Lebanon Valley College Study Abroad

10 Tips for Future Travelers

10 Tips for Future Travelers:

1) Don’t Stress

Traveling can be stressful. There is so much involved: purchasing tickets, packing, catching flights, language barriers etc. But these things are all part of the journey, and stressing will only make things worse. Relax! Embrace the chaos; it can be fun. Everything will work out the way it is supposed to. Missed a train? Find the next one. Forgot to pack something? Buy it at a local store. Lost? Ask a local for directions. Sometimes mistakes can lead you to something new and exciting, and that is what traveling is all about!

PS: I also lost a lot of my souvenirs from Italy. I was really upset at first, until I was reminded that they are only material things. I am blessed to have the amazing memories, thousands of pictures, and new friends that will last forever.

2) Blog!

Ten, twenty, thirty years down the road, you will wish you had kept a record of your travels-so start a blog/journal! Write about the people you met, food you ate, and places you’ve seen. Don’t forget to add the best pictures you’ve taken, and be sure to share the entries with your family and friends. It might inspire them to take a trip of their own one day. You can even print the blog out when you’re done and create a book for you and your future children/grandchildren to look through. That’s my plan!

3) Become a pack rat

Keep everything! Every place I’ve been, I have kept receipts, train tickets, brochures, etc. to make a scrapbook when I return. These things are free souvenirs that will last a lifetime. I even kept some newspaper clippings written in Italian and German. I also bought postcards and stamps to make a board about all my travels.

4) Eat anything and everything

If you’re worried about gaining weight on your trip abroad, you’re going to the wrong place! European food is the best food you will ever try. When will you ever live in another country for 3 months again? Never, so take advantage of the great food and drink. Try all the courses and have a dessert or three. I had dessert with almost every meal. Do I regret it? Absolutely not! The pounds will eventually come off, but the opportunity to eat those great dishes again only comes once in a lifetime.

5) Be open-minded

Europe is very different from the United States. The list of differences goes on and on, so it is important to be open-minded! You might not agree with something, but try to see the other side of things. It’s fun to embrace new ideas; it broadens your thinking and makes you a well-rounded individual. I have learned a lot throughout this journey, a lot of new things that I plan to incorporate into my future.

6) Travel outside your comfort zone

Do things you normally wouldn’t think of doing. Be adventurous.   Don’t be afraid to try new things. Don’t walk, run outside your comfort zone. You don’t want to look back and have regrets-that you coulda-woulda-shoulda done that. Instead, look back and say, “yeah, I did that”.

7) Talk to strangers

I have met so many people who I will stay in touch with forever. I have made connections in Italy, Switzerland, Austria, and Germany all offering places for me to stay when I travel abroad again. Strike up a conversation on the train/plane, in line, in a restaurant, on a tour, wherever! Ask them about their culture, places to visit, and recommendations. These connections can be a great help, especially if you ever need help while traveling. I had many queries that people at home would not be able to help with, so I utilized my European connections.

8) Please turn off all cellphones

I was upset when I found out that the Internet capabilities would only be in my apartment/hotels and in restaurants. How would I connect with the rest of the world at every second of every day?? This once horrible situation, turned out to be a true blessing. I was not able to post or send pictures constantly, or update my friends every second about my whereabouts, which was a great thing! I was able to focus on the amazing places/views/experiences around me instead of my phone. I wouldn’t want to look back and regret being on my phone 24/7 instead of enjoying what was around me. So turn off the phone during the day and then update your friends to let them know you’re safe, and to brag about what you’ve done at the end of the day.

9) Look back

You often hear not to look back but instead look forward to what lies ahead. But I would highly recommend physically looking back while you are traveling. Some of the best pictures of amazing views have been taken because I looked back. You don’t want to miss a single thing…

10) Live in the moment

Like most fast paced people, I am always looking forward to the next upcoming thing in my life. Whether it was going to high school, college, or graduate school, or even studying abroad, I couldn’t wait for the next step in my life. But as the years went on, and the people around me were wishing/wanting the years ahead, I began to slow down and live in the moment. You only get the moment for a moment, and then it’s gone. It was just a little over a year ago that I applied for this Italian internship, and over 2 years since I first heard about Eduglobal and the Italy opportunity-now it’s over. I can honestly say that I lived in the moment during my entire 3 months abroad. This opportunity comes once in a lifetime, and I wanted to remember every second.

