Snigdha in Copenhagen

Snigdha is a junior biology major, minoring in chemistry and math, in Dedman College. In Fall 2009, she is participating in the Medical Practice and Policy Program at the Danish Institute for Study Abroad through SMU-in-Copenhagen.

Field trip to the zoo

Like Waldo, I can be difficult to find. Unlike Waldo, I am short, brown and have a knack for hiding while I try to study and write papers.

At SMU, I would usually hide out in Fondren in the science section or the basement (anywhere really that was out of the way and with wide tables).

In Copenhagen it’s been a little bit more difficult than a quick stroll over to Fondren. Now I am hiding out at Panum Institute (affiliated with University of Kobenhaven and the medical school), which also has wide tables and because I know nobody there (except my cancer bio classmates, because that is where our class is held).

It is huge (with a good cafeteria) and pretty quiet. It’s a great place for me to write a research paper and presentation, write a Russian lit paper, study for three tests and tutor without getting a million interruptions.

Animal behavior

CIMG0160.jpg Last weekend we went to the Odense Zoo and Fjord & Baelt (which is a research facility for marine biology) to observe sea lions (and their pups!), harbor porpoises (and their calf!), manatees (and their several calves!) and harbor seals (no pups for them).

CIMG0236.jpg It was great to see current research on these animals and how their trainers taught them to do tricks, feed and play with each other. Although it was a long day, I really enjoyed the trip, and I think it really helped me to visualize animal behavior and movement (which we had a test on, so that really helped!).

It was also interesting to see the cultural aspect of zoos. While in the US we don’t really consider pelicans to be “exotic” (being from Louisiana I see huge flocks of them over the summer, so I bet many people in the Gulf Coast area see them frequently), but in Denmark that was one of the most popular exhibits (along with the universally popular “primate house,” lion and tiger areas and the flamingo ponds). There was also a Legoland trip that was a LOT of fun, and my inner nerd child loved it.

Under the weather

So yes, it’s been a busy two weeks for me. I also got sick recently with something that apparently everyone in our house has. There is the constant chorus of coughing and honks from blowing our noses as well as frequent complaints of fevers. I was lucky and got better within 24 hours, but while I called the doctor’s office to set up an appointment (which I cancelled once my fever broke) I realized that there are no pictures on the CPR card.

Which made me wonder, why aren’t there ID photos on these cards? Couldn’t someone steal your card and use it? In the US we have several forms of ID to establish identity and legal status (try applying for a job?) and people are usually VERY careful with these documents.

And I thought about it more (while lying in bed, because naturally one would debate these things just before bed) and finally decided, yes it’s possible. But consider that you get free health care and education with this card (not money or credit cards) and that the government is perfectly willing to give any legal person in Denmark. That’s the catch though, legal.

So if the US were going to have any sort of “universal health care,” I am sure the majority of the population would want it to include only legal residents and immigrants. Therefore we would leave a portion of the population (illegal immigrants) uncared for. And that opens up another can of political worms. At this point I decided it was time to sleep.

Travel break next week! I am so excited!! Maybe this means I should learn about the health care of France, Spain and Italy in my spare time?

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Health care in Poznan, Poland

When I pause in between the flurry of papers and reviews and outlines due, I think about Poland. Ahhh, how nice it was to be in Poznan and be able to gorge myself on pastry after pastry after pastry. They were cheap, varied and delicious. And filling (sigh) …

CIMG0603-1.jpg So I wasn’t in Poland for the pastries … I was there to look at the Polish health system. So we all know how the Danish, universal health care system works. And we all stare in awe at its efficiency. If Denmark is the poised, good-looking, over-achieving high schooler, then the Polish health care system would be the awkward younger sibling fumbling through middle school.

Poland, with lower taxes, is unable to pay for universal health care. Most doctors work at least two jobs and consider their job at a public hospital to be somewhat of a joke. They are only allowed to work 3-4 hours a day (and if you are an adult in any career field, you know that it is impossible to get anything productive done; many doctors put in several hours that they are not paid for) and then work 3-4 hours in a private practice.

