1. COLLECTED METAS

2. WASHINGTON REGIONAL
HOSPITAL VISIT
 Last Thursday, April 18th, we visited the Cath lab at Washington Regional Hospital in Fayetteville AR. Before going I
honestly was pretty clueless as to what a Cath lab was. Once I Googled it however, I found out that it was in the cardiology
department and used for diagnostics and treatments of heart conditions. I expected to learn how these things were done and
some information about the equipment. I also anticipated seeing somebody maybe getting a catheter put in first hand, which
would have been pretty awesome.
 Once we arrived in the lab I figured we where not going to be watching any catheter action today but what we did in fact
learn was equally as interesting. The lab had a lot machines and a big monitor hanging from the ceiling. The two Ladies there
showed us a little about how they would insert a catheter, and what the other equipment there could tell us about the heart.
One of the things I found most interesting was how much all of these things cost. There is millions of dollars to be managed
so every penny spent on any single item counts. We learned about the negotiations that must take place between hospitals and
medical sales reps in order for the patient to receive the car they need.
 The other topic we covered was health insurance and lifestyles of medical professionals. The differences between the US
and Sweden are large but are becoming less and less with the implementation of health care reform. A very large problem in
our county is peoples inability to pay for the health care they need and insurance companies making it difficult for them to get
that coverage, as well as making it difficult for certain doctors and hospitals to do their jobs. It causes a bad chain reaction
when a patient is not able to pay for the medical services that they needed because it causes the hospital to pick up the slack
using the some of the money from the patients that could pay. This leaves the hospital in a bind because this money could
have been used to go toward stocking the hospital with necessary supplies and equipment that is need to help future patients.
 Problems like these are mainly affecting public hospitals like Washington Regional as opposed to specialty clinics
because they rely on more federal funding. It is clear that there is a lot of frustration with the system that we have been
operating on. I am excited to see if these problems have been solved under the Swedish system and what new problems their
system is creating.

3. DR. HERSHEY GARNER
 This past Saturday we had the opportunity to here Dr. Hershey Garner come speak about the current problems and
future benefits of health care reform in America. Dr. Hershey Garner has a strong background in law, finance and medicine
and frequently has an input in state and federal government. I expected to have a clearer understanding of the new heath care
system and realize what current problems have made it necessary. One thing people might be surprised to learn is that we are
not even in the top 20 of medical care in the world. Many people go without being able to afford or be eligible for health
insurance or. Also, with insurance tied to employment, many people have had to go without if they have lost their job or
some benefits in the recent recession.
 One of the things I was most interested to hear about is how corrupt the lawmakers can be. It is clear that certain
parties have an agenda that does not include helping the majority of Americans but instead getting their own issues across and
to be reelected by mislead Americans. This also leads to importance of a unbiased news source, which can be very hard to
come by these days. One example of this is a lawmaker having the idea to put funding for end of life care into the new bill.
This same lawmaker, after getting his idea written into the bill, went around warning people of “death panels” and President
Obama wanting kill your grandmother. Clearly this is just an example of dirty politics. Because of such strong opposing
agendas, the bill may have many flaws, though it is better than nothing. Dr. Garner works in hospice and Oncology so he
knows the importance of funding for such medical necessities even for the less privileged. Like he said, it is kind of ironic that
we have the right to own a gun but not the right to health care.
 Another main point of the talk was the emphasis of preventative care. If more people are allowed to visit the doctor
regularly for check ups, very expensive problems such as a stroke or cancer can be avoided more cheaply and easily. I was
also happy to hear that the bill will open up even more positions in the medical field and make use of all health care
professionals talents such as using nurse practitioners to do examine patients so more can be seen faster. All in all I am very
happy about the incoming changes to the health care industry and hope that the progress will be expanded. There may be
many flaws but hopefully lawmakers and citizens can find some common ground for the good of the country.

