The application process was a bit stressful because of all the documents needed but it was worth the work because of my unforgettable exchange.

The documents needed included a vaccination record filled by a health care professional, mantoux test done twice, medical examination, a chest x-ray and labs done in Helsinki at the work place of Finland’s only designated doctor for Canada’s immigration, medical exams for the university, a letter from the university stating that the medical faculty is an internationally accepted medical faculty, a recommendation letter from a supervisor etc. (The applicant will receive emails about the instructions so remember to check your emails regularly.)

1st day

The first day I arrived I had one of the locals pick me up From Trudeau airport. Unfortunately she had to wait for me almost 2 hours because the lines through the passport check-ups were long and I had to show my papers to the immigration as well. At Montreal we got a bus card and went to try some Poutine- a delicious local fast food.

Hospital

Montreal Children’s Hospital was a 15 min bus ride from my apartment. All of the staff were really friendly and eager to teach. At first it was surprisingly difficult to speak about medical conditions in English. Some of the patients spoke only French and I examined them only if they had an English speaking parent with them. What made matters more challenging was the fact that at this time the hospital still uses written notes instead of dictations. I was the only medical student in the clinic (there were 2 in the ward) accompanied by 3 residents from different specialties. The hospital was quite international and the university has a lot of research going on. The work in the department understandably had to be done with precision because chemo has serious side effects and has to be given correctly. Also many of the regimens were in ongoing research and it was important to have everything filled out correctly and done how the protocols state.

I worked about 8 hours per day Mon-Fri. My job was to take patient history and examine the patients (about 3-6 patients per day). I also got to do one lumbar puncture. I attended to patient rounds, tumor board and I received private teaching in the ward with 2 other med students and private teaching of pathology of blood smears. There were different kinds of clinics each day, Oncology, benign hematology, hematology consults, follow-up clinics, procedure day, solid tumor, brain tumor etc.

I feel that the teaching was more in depth about diseases, going into the molecular level and differential diagnosis than in Finland. The people in Montreal are multicultural so there is a lot more of sickle cell disease and thalassemias than in Finland. It was interesting to learn about rare diseases or diseases that are rare in Finland. The interaction between the doctors and patients was casual and relaxed which was nice to observe. Some of the patients have to come to the clinic very frequently so it was possible to get to know them well.

Apartment and Pocket Money

I stayed in a student apartment in the McGill university area called the McGill ghetto. It was a nice student neighborhood with a 10 min walk from downtown. I got 200 CAD(145e) pocket money which I used to by lunch from the hospital. Lunch was about 8 CAD(6e)/ per day.

Social Program

I didn’t have any organized social program because the local exchange officers were 2nd year med

students who had their finals during my exchange and were very busy because of that. One of the organizer’s gave me some emails for 1st year students and I went out to eat with one of them. Montreal has a good variety of restaurants and café’s and it’s one of the world’s design cities so there is a lot to do on your free time. On my last day I went to a Christmas party of the department which was really nice.

Traveling

I took a bus or the metro to the hospital each day. The local bus drove pass my apartment in every 20 min and the nearest metro station was about 10 min way. The metros went in every 3min during rush hour. I spent 22 CAD (16e) for a weekly bus/metro card. Canada has a high quality bus system. The locals feel that it’s quite expensive but for Finns it seems reasonable (about 40 CAD (30e) one way). From Montreal buses to Quebec City and Ottawa departed every hour. In Quebec City I stayed overnight and in Ottawa I spent a day. I enjoyed both of the trips and it would have been possible to travel to Toronto, Niagra Falls and New York quite easily if I’d had more time.

Final thoughts

Overall my exchange was a great experience. I had the privilege to meet a lot of great families and health care workers and I received excellent teaching. If I could do something different I would have studied more French and Pediatric Oncology and Hematology before my exchange so I would have understood more from the start.

It would have been nice to have more company in my free time for example a tutor or fellow exchange student but the time spent in hospital taught me a lot about not only about medicine but also how to be more relaxed in my work. Thanks to this experience I have more respect for research and our interesting profession overall.

Each team was on duty every third night on average and the team that was on duty was responsible for the further management of all the trauma patients that were admitted to the hospital on that day. Most of the patients admitted to trauma and orthopaedics had been injured in a traffic accident. Compared to Finland there were very few hip fractures and patients were generally rather young. This is very understandable, since the traffic in Ghana is quite chaotic and seatbelts are rarely worn. The average life expectancy is comparatively low.

