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Erasmus Chronicles – Significant events don’t have to be life changing…

For each placement that I go on, whether it is here in Sweden or back home at Salford, I am expected to write up a Significant Event Reflection based on the Gibbs model. For the last two years, I have been completing them without really understanding what “significant event” means, and so have often found myself writing about events that I found interesting or mildly memorable that I believed might be worth sharing. To a point, these are significant events. They stick out compared to everything else that has occurred to me during my placement, but I always felt they were lacking something.

My personal tutor would always give the example of a former student writing about answering the phone, and I understood what she meant but never really thought I found one that fit, until recently. So, I thought I would share my significant event reflection with you, in case you too are struggling to understand what “significant” entails. Mind you, I’m about to start 3rd year, so took me long enough!

Tip #17: A significant event is something that is significant to YOU.

Semester: Year 3 Semester 1                     Practice placement: Infection ward, Norrkoping

What is the event I am reflecting on? Towards the middle of my placement on the infection ward, I had started to become more comfortable interacting with patients and overcoming challenges that arose due to a language barrier. This meant that I was more proactive in being involved in patient care, such as administering medication. During one shift, I had gone to a patient with a respiratory condition to provide them with their antibiotics, and tried asking how they felt in Swedish, rather than in English. This lead to the patient stating that they were not feeling well, had difficulty breathing and strong pain down their side. I took the opportunity to sit down by the bed and to listen to what they had to say, and try to comfort them as they started to cry. Although I had gone in to administer medication, it did not feel appropriate to proceed, so I waited for the patient to feel comfortable enough to continue. Before I left, they thanked me for taking the extra time to sit with them and listen even though they were embarrassed that they cried. I reassured them that I understood how it probably feels to them, having been in similar situations and that I would gladly sit with them again if they needed me.

Who was there? My patient and myself.

How did I feel? During the event I felt quite taken aback as I was not expecting the patient to be distressed. However, once I understood why they were distressed, I could relate to their situation having been in similar situations myself. So, despite having gone in to perform a task (administer medication), I felt it was more important to take the time to comfort the patient before continuing as emotional well being is part of holistic care. I know that part of nursing is being able to sit and comfort the patient, as “task-oriented” nursing is not congruent to holistic care, and it is something I try to avoid, however this was the first time that I understood what that meant. It is possible that because I am used to working with children, addressing their needs first is something that I am familiar with doing whereas I have never cared for adult patients prior to my exchange programme, and most patients on this ward will let the nurse complete their task first before asking for their needs to be met.

Has this ever happened to me before? Doing paediatric training, these events do not occur as often as expected in the placements that I had been assigned to previously. When children are upset, the parents are often there to comfort them. I have however, had one previous occasion where a father on the neonatal intensive care unit felt the need to share how he felt about the situation, but did not feel as strongly (externally) as my patient on the infection ward. A few days after this significant event, I had a similar experience with another patient on the ward, who on the contrary was very excited to speak to me as she explained that it allowed her to “exercise her mind to speak in English” and provided a great start to her day.

Discussion with a person supporting your practice (state who). I have discussed this event with my placement mentors and my contact teacher (equivalent to a personal tutor or P.E.F.) during my midpoint assessment for the Linkoping University clinical competencies, as one was regarding to the communication and therapeutic relationship I build with patients. Although, at the time, I felt that the event was significant, I did not feel that I had been able to build the same rapport with all my patients. However, during the evaluation, having spoken to my supervisors, it was brought to my attention that although it may have been with just this one patient, it is the quality not the quantity that mattered. Although I may not have had the same level of rapport with all the patients under my care, we came to the conclusion that, should they have needed the same kind of intervention, I would have given it to them without hesitation.

What would I do differently if the same thing happened again? After the discussion with my supervisors, we came to the conclusion that I would not do anything differently, as I put the patient’s needs first, and the patient appreciated it.

What have I learnt from reflecting on this event? I am capable of providing good nursing care in unfamiliar environments, despite various challenges that may occur (such as language or clinical differences).

What does this mean for your future learning needs? I need to focus on what I do right, as well as what I need to do to improve as both are equally important to my development. It is also important to consider the quality of my nursing practice, in addition to the quantity of opportunities I have to practice my nursing skills.

