We’re leaving from Shanghai next Monday so we’re writing one more time. Our last day at school was last Friday – we had a test about Chinese herbs and Tai Ji lesson. On Monday we had our last day at the practical training in Ren Ji hospital. We had a closing seremony this morning and there were all of our teachers, the principal and some manager of the school. The principal, the manager and our international coordinator gave a speech and then Emmi, one of the Finnish exchange students, showed us a PowerPoint about our stay here. Then we gave the school some feedback and the principal didn’t seem to like it. It seems that when you give some “bad” feedback here, the principal starts blaming a certain person and we don’t like it. Anyway, we got our certificates and took a group photo. After that the school really was over!

On Thursday we’ll go to a hostel with few exchange students and see some sights. We really look forward to come home but also we are really going to miss Shanghai and all of the exchange students. It has been great to share our journey in China with all of you – we really hope you travel to China someday. Thank you for all the comments! 

The school is over!

When we first came here it was cold and rainy, not exactly the dream. The school seemed really big and majestic, but we were stunned about the fact that we only had classes in our dormitory. They separated us from the Chinese students so we had no chance to get to know them. After that we have met only few of them who had wanted to hang out with us. We think they are just shy and being friends is different in China. It takes much more time for them to trust someone enough to be friends. In the beginning we were overwhelmed about everything being so different and we had basically a culture shock. After few weeks we got used to it and started to really like this city. We learned how to use public transport (not easy at all) and got used to the food here. We also got to know other Finnish students here and it was great to know that we weren’t the only ones who thought that some things here were bad and poorly organized. We also met new people in the hospital and they were really nice. We travelled around Shanghai to see some sights. When we started realizing how big the city really was, it was amazing to think that we were in a city where over 20 million people lived. It is a great feeling to some Finns who have lived in a small town most of their lives. The first trip outside Shanghai was Beijing – another big city full of history. The Great Wall of China, Forbidden City etc… The places we’ve always known about became real when we actually saw them. Another trip was to Huangshan (not including Miika), to the beautiful mountains and fresh air. It was nice to see the countryside of China too. Most of the time we have been in Shanghai because this is such a big city full of things to do. And also we haven’t had many holidays here so we haven’t been able to travel so much. Now it’s warm in here and we feel that the time has passed really quickly. We’ve never regretted coming here. We still have few weeks here and we are going to enjoy it!

The practical training has been interesting. Most of the time we have been observing different kinds of procedures and comparing differences in the health care between China and Finland. There are lots of differences but many things are basically the same in Finland. At times we’ve thought that the practical training is boring because they don’t let us do that much. Sometimes it has been really interesting, especially at SICU-surgical intensive care unit. We think that the most interesting procedure has been observing a cardioangiogram. We also learned interesting things about respiration machine and ABP (arterial blood pressure) measuring. This practical training has improved our nursing skills in many different ways. We have learned about international nursing a lot and improved our English. We have also learned important things about machines you need to know as a nurse and learned that if a Chinese nurse does some procedure in a different way, it doesn’t mean she does it wrong. If the result is the same, it’s alright to do it their way. We have realized that in Finland the health care system is really good compared to China and it’s normal because China is a developing country. You learn to appreciate what you have at home when you see how badly things could be. Of course here are things that are just as good as in Finland.

The nurses had a photography competition and we were in the gallery too. The photos are taken in the neurosurgery ward.

A little bit over a week ago I (Outi) went to Huangshan with four Finnish students. Miika stayed in Shanghai to celebrate Labor Day. Huangshan is a town approximately 400 km’s from Shanghai. There is a village called Tangkou really near and we were in a hostel there. Huangshan is famous because of its mountains. The mountains are called Mt. Huangshan. We arrived there on Saturday and it was +30 degrees. We rested the first day because we planned to get up early the next morning. We woke up at 5.00 am. and left to the mountains. It was a very foggy and humid day. We took a scenery elevator to get to a higher place in the mountains. We started climbing and the first goal was to go to the Lotus Peak. Lotus Peak is about 1860 metres high and the stairs there were really small and difficult to climb. It was foggy so we didn’t get very good pictures or see the beautiful scenery from the top. It was still a great feeling to climb there. After that we started walking to the Fairytale Bridge. The bridge was quite small and modest and not worth walking several kilometres for. We had to turn back from the bridge because there was no other route. Then it started raining and it rained the whole day. Luckily we had equipment for that kind of weather. We walked around the mountains and the last challenge was 6,5 kilometres of stairs downhill. It was really hard for our legs. When we reached the exit, I was really happy. It was a quite hard walk. We walked over 15 kilometres and took 20000 steps during that day so you can say we were a bit tired. I think my legs are still sore from that trip… The next day we went to hot springs and spent the day resting and relaxing. The hot springs were nice – there were different kinds of springs, for example a red wine spring and a green tea spring. On Tuesday we left to Shanghai with sore legs and nice memories. Totally worth the pain!

