Update: From week 4 to week 6

Time flies. I keep saying that, and yet time keeps flying. Today I write “Day #46” in my Journal; that marks one day over my half-way point until I leave Europe and half-way into my time here in Denmark. Last time I was writing to you all I was celebrating one month into my year, and now I am crossing over halfway?! So, yes. Time flies.

Do any of you subscribe to Story People? That’s probably a redundant question because I know that some of you reading these posts do, but for others: Story People is an organization that has a website, books, blog, email subscription service where an artist named Brian Andreas posts often child-like, cartoon drawings of people accompanied by a short story or message. On some days you find just a short message on top of a colorful background. If what I am saying interests you, subscribe here. It probably took me over 4 years to realize I should have subscribed earlier. At the begining of this week, I received this message in my inbox:

If there was a more accurate description of what these first 6 weeks have held for me, I haven’t found one. There are a lot of truths in Brian Andreas’s Invitation of the Day. The first clause I experience most days, and most days I get frustrated at myself for feeling this way. I’m trying to learn how to better live into the second clause, but this message came at a good time. As you will read below, a lot of good things happened in the past two weeks, yet I often felt stalled, like I was not being productive with my day. For example, transcribing a recorded conversation takes time, and it fills a solid portion of your day. At times this can feel like a waste, but I know it fits well in the larger picture. Days within coffee shops have been a refuge, a place to catch up and also to reflect. They are intermediary; they fill the voids between one scheduled thing and the next. They’re also the places I have felt most comfortable with speaking up and saying hey to a new face. Sometimes it developes into a larger conversation, an exchange of contacts, and other times it is just in passing. Both are good.

Another thing I am learning this year is the difference between where I am now and where I have been. Seventeen years of school, of structure, of Monday through Friday class, practice, and homework ingrains in you a routine that is not easily broken. It’s true, we can all take that week (or three) on the couch during winter or summer breaks, but for the most part seventeen years of school leaves you with a keen understanding for schedule. In a Watson year, you make your own schedule. This was to be expected; however, I have realized that the contents within a scheduled day can vary. Morning routine, a late-afternoon run to break up the day, and an evening filled reflecting has become a fairly staple component to life abroad, but its the schedule in between all of these things that break the mold for me. I don’t have my 9:00 am on MWF or my Tuesday afternoon lab. One day looks drastically different than the one before and even more so compared to the same day the week prior. It can be a little disorienting, but in time I have come to understand it the new norm. What struck me so strongly with Brian Andreas’s Invitation of the Day is at the end. Say, “yes,” and then repeat it.

In typical fashion, check out the sometimes eventful and other times coffee-filled days over the past two weeks. None of them look the same, and but all have been good. Skip on if you are looking for some pictures or even further for a project update!