Final thoughts:

It’s one thing to travel to another country, but it’s completely different to live and work in one. Not many people have the opportunity to embrace and speak another language while building relationships with the native people. I advise everyone to travel the world and experience life outside of the US, because it’s a beautiful thing. Remember, “You only live once, but if you do it right, once is enough”

~Jordan

 

 

 

 

 

 

 

 

 

 

PT Clinical Week #8

Our last week has come to a close, and it didn’t disappoint! I was able to increase my caseload and try new things with patients!

LOKOMAT

For two afternoons, I learned how to operate and use the Lokomat (a body weight support system combined with a machine that moves the lower legs on a treadmill). It is so complicated! There are so many things that you have to do before you even get the patient! During the examination, you have to get measurements of the legs and enter it into the computer. Then every time that patient comes, you have to manually set the machine to those measurements so it fits the patient perfectly. Each patient does it for 20-30 minutes depending on how much they can tolerate. The type of patients that can use the Lokomat varies. Some patients have some movement in their legs, so the level of assistance that the Lokomat provides is less and vice versa. Even though most patients will probably never walk again, it can be good for maintaining passive range of motion and reducing spasticity. Also, if the patient has some weight-bearing on the treadmill, that is good for maintaining bone strength.

There was a big screen set up in front of the patient that they could play games. Many of the games had an avatar who performed the same movements as them. The object of the game was to catch different items on the screen. In order to turn, the patient could use what little movement they had to change directions on the screen. There were graphs on the computer monitor that showed how much assistance the patient needed, and if their movement was corresponding with the machine or not. If the patient were cognitively aware, they would be able to adjust.

INDEGO:

One of the coolest things I saw was the “Indego”.  It was invented in Germany, but Italy is the first nation in the WORLD to get it approved and use it in their clinics. It is like the Exo-skeleton (which is also a body movement walking system) but much smaller and lighter weight. All you need to be able to use it is passive movement of your legs. The level of assistance the machine gives can vary from patient to patient. There is a computer in the hip and the knee and the total weight is 12lbs.

Indego

Our hospital/clinic was on the news because there was a patient who was getting married, and he was to use the Indego to walk down the aisle!!!! It’s amazing what technology can do. The ultimate goal is that because it’s so compact, lightweight, and easy to use, that patients will be able to use it at home. It costs about $80,000 so those who can afford it can purchase it; otherwise,  the hope is that as the price goes down, they will become more affordable.

One of the Indego patients was a 47-year-old woman who also had surgery on her spine and no longer has use of her legs. She uses the Indego almost every day. I also saw an Indego examination of an anesthesiologist who fell from a small ladder and injured C3-C5. He regained use of his arms and trunk, but not his legs.

INSERVICE:

On Wednesday, Kristin and I presented our inservice, “Mobilization with movement” (Mulligan Concept). We spoke in English incorporating some Italian, but our Powerpoint was ENTIRELY in Italian. It went awesome, and all the therapists were really impressed. We even included two demonstrations of the techniques. Normally in the US we bring in food for the inservices we present, but here they had a spread of pizza, paninis, and dessert!

MY FAVORITE PATIENT:

My favorite patient was always treated in her room because she had a trach and an NG tube. In the last two weeks, we progressed to standing and walking! Her hair was always crazy when we started getting her out of bed, so I would comb it for her (one of my favorite things). The last week my therapist and I would tell her I was leaving and traveling Europe and then heading back to America. On Friday, I told her “ e stato un piacere” (It was nice to meet you), buona fortuna (good luck), and even asked her to come back to my house! After all this, she looked up at my CI and says “ill see her Monday??” We had to explain I was leaving…forever. ;(

BUONA VITA

Before leaving, one of the CI’s told us, “Buona Vita”, meaning have a “good life”. Contrary to belief, it’s a term used instead of goodbye, in the possibility of reuniting in the future even though we are a world apart. I love it, and I will be back. I promise.

~Jordan

PS: Next post from Vienna, Austria!

Cinque Terre & Pisa (Round 2)

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This was our last weekend trip in Italy, and it was by far the best experience I have ever had. The other girls had not seen Cinque Terre, so I decided to go back with them, and I am sure glad I did. The 5 towns are nothing too spectacular individually, but we did the hike between the towns along the coast, which is a MUST DO.  It was the most amazing/beautiful hike I haven ever done. The weather was perfect, and I wore a sleeveless shirt the entire time! The views were absolutely breathtaking. Here’s a glimpse of just how much physical activity was involved:

  • 33,000 steps
  • 232 flights of stairs
  • 14 miles

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We didn’t make it to all 5 towns because we wanted to stop in the second to last one to watch the sunset. Everyone was standing around just waiting for it on the cliffs and taking pictures. There is nothing more to say…the pictures say it all.

