the procedure and also interview the patient after the surgery. The other week was at the Lower gastric Surgery Department, I learned a lot here, my supervisor was a nice doctor that let me assist to a lot of surgeries and many times let me scrub in and assist her during the surgeries. The third week was at Urology, I found this speciality quite interesting because I have never had this as a subject before, so everything that I saw and learned was new. One thing that I really like was that we had lectures in the afternoon with our supervisor and she taught us important things that we will use in the future, and focused in important aspects of each urological disease. The fourth week we had Anestesiology, as the speciality above, I have never had these before as a subject so I learned new important things and for me it was very interesting. in my case I was asigned a tutor that was in Gynecology and I saw many astonishing procedures. My teacher letted me practice a lot like sometimes she letted me try intubation on a patient, let me put a periphereal line, ventilate the patient, and of course, perform the physical examination. Although, the schedule was heavy, I had an amazing time in the surgery department and I earned skills and a lot of knowledge from this activities, and that I know that would help me during my career. In this department besides the international classmates, I had also swedish classmates, the majority of them were very nice people and were very helpfully. The only thing that I would like the coordinators to change about this course was that once we had a seminar, together swedish and exchange students, the meeting was in english, but us, the international students, did not receive the cases, so we could not prepare the material, and when they put the cases on a presentation for us to develop the topic they were in swedish so it was really hard for us to follow the class.
2EE090 : Emergency Medicine
My last course was at Sodersjukhuset too, at the Emergency department. I enjoyed very much my time at this department, because my supervisor was a very nice person very opened to listen to us and always asking how things were going. The emergency department, as is known, sometimes could be crazy but something that I learned here and that I will never forget is that no matter how hard is the situation you should always be calmed and try to think without stressing. One day during the week was designated for the seminar with a different topic each one. We were able to prepare the material for the class and also we could decide when the next seminar was going to be. During this day we came studying and after hearing a case we discussed different diagnosis and all together, in the end found the solution and also gave the patient a treatment. I am used to this system because in my country we receive classes with this modality, so I felt comfortable paticipating. The cases were real, we disscused about daily diseases at the emergency department, very common things that I am pretty sure that will see in any hospital. In the last week, we had the last seminar, in which we were the ones giving the case and letting the other students discuss and this also was evaluated as a final exam. Each day, we were asignated to a different tutor in different areas of emergency, so at the end we had spent time all over the place, and knew how every speciality worked in acute situations. All the tutor were selected carefully by our supervisor, based on their experience to interact with non swedish speaking students. Comparing to my rotation in the other Emergency Department, I can say that here they are more used to have students and they are more calmed. I practiced here a lot in things like taking blood samples, blood gas, examinating the patient and also some tutors let me interview the patient and after that, they let me gave the recommendations. This made me feet included and taken in account.

Summary

In general terms, I found this experience as very enriching as a medical student and also as a person. As I said before, I was able to visit and be envolved in a health system completely different than the one that I am used to, the diseases that are very common in North Europe, in my country  are extremely rare because of the genetic influence, the weather, traditions, and even I  might not be able to see or diagnose ever one of those.  Also somehting that was new for me was the technology and the organization when they had to diagnose and treat a sick person, that is just stunning.
 
I recommend 100% this course for any medical student, because as me, they might open their minds to a different perspective of how everything is managed in a developed country, they could learn many things and gain tons of habilities taught by incredible professionals.

 I am very happy of the time that I spent at KI and in Sweden, I´m also very grateful with all the people that I had the opportunity to share with. Everyone made me grow and be a better person, from the coordinators to the teachers and also my classmates, I want to say thank you very much for the opportunity and lessons that you gave to me, I will  keep them forever with me.

Language and Culture

No I did not participate in any Swedish course,  but I would have liked to.
I think that I would enjoyed much if i had known any Swedish, because it was really difficult for me to understand the situation before the teacher translated to conversation to me. I know that almost everybody in Sweden knows english, but during the medical interview, when the patient had to explained what they were feeling, obviously they prefered their native language, they did not want to miss anything while they were telling the situation to the doctor.

Eventhough I know this was not the course fault is the only complaint that i have according to the language. In fact, in some situations I felt useful, because I was able to translate from Spanish (that is my native language), to English because the patient was not able to speak in swedish or english and without me they should have waited for a translator, and that might took a little bit longer.

Studies in general

I consider that my experience in KI was amazing. As I mentioned before, the enviroment in my home university is completely different, we are trained in very different ways. 
In my home university, we continue with the idea that we have to focus a lot in knowing everything that is written in books, but when we have to develop in the hospitals we found that the resources are limited and what we have read is only happening in developed countries. Here in KI, the teachers here really like to teach, they love having students with them, they like to explain what they are doing, and it is not a big fault if they ask you something and you do not know the answer. This kindness is between the whole team in every area in the hospital, like doctors, nurses, assistants,  if they notice that you are a student they are always worried if you catch all the information to understand what is happening in every case. 

In KI, the relation between teacher - student, is friendly, the students are always free to ask if they want to know something or if they did not understand what is happening. The teachers open the doors of the hospital to the student and make them an important part of the team. I felt this treatment starting when in the morning meetings they present us as exchange students that will be working with a specific team, and during the day they asked us if we had any question, if we want to suggest something or if we agree or diasgree with the approach that they are taking. It does not matter if they are too busy they always find time to answer your questions, in my case, they always find time to translate the information from swedish to english, to make easier and interesting for me to follow he situation.

I can talk about my experience  as a spanish and english speaker in the student- patient relation, sometimes it was really difficult for me to talk to the patients, because eventhough they know english, when they want to explain their sickness they of course prefer their native language to make it clearer and do not miss a thing. Few times I was able to talk to the patient as I am used to, but I was always welcome to ask a few questions during my supervisor's interview. A couple of times I was asked to translate from spanish speaker patients to english, in order to help the doctor that was in charge. In this last situations I enjoyed to much the experience, because I could truly interact with te patient and was able to understand the whole situation. 

As I said before, this experience trainned me in many different ways, that I know that I would use in the future and I would be able to combine what I learn in home and the new skills that I earned during this three months. The main difference that I found, was that according to what I have been teached, we focused mainly in the physical examination and after that we see the lab tests. What I noticed here is that they of course performance the physical examination with the patient, but when making decisions they mainly focuse on the lab tests. I know, that it depends on the situation and in the place that you are working, but I truly believe that mixing those approaches it would make easier for me to take care of the patient in any situation, with or without enough resources. 
In my home country, as students we are able to practice our skills, because we have lack of personnel and a big amount of patients everyday, for us, this is an excellent way of trainning and of gaining experience, but talking about the quality of  service that the patient receive, it might not be what they prefer.