Entire wards can be closed down because the government can’t pay for the influx of patients beyond what the contract with the hospitals states. Patient rooms are crowded, and while the technology and care can be comparable to what we see in US hospital, the hospitals are not.

We were able to observe an endoscopy, and while the procedure would be similar to US procedures, the endoscopy was performed in the equivalent of an office: there were fax and copier machines and nurses were drinking coffee while assisting. The room was crowded with other students and other doctors coming in to get a second opinion on their own cases. In short, I can identify with the patient when he was crying (not from pain, he was under anesthesia; probably from the shock and confusion).

So while facing high economic pressures, it’s remarkable and commendable that Poland has a universal health care system; it’s not perfect, but it’s working the kinks out.

OK, health system comparisons aside (it may be hard to do this; instead of working on a Russian Lit paper, I was perusing the House Bill for health care reform H.R. 3200 … don’t judge me, I found it to be super interesting), I got to do an ultrasound on a pregnant woman. It was amazing to see her baby’s heart beat really fast and each tiny valve open and close rhythmically and it lined up with the perfect little spine. It was crazy to think we could see all this just by using sound waves and that in a few days this baby would probably be out in the world. Amazing.

It was also fun to meet all the expectant mothers in the wards who were sitting there with Polish magazines and just chatting about their babies. We were able to see the heart rate charts for a pair of twins and then describe changes that would be present if the chart was abnormal. All in all, good day.

CIMG0606.jpg Tourist information … right. Poznan was a beautiful city and interestingly completely renovated since WWII. We did a brief walking tour and got to see one of the most beautiful churches that was built in the Baroque style. Also because of the cheap(er – compared to Copenhagen) prices, I was able to pick up some fun things while shopping. We also visited Lech Brewery (where I am sure there is some massive Organic Chemistry going on …) and ate at a Dark restaurant. The premise there is that it’s dark. Completely dark. So you can’t see anything and you are basically feeling for your food (which was quite delicious).

Anyways the Polish are super nice and have delicious food (pierogies are good!). My friend lost her cell phone and some nice person is now mailing it back to her. They were also very helpful when we were lost or needed to find the right tram to get to the hospital.

I had a great time on my study tour and wish I had more time in Poland!

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We are in Berlin!

Vegas showgirls? Check. Falafel? Check. Lenin and Marx together? Yeah. BERLIN. GET EXCITED.

Ever since we got here on Sunday night, the MPP kids have been going and going and going. Our days are pretty much planned from 8 a.m. to 10 p.m. (or even later! I am writing this at 11 p.m. from my hotel room sans wireless).

While yesterday was purely a cultural visit day with visits to the Berlin Dom (we climbed staircase after staircase after staircase), discovering life in East Berlin at the Museum (DDR = Deutsche Democratic Republic = GDR = German Democratic Republic, not Dance Dance Revolution), lunch at the Reichstag (the line to just visit the top of Germany’s Parliament building was nearly a 2-hour wait, but we breezed through with reservations for an AMAZING gourmet lunch), and we burned off all the calories on our bike tour. (If you ever get the chance to do a bike tour, go for it; we went to nearly 10 landmarks and it was all really fun, easy and safe!) CIMG0304.JPG

And then, we went to the Jewish Museum, which was a detailed, thorough and very interesting museum chronicling Jewish history, culture and achievements. Although we did not get to visit every exhibit, our whole group wished we had more time to visit.

Interestingly, Berlin also has a wide variety of ethnic food, ranging from Middle Eastern (due to the large Turkish population), Mexican, Peruvian, Vietnamese, Singaporean, Indian (I was hassled by a waiter at an Indian restaurant when I was walking by, he had to pick the one Indian girl in the group) … yeah, the list goes on and on. And every place we ate was fabulous, the Italian, Bavarian (a region in southern Germany) and Middle Eastern. Needless to say, we are not weak from hunger! Which is very important!

German health care
Today we visited Charite Hospital in Berlin. This is a large, historic (300 years in 2010) teaching hospital near the center of Berlin (close to the Reichstag) which provides an assortment of care based on referral from a general practitioner.

