In August 2015, I did my clinical internship at the department of Otorhinolaryngology (ENT) in Tartu Ülikooli Kliinikum, the only university hospital in Estonia.

Some of you will think, why are you going to Estonia?! Probably some of you won’t even know where exactly to point Estonia on the map. Furthermore, the weather is cold and wet, the food is awful like back in the USSR with soup kitchens and the people are grumpy. To most of that, I can only agree, although the latter is only truth for the first days. Estonians are like Kinder Suprise eggs - you have to get through the hard outer shell to meet enthusiastic, helpful and friendly personalities inside.

So why did I go to Estonia? Well, it is unbeknown, I was never been there and that’s what appeals to me. Furthermore it’s close to Russian border. Russia intrigues me; it’s so close to Europe but so elusive. Estonia is in the middle between Europa and Russia and I wanted to know how such a country deals with that situation. Furthermore, how do they deal with the cultural differences in the clinic as almost 30% of the population is from Russia?

During August I stayed at a dorm with 3 other girls who were on a IFMSA exchange as well. The dorm was close to the city center and only 20 min walking to the hospital. In total, more than 40 students from all over the world came to Tartu for the exchange. It was wonderful, there was always something to do. Tartu is an small and modern student city with about 200,000 citizens. There are a lot of beaches and parks where the locals spend their spare time. On a larger scale; Estonia is a flat and green country, very similar to the Netherlands. We were very lucky with the weather (I think was the best weather Estonia ever had), as we had only sun and the temperatures between 16 and 25 degrees.

Unfortunately, the doctors and nurses in the hospital followed a summer schedule during august. This means that there were very few doctors and patients and in conclusion very little to do. Every day I was sent home after a few hours. The latter weeks were more diverse and interesting as more and more doctors came back from their holidays. There were some languages difficulties. Most doctors did not speak English as they were trained during the Soviet Regime and therefore learned Russian instead of English. However, this was very helpful in the outpatient clinic as there is a large percentage from the Estonian population originated from Russia. For me, unfortunately, it was therefore allmost impossible to follow the conversations. Luckily, the younger doctors and the interns speak English very well, so I tried to go with them. There was an Estonian Medial student as well, she was my angel and my mainly supervisor. She helped me with everything. ENT is a very diverse department with surgeries from tonsillectomies to Cochlear Implants, and an outpatient clinic from hearing loss to sleeping problems. I could go wherever I wanted, so I could see the most interesting cases. In Estonia 90% of the population has a health insurance. Everyone has the same insurance as this is organized on a national level. The main care is organized in public hospitals but some doctors work in private clinics as well, for example for cosmetic surgery. Due to the relatively small amount of Estonian habitants, the

 

treatment of low prevalent diseases might only be carried out by one or even none doctor. In these cases, an attempt is made to send the patients abroad. If this is not possible, for example because other countries do not accept the patients, doctors do their best to treat the patients themselves, although this might be the first time they are confronted with the disorder. Besides, the prevalence of some well treatable diseases, like cholesteatoma, is higher compared to the Netherlands. This is due to both cultural differences (people don’t like to go to the doctor unless the suffer a lot) and the health care delay as the waiting periods for treatment might be almost a year.

The social programm organized by the Estonian Exchange Committee was wonderful. Estionian people are very punctual and we received the planning of the social program already in the June. A Facebook page was made in which Exchange students and the organizing committee were added. Here you could discuss all planning’s and questions you had. The committee was extremely kind and helpful. Every weekend during the Exchange we made trips to several regions of Estonia. In the free weekend, people went to Russia, Latvia or even Lithuania. Moreover several activities were planned during the week for example International dinners and sauna party’s. As most of us only went to the hospital in the morning, there were a lot of daily activities planned as for example going to the beach or nearby cities.

What I loved about this exchange was not only to learn about the healthcare system in Estonia, but about healthcare systems from all over the world. Although there are always some challenges, we must be really happy with our system. We don’t have to deal with corruptive doctors or governments. We don’t have to send patients home because the cant effort the treatment. And finally, our study is well organized. I will appreciate our sometimes overregulated system more after this exchange.

 

International Dinner 1

Ear clinic - Tartu Ülikooli Kliinikum

 

1 month of traveling across Estonia