In Ghana it’s possible to buy a public health insurance for about 10 euros a year, but not everyone has it. Emergency situations are always treated, but those who don’t have insurance, have to pay all the costs themselves. Apparently the public health insurance covers certain medications and treatment, but even the insured patients have to pay extra for implants and such. External fixators are covered by the insurance, which is probably the main reason for why they are used much more than in Finland.

English is the official language in Ghana and the doctors mainly spoke English with each other and a local language with the patients. Most doctors spoke fluent English, but some had a pretty strong accent that was sometimes difficult to understand. All the doctors were very friendly and always ready to answer if I had some questions.

I travelled with a friend and the two of us shared a room at the clinical student’s hostel right next to the hospital. We shared a shower and a toilet with two other exchange students. There were two beds with mosquito nets, two closets and two chairs in the room and we also had our own balcony. There was cold running water on most mornings, but usually not in the evening. However, there were big containers that could be filled with water, so that you could flush the toilet etc. even when there was no running water. There was wireless internet in the rooms (5 euros for 25 hours) and it worked somewhat reliably most of the time. Lunch was served at the hostel canteen and there were five Ghanaian dishes to choose from, most of which were vegetarian dishes with either fish or chicken on the side. You had to pay extra for drinks (5 cents for a bag of water or 40 cents for a bottle of Coke/Fanta/Sprite). There weren’t many other IFMSA exchange students in Kumasi in December-January and that’s probably why there was no official social programme either, but the local students were very nice and helpful. We did a lot of things by ourselves and together with the other (non-IFMSA) exchange students.

We flew from Helsinki to Accra and back via Frankfurt and paid around 1100 euros for the flights. We arrived in Accra in the evening, spent one night in Accra and took a VIP bus to Kumasi the next morning. You just need to ask a taxi driver to take you to the VIP bus station and they should know where it is. The VIP buses run on the principle ”it leaves when it’s full” and we didn’t have to wait longer than half an hour. In Kumasi the VIP station (last stop, called Pampaso) is close to the clinical student’s hostel. Another option would be to take an STC bus from Accra to Kumasi. The STC buses seem just as comfortable as the VIP buses and cost about the same (under 10 euros). They have set departure times (several times a day between Accra and Kumasi) and you can buy tickets in advance. The STC bus station in Kumasi is further away from the hostel, but the taxi drive to the hostel shouldn’t cost more than 5 cedis (2,5 euros).

Besides the travel expenses, expect to spend around 100 euros for a single entry visa to Ghana. In theory it’s possible to get a visa on arrival in Ghana, but since there have been a lot of problems with this procedure, it’s highly recommendable to apply for a visa in advance. Since there’s no Ghanaian embassy in Finland, you need to send your passport, some filled forms with passport photos, an invitation letter which you can download from the IFMSA database and 12 international postal coupons to the Ghanaian embassy in Copenhagen. You should get your passport with the visa back within two weeks, so it would probably be a good idea to apply for the visa 3-4 weeks before you date of departure.

Yellow fever vaccination is compulsory for everyone travelling to Ghana and it would be foolish to travel without appropriate malaria prophylaxis. We used Lariam and didn’t experience any adverse effects. Malarone would be a much more expensive option for such a long trip. In addition to those I took meningitis, typhoid fever, cholera and influenza vaccinations and a tetanus boost. Besides protecting from typhoid fever and cholera, the typhoid fever and cholera vaccinations also recude the risk of traveller’s diarrhea. I don’t know whether it was because of them, decent hand hygiene, probiotics, pure luck or the combination of those four, but I didn’t experience any stomach problems whatsoever during my four-week stay in Ghana. Expect to spend 200-400 euros on vaccinations and malaria prophylaxis, depending on which ones you decide to take.

I will have the exchange accepted as a part of my elective studies and it will be worth 2 ECTS.

Practical tips:

-       Take enough sunblock and insect repellent (e.g. Autan) with you, as they might be hard to find in Ghana.

-       Take a travel guide with you, since a lot of valuable information can’t be found on the internet (even if you have access to it). I’d recommend the Ghana Bradt guide rather than the West Africa Lonely planet unless you’re planning to travel in the neighbouring countries, too.