~Jordan

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PS:  The tower is still leanin’…

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PT Clinical Week#7

Another week down, only one more week to go! This week flew by especially because I was sick on Wednesday so I only worked 4 days.

On Monday, I completed a home exercise program for a patient who was discharged home. I included 5 exercises with pictures, descriptions, and prescriptions. Because the computer wasn’t working in time to print before he left, it will be mailed to him. And because I was in a time crunch, I used Google translator to translate from English to Italian (hehe).

The older gentleman with the stroke (that I mentioned in an earlier post) was discharged on Wednesday. On Monday, I was working with him alone, and he said something to me in Italian. I responded with, “yes” even though I didn’t fully understand what he said (never do that). The next thing I knew he was trying to go from lying down to sitting up on his own and his face was bright red! I was able to help him up, but I was not ready for that unexpected transfer. The language barrier has been tolerable thus far, but it can become really scary when you are alone and something unexpected happens. Sometimes when I am transferring this patient, he begins before I am ready. So later in the week, I tried to instruct him in terms of steps that I wanted him to complete first like “viene avanti” which means “come forward” in his chair. Then I count to three (uno, due, tre) before he begins. This method has gone a lot smoother.

We had 3 new patients this week:

  • 41 y/o incomplete SCI patient C3-T1 (motorcycle crash) also sustained 2 broken elbows & nose
  • 40 y/o TBI (fall at work) hemiplegic L side, frontal lobe signs, and has a 17 month old son
  • 77 y/o stroke patient who gets very emotional and cries several times each session.

DIFFERENCES:

Most therapists transfer a lot differently than we would. They transfer with their arms under the patient’s armpits instead of their hands under the patient’s butt, and it seems very unsafe.

All the therapists, nurses, and health assistants wear scrubs, but the doctors wear business casual and even some wear jeans (nicer jeans of course). I find that really cool.

PT’s go to school for a total of 3 years after HS and receive a bachelor’s degree. Nurses also go to school for 3 years after HS. The HS system is a lot better in Italy so a lot of our general education courses that are taught in undergrad in college are actually taught in HS here. They feel that PTs in the US actually have two bachelor’s degrees (undergrad and then PT) because of how the 6 years is divided by different subject matter.

~Jordan

Orvieto

Orvieto Cathedral

Facade of Orvieto Cathedral

Facade of Orvieto Cathedral

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The second place we traveled to this past Saturday was Orvieto. The parking garage was located underground below the city, and we wanted to take the escalators to the top but they were broken! So we walked up 100s of stairs! After that workout, we explored some of the city, and then three of us took a 3 mile walking path that encompassed the city parameters. Because of the location of the city (see below),  the trail was extremely difficult and we were sweating by the end.

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The girls wanted to get gelati following the hike, but every gelati place was either closed or the open restaurants didn’t serve it. The season for gelato must be coming to an end until spring?? I hope not.  Before leaving the town, we headed to some underground caves. They were really cool and not what I was expecting when I thought of the word “cave”. The one we went into was founded in 1984 by people who were working on their trattoria. They began excavating the cave in that year, and the excavation still continues today!

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We were going to eat dinner in Orvieto because there were a lot of great restaurants recommended, but because most Italian restaurants don’t open until 7:30, we decided to call our landlord Paolo, who makes the best italian food known to man, and he prepared dinner for us to have when we got back.

Only one more weekend of Italian travels!

Inside the caves

Inside the caves

Caves

Caves

Caves

Caves

FACTS:

Situated on the flat summit of a large butte of volanic tuff. The site of the city is among the most dramatic in Europe, rising above the almost vertical faces of tuff cliffs completed by defensive walls built of the same stone called Tufa.

A major center of Entruscan civilization

Orvieto was annexed by Rome in the third century BC and was last conquered by Julius Caesar.

The city of Orvieto has long kept the secret of its labyrinth of caves and tunnels that lie underground. The underground city holds more than 1200 tunnels, galleries, wells, cellars, etc. Many of the homes of noble families used these tunnels as a means to escape times of siege. The tunnels would lead from the city of palazzo to a safe exit point some distance from the city walls.