 

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Erasmus Chronicles – It’s not just a coffee…

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Coffee and a Chokladbollar

If I were to ask people who has been to Sweden, what is the first thing they think of in regards to Swedish culture, I can almost guarantee someone will immediately think of Fika. It’s embedded in the lifestyle here as milky tea is in England. However, it’s more than a cup or coffee. A translation would mean coffee break, but it’s more social than what a simple “coffee break” would imply. It involves a cup of coffee and something to eat – usually sweet – and some company to share the moment with, be it family, friends, colleagues or someone you are getting to know.

 

During our orientation week, the coordinators organised Fika for the students in the morning on the first and last day, my contact teacher for my placement invited me for Fika on my last day on the ward to complete paperwork, my friends and I don’t “grab a cup of coffee” instead we “go have Fika”, and the “kitchen person” of the week in student halls must host Fika on Sunday at 20:30. There is no escaping this phenomenon.

Tip #15: Coffee is the primary drink of choice, but don’t worry, there are always other options if that is not your thing.

During these first few weeks, I have come across people joking about the quantity of coffee that the Swedes drink in a day, usually closely followed by “only to be surpassed by the Fins!” I swear, there seems to be a contest between these two nations on a cultural level…

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For someone who used to drink a lot of coffee, then didn’t, then did… (I am a fickle friend to coffee apparently), my caffeine intake has increased dramatically since I started my Erasmus exchange here. On the ward, along with your official 30 minute lunch break, there is an unofficial Fika during each shift, as well as the one at the end where all the staff get together to have a chat and unwind after a days work. I have been told by staff that when we are in the staff room for Fika, the call bell doesn’t exist (unless an emergency, obviously) – the staff still out on the ward are to answer it. It’s your 15 minutes to switch off entirely, and I do think it makes a difference as you don’t come back on the ward feeling like you have had no break at all (“Have you tried turning it off and on again?” comes to mind).

You could almost say that this activity summarises the Swedish mentality quite well. They are hard working people, very structured and orderly, but always make time to relax and socialise with others.

Tip #16: Enjoy the small comforts. Have a Fika.

Erasmus Chronicles – Homesick, Already?

Before I start – let me preface this short rant with one thing – I do not think that my situation is the norm, complications occurred.

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My first four weeks – Oh boy…

So, as I may have mentioned before, I have 12 weeks worth of placement while here in Sweden. I also have to follow the theory modules at my home university, remotely through Blackboard collaborate. To cut a long story short – I am doing a full time theory module at the same time as full time placement and all the work that Erasmus entails (e.g. local competency logs, mandatory Erasmus + language courses). There are barely enough days in the week, and this leads to me having quite the packed schedule simply to meet programme requirements. When I first found out there was no changing my requirements I was a bit annoyed, however,  at the time I thought that with effective time management I would be able to do it all without any problem. One important aspect of going on an Erasmus exchange, that I had forgotten at that moment, is that you also are there to experience the culture, people, and socialise with others who are studying at that university.

Tip #13: Social health and well being is a thing for everyone – including you.

Now, where I live (Flamman) there is Flamman Pub&Disco only 10 meters away from my window. This means, now that term has officially started at the university, loud music and singing and general merriment occurs just outside my room, The 6:45 start and about a 1.5 hour commute there means that I wake up early. Going from a late to an early shift with this window-rattling noise is even worse as I have 9 hours to get home, “cook”(instant noodles are my best friend) and eat dinner, catch up with family back home, and sleep before being back on the ward. I might, just maybe, be a little sleep deprived.

To top all this off, I miss my family. I miss spending the evening curled up on the sofa with my partner while the rats plot mischief. I miss getting irritated about the noisy hamster wheel in the bedroom as I try to sleep (now I’d take that any day over off-key singing). Oddly, I miss the organised chaos that is an NHS ward and the banter between staff. Although I feel more confident every day on the ward, I still feel out of place. My supervisors are great at making sure to always speak in English around me, and explain Swedish terminology so I can follow what is going on. However, I miss listening to staff talking about their weekends or crazy events that happened during that other shift. These conversions still happen, but I can no longer chime in because I don’t understand anything. I can honestly say I can now sincerely empathise with patients who do not speak English who come to our wards back home. It sucks.