I (Miika) spent my Labor Day in a Finnish way – hanging out with friends and drinking. The Chinese spent their Labor Day with family at home. They don’t actually celebrate like Finns. We went to a restaurant and ate well and then we went to a bunch of night clubs. We also went to a park and spent time there with other Finnish students. The night was really nice and warm and we had a good time. It wasn’t the same thing to celebrate Labor Day here than in Finland. There was no “sima” or donuts. I think that the Finnish Labor Day is more cheerful than here. The Chinese don’t use any graduation hats here. Shanghai seemed so peaceful because everyone was home celebrating or had travelled away from the city.

We have been practicing in surgical ICU for three days now and next week we’ll have one day and then that practice is over. ICU in Ren Ji hospital is in building 7, the 3^rd floor. There are about 25 patients in the ward and one nurse per three patients. A lot more compared to Finland. There are patients who have been in the ward for years, for example there is a patient who has been there for four years. The relatives want to keep him alive and the doctors allow it even though the patient is in a vegetative state and has no brain function. In Finland that kind of patient would not be in ICU, probably they would have stopped the respiratory machine after few months. The nurses told us that this is a big problem in hospitals all over China because the patients who really need a bed won’t get it. There should be a ward or nursing home for patients who are in a vegetative state. Our nurse supervisor, Van, has been really nice and his English is really good. He has been telling us about the respiratory machine and ABP (arterial blood pressure). Another nurse told us about basic nursing in the ward and about their work in general. For example the nurses have this system where the head nurse evaluates them monthly. If a nurse does some mistake, the head nurse will take some points from the nurse. When you lose five points, you will lose 50 yuans from your salary. The nurses who haven’t done mistakes in a year, will get the money from other nurses who have done mistakes. We think it’s a crazy system and the nurses feel stressed about it. We think that if a nurse does a mistake, she won’t tell anyone and the patient can get hurt.

Yesterday we went to a nursing home with other exchange students and there was a 10^th anniversary show of the nursing home. After that we went to see the Oriental Pearl TV Tower. It’s the tower in the Pudong area and it’s height is 468 meters. We visited the sightseeing floor, where you can walk over the floor that you can see through. It was in 259 meters and it was really scary! We also went to 350 meters, where the sights were amazing. It was a beautiful day so we could see really far away. Also we went to a roller coaster which was in 90 meters. It was weird – a roller coaster is a sightseeing tower. It was nice though. The Pearl Tower was a really nice experiment and we both enjoyed it a lot.

Sight from the tower.

The Space Module at 350 meters.

We have been studying acupuncture for a few lessons now and we think there will be more lessons soon. We started with a bit of theory and then the teacher showed us some acupuncture points. One of us was the patient and the teacher inserted the needles to different acupuncture points. Then we practiced inserting the needles to napkin packets. It was more difficult than we thought because the needles were so thin. There are different kinds of needles and it depends on the place what kind of needle will be used. Also the size of a patient needs to be considered when selecting a needle. The skin of a back is thickest and you can use long needles there. After studying we started practicing with each other. One of use was the patient and the patient could say where he wanted the needle to be inserted. Mostly we inserted needles to our hands and legs. Some of us were scared of the needles because they are so long, but we weren’t. The needles were long but so thin that it didn’t hurt. Only when the needle hit the nerve you could feel numbness and pressure. Then you knew the needle was in a right place. You could also stimulate the nerve by moving the needle a bit. Before starting you had to take care of hand hygiene when you were inserting needles. Acupuncture lessons were really interesting and we learned a lot. We hope there’ll be more lessons soon.

Tuina massage is massage with different kind of forms and techniques. Tuina massage is based on yin and yang energies and acupuncture points. We have been practicing the massage for four lessons now. There are many techniques, for example grasping. It’s a technique where you lift the muscles and then turn them. We have also learned how to make patient’s joints more moving by doing some circle movements. Last time we pressed acupuncture points on our faces and massaged our faces and ears. We practice with a pair and we massage each other. It’s nice to learn by practicing with each other. We have massaged our backs, legs, arms and stomachs. While you practice you also get a free massage so it’s win-win situation!

The acupuncture needles - different kinds of needles.

The teacher inserts a needle to Miika's leg. The point is good for lower back pain.