  • Tuesday 8/8: As you may have read, the 8th was filled with blogging to you all! I spent the day at The Big Apple, a quaint yellow coffee shop on the corner of a street near Strøget, and right next to the old University of Copenhagen. The building kind of leans a little bit when you take a step back and look at it. It reminds me of how old Shenanigans used to look, pre-refurbishment.
  • Wednesday 8/9: I volunteered for a Music, Beer, Food, and Arts Festival called Haven. It was their first year for the festival and they were offering free tickets to those who volunteered. We constructed different bars for Mikkeller Brewing Company. We were a group of about 9 people, mixed between myself, local Copenhagen-ers, an Australian, a Swede, and some from Jutland, the mainland part of Denmark.
  • Thursday 8/10: The 20th felt a little off-beat. These are days, as I mentioned, I am still learning to utilize. Plans Monday, Tuesday, Wednesday, and Friday of this week left Thursday caught in the middle and totally open. I knew I had accomplished good work in the week, and that there was more to come, but then I was still left waiting. My evening running group helped put more structure to the day. The track was even hosting some races so I got to stick around and watch 1500m and 5km races! If you don’t know already, I love to watch other runners run.
  • Friday 8/11: The day started off great. I met the head Paramedic and Director of the Ballerup Falck Ambulance & Fire Station. I toured the facility, learned about their education process, and set up a day the following week to ride along with them! It was confirmed later that I was unable to do so. What I had previously thought to be an organizational policy is actually a Regional Policy/Law. The day ended by traveling to Thy National Park in the northwest corner of Denmark. Sitting atop WWII German Bunkers tucked within flowing sand dunes, we watched the sunset and prepared for the wedding.
  • Saturday 8/12:  Wedding day! A large communal breakfast and a trek to what I was told to be the smallest Church in Denmark, we watched the wedding and then celebrated with champagne and lunch by the beach. With an afternoon lull, I went on a run, swam in the Atlantic, and enjoyed meeting extended family. The night consisted of good food, lots of laughter and numerous occasions of Skål-ing (Toasts).
  • Sunday 8/13: With a long drive ahead the family and I got moving pretty quick and soon departed the camp site. We took an alternate route this time that would take us through the mainland rather than across a ferry like before. We stopped halfway at what Danes refer to as Denmark’s Birthplace. At the site were two large burial mounds, a church and two large Rune Stones laid by ancient Viking Kings Gorm and his son, Harold Bluetooth. I learned that King Bluetooth united all of Denmark and Christianized the nation.
  • Monday 8/14: On the 14th I had one last shift volunteering at the Haven Music Ferstival. New faces and new connections made, we finished with hours to spare and received a free beer as a reward for a job well done. Later in the day, I trekked to Udinaturen, a large Nature Reserve southwest of Copenhagen and did a long run. The majority of it circled along the ocean. There was water on one side and open fields, marshes, and trees on the other. It was pristine.
  • Tuesday 8/15: The 15th was another day similar to the Thursday before. A little idle. I found myself captivated with news from home. Reading articles on Charlottesville and watching news clips in an effort to make sense of things. It was an odd feeling to feel so close to the events that occurred, so frustrated, sad, and hurt, but to also be so distant from its source. It left me questioning, as I often am left with, of how to best combat against the injustices we see. I’m still questioning, but one thing I have learned: Listen.
  • Wednesday 8/16: The 16th was much like the 15th, and I am learning that this will often happen, but I was able to secure some meetings later in the week and early into the next one with members of the Danish Parliament!
  • Thursday 8/17: The big part of my day on the 17th was receiving a tour the main psyachiatric hospital in Amager by one of the head nurses. We toured both inpatient wards and the acute/emergency clinic. I raced a 5km in the evening. It also rained (just like the last) but we had a blast running through blurred vision and enjoying free food and drinks after.
  • Friday 8/18: On the 18th I had the pleasure of meeting Jeppe Jakobsen, a member of Parliament who works on the Health and Senior Citizen’s Committee. We had a nice discussion about policy, the future of Danish Healthcare, and how the Parliament plays a role into the health system.
  • Saturday 8/19: Saturday truly felt like the weekend, which I am learning is important to distinguish between a “work week” and the weekend. I went on a morning run and then headed into the city center for the Copenhagen Pride Parade. There was much celebrating and happy faces all around. Something that struck me, however, was the level of terror control put in place. I can understand the city’s efforts for preparedness, but to see it implemented in person was something else.
  • Sunday 8/20: Sunday morning was treated by another fantastic long run in the Nature Reserve, an afternoon in a coffee shop, and an evening seeing a Sewanee face. Lucille Conrad had just arrived for her semester abroad. We grabbed dinner and swapped stories: of the mountain and here.
  • Monday 8/21: I sort of told myself that I would give myself the first 6 weeks to not think about the next step (at least not in grand detail), but on the first day of my second 6 weeks, I found myself doing some planning. I bought a plane ticket to Chile! It definitely makes things feel more official: to have a date and to know exactly how much time you have left. Although it still seems so soon, I am reminded that I have just as much time left here as I have been here. I’m exactly halfway between!
  • Tuesday 8/22: So far today has continued a little of Monday’s planning. Choosing a flight has helped give some (needed) direction into my next six weeks and plans are becoming more rigid. This is both an extreme excitement as well as a huge relief. I had lunch with another memeber of Parliament on the Health and Senior Citizens Committee. It was great to hear another perspective. This afternoon and evening consists of finishing up the remaining transcribing the remaining recording into notes and meeting back up with the Sparta Running group.