Tip #14: Have someone you can vent to about how you are feeling – Friend, family, exchange coordinators,…

And I am homesick. Other than have a short cry, I don’t know how to deal with it.

That being said, I have been trying to seize opportunities that come my way. On Friday, after a bit of a power nap, I went to take part in a practice session for the “Olympics” that the exchange students take part it (oh, note that I did not attend the actual event as I am on the ward instead – yeah ok, I may still be a bit bitter about my schedule). Now, considering this is a student led competition, the events involve University-esque events such as chugging a bottle of beer (I managed without getting it up my nose, it was a proud moment) or a race where you spin 10 times first. One event involving glass bottles, water, string and a tampon warranted us some very odd looks from fellow park-goers. It may have only been an hour or two with fellow exchange students, but I was glad to have someone to talk to about something other than care for infectious diseases. On Monday, I will attend a dinner organised by the Medical faculty for new students, so I am not stuck in my room all day listening in on lectures.

And with that, I leave you to try and get some sleep, with drunk singing as my lullaby. Man, the 90s had some decent music…

Erasmus Chronicles – First week as a sjuksköterskestudent!

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Hej, jag är en sjuksköterskestudent och utbytessudent! (Hey, I am an nursing student and exchange student!)

My first of twelve weeks on a Swedish ward has started, and it has been quite the adventure so far. I am currently on a four week placement on an Infection ward, where patients with infections are sent from other wards to be treated. As a paediatric nurse in training – all my placements have been in children’s wards, so delving into a ward where the average patient age is closer to 60 than 6 puts me a little out of my depth. Luckily, I have been given amazing supervisors to work with, so it was never a sink or swim situation. Despite the initial terror of a language barrier, I was soon proven that with a bit of acting and compromise, it was barely an issue. Most patients I have worked with so far have had some level of English (I had one patient outright say he does not, then the next day tell me to watch Sweden play Hungry in football that night at 19:00, on channel two), and those who don’t are patient and understanding as I mime out my intentions. If all else fails, my supervisors have been happy to help translate where needed.

Tip #10: You might need to get creative to convey information – effective communication and all that jazz.

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“Doctor”

Speaking of communication – the uniforms. The uniform policy is fairly similar to that of England, with one major difference that I feel most nursing students might appreciate – the only restriction on types of shoes is that they are clean indoor shoes. That’s right, they don’t care what colour, material, open, closed, heeled or not. I have witnessed “socks with sandles”, clogs, and tennis shoes in a multitude of colours and patterns. The same goes for socks (they might even be optional). Also, everyone wears the same white scrubs, doctors included, meaning that the only distinguishing feature about then is the “profession” badge – doctors have red ones, nurses blue, “under-nurses” or our equivalent of health care assistants have green. Each profession has a coloured badge for patients and staff alike to easily recognise each role at a glance (the white uniform helps). Mine is white, with my full name, the university logo, as well as “nursing student” and “exchange student” written.

Another difference is that the uniforms are closer to scrubs than the tunics that we have. They are loose fitting tops with button collars, and the pants are fairly basic (also very comfortable). Each item of clothing (tops, pants, and dresses) have a chip sewn in. This is due to the fact that the uniforms belong to the council, who is then responsible for their cleaning and maintenance. The chip allows for fancy tracking of what has been taken out of storage. So no need to order uniforms in your size, wash and iron them – just grab what you need out of the storage and put it in a hamper before going home.

Tip #11: If they say uniforms will be provided, they meant it (don’t bring your uniform “just in case” like I did).

InfuuszakjesI covered the difference in skills taught between England and Sweden previously, but I did not realise just how important that difference would be until I arrived on the ward. The majority of the patients are on IV antibiotics or other similar medication, so being able to perform all the associated tasks such as cannulation, flushing, prepping and administering IVs is a significant part of the nursing care that is provided on this ward. However, my supervisors and other staff have been extremely supportive in letting me go at my own pace when learning about these respective skills.

Withing the first 5 days I have had the opportunity to do as many learning experiences and exposures as it usually takes in 2-3 weeks back home. Between learning curves in skill, communication and acclimating to their need to recycle everything (seriously, packaging gets taken apart into plastic and paper recycling!) I have done bladder scan and a 12 lead ECG under supervision as well as attended a lower leg amputation. I still have about 10 days left on this ward and the opportunities seem endless!

