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1 Udveksling til (land): Thailand, Bangkok Udvekslingsperiode: 29/01 29/04 Navn: Celina Frederiksen Tlf. nr Evt. rejsekammerat: Grouptravel Hjem-institution: Holdnummer: Nurse Education, Slagelse Sealand Sep08B Værtsinstitution/Universitet: Praktikplads/Hospital: Speciale: Ramathibody School of Nursing, Mahidol Univercity. Ramathibody Hospital Surgical and medical

2 An international perspective which gets under your skin Why did you choose to go on exchange? When I started at School of Nursing in 2008 I knew that I wanted to have another international perspective in my future education than it contained in its context of the modules. Therefore I applied at my school to take the 5 th module, the Interdisciplinary module, in English where we collaborated with other professions and across nationalities. The course was held in Denmark. At the same time I was working as a tutor at my school where I frequently welcomed new exchange students. These students inspired me by their desire to go abroad and were a big factor in my further development of my desire to go abroad. I have always felt that our school has done a good job at informing us about ongoing exchange and new opportunities for exchange programs and after several reports from returned students I felt that now I wanted to feel all that that they have felt during their exchange; a positive development and an adventure! Why did you choose this specific place? I chose Thailand, Bangkok, because I had the opportunity to travel along with other students. It was not because we didn t have any good opportunities at our own school but I wanted to go to a contrast filled country and at our school no one else had applied for going to our big spot Namibia, Africa, so I had to seek other possibilities since we weren t allowed to travel alone to Africa. I had heard about Thailand during my first International day at my school. The report had since that time stayed with me, so there was no doubt when the application date was advertised at the school. My application was done in a hurry but I had to apply to times before I got admitted to the exchange program. Furthermore, as I mention earlier, I was seeking for a country which could give me the opportunity to see, feel and meet a contrast in how nursing care is provided. I did not think that an exchange program to the Nordic countries for example could give me the same benefit. I wanted a contrast and I got it!

3 Your preparations before the exchange program After the approval of my application there were a lot of practical things which should be done. There were contracts at my own school and VIA, ordering the travel through the travel agency, ordering vaccinations and economical grants which should be applied for. As a part of the exchange program we were invited to an information day in Århus where returned students gave good advice and told us about their experiences. It was a good and informative day which also enriched with professional aspects before meeting a new culture. It was also a good opportunity for all of us to meet before the exchange. It was great to put a face on the people that I was going on exchange with and we quickly got a good communication going. We decided to set up a group on Facebook where we, until departure, were able to talk to each other about everything, make friendships, exchange earlier travel experiences in Thailand and so on. It was really great and also gave us the opportunity to talk together about what we had been told at the information day, in case we had not heard it all. The excitement of seeing everyone and generally about the upcoming exchange made the body work to its fullest. I was glad that I had taken some notes from that day. Since I hadn t been travelling in the east before, I had to have all of the necessary vaccinations. Lucky for me I was a member of Denmark, so I got 50 % on all of my vaccinations. When we came to Thailand our different experiences with the vaccinations, especially the Tuberculosis vaccination, was a good conversation subject. I would recommend all to find the exact procedure description of how it is done to prevent any mistakes. It turned out that we all had been given different information s about the vaccination so we all had it placed on different places and some had strongly reacted to the injection. So now, some have small scars while others have big scars as an eternally memory. I was not fully economically prepared for the big payment which shortly came after the approval of my application for the exchange program. We had to pay for the flight, 3 months of rent, insurance and tuition fee for the intensive Thai course on forehand. I was glad, that I, during my study I had laid a little money aside every month for when I was going on exchange but I still needed a sum of money. So I looked at every page in the grant book but it was

4 only a few of the descriptions which fitted with my study, city and purpose. I applied for 3 grants and god approval from 2 who helped me with respectively Danish crowns. In the end it all looked better when VIA told us that we were able to apply for an exchange grant through the State Benefit (SU) to cover the amount which we had to pay to UTCC for the Intensive Thai course. If I had had the possibility in the area where I live, to have prepared myself with a Thai language course before the exchange, then I would have done it. The Thai Intensive course is very good constructed and compressed but it is very difficult to be able to learn everything when you every day is presented to new words and proverb. Therefore I would recommend all who feel that they have the energy, time and money to take a course on forehand to do it. You will definitely learn and profit from the work you do on forehand both because it increases the benefit from the intensive course in Thailand but also because it affects what you get out of you period in Thailand. Professionally benefits When we started at Female Surgical Ward we talked with our adviser about what we were supposed to do and how we could implement each goal from our Danish education to the ward in Bangkok. I was surprised that our adviser had not got our goals at that time so she could have prepared herself and how to give us the best learning conditions. At Female Surgical Ward we had a lot of time to kill. We were not able to have long conversations with the patients and the journals were mostly in Thai which of course we were unable to understand. So we sat a lot and waited for procedures that we could do or observe. Our adviser at Intermediate ward was better to implement our goals during our period at the ward and she only gave us procedures which would develop our skills and were concrete to our goals. Generally we had troubles with integrating us at the ward with the daily staff because of our lack of language and different way of during procedures. We did not have patients in the same way as we do it at Danish wards when we are doing clinical practice. Mostly I felt that we got around our goals but you are not able to complete them with the same professionalism as in Denmark which of course you have to prepare yourself at on forehand. I had not prepared myself to the fullest about the feeling that the lack of procedures going through my hands could give. I felt frustrated some times because I was worried about how to reach my goals when I arrive back in Denmark. I kept telling myself that this exchange would give me so much more than a Danish clinical practice ever would be able too. And I was right.