After three weeks at the cardiac unit and the holiday in Beijing we started our practical training at the neurosurgical ward this Monday. The ward is in the building 7 at the seventh floor. The ward consists of about 40 patient beds and NICU – Neurosurgical Intensive Care Unit. In NICU there are about 14 patients. The total amount of patients is about the same than in the cardiac unit. The first day was just presentations, procedure videos and getting to know the ward, our supervisor and two students who are helping and tutoring us in the ward – Viv and Abby (those are of course their English names). Viv and Abby were really nice and they talked with us without saying “Oh no, I’m so bad at English” all the time. It was really nice for exchange. Miika was at the NICU and the rest of us were at the ward. We just observed the nurses and asked questions about the nursing in their department. They sure use drugs and i.v. medications more than in the cardiac unit. Most of the patients are in very bad condition and it’s physically harder to treat them.

Because Outi got sick on Tuesday and wasn’t in the practical training on Wednesday either, the writing is from Miika’s point of view. Miika observed different kinds of procedures with his tutor, for example tracheostomy and lumbal puncture. He thought that the tracheostomy was very terrifying because the doctor only had sterile gloves and a mask when he did the procedure. He also thought that the patient didn’t get enough medication and felt pain and the doctor was sweating all over the patient’s tracheostomy wound. Pretty disgusting! At the ward the doctor gives prescriptions to the patient’s family and relatives and they get the medication from a pharmacy. That means family members etc. have to pay all of the medicines themselves and that’s expensive. After the lunch break Miika watched videos about basic care.

The Great Wall of China - Mu Tian Yu section.

Tiananmen Square.

We thought that the nurse-patient relationship would be different from Finland but it really isn’t.  Of course it’s hard to say what the nurse and the patient are talking about with each other because of the language, but we would say that it seem similar to our country. The nurses speak directly to the patients and aren’t so afraid that the patient would be offended. In Finland the nurses are more careful of what they say to the patients. We think that there aren’t that many things you can’t talk straight with the patient. For example in a patient room there were three nurses and us and one nurse asked the patient some questions about intimate things and the patient answered without embarrassment. In Finland patients would probably be ashamed or angry if there were five persons listening. It also depends on a patient. Our classmate Emmi was also in the patient room and she translated the conversation for us. She has lived in Beijing for two and a half years so she is pretty good in Chinese. She has been very nice and translated us a lot of things here in Shanghai. It would be hard to travel by bus if she hadn’t written us the names of the buses in Chinese.

We are going to Beijing tomorrow and we’ll be back in Shanghai on Wednesday or Thursday. It’s a tomb-sweeping day here from Monday to Wednesday (a national holiday) so it’s possible to travel. We’ll tell you about the trip when we come back. 

Sightseeing at the Bund in Shanghai.

The patients of the ward are cardiological, so they have a disease that is related to the heart. Most of the patients are over 60 years old. They are at the ward because they have had problems with their heart. Some patients go to CAG (coronaryangiography) and some patients get a pacemaker. Some patients have a heart failure and they don’t need surgical help. The patients come to the ward from out-patient department or from the ER.

In a morning shift (the only shift we do) the nurses administrate the medicines and then they have a report given orally. After that they move from room to room to check the patients. Then they start making the beds and cleaning the patient rooms. After that the nurses wait for i.v. therapy medicines from another floor and then they start giving the medicines and setting the drops. Then the patients go to operations and some of them rest in the afternoon. We think that in the afternoon the nurses do different kind of things depending of the situation. For example if there is a new patient coming or leaving, there’s a lot of paperwork.

Studying.

The families of the patients do most of the basic care – bathing, eating etc. The nurses just make beds and clean up the room. They also check how patients are doing. Today the nurses who guide us showed how to make patient’s bed correctly and how to place the chair next to the bed (really weird). In the afternoon all of us Finnish students watched how a nurse measured patient’s blood sugar. It was a bit funny because it’s a daily routine in Finland and it was basic stuff in our previous practical trainings. Few of us saw the nurses doing i.v. therapy and we got to help them a little. We have got a feeling that we don’t know how to do things in the right way because the nurses seem to think we don’t know anything. A guess they don’t know much about health care in Finland. We noticed that some things are different from the things in Finland. For example a nurse put hand disinfection after she put on the gloves so she wore the same gloves with every patient. We also have to use a mask every time we are in a patient room. We are confused about this training because it is so different and weird, but luckily the staff is nice and they try to help us much as they can.

Ren Ji hospital, the cardiac unit. From the left our tutor in the ward, Miika, Outi and Olli.