Finally, Fika, or the Swedish term for a coffee break, is an integral part of the day for both staff and patients alike. And I don’t blame them. Taking 15 minutes to sit in the world’s most comfortable staff room with a cup of coffee or tea and a small snack, everything seems right in the world. I’ll tell you all about this in another post though, promise!

Tip #12: Fika is love, fika is life.

Erasmus Chronicles – Odd one out!

*All photographs from the clinical skills centre were taken with permission*

Yesterday was the first day of the orientation week, and one scheduled event for the day was to visit the clinical skills centre that the Medical Faculty at Linkoping University provide. It’s safe to say, I was very excited – finally something a bit more within my comfort zone (as we had spend the day doing introductions and Swedish)! What magical rooms and teaching sessions were available to us during our exchange programme? How does it compare to what I have on offer at Salford?

 

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Unlike at Salford, where we have clinical skills rooms and a simulation suite that are used primarily by nursing and midwifery students (I think the physiotherapy and occupational therapy students have theirs elsewhere), Linkoping University has a Clinical Skills Centre – a building dedicated to the development of clinical skills for both students and qualified staff. Similarly to Salford, and most Universities, they have clinical skills rooms, equipped with all the equipment and materials that we would use in practice. Unlike Salford, all programmes are within the same skills centre. Physiotherapy rooms, rooms set out as 4 bed bay, practice rooms with mannequins and models, and study rooms – all within the same area. We even bumped into a lecturer giving a session on acupuncture! Every room seemed to hide some secret to improving our skills.

Tip #7: Take opportunities to explore what the campus and faculty has to offer!

The Medical Faculty strongly believes in hands on learning, and learning through experience – and this shows through how the centre is put at the student’s disposal. It opens every day (weekends included!) from 7:00 to 22:00, and students are welcome any time to practice whatever skill they feel needs brushing up on. Unfortunately, I have not had the chance to book into a skills session at Salford, so I am not able to compare – however, here we were told that students come either on their own or with other students and lead their own learning.

You book your rooms, ask for the equipment needed, then you’re on your own to practice. Other students and student assistants may be present to help, but these aren’t teaching sessions but direct supervision is available if you take part in a teaching session. You have access to all the equipment and are expected to treat it appropriately, safely, and return everything that has been used. Nothing can leave the rooms.

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“nursing” mannequins

They also have, along with simulation suites (complete with creepy mannequins that breathe, cough, talk, physiological changes, organ failure – you name it, they can probably do it), they have a visualisation table. Although we didn’t get to see it, it’s a table to help students understand the human body in 3D. Images taken from real MRI scans are , by computing magic, turned into a 3D image that can be rotated and taken apart on a screen. Oh and they also do dissection (nursing students included).

Additionally, during the simulation sessions, they are quite keen on incorporating inter-professional sessions into the curriculum – student nurses, physios, speech and language, and medical students all work together as a multidisciplinary team to care for this (simulated) patient. If there is anything I hope I can encourage when I return to Salford, is to incorporate these types of simulations. From the explanation given, it provides students the opportunity to experience the responsibilities and boundaries that they will have once qualified, within a safe setting. After each simulation, a reflection is done where the team discusses how it went, what went well and what could do with improvement. They also have interdisciplinary (student-led) training wards that you can do as placements (see an article about them here).

This leads me onto the very big difference between Linkoping (and Sweden in general I believe) and Salford (and the rest of the United Kingdom, again, as far as I am aware). Our Swedish (and Finish, and Kenyan, …) counterparts are expected to obtain certain skills we are forbidden to do until after additional training as a qualified member of staff – cannulation, blood samples, administration of IV medication, and male catheterisation to name a few that I have come across. By the time they reach the same stage of training that I am in, they are expected to be able to complete these tasks without direct supervision (similarly how we would approach any skill that we have been signed competent for). We are not.

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Tip #8: Be aware of the differences in skill sets.

So, with a bit of a panic that I would be expected to cannulate patients on my first placement, I asked (repeatedly – I think everyone was a bit tired of me by the end of it) if I would be expected to learn these skills as they are not part of our standards. I was assured (also repeatedly) that as long as I informed my mentor, there would be no issues and that I will learn these outstanding skills during my exchange.