5 We had a good contact to our advisers. They were kind, flexible and helpful. Weekly we had lectures were a topic were presented in a power point presentation followed with a discussion and questions. We could at any time contact our advisers and they were more than glad to help us if we had any problems at the Hospital or with getting around in Bangkok and Thailand. They were very interested in or adventures and feelings about being in Thailand and meeting a new culture. No questions were stupid! As I commented earlier I would have wished that my Thai would have been better so I would have been able to make smaller conversations with the patients. The language barrier was a big daily problem but mostly during our time at the female Surgical Ward, since most of the patients at the Intermediate Ward were intubated. Instead we got very focused on our body language and what we radiated to the patients. We developed a better connection to our creativity to be able to make us understandable in situations where we did not have the words to express us with. Cultural benefits Both from the preparation day in Aarhus and during my exchange I have learned a lot about how Thailand s culture looks, feels and moves. At the preparation day in Aarhus we were told about the most important things about the cultural difference compared to Denmark. It was a good grounding for our exchange and the preparation of us before going abroad. Thailand is build up in hierarchy and status is very important to the individual. An example is the way we interact with our advisers and teachers in Denmark. In Denmark we see each other as equal and we do not address the people by their status. In Thailand you very much respect your teacher for their knowledge and their position. You bow, greet and address by using Teacher in front of the teachers name. In general Thai people are very kind, open-minded and spiritual. They respect their dynasty in a whole other way than we do in Denmark. This is shown very openly and any disrespect has its consequence. What came really clear to me after 3 months in Bangkok and travels around in the south was that Bangkok is becoming a modern metropole where the influence from the rest of the world is beginning to set its marks. People are more genuine friendly when you go outside Bangkok and the religion comes more straightly from the heart. At the hospital we saw a lot of cultural differences when the monks came to pray for the patients, when small speakers were places by the patients beds to Mass the prayers of good karma or when sacrifices were given to bring good fortune to the patients. Thailand traditionally medicine is still being used in Thailand and it is not rare to see medicine- men or women who makes cocktails of herbs, flowers and water in order to help people with their illnesses. Zone therapy and massage is also still a very big part of how to treat ill people. Nurses are allowed to use their knowledge about traditional medicine on the patients during their admission.

6 In the east traditional medicine is still used as the first treatment because of their religion where it is more common to see the medicine men or women and then pray for it to cure the ill. If that does not help they will choose modern medicine as second choice. In the west we do the opposite; modern medicine is the first step followed with the opportunities of using alternative medicine as treatment. In Bangkok it is more common for people to go directly to the hospital which could be an affect of the modern society and a result of better knowledge in the city. I think that being a nurse in Thailand is generally quite similar to being a Danish nurse. We have the same output of work, contact with the patient and daily schedule. What I have found different was how we worked around ethical issues and how to show compassion for the patients. Thai people are known for being at race that does not show feelings obvious. It is very rare to see people cry, show anger or similar. With this in my mind I of course saw a friendly nurse but I did not see a compassioned nurse. From outside I could imagine that it could look quit hard and routinely sometimes even I had to close my moth of astonishment. We had some personal conflicts which we mutual talked about and discussed. Mostly it was because of the ethical differences which were very shocking for a blue eyes Danish nurse student. What could be a very unseen in Denmark could be legal and accepted in Thailand. Examples of this could be when it was OK to fixate a patient, patients participation in treatment and patients rights. Social benefits I was met by groups of friendly and welcoming staff at both wards but mostly they kept them to themselves because of their lack of language skills. I was not because of lack of interested but they simply were to shy to speak up and approach us. But if we on the other hand approached to them and showed them interest they did their best to try to speak to us and help us. Sometimes they brought fruit, snack and food for us to taste at the ward. People were genuine interested in our stay and what we did when we were off duty at the hospital. During our stay we also met a lot of nurse students which were just as kind as the staff at the hospital. If you opened just a little bit to them they were willing to show and tell you everything. They would more than gladly be your friend.

7 Important benefits during the exchange program The most important benefit for me has been the opportunity to learn about a country and a culture from the inside. I have lived, worked and developed around Thai people. It is very rare that you during you life have the time, money and opportunity to travel aboard and are able to get an insight so deep as we have had the opportunity to in those three months. For that I am very grateful. Furthermore I have felt how it is to use my profession in another country and which barriers it can cause. With barriers I mean language, professional knowledge, ethics, patients rights etc. I have developed and gained knowledge in how to meet patients who speak another language than my native language, how it feels to be alone in another culture and in another part of the world. I am sure that the experiences which I have felt on my own body will help me to meet foreign patients in Denmark in another way than my Danish colleagues. I have challenged myself to develop my professional language in English and I now find myself more competent to talk about my profession in English because of the development of my vocabulary. On top of it all I have developed my skills in working and socializing with a group of unknown people. We have traveled, worked and lived as a group, which has made me more open, compromising and tolerant than before I when to Thailand. This I see as an importing development towards soon being a part of a group of staff when I in short time graduate to become a Nurse. Other which should benefit for future exchange students I don t think that there is so most to say other than if you have the desire to go on exchange you should give yourself the opportunity to feel what I have gain on your own body. It will enrich you as long as you will let it. Nursing student, 6. sem., Celina Frederiksen Nursing School of Slagelse, Sealand.