Germany provides the hospital a lump sum payment based on the diagnosis (the more complicated a case, the more money a hospital gets). This minimizes hospital stays and patients seem to like this as doctors are motivated to treat them.

You must be wondering, don’t some patients leave before they are ready? Do some patients come back because they were discharged early? Yes, but these cases must be reported every two years in a quality report. Doctors are also encouraged to keep imaging and other test requests down to minimize costs.

Some downsides? Definitely! Rooms are pretty bare, outpatient days are higher (but outpatient here is better than inpatient according to the Germans), immunization costs are not covered by public insurance, which is what most of the population has. The individual pays 50% of the insurance cost, and the employer kicks in the other 50%. Insurance is provided by about nearly 300 regional groups.

The most important thing is that even if you are unemployed, you must still pay for insurance. And although most services are provided, there are long waiting lines. Again with immunization being relatively optional due to prohibitive costs, there is a rise in tuberculosis (which the U.S. no longer vaccinates against), measles, etc. Also, as the population is aging and with the downturn in the job market worldwide, there is less money to fund the pay to the doctors. Let’s all collectively sigh right now as we ponder the state of our health care reform. Okay, done?

Good, because we saw a medical museum filled with all sorts of oddities (deformities, an iron lung, obstetric tools and surgery tools throughout history). And after that was a great lunch at a Bavarian restaurant, and then immediately off to the clinical skills lab where we learned basic emergency care, such as CPR, and then looked at models. Can we say fun?!

All things sparkly

After that, we girls changed into our nice evening wear (who goes to the theater in jeans? I must say, I still have some SMU in me, I knew to dress up!) We saw an amazing acrobatic, musical, theatric performance called Qi (pronounced “key”). Consider it a mash-up of Bollywood, Vegas, and the 1980s. Consider it also as the subconscious of my best friend who loves everything sparkly, shiny, glow in the dark. It was spectacular!

Technological advances in telemedicineCIMG0559.JPG
Our last visit was at the Max Delbruck Center for Molecular Medicine (a clinical research center) where we looked at technological advances in telemedicine. For example, let’s say you were a doctor who needed a second opinion from a doctor across the country. You could use the neat 3D cameras and special glasses with laser-equipped microscopes to look for extra masses that might be invisible to the naked eye.
(In photo: laser microscope placed over a mock colon sample with a tumor)

There was even a machine with an attached stylus that simulated a patient’s face. So it would be like feeling the patient’s cheek or forehead, etc. So maybe when the babies of today practice medicine, they will be working with a lot more tools! The aim, however, is not to replace the physician, but to assist them. It is important to know this, because many people fear that robots will replace people.

After that we got to see the MRI machine. It’s a 7 Tesla machine, which means it is much, much stronger than the ones used normally (the ones we normally see are between 1 and 3 Tesla), and even with the machine off we could feel our belt buckles being attracted to the machine along with keys in our pockets. It was a lot of fun!

Well now I am in Poland, and I will give you the rundown on things I have seen, done and generally been excited about!

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Bus rides, baby carriages and Obama in Denmark

Hund’s rule should be renamed as the Danish Bus rule. Yes, the rule about putting up the neat arrows in each box before putting them down for electron orbitals should accurately reflect Danish bus etiquette.

Danish people will NOT sit next to each other. They will walk to the back of the bus before sitting down next to someone in the front of the bus. They will stand up before they sit down next to someone else. And they will rearrange themselves if there’s suddenly an open row for them. It’s true.

And they LOVE their baby carriages. They are tricked out. Fancy shock absorbers, netting, zip-up covers … if I had a carriage like that as a baby, I would have never wanted to walk. And I have yet to see a child riding a bike on training wheels. It’s like they magically go from the baby carriage to the two-wheel bikes. It makes me a little nostalgic for when I was little and rode my bike with my dad’s help.

And Danish food … even though I’ve been cooking for myself, I know the Danish love their potatoes. And the potatoes are ADORABLE. We have big Russet potatoes at home, but here, they’re little, the biggest ones smaller than my palm (and I have a small hand!). And these potatoes are baked, boiled, fried, everything, usually with frikadeler (meatballs). And because of the sizable Middle Eastern population, there are shawarma and falafel shops all over the place. And they are quite delicious.