-       If you plan to have clothes tailored, do it as early as possible, since it might take a week or two to have them ready.

-       Enjoy your stay; Ghana is a wonderful country to travel to!

I was in the clinic 5-6 hours per day. I was with the local medical students and they started their day at 7 am and ended at 4 pm. I also had to take part to their meetings and teaching sessions and they all were in Thai. So I did not find it useful to take part in all the teaching. I took part of their lectures, because the slides were in English.

I was very pleased with my clerkship, because I got to see so much and I also was able to do many things on my own. I didn’t have so many expectations before the clerkship and I decided to be open-minded. I hadn’t been in Gynaecology department yet in Finland but I am there now and I think that the basics are similar between Finland and Vajira hospital. Maybe the biggest differences was that in Vajira hospital women’s eyes were covered before pelvis examination, they didn’t use really much analgetics before delivery, women in labour were surprisingly quiet and didn’t complain much and fathers didn’t come to the delivery room. There were midwifes but doctors took care of the delivery and they didn’t do emergency c-section so all high risk pregnancies (>35 year old mother, breech, fetal malformation) went straight to the elective c-sections. I didn’t see any deliveries without episiotomy.

The staff in Vajira hospital were really nice to me and especially local medical students were so helpful and they translated everything which was in Thai for me. Doctors liked to ask me questions and teach me things and I think they were interested in Finland and Finnish health care and they asked a lot of questions about those things. I had to speak English because I can’t speak Thai at all, but that wasn’t a problem at all. Although some of the local people didn´t spoke English so well but there were always someone else to help and the local exchange officers spoke really good English.

There are only nurses in health centres in Thailand and the doctors work in smaller hospitals (which have only some specialities), university hospitals or in privet hospitals. The place where people have to primary go when they got sick is their nearest place which could be health centre or university hospital. Hospital fees in privet hospitals are approximately 10 times higher than in public hospitals.

Medical school takes 6 years in Thailand. There are public and privet medical schools and those who go to the public medical school have to work three years to government after graduation. They can start specializing three years after graduation. There are 18 medical schools in Thailand and 8 of them are in Bangkok. They have problem based learning, bed side teaching and other small group teaching. I think that there were great studying environment and the discussion between students and professors was smooth. Local student had to write reports from their own patients. Also they had to be once a week on duty and they had to be on duty sometimes on weekends and holidays. In Thailand medical students have only three weeks’ vacation between semesters. In Thailand medical students can’t work doctor’s substitutes during medical school. I think that they had to study harder than us in Finland.

I travelled with my husband and we stayed at hotel. It felt more like a vacation at the same time when we stayed at hotel and travelled together. There were student apartment right next to the hospital if I had travelled alone. They gave me pocket money for eating and I usually ate lunch with local students in hospitals cafeteria or some restaurant near the hospital. There was just a little social program because I and my husband wanted to make our own travelling plans. We had farewell parties at the local restaurant on my last night in Bangkok. The best things to do in Thailand and Bangkok were riding an elephant, watching Thai Boxing, shopping and getting tailor made dresses and suits. Also was nice to be in Thailand on New Year, they had four days celebration then. We did a weekend trip to Pattaya, it was nice to be on beach and go swimming in ocean, but I think there might be better places also to go and it was easy to travel inside Thailand (I prefer busses).

I travelled to Thailand by airplane. I had two landings in Stockholm and Beijing on my way. The flight tickets cost about 700 Euro. The four star hotel with breakfast and swimming pools just 3 km away from the hospital was 30 Euro per night. I took a taxi to the hospital and that cost 1,5 Euro.

I got 3 academic credits from the clerkship for optional studies. My advice for others who likes to go to professional exchange: be active and ask if you want to do things differently or if you want to exam more patients or assistant in operations etc.

In o&g there are 5 teams (from A to E) which consists of 3-4 house offices and 1-2 seniors and consultants. In the beginning I had some difficulties to find out which team I was placed to and on the other hand where they were on each day. There was also lack of house officers in my team which meant that the rest had to do pretty long hours and cut all the extra activites for example elective surgeries. Because of that the amount of my working hours varied a lot. If we had some interesting cases or the team was on duty for 24 hours, I tried to be with them as much as possible. On the other hand on some days there was nothing more than 2 hours’ rounds at the wards. On those days I sometimes joined some other team if they had something interesting to do or follow. So in general the exchange was pretty much similar what it smoetimes can be in Finland as well; you have to be creative and active if you want to do something. Once you learned the places and the structure of the week you could somehow plan or think about some options what to do if your team had a short day but of course it required some extra effort.