~Jordan

Civita di Bagnoregio

This past weekend we decided to do two places on Saturday and spend Sunday at home in Umbertide. The first place we went to on Saturday morning was Civita di Bagnoregio. This town perched high on a small cliff surrounded by a valley. There is literally only one road/bridge that you can take to get there. You park at the edge of the bridge and then walk up to the town. The entire walk across the bridge was absolutely incredible and filled with great views.IMG_3543
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It was supposed to rain all day, but that morning when we checked the weather, it said it was going to be clear all day! We really lucked out. We walked the city and did a tour of a small house that was built into the side of the mountain. Shortly after we were informed that it was used in the film “Pinocchio” here in Italy.  We also went through a tunnel that cut through the mountain (it was off limits to tourists, but the fence was kicked over, so we went through anyway. It was a rather large tunnel, but centuries ago it was just big enough for women to hold their water jugs on their head to transport place to place. It was one of the only tunnels used to go from one side of town to the other…and later they widened it so farmers could go through with their equipment.   
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Cliff house

Cliff house

Cliff house

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FACTS:

Civita was founded by Etruscans more than 2,500 years ago

At the end of the 17th century, the bishop and the municipal gov’t were forced to move to Bagnoregio (former suburb) because of the major earthquake that accelerated the old town’s decline.

In the 19th century, Civita’s location was turning into an island (as seen in pictures), and the pace of the erosion quickenend as the layer of clay below the stone was reached in the area where today’as bridge is situated (the only way to get into the city from the mainland).

Civita became known in Italian as “il paese che muore” (the town that is dying).

 

~Jordan

PT Clinical Week #6

Week six has come to a close, which means Kristin and I only have 2 more weeks in the clinic before we start Part 3 of our journey.

This week I did a lot more hands on with patients than the previous week. But it was a mix of observing, helping, and then working independently, so I was able to learn in different ways.

The patient I am treating independently goes to occupational therapy following her morning treatment session with us. So I am allowed to follow and observe her there. At first I was just watching, but then no one was really telling her what to do or even watching her so my instructor told me to come up with exercises for her to do to work on the deficits I found in PT! Didn’t know I would become an OT on this journey too! I have her drawing, building block towers, and using a tiny peg board (fine motor skills). I work with coordination and proprioception of the UE but also endurance. It’s different from the US because a therapist would normally be 1v1 with a patient working or at least working with a group of patients.  But sometimes I am the only person in the room, and I am supposed to be with PT!

PT’s here are able to use the hoyer lift and don’t have to get the nurse to do it for them. I’ve never actually seen one used fully before, and the one they have is so easy to use! One of my patients has tetanus and has been bedridden for quite some time due to the infection. She is on an NG tube and isn’t able to go down to the gym for treatment; so we visit her room twice a day of which she shares with 2 other roommates. I was worried that Italians did not take tetanus shots as seriously as we do, but they do.  She just happened to be someone who didn’t get one.  Definitely a new diagnosis for me.

Friday, Saturday, and Sunday here there is a course going on Bobath NDT (Neuro-Developtment Treatment). A lot of the therapists are involved and are using some of my patients as participants. Italian therapists use a lot of Bobath concepts here, even though there isn’t a lot of evidence supporting it. We touch upon it briefly at LVC, but don’t harp on it because of the lack of evidence.

DIFFERENCES:

They have a break room where there are tons of goodies from patients or that the staff brings in. For instance, my patient is being discharged today, so he ordered a huge box of pastries for everyone. Not only do they have caffé and biscotti/pastries in the break room but they also have wine! Some of the therapists drink wine during lunch.

Apparently Italians don’t use hand sanitizers too much. It is not located in the clinic (to use after treating each patient) and it is actually really expensive for a tiny bottle in stores. So instead, therapists wear rubber gloves when treating, or they just be sure to wash their hands after each patient. They also don’t utilize spray sanitizer for the plinths like the US does after every patient. Here, they have the paper that they roll over the beds like you see in the doctors offices. Only if the bed is really dirty do they use the spray (I saw it for the first time today).

 

~Jordan

A Country Within A Country-San Marino

Torture Museum

Torture Museum

Saws used for beheadings

Saws used for beheadings

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Mega pizza

Mega pizza

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Sunday, Kristin and I decided to travel abroad yet again! This time we went to the little republic of San Marino, which lies within the Italian borders. The other 5 girls opted out of this trip, so it was just the two LVC girls making the journey. And it certainly was a journey indeed. It was a 2 hour drive from Umbertide and ¾ of the trip was up and down the mountains with switchbacks after switchbacks. I have never driven on ANYTHING like it before. It was absolutely INSANE.

Once we got there, we ate lunch that consisted of two individual small pies (yes, we each ate our own pie). The best part of the restaurant was that it was right on the side of the mountain and you could see the whole countryside and mountains from the windows that lined the wall.