4. SIM LAB AND SPEECH AND
HEARING CLINIC
 Last Thursday we had the opportunity to visit the Simulation Lab in the new Donna Epley Nursing Center.
Before going I was very excited because I knew that we would be seeing where the nursing students do their
training on manikins and was very interested in seeing them as well as the new building. The first thing we did
once we arrived was tour the bottom half of the building with Dr. Hagstrom. This area dealt with communication
disorders in youth. There were many different rooms for each age group where evaluations and studies are done
on children’s speech, hearing, and swallowing. It is hear where children get cochlear implants to enable them to
hear and can be helped with other communication problems. The center can also be a great help to adults as well.
If an adult is diagnosed with a diseased such as ALS, they may consult the center to gain communication skills
even after their ability to speak is gone.
 The second part of the center we toured was the nursing education center. This was my favorite part of the
tour. We where shown numerous rooms used to simulate a hospital or a clinic. One room was just full of hospital
examination beds where the students could practice on themselves. The next room contained many beds each
with a manikin. These where the basic manikins, they could not speak or breath but some in there could open
their mouths and even store some bodily fluids. The next set of manikins we saw where very high speed. One
could breath, talk, and even had a pulse. The most surprising thing to me was how much theses things cost. Even
the basic dummies where about 5 to 7 thousand dollars and the more advanced ones could be more than $60,000.
Clearly these tools are expense, albeit necessary to medical education.

5. QULTURUM
 Before going to Qulturum I honesty had now clue what to expect. I thought that it might be some sort of
clinic or research hospital and that Qulturum was just the Swedish term for Doctor’s Office, who knows.
 I was actually quite surprised to see what Qulturum actually was. Apparently they did not practice medicine
at all. When we arrived a woman named Agata Rukat gave us a short tour and told us about an average day at
work there and their responsibilities and goals. After the tour we where taken to a room where Agata and the
director of qualtorm gave us a presentation about the facilities goals and what they have done to improve hospital,
health professional and patient relations. Also they talked about how they are changing the way medicine in
practiced in general to help both doctor and patient.
 One of the things I found most interesting was the video about self dialysis. Dialysis is a very time
consuming process for people battling kidney disease and awaiting a transplant. At Jonkoping there has been
instituted on of the first “DIY” dialysis clinics. This is much more convenient for the patient who can now go get
treatment on their own time and feel more involved in their care. Also a great thing is how they focus on health
more than care in practicing health care. In order to promote health Qulturum puts together programs such as
Passion for Life, which gives healthy living tips to an aging population.
This information will be very useful in the future. Hopefully as a physician I will not only think about how
effective the care I’m giving is, but how the care makes the patient feel. By assessing the culture of medicine
Qulturum is helping both doctor and patient toward a higher quality of life.

6. SWEDISH SOCIAL
INSURANCE
 This Monday we paid a visit to the Social Security Office in Jonkoping. Before going I expected to learn more about
Sweden’s tax system and benefits for its citizens. I had been learning in my time here that Sweden had some pretty high taxes
but some very large government benefits as well.
 When we arrived at the office soaking wet, Klas Rydell, who worked at the office, took us to a conference room. Mr.
Rydell was very nice and funny as well as a very engaging speaker. He showed us a power point that included fact and
statistics about Sweden’s population, income, and lifespan. He told us a lot about all of Sweden’s government benefits, which
include health care, housing, extremely long maternity leaves.
 What I learned about the Sweden’s social security made me realize why their high taxies are so worth it. What as just
amazing to me was that not only health care, but also all schooling, including college and graduate school, is completely free to
Sweden’s residents. I also learned that Sweden is very geared toward equality and the promotion of families. The basis of the
social security system is that the young support the old. With people living longer and longer lives and with smaller family
sizes, this is becoming difficult to do with the number of elderly people unable to support themselves exceeds the limit that
can be supported by the working. One way they are trying to solve this problem is by offering more incentives for having
children such as long maternity leaves – about two years per child- and by giving a monthly child fee to the family that can go
towards day care or other needs.
 I found this information incredibly interesting. Knowing this I can better understand the reasoning behinds Sweden’s
financial policies. This can be applied to the health care system very easily because it is a person’s social security in Sweden
that provides them with the care they need. In the future I plan to learn a little more about Americas social security system so
I can better compare them and ask questions accordingly.