Now its time for some pictures! Take a look below for some of the sights and things I have done in the past two weeks. Keep scrolling for more news on my project!

Looking west towards the Atlantic; a view from the Wedding Site
Turn your head left or right and this is what you will find
The wedding chapel, said to be the smallest in Denmark!
Humble bragging about Iben and I’s “Model Status” on the beach
Standing atop a German WWII Bunker
Stairs leading into the bunker
Eerie sights on the inside, now reclaimed by blowing sand and graffiti
At Kongernes Jelling: Atop a Viking Grave, surrounded by a Christian Cemetary, within a large ship; the bow marked by the white stones in front
I happened across a car accident. Ambulance, police and fire had responded.
Christiansborg Palace, the old royal home, which now houses the Danish Parliament
An Ambulance in the Pride Parade
(Not my photo) Google Map’s description of where I have been doing long runs!

And now for some more updates on my project! Once again, thanks for sticking around.

To Recap:

  • Visit to a Falck Group Ambulance Station
  • Psychiatric Center Tour
  • Two interviews with Danish Parliament Members

Follow-up on Emergency Room Observation:

Last time I spoke a little about the triage systems and I wanted to elaborate a little on them for you all so you have a better understanding of their meaning. These levels are guidelines and not set in stone. Any patient who comes in is given a level (blue, green, yellow, orange, or red), and everyone can fluctuate or change along that spectrum of colors depending on the progression or improvement of their condition. The systems classifies the patient based off of condition and determines when treatment must be started.

  • Blue – Blue basically means the patient does not need to be in the hospital and is in good condition (While I was there, I did not observe any patients under the “blue” category on the waiting list
  • Green – Green patients are the most acute level. It is clear by the admitting nurse that a delay in treatment will not harm the patient any further. Treatment must begin for these patients within 240 minutes (4hrs).
  • Yellow – Patients in the Yellow category are in need of treatment, but it is not urgent. Treatment must begin within 60 minutes (1hr) of arrival to the hospital.
  • Orange – Patients qualify for Orange with decrease mental function/awareness, chest pain, and other signs/symptoms that point towards severe conditions such as heart attack or stroke. These patients must be seen within 15 minutes
  • Red – The patient is at risk of immediate death and needs to be immediately seen.

The doctor I shadowed mentioned that this system helps things run smoothly; however, it can at times be too rigid, and thus more qualified nurses often change patient’s color based off of their own understanding rather than what the triage book says. In the same way, the lead doctor on call helps look at the charts and determines which patients (s)he can rapidly see to open up space more quickly. It is a chaotic system that has an underlying tone of structure and order. The emergency ward is always on the move, and there is minimal time to sit still, but things are running efficiently.

The doctor I shadowed also elaborated on the work that he does. As an overseer, he looks at the charts and makes judgements on what steps need to be taken next. At the most severe times he can call the alarm center and halt any more admittance of patients by ambulance, having them be diverted to other hospitals within the city. He noted that this is a last resort and is rarely used; however, an alternative is to immediately transfer patients to various departments based off of their chief complaint. If he see’s an elderly individual who has a history of heart conditions who comes into the emergency ward, it can come to be inferred that this patient will ultimately be admitted to the hospital and therefore he will transfer the patient to cardiology for initial diagnosis and admittance. This may not always be preferred by other departments, but in the limited space the ER has, it was clear that it can sometimes be necessary.

As are many hospitals in the country, Bispebjerg Hospital is receiving an upgrade and an entire new emergency ward. Upon completion their emergency ward will house 120 beds rather than the 20 they currently hold. This is a drastic change and will likely necessitate some changes in the ways doctors, nurses, and staff work. For the time being, I learned that the way they work now is the most efficient. The wait times on the board were not astronomical. Sure, there was the occasional person who had been there a few hours, but I learned that this was a result of a patient waiting on test results (which can take time).

