Small Victories & Bread Crumbs

Hello there! Can you believe that another week has gone by? Because I cannot.

A few stats on where I am so far:

  • Number of Ice Cream scoops consumed: Too many to count
  • Number of pages read: 160 (anyone who knows me knows this is a great start!)
  • Number of miles walked + ran: 158.5
  • Number of pages journaled: 40
  • Number of familiar faces seen: 2
  • Number of random community members interviewed: 1

Now, its a small statistic, but let me tell you, that last number, that small number 1 you see, was a huge step. In this post I want to share, like I did last week, what I have done, where I have been, and what I have learned, but I want to start for a moment focusing on that small number 1 you see above.

In two weeks time, I managed to conduct one interview with a random individual in Copenhagen area. If you had to ask me what one of the greatest challenges these first two weeks have presented, up there on the list would be introducing myself, sharing about my year, my project and asking to sit down, speak and learn about people. My project focuses on the systems of emergency and ambulatory care around the world, and I have been taking the steps towards meeting and learning the people within the health care field that make this possible; however, another big component to my project and my year as a whole is meeting people: their stories, feelings and opinions on what it means to feel safe, to trust and be cared for. Taking that step, the step where I go up to someone I do not know, and ask if I can sit down and speak with them has caused more anxiety than I had anticipated. For the most part, this has come as a surprise to me, and thus has also caused a lot of frustration internally. I typically really enjoy approaching new people, learning about them and sharing a great conversation, so being here and struggling at accomplishing one of the things I enjoy so much has been an unforeseen challenge. It is a clear example how I am learning things about myself I did not know before!

Yesterday, I took the plunge. Sitting at a coffee shop near my current home, I was sipping on an iced coffee, writing down some thoughts in my journal, and observing those around me. The thoughts in my journal consisted of me writing down everything I was currently thinking: “There’s a couple beside me, do I ask them if I can talk, or is that rude? Oh, dang too late, they got up and left. There’s a young woman to my left eating alone; oh never mind, she put her headphones on. There’s a woman sitting in the grass just looking…wait, never mind she laid back and closed her eyes.” Each time I got close to mustering up the courage to introduce myself, it seemed as if my opportunity vanished. I was getting increasingly more frustrated at my lack of confidence to start up a conversation, and all the while more people were moving on about there day. Throughout this time, a family of 5 was playing in the grass. Mom and Dad had been making sure their three kids didn’t wander off too far, but mostly, they were just enjoying the day. I packed my things and decided I would try it, even if it turned out unsuccessful. Turns out, it was a success! The mother and I spoke for just over a half an hour, and during that time I got to hear about herself, her family, and their relationship to the Danish Healthcare system. Walking away from that conversation gave me so much joy and it was a glimmer of hope, a reminder of why I was so excited to start this year in the first place, a victory (a small one perhaps, but a victory).
I have found that it is quite important to recognize the victories as you go. It doesn’t matter whether you made the greatest step forward or if you just conquered one barrier that had previously been in your way, its victory, and I have come to celebrate the ones I make each day.

The first two weeks have been a whirlwind. It has been filled with moments of extreme excitement and also worries of how one could possibly do it. I’m learning not to set quite so many expectations of what I am supposed to be doing, seeing learning. This, along with introducing myself has been the two most challenging components to date. I anticipate (though trying not to expect!) that both of these things will improve in time. The Watson Foundation sent us a few things in preparation of our departure, one of them being a pocket size survival guide titled, “Getting it Right?” I have found myself going to it more than once so far, and two pieces of advise has stood out to me.  One: “Treat the Journey as the Destination: Feel the edges of your project, even as it moves across disciplines (or borders). Stay curious and open to the unplanned.” Two: “See challenges as opportunities: try Hard. Hold Hard Standards. Fail up. When things don’t work out, integrate the learning.” As I move forward, I am reminding myself of both of these things, and I think it is a great thing for us all to be reminded of.

Recognize the Small Victories.

Treat the Journey as the Destination.

See challenges as opportunities (and Fail Up).

First, a brief recap of the things I did and saw this week: (Followed by some photos!)

  • Monday 7/17: Sorting out a plan for the week, Ingolf’s Kaffebar, and research into potential new contacts
  • Tuesday 7/18: Interview with Dr. Peter Berlac, Medical Director of Copenhagen EMS
  • Wednesday 7/19: Documenting my interview, scheduling follow-up, and continued research
  • Thursday 7/20: A day of city exploration, meeting an old camp friend and enjoying good sights and good food
  • Friday 7/21: Biking through the city to meet and increase networks and a SOAKING wet ride home through unexpected rain
  • Saturday 7/22: Attempted to join a running group (closed), an afternoon at a Kaffebar (Coffee!) and my first interview!
  • Sunday 7/23: An incredible long run through the city, documenting my first interview, a phone call home, and greeting the return of my Host Dad, Morten
    Home on the Water, Christiania
    Evenings in Strøget, Pedestrian Streets
    Copenhagen Ambulance, Weaving through Pedestrian Streets
    Church of Our Savior
    Views from 400 steps up!
    Friends in High Places! (Top of Church of Our Savior)

More great sights seen, discovered, and discovered again. Each corner I turn around in this city looks incredibley familiar and yet totally new at the same time. It is quite the adventure!