7. SWEDISH HEALTH CARE
SYSTEM
 Ingalill Gimbler gave our fist official lecture over the Swedish Health Care System. Going into the lecture I prepared by
having my fourth cup of Swedish coffee for the day and had expected to learn more detail on how the Swedes operate their
medical system from someone who knew first hand.
 Ingalill was a nurse anesthetist who had lots of experience working in the Swedish as well as American health care
system. She gave us a PowerPoint presentation not only talking about the health care system but also giving lots of statistical
information on Sweden as well as the rest of the world. We also got to hear a few interesting Swedish facts and see pictures of
grandchildren along the way.
 I still cannot fully wrap my head around northern Sweden being dark 24/7 in the winter and light in the summer but
according to Ingalill it was very depressing. One of the first things she mentioned was how high the suicide rate was in the
Swedish city of Kiruna, way far north. Also Sweden is very sparsely populated with only 9.4 million inhabitants. Because
Sweden has always been on the lower side as far as population count, the government started very early in trying to prolong
the longevity of its residents. Acts to promote clean water and sewage as well as bans on alcohol were all put in place to make
a population healthier. I would say this has been very successful seeing as the average lifespan is around 82 years and an
infant mortality rate of 2 per 100 live births. Another thing that was mentioned was the high use of midwives in Sweden and
how it may contribute to this low mortality rate. I believe preventative measures such as regular checkups and promotion of
healthy lifestyle is part of what makes their health care so successful.
 The thing I will take away from this talk the most will be the focus on preventative care. If people spend more time
taking care of themselves they are more likely to avoid a more life threatening and costly illness. In the future I will ask more
questions about how Sweden’s preventative care measures compare with those in the United States.

8. RYHOV HOSPITAL
 One thing I was very excited about Monday was to visit the Ryhov hospital in Sweden. Having already been to a
hospital and cath lab in the US I was pretty sure what to expect. But I was also interested to see inside a Swedish hospital to
compare it with our tour of Washington Regional back at home in Arkansas.
 When we arrived we ate lunch in the hospital restaurant and then walk back down to the main lobby to wait for the
cardiologist. Once he arrived he led us down stairs and through the cardiac wing to a conference room where he gave us a
talk that included some facts about the hospital as well as about the patients they treat there. Next a nurse Annika took us on
a tour to the cath lab and then to the nurse’s station in the ICU. We finished our tour with a look through the emergency
room before returning back to the lobby where we found ice cream.
 My favorite part of the hospital was just seeing around inside of it and lunch. I found it interesting how the hospital was
made to be apart of the community. It had lots of art, which is provided by the state, and even a library and coffee shop. It
was much more relaxed feeling than many other hospitals I’ve been to and had more people just walking around then laying in
their rooms. Annika told us about how the patients who are able to are made to come out of their rooms for meals and
socialize, which I thought was pretty cool. Another thing I noticed was while there was a lot of art and people, the hospital
itself seem a little outdated. Compared to the Washington regional lab, the Sweden Cath lab was much less high tech. One of
the most noticeable things in Washington regionals lab was the huge television monitor that hung from the ceiling. These
supplies cost them millions each year. Sweden’s lab was definitively less modern looking but costs less and based on the
figures from the PowerPoint, delivered just as good of care.
 One thing I wish I had done differently before this lecture would have been to have a large cup of coffee. It was a long
and rainy day so I was honestly dragging by the time we made it to this stop. Despite wanting to lay down in a hospital bed, I
really enjoyed the hospital and will try to see the them as part of the community as opposed to a separate place only sick
people need to go to out of necessity.