New Information Learned at Falck:

At the Falck Station in Ballerup, an area/large neighborhood on the northwest outer region of the city, I met with the head paramedic and the station director. Throughout my time, I received another tour of their ambulances and learned more about the education and quality assurance mechanisms they have in place in order to maintain the appropriate levels of care.

To start, ambulances are standardized within the region, whether it is with Falck or the Copenhagen Fire Brigade. They look the same on the inside and out, which is a nice small piece to the puzzle. As an EMT in the states, Sewanee EMT’s had their own ambulance, which was organized and structured in a way we all knew well; however, sometimes we used a neighboring ambulance when ours was out of service. In the switch, not only did the size of the ambulance changed, but so did the location of equipment. I could tell that unless we spent time to familiarize ourselves with both types of ambulances, we would be in trouble for providing rapid, secure care. Here, there isn’t an issue. The standardization eliminates the possibility of the confusion I faced as an EMT. Beyond that, I would say that the ambulance, their airway/breathing equipment, their bleeding/circulation equipment and the various other components carried on an ambulance were the same as what we had in the States. I was shown a paramedics ambulance, and thus saw more drugs carried; however, this was also the same as our truck in Sewanee. The Basic truck, which was run by Advanced EMTs held a limited number of drugs, while the Advanced truck, which carried a paramedic, had more drugs like what I observed at the Falck Station.

We also spoke about education, which I know I have briefly mentioned before from my conversation with a medic. Education here lasts three years, but is broken up into different modules where the student learns in the classroom and from the book and then goes out for observation before starting the next module. This takes some time, but by the end of three years, the students are ready and qualified to start work right away. This style of education removes any experiential learning curve, which is something I struggled with starting out as a newly licensed EMT. When you finish school here, you become a Level 1 Technician. Level 1 Technicians have no responsibility for the patient, but they are allowed to drive the ambulance and assist Level 2 Technicians or Paramedics in treatment. In Denmark, you must be a Level 1 Technician for a minimum of one year before being approved for Level 2. Level 2 trainees take a 16-week course divided into 4 modules that mimics the style of learning they had as students. Afterwards, there is a test before receiving the Level 2 qualification. Level 2 Technicians must serve for three years before qualifying to be a Paramedic. Similarly, there is a 16-week course in Aalborg that all future paramedics must go to. This is a city in the Northern Part of Denmark and is the only location that trains Paramedics. It does not matter which health region the Level 2 Technician works in or which service they work for, all travel to Aalborg for this certification process.

Something I think is cool about this process of education is the flow of it. During my time as an EMT in the states I learned that you could enter into the ambulance system at different levels depending on the schooling you did. It’s clear here that everyone is channeled through the same process, which takes a minimum of seven years before you are a paramedic. That seems like quite some time, but it also speaks to how qualified these paramedics are by the time they are the leader of an ambulance. No one who serves in the paramedic role is new to the field. They have all had seven years of combined classroom and experiential learning that has prepared them to lead in such a way. I learned that with Falck, it is the intention for all of their employees to start and ultimately become Paramedics. To be accepted into the program is selective; there are hundreds of applicants for just a few dozen spaces each year. Falck makes an investment in those they select and it pays off in the care provided to people over the course of many years.

Psychiatric Hospital News:

I happened upon this opportunity biking into the city center early on in my time here. Close to where I live was a sign directing people to the Amager Psychiatric Center. Thinking that they may have some keen insight on care here in Copenhagen, I stopped by only to find vacant hallways and danish signs I didn’t understand. Eventually I found a person who gave me an email for the right place. This email led me to meeting with a head nurse at the main Pschiatric Hospital in Amager. Here, found out that the initial center I entered is an out-patient center designed for people to pay a visit in the days and weeks after treatment for follow-up visits.