So armed with the knowledge that I have a lot of learning to do, I am looking forward to my first placement next week – Infectious diseases ward. I wonder what I should be prepared for?

Erasmus Chronicles – Linkoping, where the Bicycle is King.

Linkoping and its surrounding areas of interest (e.g. University campus Vallan and US, Ryd, Ikea…) are on average 30 minutes walk away from where I live. I learnt the hard way, on my first day, that walking everywhere is not an option in the long run. I also learnt the first day, no one walks anywhere and few take the bus. Public transport is difficult in my opinion – you need to find a “quickomat” or ticket machine to get a ticket for the bus and so far I have only found one in Ryd. Or go somewhere very specific – don’t know where – to get the local equivalent of an Oyster card. You can only buy tickets on regional buses, by card (no cash on buses). Clearly, bikes are the superior mode of transport in this country.

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But what about winter and the snow? I imagine some of you asking. It is true, that the rest of the world that is not used to snow (and all transport comes to a halt – I’m looking at you Brussels), we tend to shy away from the cold. Not in Sweden. Where the rest of us tremble at the thought of biking in the cold, they brave it with – warm cloths. That simple. And they clear the roads with salt.

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Bike lanes are clearly signed

Speaking of roads – Linkoping has the best biking infrastructure I have yet seen (and I have visited – briefly – in the Netherlands). You can get anywhere without being in danger on the road. They either have a separate biking path on the sidewalk, or a designated lane on the road. With everyone biking, the divers are aware of cyclists and there is none of this irritating honking of horns and silent swearing. That being said, the cyclists respect road rules, stopping at red lights and indicating their directions like any other road user. It’s a system that works well, and could easily be implemented everywhere else with a bit of effort.

 

Tip #4: They drive on the RIGHT side of the road. So do the bikes.

Knowing that I would need a bike eventually, I had even brought my helmet from Manchester, not knowing if it was mandatory or not by law (however, always heavily suggested everywhere even if not legally binding). So I did what everyone looking for a second hand bike would do. I googled it. Turns out, there are local second hand shops (see suggestions from the Univeristy here – a receipt is needed for insurance coverage) as well as bikes being sold off by students who either no longer need them or are leaving. Those that are sold by students are either on the university notice board, or there is a Facebook group – ESN Linkoping Flea Market (also has various other items such as kettles, routers, furniture, etc.)

Tip #5: Suggested price for second hand bikes is between 700-900 SEK. But you be the judge, you can find some for more and some for less.

CaptureThe bike I eventually got seems to be fairly standard. No gears (tiny inclines are a bit challenging, but let’s be honest, I am also very out of shape), peddle brakes (rumour has it this is because hand brakes risk freezing during winter), a kick stand, bell, lights, and the metal thing on the back to put stuff on. Sometimes they also have a basket and lock. But you can also find mountain bikes, city bikes with gears, with hand brakes on the group and definitely in the shops. So it depends what you are looking for. There are some legal requirements for bikes in Sweden – both front and rear lights, front and back wheel reflectors, and a bell. I still have some fixing to do to make this bike “legal”, but for now, it should be fine.

Tip #6: Umm, maybe don’t by the very first bike you find? I mean mine is fine and everything and it does the job… but those peddle brakes will be the death of me.

So, now that I have a bike, I can honestly say that I no longer feel stuck. If I wasn’t fit when I arrived, I definitely should be by the time I leave!

Erasmus Chronicles – My Journey Begins!

My journey begins, at 3:00 in the morning, one august morning (the 16th to be exact…), where I am pacing my living room, waiting for the taxi to arrive. It arrives on time, and I arrive to the airport without a hitch, with 20 minutes extra than planned. There’s a large queue for the check-in and honestly, I panic slightly. But not to fear, it moves swiftly and eventually I give in my bag and off I head to security. Great! maybe this is foreshadowing that the rest of the trip will be this easy going. HAHAHAHA.