Everybody on my team and in o&g were very nice and friendly to me. You could always ask for something and they gladly explained. My house officers also asked lots of questions from me and gave me some homework to study. Sometimes the rounds were quite difficult to follow because of the strong African English accent or some different abbreviations they used, but you could always ask if there was something unclear.

In o&g there where differences and alikes in the diseases and treatment plans compared to Finland. In most of the cancers the patients were much younger and the cancer has prolonged much futher until they seek the medical care. They don’t have any national screening system here in Ghana. Also because of long distances and poor transportation they had some patients in the ward which in Finland would have propably been at home. Also unfortunately there was few very young emergency cases who died because they were sent too late to the KATH or they were misdiagnosed earlier. In many cases you could see that the doctors couldn’t use their best knowlegde because of lack of resources or equipment. They did enourmously well though and it was really interesting tips and hints they used instead of labs or scannings.

In Ghana most of the patients have an insurance but even that doesn’t cover all. For example some cancer treatments a patient needs to pay for herself which was in some cases the problem. Of course they treated the emergency cases whether the patient had the insurance of not but sometimes it was sad to realise that there was nothing you can do or at least not much.

In the end I’m not sure what was the clinical value of the exchange for me. I learned and saw some cases I didn’t see in Finland or probably I might never even have a chance to see but sometimes it was very frustrating to try to find the right places and people at the right time. I guess some part played the understaffing in my team and also that I made the choise of clinic before I’ve had it in Finland. During the course in Finland I found out that it wasn’t probably my thing and that may also have affected to how I felt about the clinical value. But it wasn’t completely waste either and at least the people were very nice and I felt I learned a lot about the culture anyway.

We lived in the student dorm at the campus area near the hospital. It was really an ideal place to live since it was close to the hospital and also had lots of students around. It also provided some few canteens, laundry service and small shops were you could find all the necessities. Our room was a standard room for two with shared bathroom with another room. We had other exchange students there so it was really nice. Our apartment could probably have been in little bit condition but on the other hand it didn’t have any big flaws either. There was also this really helpful guy who was in charge of the rooms so ha for example fixed my broken bead and brought me a bed sheet. The luch was provided at the canteen in the campus area and it had only local food. Yet we found something to eat everyday and on the other hand that was a brilliant way to get familiar with local food.

Social program was mostly organised by us and the other exchange students. The main reason for that was propably the fact that the local students were quite busy with their exams and after the exams they had a Christmas holiday. That was of course too bad for us but totally understandable. Yet we didn’t feel abandoned, we were picked up and if there was any problem with our accommodation or practical issues, there was always some help provided. We were also quite active organising some activities with the other exchange students so we didn’t have any problems filling up our free time. Also my house officer took me out last night to some local restaurant and that was really nice gesture from him.

We travelled to Ghana obviously by plane at the tickets to Accra cost 1100 euros. Besides there came some costs we didn’t think beforehand, for example the visa (100 euros) and all the vaccinations and malaria medication (350 euros). Yellow fever is a must but since we worked in the hospital I decided to take meningitis, tyhpoid fever, cholera, influenza and a boost for polio also. A malaria prophylaxis was also advised and we used Lariam for that.

Applying for visa was also little bit challening since we had to send the passport and all the necessary documents to the Ghanian embassy in Denmark. The visa is only valid for three months after approval so you couldn’t apply for the visa too early either.

I did’t apply for any stipends or grants for my exchange since we don’t have anything provided by our university, but maybe for the next time I should try to find out something about other institutions as well.

I haven’t asked yet whether I can combine this exchange to my studied but at least for the optional studies it should be possible. I’m not in the desperate need of those credits but if I’d be this would definitely be a nice way to achieve them.

During our exchange we also spent some time for travelling and I want to encourage people to do that also. It was really nice to see other parts of Ghana as well and learn something about the history, culture and nature as well. This was my first exchange experience but I hope not the last!