If you are to classify the treatment facilaities within the Capital Region, you have two distinct types: Somatic and Psychiatric. Similar to there being multiple somatic hospitals through the city and the greater Capital Region, there are also various Psychiatric Hospitals and additionally more acute specialty centers for patients with specific diagnoses such as ADHD, PTSD, Depression, Anxiety, or Eating Disorders. The main Amager Psychiatric center has four long-term wards, an elderly ward, and an acute/emergency center that has its own temporary ward for admitted patients. Similar to the somatic hospitals, the psychiatric hospitals also operate under the Health Region and are thus funded by the welfare state. In contrast, however, is the ability for those in need of psychiatric treatment to walk into the psychiatric center without prior scheduling or calling. In past posts I have detailed the difference between 112, the emergency dial tone, or 1813, the number to call for non-emergent medical inquiries. In order to enter an emergency room at a somatic hospital, 1813 must have first been called. At the psychiatric emergency room, this rule does not apply and patients are able to walk straight in. In addition to being able to walk into the acute center, patients may also call the hospital for nurses or physicians to provide a home visit. This is one way to help maintain the efficiency of the hospital while reaching more people in the community.

I have previously detailed the Psych-lance and the Social-lance as innovative forms of care provided in Copenhagen. I was able to learn a little more about their function. The Psyche-lance operates after 4:00 pm and before 8:00 am when general physicians are not working, and thus are responsible for responding to psychiatric emergencies after hours. These ambulances are restricted in who they can care for; both the hospital and the Psych-lance cannot respond to a patient unless they are directly requested. On the other hand, the Social-lance does not have this restriction. The Social-lance, as a part of the København Kommune (Copenhagen Commune – the city government system) is able to respond just to check-in, and often they have decent success at gaining access to patients due to the respect people hold for them. The Social-lance is a collaboration between the ambulance system and the Kommune. Staffed on board is a paramedic and a social worker who can address immediate needs while also caring for long term needs the patient may have. The nurse shared with me that this vehicle often responds to people dealing with larger, long-term issues such as abuse, alcoholism, or homelessness. I learned that many individuals in this demographic have come to call the Social-lance as “Our Ambulance” because many finally feel they are getting the care that they need. In times prior, these individuals often felt like they were lost in the system, and the Social-lance has begun to fix that issue. Individuals working on the Social-lance are also trained to recognize various psychiatric needs and can transport the patient to the psychiatric hospital if necessary.

As an aside: to me I really do think this is an incredible component to Copenhagen’s stystem of pre-hospital care. It sounds to me as if the work done by the Social-lance helps fill the gaps in care that once existed. I am currently working on setting a date to meet some of the workers at the Social-lance center.

One thing I have come to hear more repetitively is the use (or overuse) of the welfare system here. When individuals come to understand that they are covered and treated for everything without any additional cost, you run the risk of being overloaded with patients coming to the hospitals. The issue is that more often than not, those coming present themselves with a relatively minor situation that may not need direct or immediate treatment and it can put a strain on the hospital staff. You also run the risk of jeopardizing those who may not have the appropriate networks or resources outside of the hospital system for help. This is something that I have now heard at the Physician Pre-Hospital Center, the Hospital while observing, at the Psychaitric Hospital, and also in conversation with a member of parliament. It draws an interesting question about the access to healthcare. It is clear that everyone supports wholeheartedly the ample access to care here, but they are also recognizing the dangers of people taking advantage or overusing the system.

Parliamentary Discussion:

This past Friday, I went to the Christiansborg Palace to meet with Jeppe Jakobsen, a member of the Danish People’s Party and a sitting member on the Health and Senior Citizen’s Committee. After contacting his office previously, he agreed to meet and share with me some of the work Parliament does in regards to healthcare.

To continue the flow of thought from above, Jeppe also recognized the strain hospitals are put on when they are pressured with an increasing amount of patients. Jeppe noted that a large portion, though not all, are young parents who are worried about their children. He noted that a possible solution to this is to increase the level of education on what needs immediate treatement and what doesn’t. Jeppe shared that every pregnant woman in Denmark is given a midwife and a nurse, and that education about when your child needs to sleep off a minor temperature spike versus needing immediate treatment should be taught through the midwife and nurses assigned.