FB_IMG_1502856036269I procrastinate in the waiting lounge, using up whatever mobile data I have for that month – getting my money’s worth, I won’t be able to use it in Sweden! Eventually I meander to the departure gate, and everything is calm and collected. Not an issue in sight. We board the plane, sit down and I take a nap – after all, I had only slept about 2 hours that night. I wake up, after what I thought was a lengthy dose, only to realise we have yet to leave the ground! We are grounded. It’s too foggy in Amsterdam for planes to land, so the airport has restricted air traffic. Ok, fair enough. Better safe than sorry, I have a 4 hour layover anyway so it’s not like I can’t be a little bit late.

But wait, what time is it? I check my phone, TWO HOURS? We’ve been grounded for two hours! I do some very groggy mental math – it could be worse, I would still have an hour to get to my connecting flight. As long as we leave soon. Then the announcement comes on. We’re leaving! In 45 minutes. WHAT? An audible grumble echoes throughout the plane, apparently, I’m not the only one with a connection to catch. The captain lets us know he had ordered some food to be brought onto the plane before departure, but they were stuck at security. Our biscuits, they didn’t have their passport! Or so I liked to think, it made the situation a bit more lighthearted. After a few complaining texts to family and friends, I go back to sleep. I might as well make the most of the situation.

Tip #1: Travel insurance might seem like a waste of money – until the fog hits…

We eventually take off, and all finally seems right with the world. Amsterdam, I’m on my way! Hopefully, if my first plane is late, so will my second? About 20 minutes before arrival, the flight attendants announce the severity of the delay – some passengers have missed their flight, some have minutes to spare, some have also been delayed. My flight doesn’t get mentioned, so I hope that it means that it’s on time and I have enough time to connect.

I got to the gate 5 minutes before boarding. But I made it, and the flight was on time.

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Compared to the plane to Amsterdam, this one was smaller. To be expected, it’s not like I’m going to Stockholm. I feel that should have prepared me for the smallest airport I have ever seen. It was adorable. One runway, with our one plane. One entrance and exit to the runway. One luggage carousel. One toilet.

We all wait for our luggage to start arriving. I wait, and wait. No new luggage was being put on and the next passengers were boarding the plane we just got off. Umm… Where’s my bag? I look at my carry-on luggage. It has my Practice Assessment Document (PAD), bike helmet and shoes – not much to go off on. I count my lucky stars that I didn’t put my PAD in the check-in luggage. I guess the trouble’s aren’t yet over. I trek over to the customer service, inform them over my missing luggage and then decide to split a cab fare with another student to the University.

We arrive, and get our documentation and accommodation sorted. He’s staying in Ryd, where most student accommodation is. I’m in Flamman, a smaller accommodation building. We say our goodbyes and decide to keep in touch by Facebook (I still owe him half the cab fare!). The international office has organised free transport that day for students to their accommodation. And so, I’m off to discover where I will be living the next 3 months.

I get dropped off with (some of) my luggage, and told which direction my room is. The rest is for me to figure out. Ok, I can do that. But my first challenge was to figure out how to get into the building. I had been given two keys and two fobs… I try everything until I figure out the fob isn’t instantaneous – I need to learn to wait. Patience is a virtue and all that. I find my room on the top floor. It has exactly what was said – bed, desk, chair, LAN cable, bookshelf, toilet and built in wardrobe. What more could a girl want?

Oh yeah, food and bedding. Time to go shopping I guess. Google maps has become my best friend.

Tip #2: Bring good walking shoes – converse are not good walking shoes. Who knew?

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My Destination – in the distance!

I walked about 45 minutes to IKEA, and probably longer on the way back. Oh, did I mention it was boiling? Yeah, I failed to realise August is summer for the northern hemisphere – including Sweden. 24 degrees, in black somewhat thicker sweatpants and leather converse shoes. I melted on the way there and back. I also managed to get the world record in blisters. I was crippled for the rest of the day, but, I had bedding, instant noodles, bananas, some pots, plate, bowl, mug, and cup. Oh did you not know that student accommodation is well stocked with all kitchen stuff? Yeah, neither did I.

Oh, and my luggage arrived. At 23:00, when I was pretty much at Snoozeville. I unpacked, made my bed and went to bed, swearing I would find a bike as soon as possible. For the sake of my feet, and my sanity.

Tip #3: 23kg is a lot of room for check-in luggage. Use all the weight/space you paid for and bring your own bedding. Save your pennies – you will need them for other essentials!