But to keep costs down I’ve been shopping at Netto, not Magasin (imagine buying your groceries at Nordstrom … feel your money slipping away yet?) and I’ve had some delicious results so far!

CIMG0243.jpg But I know you all want to know about Obama and Oprah in Copenhagen! No I didn’t see them (come on US Embassy, pull some strings for us!) but I was at the announcement concert at Radhuspladsen (city square) where we listened to Aqua (yes! Barbie Girl!!) and DAD (a Danish band). (In photo: Aqua’s lead female singer Lene Nystrom)

K%C3%83%C2%B8benhavn%20027-1.jpg It was fun cheering Chicago on (until we lost! How sad!) and then cheering for Rio because we were standing next to a large group of very vocal Brazilians. And I got pictures with the pikachus from Japan representing Tokyo. (In photo: That’s me with the Japanese in Pikachu costumes)

And I went to the studenthaus, which is a club for Danish students. My network buddy, Linnea, invited me to go with her and her friends, and it was fun watching Danish students dance to music and socialize.

And before I forget: a HUGE thank-you to all my SMU friends who sent me the care package! The emergency queso and tostitos, candy, teddy bear and, most importantly, the letters warmed my cardiac muscles. I was thrilled and didn’t stop bragging about my awesome friends to my housemates (I’m sure they’re fed up with me now!) so again, thanks for making me awesome people!! I miss you all!

Other than that I’m going to Germany and Poland this week for our long study tour! So get ready for a looooong recap with lots of fun pictures, hopefully!

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Blobs and backstage passes

“Get inside the patient’s head.” Ok, so I’m really not in your head. But today is Radiology day with my Human Health and Disease class, and we’re looking at traditional X-rays (yeah, like the ones from the dentist), CT scans, MRIs and ultrasounds.

“But Snigdha,” you might ask,”they’re just pictures of people.” Yeah, just pictures? If the Biology, Chemistry and Physics departments at SMU decided they wanted to have a common course, it would be about radiology (I’m sure there would be a lot more, but a good chunk would be about radiology. I’m sure the Math Department would want to get in on this too).

The images are fantastic, and as we scroll through the consecutive scans, it’s almost as if we are floating right down the axis of a person and looking inside. This might be what ghosts of medical students see on their late-night haunts.

Awkward humor aside, we not only learned the theory behind imaging, but also got to look at ultrasounds, MRIs and CT scans. It was definitely eye-opening to point out organs from different angles (lungs from the side are fun!) and to see the differences between healthy and unhealthy tissue.

The best part though, was reasoning through all the “blobs.” “What’s this mass here? Why is there a straight line? What makes a straight line here in the lung?” (The answer, in case you are wondering, was fluid.) Dr. Norregard patiently guides us through each scan, and we all take turns with the laser pointer to try to figure out tumors and fluid levels. It’s something we also do in our Complexities of Cancer class.

Each class we get two case studies and after discussing basic exam procedures, we get to look at a sample X-ray and our teachers ask us questions about what we see. Metastasis? Malignant or benign? But the most important question is, “Why? Why do you think that?”

It’s also worth noting that in Denmark, all patient records are on the computer. There is a paperless system that they use here, and whenever a doctor needs to look at a patient’s records, they just type in the patient’s CPR number (kind of like the Social Security number), and all the information regarding hospital visits, exams, test results, and medication is present. It cuts down on errors, and it’s just more streamlined and efficient. Another health care reform idea?

Moving on from human bones to animal bones … when people think backstage pass, they think an amazing concert with their favorite band. Our Biology of Marine Mammals class got a backstage pass … to the Zoolgisk Museum in Copenhagen. You’re all probably thinking, oh they just got a special tour of the Danish version of the Smithsonian.

CIMG0205.jpg We got to go into the storage rooms in the museum and look at all the skeletal, stuffed and preserved models. Our tour guide, Mones, who specialized in reptiles, regaled us with stories of catching snakes (he once had to take the insides out of a viper because they were afraid of being over the airline’s baggage weight limit) and of preserving them for the museum’s collections (around 10 million in the total collection, some of which date back to the 1600s).