After lunch, we walked the city and visited some shops. Before heading home, we stopped into the torture museum (6 euros). It was one of the best museums (partly because I love that kind of stuff). It had two floors filled of ancient torture devices with pictures and descriptions underneath as to how they were used. I was not aware of the crazy torture techniques that were used in the past. Some torture mechanisms are still used today in parts of the world. They literally did anything and everything to the human body. Here are some torture examples:

  • Horses: They would tie the 4 limbs of a person to individual horses and then have the horses run in opposite directions. Because the body is so strong, the executioners would cut the tendons, genitals, breasts, beforehand.
  • A lot of the mutilation consisted of having things pushed or cut into the genitals of males or females. They would do so by hanging the person upside down so the blood would rush to their head so they would remain conscious. And only when the saw reached the mid stomach-breast bones would the person lose consciousness.
  • Not only were people hung by their necks they were also hung by their wrists from behind their backs in order for the shoulders to dislocate.

FACTS:

  • San Marino, officially the Republic of San Marino, is an enclaved microstate surrounded by Italy, situated on the Italian penisula on the north-eastern side of the Apennine Mountains. It is just over 24 square miles and has the estimated population of 32,000.
  • San Marino claims to be the oldest surviving sovereign state and constitutional republic in the world.
  • Governed by the Constitution of San Marino, a series of six books written in Latin in the late 16th century, that dictate the country’s political system, among other matters. The country is considered to have the earliest written consitution still in effect
  • The country’s economy mainly relies on finance, industry, services, and tourism. Despite having an extremely small economy for a nation state, it is one of the wealthiest countries in the world in terms of GDP (per capita), with a figure comparable to most developed European regions.
  • It has a highly stable economy, with one of the lowest unemployment rates in Europe, no national debt, and a budget surplus. It is the only country with more vehicles than people.

~Jordan

 

Lake Trasimeno

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Another weekend down! This weekend, Kristin and I had dinner and breakfast cooked by our landlord-2 times. It is always so delicious, so it was great having it twice in one weekend! His food is so amazing that we asked him if we would be able to have our own cooking lessons, and he agreed. So Saturday after breakfast, he and his chef taught us how to make homemade: bread, ravioli, and tiramisu. He showed us and even let us help with some of the steps. Then we got to eat what we made!

We originally planned to stay around and explore our town of Umbertide, but we made an unexpected trip to Lake Trasimeno instead. We walked the streets, vineyards, and docks. We walked a total of 6 miles in a short time there. On our way back to the car we caught a glimpse of the sunset over the water. It was beautiful.

~Jordan

PT Clinical Week #5

This week I started downstairs in inpatient neurology. Such a change of pace from inpatient orthopedics. My new clinical instructor is Roberta, and she speaks very little English. This week, another student who is living with me is working with Roberta as well (as she has been for the past 4 weeks), so I did a lot of observing while she did most of the hands on work.

The schedule is much different in neuro than ortho. We see 4-5 patients in the morning for 50 minutes and then see the same patients in the afternoon. We focus on ROM and mobility in the morning and then do more functional activities in the afternoon. Our caseload consists of: patient with tetanus and previous stroke (1998) // patient previous ischemic stroke & patellar fracture // patient previous TBI (2014), hip calcification, femur fx, and tibia fx // and patient previous ischemic stroke with shoulder dislocation.

On Tuesday, Kristin and I drove to Perugia to see surgery! The surgeon was the nicest guy and even waited 30 minutes to start the surgery for us, which would never happen in the US! He spoke great English and told us every thing he was doing and why in great detail. There are very little rules in the operating room, and therefore, we only wore a mask and a hair net along with scrubs and covers on our shoes. We did not have to wear gloves, long sleeves, or remove any of our jewelry. We could literally stand right over the surgeon and the patient to see unlike the US where I had to remain far away. I stood so close for one of the surgeries that I managed to get blood on me during the hammering of the bone! We talked to most of the patients pre-op. The surgeries we saw consisted of:

Hemi Knee Replacement

ACL reconstruction

Total Hip Replacement

Tumor Resection in the medial knee.

The patient with the tumor (benign) was a young girl who during the surgery woke up and started screaming in pain! It was absolutely insane. One of the doctors quickly injected more anesthetics and she went back to sleep. Two of the other patients were awake for the entire procedure, but could not feel a thing.

 

MORE DIFFERENCES:

PTs here get 5 weeks of paid vacation time throughout the year. Most split it up: 3 weeks in the summer and 2 weeks during the winter. In terms of sick days, they can go to the doctor and get a written excuse and then it can become a paid sick day. Also in the Italian PT world, as soon as a woman becomes pregnant, she can take leave until the baby is born. After the birth, she gets approximately 6 months then if needed, can add on her vacation time. Once this time is over, she can work part time until the baby is one! Here in Italy, there are a lot more holidays than in the US, and the PTs get off for almost, if not all of them.

~Jordan