In our conversation we expanded beyond just the Capital Region of Denmark, which is where I have been focused these first six weeks. As a member of the Danish Parliament, the policies he and his collegeue create are implemented on the nation. The main issue we discussed was about figuring out a way to provide a more equal and sustainable system of equal access to healthcare across regions. Something that was assured to me though was that the politicians within Parliament do not often clash when it comes to instances of healthcare. Sure, there are minor disagreements, but every party is on board with supporting and maintains the Danish Welfare system.

Paraphrasing from or conversation — One of the main topics we deal with at the moment is geographical equality in terms of health. We are a small country, but within 200 miles we have a difference in life expectancy by 10 years. Southern Zealand and Northern Jutland have much lower life expectancy. That’s a big issue for Denmark right now in terms of feeling safe. These are the parts of the countries with the citizens who need the most help, and also the regions with the fewest doctors, fewest hospitals, and least amount of access.

A few key points that came from this comment:

  1. The above comment lead us to discuss the ongoing debate of redrawing or eliminating regional lines. Jeppe shared that many people do not know who their regional politicians are. They know their local municipality elected members and parlaimentary members, but not the region, who are the ones making decisions on health. He addressed the concern there is behind people not knowing their elected officials, especially since they are the ones making the decisions for the region in terms of health among other things.
  2. We also discussed budget issues in relation to this. Each Health Region is given a certain amount of money for healthcare spending to be used in a fiscal year; however, this proves to be less concrete than it should. For example, Region Sjælland (Zealand), does not have the capacity to treat every patient in their region and thus often defers treatment to the Capital Region which neighbors it. The first issue is that patients from Sjælland are not put in the same triage system and are thus second to everyone. The second issue is that the Capital Region then charges a fee to Region Sjælland for providing the treatment. Though this covers the cost of care for their patients, it also misdirects the allotment of funds given by the national government in the budget.

These were interesting perspective that I had yet to hear until our meeting. Perhaps it is because I have mostly talked to people in the Capital Region, and their Health System may be touted as more secure than other areas, but it was good to learn about some of the division that exists.

Though there is always more to share and some pieces of information have been left out, these were some of the key take-always in the past two weeks. What I have learned has prompted me to think forward to some other outlets of care that I once did not think about, such as the Social-lance. I am working to meet with those who work in this organization next week. In other news, I have secured an opportunity to shadow on an ambulance. Next week I will be traveling to Rosklide in Sjælland, as was just mentioned, and will be on a Falck Ambulance for a day. In between those great things, I’ll be taking a little “Halfway through Denmark” break. On Friday, I head to Prague where I will see James Dunaway, a best friend of mine who is returning from Uganda as a Fellow with the Carter Center. I’m quite excited to see a new place and see an old face.

Something I have yet to mention in these blog posts is asking for suggestions on improvements. If you ever have any questions or pieces of advice as to how to make these posts more appealing to you, please let me know! I want to be able to share with you all what I am learning, but I want to make sure it is coming across in a presentable way! If you have thought of new questions that you’d like me to think about or look further into, I would love to hear those as well! There is a contact page, and I’d love to hear from you!

Lastly, to all my friends in Sewanee welcoming the Freshman into PRE (one of our university’s freshman orientation programs), I hope today is a blast. It’s truly one of the best parts of Sewanee. I miss it, but I am happy to know it will continue to be as great as it always is because you are there.

Talk to you again soon,

Mark

One thought on “Update: From week 4 to week 6

  1. More questions for you later — but…my initial ones: 1) Are ambulances standardized in the States? 2) Is there some kind of hierarchy of technicians on ambulances in the States? Or do all EMTs on board have the ability to provide care? I’m interested to know how this compares to the structure/organization of what we have at home, which I’m sure is even different from a Sewanee ambulance!

    Also…the Social-lance interview opportunity! That’s awesome. I’m really excited to hear about that and wonder if the social workers on board go into social work with the intent of serving on an ambulance? That and your shadow experience are very interesting to me and I can’t wait to hear more. You’ve got some great things on your plate for the second half of Denmark…I am so proud of you, per usual, and 4312!

    Like

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