Hints and tips:

-          take a pair of scrubs with you

-          take a pair of good indoor shoes with closed ends

-          remember to apply for visa early enough

-          a good travel guide is worth of gold

I lived with a Danish medical student in her two room apartment. She was my contact person as well. Her apartment was quite close to the hospital, so it took only took 10 minutes to bike to the hospital. She guided me to the hospital and helped with practical things like renting a bike for the month. Bike rent cost about 80 euros/4 weeks. I had a cafeteria card and ate lunch in the hospital canteen daily.

In October there were only one exchange student beside me. Because of that there weren´t organized social program during the month. We had a welcoming dinner at the first week, but after that me and the other exchange student eg. planned city tours, made food together with contact persons and roommates, and visited another city, Roskilde on one weekend. I think it would be more nice if there were at least 5-6 exchange students at the same time. If there would be only one student and her/his contact person/roommate wouldn´t be so active and arrange program, it could be quite a lonely month. On the other hand it´s nice that Denmark is having exchange students also outside summer months, but just would be having few more students at the same time.

I travelled to Copenhagen by plain and the return tickets were little bit over 200 euros. I haven´t included the internship to my studies yet, but I guess that should´t be a problem. I really learned more about dermatovenerology and now be a little better able to recognize different skin diseases, got to know Danish culture and new people. I definitely would recommend going for a clinical exchange!

The university of King Chulalongkorn is a very valued university in Thailand. It is the oldest university in Thailand and generally regarded to be the best one also. It is the country’s highest ranked university. The university campus is located in the very heart of the city, between two popular squares, Siam Square and Silom. The Faculty of Medicine is also vast and the most respected faculty in the university as well.

I took a direct flight from Finland to Suvarnabhumi airport in Bangkok in the end of September. My contact person couldn’t pick me up from the airport, so I took a train to the city centre. We met in the Silom BTS station, which is very near to the campus. After my arrival he showed me the campus area and my apartment. The campus area was vast and very labyrinthic. Still there were all the necessary utilities, for example the library, two canteens, two 24-hour open 7-elevens, a gym, a swimming pool, a laundry house etc. I stayed in an old dormitory where I luckily got a private room since there were no other female exchange students at that time. My room was very modest, there was a bed (without sheets), a table, a chair, a sofa and a private bathroom. The room was not that tidy, but after a little cleaning it was ok.

The department of general surgery was divided into different sections. I got a chance to be in the sector one, which was all about liver surgery. The staff was very friendly to me. The professors spoke very good English and some of the residents also. In general the language skills of the students are not as good as in Finland. However, we managed to get along and they got some practice with their English also.

During my exchange I saw a lot of liver surgery, hepatotectomies, liver transplantations etc. I stayed in the operation room three days a week. Those days were really long, approximately from 6 to 10 hours. I really enjoyed those days and a couple of times I got chance to assist in the operations. Because the operations were really demanding, they didn’t let us do that much. The residents were usually the first assistants in the operation. The operations went on quite similarly than in Finland despite the fact that hygienic issues were not that strict that we have in Finland. There were several operation rooms in a row and one could easily hop from room to room, the doors were open all the time. There wasn’t any clean or dirty sides, people were flocking around the table freely. You didn’t have to do any cleaning before you entered the operation room, which I fpund a bit strange. However the anatomical knowledge of the surgeons was remarkable and they did amazing things there with very pour technical utilities. There was also a scoreboard in the operation room, were they could easily check the exact anatomy during the operation.

Twice a week we had an open-patient clinic, which I found very interesting. Patient came there without an appointment, bringing their own files with them since there were no computers in place. Most of the patients were post-operative wound controls, but we also saw some snake bites, final stage Charcot foot, hernias, abcesses etc.

Every day we had morning round in the surgery wards. The rounds were held in thai language, but one of the residents translated to English. However the rounds were not that informative to us since the patients didn’t speak English and all the files were also written in thai language. But we got a chance to see the hospital routines, which was also very interesting.

The health care system in Thailand is very complex and does not work that good either, which makes it even more difficult to understand. They have some kind of primary health care, but usually people prefer going straight to the university hospital. Usually they will treat those people, so there is a lot of confusion who pays the treatment. In addition to the public health care, there is also a complex private insurance system, which is of course available only to wealthier people. Many people, especially in the very rural areas, are out of reach of the health care system.