9. MATCH MUSEUM
 This Tuesday we visited the Jonkoping’s Safety Match Museum. I planned to learn what exactly a safety
match was since I did not know there was a totally safe match. Also I was excited to see how matches were made
so long ago and what effect it had on the development of Jonkoping’s.
 When we arrived I saw that the museum was actually in one of the original match factories, which was a two
story white building. When we first arrived we watched a video that explained about the safety match and about
the factory origins and work conditions. After the video we made our way around the museum, which contained
lots of information (unfortunately all written in Swedish) about the tools and the procedures used all those years
ago to create the safety match.
 Even though I could not read any of the informational signs I did in fact learn a lot about the safety match
and about life in Jonkoping all those years ago. Ironically the match was not safe at all. The video told about the
horrible working conditions that the factory created. The factory was primary employed by women and children
because their small hands where better for handling the tiny matches. This was very sad because many of them
died or became horribly ill. We also learned about the living conditions of the workers. Apartments were provided
to a family if all of the members were employed in the factory. We were able to see a model of these homes and
learn about the many safety and health risks came with factory work.
 I found this museum very interesting and it gave me a good insight into the city’s history. In the future I plan
to look into more small local museums like this because it helps you see what makes a city unique.

10. DINNER WITH THE
SWEDES
 We had the opportunity to go have dinner with Fran’s good friends the Junefelts, at their home near
Stockholm. I expected to see what a typical Swedish house was like and to have some great Swedish food (looking
forward to fish).
 I did in fact have a great meal complete with reindeer rolls and yep you guessed it, fish. No complaining
here. Our night was rounded off with good conversation and a game of charades.
 Besides the food, my favorite part of the dinner was our party games. Of course we had the obligatory deck
of cards and with the help of John Flannigin’s two little girls we took part in a riveting game of charades. The
little girls taught me that you could in fact be a food item (such as a waffle) in this game. As much as I would like
to say I delved even deeper into the world of Swedish health care I have to be honest and tell you my time was
pretty occupied by acting out movies and deciding if a little girl laying on the floor was a chicken nugget or a
pancake.
 In the future I plan on inviting myself into more European households because I am sure they would have
great food stories. So if any of you have to bail me out of a Swedish jail for breaking and entering you can be sure
I only had the motive of dinner and party games in mind.

11. THE VASA
 One our first full day in Stockholm the HTA group set out for a trip to the Vasa Museum. I really did not
know what to expect partly because I had no clue where we were going and will blindly follow pretty much
anybody.
 Once at the museum we spent the next hour exploring the 400 year old Vasa which sunk in the 1600’s on its
inaugural sail.
 I learned a lot about sea travel in the old days of Sweden. I got a new appreciation for their handywork
looking at all of the fine details that went into the ship. It was unfortunate that they did not spend a little more
time thinking about the mechanics of the ship instead of the looks. The ship was to tall and narrow to float and
sunk about a mile out killing everyone on board. The ship and its passengers remained in the port until it was
brought up and restored in the early 1900s.
 From the Vasa people today learn a lot about the lives and priorities of those early people. They clearly had a
passion for fine detail that was ultimately their downfall.

13. ABBA
 Our last full day in Sweden we got up bright and early to head to Sweden’s Music Hall
of Fame and ABBA Museum. I expected to expand my knowledge of ABBA beyond the
movie Momma Mia and hopefully get down with my bad self to some rockin’ 70s’ tunes.
 As for what we did, please refer to the next slide.
 What I learned from this experience was that ABBA was a BIG deal. I also learned
that Dr. Allison makes a great dance partner. Unfortunately I do not have video evidence
of this, your just going to have to take my word for it.
 In the future I will use this new found knowledge of Swedish music to grow on my
iTunes library and jam out in my bedroom.