CIMG0211-1.jpg But the point of the field study was to look at the marine mammal skeletons: the whales (Narwhals with two tusks? River dolphins? Sperm whale skulls? Baby whales?… You betcha!), the seals and walruses, polar bears and manatees. We even got to see skeletons of a blue whale and a sperm whale, and they were massive! Just the sheer size of the skulls was impressive. All in all, a day well spent!

In photos: a blue whale skull (above left) and a bowhead whale (right).

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Classes, hospitals … and fun!

Such a busy week! Papers, tests, movies … things that all need to get done. Not to mention the daily chores, and now that the fall lineup of everyone’s favorite TV show (HOUSE!) is starting tonight, I can only say that there will be a lot of work ahead.

Not to say that it’s no fun. When you’re a bio nerd like me, there is nothing better than learning about cancer treatment and researching popular cancer drugs. That’s this week’s to-do for our Complexities of Cancer class. We have a group paper about breast cancer drugs, and I got Taxol. Now, everyone who’s taken Cell Biology at SMU knows that Taxol is covered by Dr. Ruben when he teaches his course. So I already feel ahead of the class on this one!

We also have a trip planned to the zoo for our Biology of Marine Mammals this week. I’m super excited and can’t wait! I have to say, almost all of the classes here at DIS (Danish Institute for Study Abroad) integrate a field study into the course, while the core course (the class that the program you sign up for is based on) has a short study tour and a long study tour.

Our short study tour was two weeks ago, and we went to Odense for the Hans Christian Anderson Children’s Hospital and Arhus to visit the state-of-the-art imaging center at the Arhus University Hospital. We had little pit stops in between, like visiting a general practitioner to understand the Danish health system and a medical museum.
CIMG9897.JPGSince the U.S. is currently undergoing this massive health care reform debate, it’s probably important to shed some light on the Danish system. Basically, health care and education is free.

How does it not get expensive? They use the gatekeeper model – that is, the general practitioner (your family doctor) is the first doctor you see and the doctor who basically oversees all your treatments. If the gatekeeper deems it necessary, he or she will refer you to a specialist or to the emergency room if he can’t immediately fix it.

Also, instead of rushing to the ER because the doctor’s office is closed, people here call a hotline that basically does a quick triage over the phone. A doctor (who is required to sign up for this duty a set number of times each month) listens to the caller complaints and then decides whether the caller should go to the ER, stay home and wait for their regular doctor, or can send a doctor to make a house call. This leaves acute emergencies for the hospitals. I hope our lawmakers are taking note!

At Hans Christian Anderson Children’s Hospital, we got an in-depth look at neonatal care (specifically how Danish hospitals avoid using ventilators in premature infants) and visited the genetics lab. It was lots of fun and pretty interesting to see all the equipment.

You’re all probably thinking, “But Snigdha, this just sounds like work, and it’s all boring in Denmark.” First of all, it was fun. I got to interact with doctors and sit in on lectures on brain function! Second of all, we went bowling and to a modern art museum that was very interesting. There were plastic bubbles, preserved horse specimens and chairs with pyramids on them at the Arhus Museum of Modern Art.

CIMG0027.JPG Arhus (northwest of Copenhagen) itself was beautiful with huge canals and quaint little streets. So I did have fun! And my housemates are a lot of fun, and we had homemade chocolate cake for a birthday this week. That’s fun, too!

But enough of the little study vacation. Time to hit the books! My Human Health and Disease class (my core course for the Medical Practice and Policy program) meets twice a week at Frederiksberg Hospital, and while we do overviews of the human body, we also get to see real patients.

We’ve learned how to take a patient history, and about every 2-3 weeks, our professors/doctors (the professors here at DIS aren’t primarily teachers; they have other occupations, such as researchers, doctors, businessmen or administrators – so this way we get a window into their “real” world) bring a patient in for us to practice our patient history skills. The point is to learn how to gather important details without making the patient feel uneasy. And in a room full of 20 kids, it’s hard not to feel uneasy. So, we do appreciate all of the patients who volunteer.

Well, enough for this one post … I miss you SMU!

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