The social programme was a big disappointment to me. The thai students had to study a lot so they didn’t have any free time. I saw my contact person on the day of my arrival but that was the only time. I got acquainted with the thai students in our surgery group but they didn’t have that much free time either. Once one of the residents took us to see some sight-seeing and for a dinner. That was a really nice thing to do, since that day was her only free day in the whole month! Once two of the students took us for a dinner too, but that was all. We didn’t have any dinner with other exchange students but luckily we met each other in the campus and hang around together after that.

My exchange ended one week beforehand because of the floods in Thailand. In the beginning of October there was some serious floods in the Northern Thailand and the situation got worse during my exchange. In the mid of October we found out that we are in the middle of a serious natural catastrophe. The floods were threating Bangkok also and the whole city was surrounded by the floodwater. The situation was quite scary since there were all kinds of rumours amongst the local people about the floods. Many students lost their homes and other property and some also lost their relatives. In the end of October, a week before the exchange was dued to be over, the university told us to leave the country. The situation was so chaotic around Bangkok that they had to close the hospital. I didn’t return to Finland since I had planned to travel around Asia. I travelled to Southern Thailand, which was a safe area at that time.

During the exchange we got very contradictory information about the floods and we were very confused about the situation. The IFMSA didn’t inform us about the safety matters so we had to be very self-imposed when getting information about the floods. However I don’t accuse anyone since neither the Finnish embassy or the media knew about the situation any better. The university and the residents took care of us very well and told us to leave when the situation got dangerous.

I warmly recommend Chulalongkorn university, the exchange was a great experience for me! I’ve heard that the floods are a huge problem during the rainy season every year (this year was the worst in 50 years) and the situation will get worse year by year. For that reason, I recommend not to participate the exchange programme in Bangkok during the rainy season nor straight after that. The rainy season is from June to November. Someone who looks for a vibrant social life I don’t recommend this university either.

In conclusion, I really enjoyed my time in Bangkok and I learned a lot! Bangkok is an interesting city that offers something for every senses. Thai culture is a very unique and intriguing and thai people are the friendliest people I have ever met. Thailand has me.

Even though the hospital I attended was a rather fancy one with much better resources than most Russian hospitals, they still lacked a lot of things and equipment that we here in Finland would take for granted. Many times the way their organization was built and arranged seemed absurd, even to Russian doctors, just adding to their work load without producing any benefits, burdening doctors with tasks that do not actually require a doctor as their performer and even leading to bad and scientifically unjustifiable treatment. Towards the end of my clerkship as I got to know my tutor better he would cast light on some of the issues of the Russian society and health care that were many of them related to corruption, other kind of mischief, pursuit of individual good and weak system. Many of his stories and the phenomina he discribed sounded absurd to me. In the hospital I attended there was apparently some scientific research, as a radiologist presented me a method she herself had developed in her doctoral thesis, and some of the neuro surgeons were going to the US and Finland for courses and further education, but still my tutor as a junior doctor felt disappointed in how isolated most of the clinic was from the scientific discussion and development in the rest of the world, as also only a few of the doctors could follow the medical publications in English.

On a surgical ward the differences in the interaction between the patients and the doctors between Russia and Finland seemed pretty subtle. Of course, in general, there is a difference in the way Russians display their personality and the way they approach eachother. Also, in my experience the patients had a lot more relatives staying at the ward with them than the patients in Finland.

I lived in an apartment rented for me by my contact person. The flat was some 5 km from the hospital and from the centre of the city. It was in a nice condition and decorated fairly OK. It is by far the most spaceous apartment I have ever lived in alone and had all the conveniences and equipment I could wish for. I heard, though, that in the summer most of the exchange students stay in the dormitory of medical students, where the conditions are much more harsh.

In September I was the only exhange student in Kazan. Earlier, in July and August, they had had several students there, and I could see from the Facebook group they had made for their incoming students, that the local medical student’s association TAMSA really took a very good care of them and organized a lot of programme for them. It seemed that these students were very happy with their exchange. Even though I was the only one in September, I was still well taken care of. They organized something for me at least once a week, and I also met my contact person severeal times a week and she was relly active in taking me to places. We went to sisha-bars, for pizza and for traditional Tatar food, for coffee, seeing different sights of the city, to the opera, even diving in a nearby lake, biking around the city centre, they organized a movie night, some nights out.. Also my tutor in the clinic with whom I made friends took me to see some nearby sights, helped me organizing some excursions of my own, took me to see a play in a theatre and to the movies and invited me and my contact person to eat at their home. All in all, my contact person and the exchange officers helped me out a lot with all the practical things so that I would have internet, know where to buy food, know how to use the busses, all that.