Project Reflections & New Information:

First a recap of my meeting with Dr. Peter Berlac, Medical Director of Copenhagen EMS

Dr. Berlac shared with me some of the history within the service here: where it started and how it has come to be what it is now. Copenhagen now is drawn into 5 regions, and within these five regions are a total of 98 municipalities. Each of these 5 regions have their own EMS Service that supports the population who live within them. Currently, I am living in the Capital Region of Denmark,  which serves the greater Copenhagen area, including the island of Bornholm found in the Baltic Sea. Historically, there were 14 counties and 270 municipalities; but in 2007, with the Danish Municipal Reform, these lines were redrawn and cut from 14 & 270 to 5 & 98. Accordingly, this was a large improvement to the structure within Denmark. The former Counties were not in sync, and often differed in style of organization and work. Redrawing these lines held ramifications all through the political spectrum of Denmark, one of which was Health Care and Emergency Services. Now, each of the 5 regions has their own Emergency medical Service. The dispatching center I toured previously accepts calls for all individuals within the Capital Region, and the other 4 regions also have their own dispatching office. Although the one found in Copenhagen is the largest, the other branches are adequate for supporting the populations within their region. With this change in 2007 brought the beginning of a truly integrated health system. From the phone call to 112 or 1813, all the way to the Hospital, the system is integrated and connected to provide the highest care and best support one could offer.

In regards to ambulances, I learned that Denmark has three main types of Ambulances that can go on calls, or missions, as Dr. Berlac puts it.

  • You have your Regular Ambulance, as seen in the image above and last week. The majority of ambulatory needs within the population are met by this truck and it has the capacity to treat and transport a varying array of health conditions.
  •  The Babylance: This truck, as the name puts it, is designed specifically for new borns. The truck is quite a bit larger than a regular ambulance, has a separate seating area with viewing room for the family involved and has a fully equipped neonatal support system. For an infant in need of hospital transport or home pick-up, this ambulance is able to provide exceptional care.
  • The Psychelance: This ambulance is also different than a regular ambulance and is devoted to responding to psychiatric emergencies. The paramedics on board are trained more specifically to recognizing and treating various psychological conditions, and thus offers an incredibly specific level of care for individuals of psychiatric treatment.
  • Helicopters: Helicopters are also available to reach longer-distance calls. The presence of these in each region allow for the services to maintain fast response times. Individuals on the Helicopters consist of trained physicians and a pilot.

Within each type of Ambulance, you have trained Paramedics onboard as well as some lower-ranking EMTs; however, Dr. Berlac informed me that they are in their proses of staffing only paramedics on each truck to maintain a high level of care. Additionally, as shared last week, there are physicians on call at the dispatching center and at various Ambulance stations throughout the City. These physicians are often the ones with the most experience. Though this practice of staffing physicians to perform home visits and go on emergent calls is not a new practice here, the level of care has increased. Previously, it was often a position served by new doctors; however, it is now the more experienced who serve here in order to provide the highest care possible from the start. About 20% of the time, physicians accompany paramedics on calls. On psychiatric calls, the majority of cases are handled via the phone with a trained health care providers, but about 30% of all calls received are responded to by the Psychelance. For these calls, a physician joins the Paramedic.

The role of well-trained physicians also works well for the purpose of inter-facility transport or IFT. Previously, ambulances would pick up a patient for a transport and a nurse or doctor at the current hospital would join the patient in the transport. This resulted in an inefficient form of care because you would decrease staff at one hospital and keep an ambulance out of service and readiness to respond to calls for a longer period of time.

Last week I learned the interesting fact about CPR requirements for receiving a Driver’s License. This week I learned of another piece of community care that was implemented in Denamark. On the Island of Bornholm, a relatively small island in the middle of the Baltic Sea, every member was certified in CPR. This training was implemented to everyone of age (and not just those seeking a license to drive). Following their training, health care providers witnessed the tripling of their out of hospital cardiac arrest survival rate.

I also spoke about the map that Copenhagen EMS has for every AED within the region. Walking along a street, it is not a rare assurance to find these (as picture below) attached to walls. Instructions are found in English and Danish and they often include a sign showing the local companies that sponsor the existence of the device.

An AED found along a Main Street in Amager, Copenhagen

To me, all of this is incredible, and speaks highly of a system of Emergency Care that is clearly focused on supporting and sustaining life. What I think stands out is the way the community is involved. The system of care you find here extends beyond your typical health care provided: EMT, Paramedic, Nurse, Doctor, and reaches into the community. Local businesses are in support of the care of their community and individuals are being trained to care for their neighbors, even the ones they may not know. It fosters a relationship among people

I am going to hold off on detailing my first interview until I have conducted a few more and can share a post dedicated specifically to that. Stay tuned as I learn to take new leaps and make new introductions as I continue to learn about how individuals of different backgrounds feel about their system of care.

Whats up ahead this week?

Well, this morning consisted of misreading previous emails and preparing for a full day of observation at the Copenhagen Main Fire and Ambulance Station. Turns out the day of observation is Friday, the 28th and not the 24th (…) , so something to look forward to! More interviews to come (after getting one under my belt, there’s no where to go but up!). Seeking out communication with local politicians involved in health care. A Museum Tour with my Host Family coming this Wednesday, and a birthday celebration for Rune; he turns 11!

That just about sums up this week! For those following along this year, thank you. And thank you for sending support my way as I continue to discern the next step. At many times, I have felt a little like Hansel and Gretle, picking up the Bread Crumbs that keep falling out in front of me. I have spoken about expectations some already, but this has been a learning experience. Sometimes all you can do is follow the bread crumbs and trusts that they are leading you in the right direction. There are small victories along the way and often a few detours that take you down new unforeseen paths. Most of these things, however, are not what I expected or anticipated experiencing. This has been both a challenge and an opportunity.

Another week down, and a brand new one coming up! Looking forward to finding new bread crumbs to follow, recognizing the small and large victories along the way and sharing with you all.

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