I took a bus and two trains to get to Kazan and two trains to return to Helsinki. All in all, I think I spent some 350 euros travelling there and back. It might have been cheaper on a plane or using some other train connections, and also it would have been possible to spend a lot more money on it.

So far I haven’t tried to include this exchange in my diploma in any way. I believe I still will try to get one point for medical English for these studies, but that’s about it.

All in all, it was a good and interesting experience and TAMSA, Tatarstan Medical Students’ Association, worked quite brilliantly all the way.

Flights to Münster and back to Finland cost about 300 euros. My trip started with some problems because my flight from Berlin to Münster was late for 4 hours and when I got to the airport of Münster I realized that Air Berlin had lost all my luggage. Nevertheless I tried to keep myself in a positive mental state and travelled with bus first to the Central train station and then with another bus near the place where I was suppose to stay. I got quite good advice where to go from my contact person by SMS. She was first supposed to pick me up from the train station but the delay of the plane ruined these plans. Despite of this I was able to find near my becoming flat where one of my roommates was waiting for me. I stayed in dormitory which was usually inhabited by 6 students. All had their own room but most of the students were now away for holidays.

First day at the hospital was interesting. I got white coat from the hospital because the one I had taken with me was in my luggage. All doctors at the department of Cardiology were very friendly and it stayed that way the whole time of my stay. We spoke mainly German but sometimes if I didn’t understand something they spoke me also English. For some of the doctors speaking English still seemed to be quite difficult. I had learned 9 years German at school but I had never used it. So at first it was quite hard to speak and understand but after a couple of weeks I think I was able to manage with my German language.

My luggage arrived to the front door finally at the 3. day of my stay and I appreciated much that I got clean clothes. There were 4 other medical exchange students with me at the same time in Münster. Me and a Bulgarian student stayed in the same dormitory and we had a blast! We all met almost daily. Our contact person arranged many meetings for us. We usually went to see the city, drank some beer or chilled out near a lake called Aasee. We also did a trip to Cologne and with the Bulgarian student we did a short trip to Amsterdam which is quite close (about 200 km) from Münster.

There are around 270,000 people living in Münster, with about 48,500 students. The architecture of the city seems to be quite old and there are many beautiful churches. In Münster bicycling is very common. In 2007, vehicle traffic (36.4%) fell below the number of bikes used in traffic (37.6%). We were also able to rent a bike for free from the German students. It seemed to be raining every day in Münster at least a little bit, you should only hope that you are not on your bike when it starts.

The doctors at the hospital did very long days. I came to the hospital at 8.00 am. and usually left the department of Cardiology at 4.30-5 pm. I heard rumors that the doctors which worked there usually left at 7 pm. In Germany they don’t get any more pay from the extra hours but it’s like an unwritten rule that you have to be in the hospital until the evening. It doesn’t even matter does the doctor have any work left or not. At the Cardiology department the doctors mainly work with computer whole day and write the texts. They also have plenty of time to teach and explain things to students.

Every week there came two new German medical students to the department. Medical studies in Germany are maybe little more theoretical than in Finland. The first two years they study preclinical subjects. After that they do clinical studies but then they mostly sit in lectures. The fifth year is more practical, the students spend one week in every department to see patients. The sixth year in Germany is a practical year. They have to work in hospital at surgery and internal medicine and in addition to this at one other department. The duration in each department is three months. During their clinical studies the students also have to do 4 clinical clerkships without salary. The duration of a clinical clerkship is one month.

I didn’t have so much to do at the department. I took some blood samples, interviewed and investigated one patient in German. Usually I went to the catheter lab to look angiographies and ablations. I also saw plenty of transthoracal ultrasounds.

All in all the exchange was a great experience! I learned many new things about Germany and Cardiology. I think I would have been able to survive the exchange with only English but if you want to get the most out of it, then it’s always good to know a little bit of German language. Maybe it would have been easier to use only English in some surgical specialty. The night life in Münster is quite good, the beer is good and there is much to experience!