Category: Days in the Netherlands

Today started off with an early morning! Breakfast was at 7:30 and all were grateful for the delicious hotel meals that filled us up before the train whisked us away.

The group travelled to Nijmegen in order to visit the offices of TVN, a home healthcare group. Palliative nurses from a few different local organizations gathered to meet with the students.

Jack and AnneMarie, two nurses from the TVN organization, gave a brief overview of the home healthcare group to start off their presentation to the class. We then watched a video on palliative care that showed how the end of life stages occur with no words, then discussed what palliative care truly is and how that can best be provided. The video was very impactful and can be viewed below:

We also discussed how to identify when an individual should enter palliative care. One of the main ways this is done is through the use of the surprise question. The surprise question is when the physician asks “Would I be surprised if this patient died within 6 months?” If the answer is no, the patient is eligible to enter palliative care.

Jack went on to describe the main mission of the service, which is to identify every individual in the palliative care phase and ensure they receive high quality palliative care. Jack and AnneMarie then ended their presentation by going over a few palliative care cases, and evaluating how the care decisions were made.

Following the case studies, we took a break for lunch and enjoyed some delicious sandwiches, fresh fruit and pound cake. After lunch, our good friend Paul, an incredibly experienced palliative care nurse, gave his own presentation! In his presentation, he asked the class a very complex question: What would we change about palliative care within the US, and how would we actually accomplish that change? We split into small groups to answer the question, then wrote our answers on a whiteboard at the front of the room.

After writing our answers on the board, the class had a very in-depth and complex discussion about how to improve palliative care in the US. I can personally say the conversation was incredibly engaging and truly made our class think more complexly than we have the entire trip.

We took a short break after Paul’s workshop to take a walk and get some fresh air. Then, students gathered in the office to welcome William Yang.

William Yang has recently earned a PHD. He focuses on using yoga and theology to help cancer patients through the lens of palliative care. Yang spent some time connecting with the class, explaining his background, and engaging with the interests of the students. Then, he walked the group through a few exercises he teaches in his classes. It was amazing to see how such subtle movements can transform the body. This experience was a fantastic opportunity for students to see how crucial spiritual care is within palliative treatment.

After finishing up with presentations, students returned to Utrecht and went off in groups in search of dinner! There were so many options, it was hard to pick just one.

by Conor Wagner and Sofia Perrone

Get ready for a doozy everyone – it was Amsterdam day!

As always, the group started off with breakfast, once again provided by our amazing hostel – eggs, yogurt, pancakes, BLT’s, and delicious croissants were available for our choosing. After a hearty meal, the group headed to Utrecht Centraal station to make our way to Amsterdam! Once we got off at our stop, which was on the outskirts of the city, we took a quick bus ride to Museum Tot Zover, or the Death Museum.

We were impressed with the art installations at the museum. Sarah Grothus’ work was accompanied by Daniel Maalman’s composition. The opaque canvas was placed in front of windows, allowing the images to change with the sun. 

In addition, the museum also focused on how death rituals differ between cultures, and how they have changed over time. A standout for students was a student project where they had mimicked an IKEA building manual in the form of a “build your own” coffin. While it was not actually from an IKEA, the exhibit asked: “At IKEA we buy our first crib, so why not our last?”

Following the exhibits, students took a walk around the cemetery outside. Many different forms of burial were present. The space offered great insight into the juxtaposition found in afterlife experiences. 

Two people from our group decided to mix it up and headed to the Rijksmuseum, the national art museum of Netherlands and one of the largest art museums in the world. These two art fanatics explored pieces by Dutch masters such as Rembrandt van Rijn (highly recommend the Night Watch Gallery!), Franz Hals (Steve’s favorite) and Johannes Vermeer.

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However, one of the most impactful and poignant pieces they encountered were part of a special exhibit on the Indonesian independence movement from Dutch colonization.

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The Death Museum and Rijksmuseum were just the first stops of many amazing opportunities the Dickinsonians got to experience today. Because the students were then free to go off and explore Amsterdam, lunch plans were made and the groups rushed to their destinations. The food in Amsterdam not only excels in quality but also in diversity of cuisine – just along one block could be an Italian pizzeria, an Argentinian restaurant, or authentic Indonesian cuisine. We split up from here – some of us went to a traditional Dutch pancake shop, while others went to “Foodhallen,” a type of food court only seen in your dreams.

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After lunch, we all met up at the Anne Frank House for a voice-guided tour. While there are no pictures/videos of any kind permitted once you have started the tour, students were able to grab some images of outside of the original house and inside the lobby section of the museum.

The tour of the Anne Frank House, though self-guided with voice prompts on personal devices, was completely and utterly a surreal experience for the students. While the majority of students in the group had read Anne Frank’s diary, there was still plenty of new information to be learned. Being in the house where Anne Frank wrote her famous diaries while she was in hiding from the Nazi regime was mind-boggling. Thoughts and emotions were at an all-time high for everyone on this tour. From the emotional quotes from Anne on the walls, original documents of final correspondences, and simple decorations put up by Anne and her sister Margot to make their house a home cultivated much reflection and learning for us all.

After the Anne Frank House, two people from our group (Krisha and Laney) headed to the Body World museum, home to a collection of plastinated (preserved in plastic) body parts and systems. The experience was incredibly fascinating and gave them an inside look (pun intended!) at human bodies.

In between these larger museums, students found time to stop and shop at the Tulip museum, as well as the cheese museum! 

The day ended in different ways for all of us. Some people chose to do a beautiful and informative canal ride through the center of Amsterdam and ate some seriously delish burgers for dinner (Fun fact learned on the canal ride: Amsterdam actually has more canals and bridges than even Venice!).

Others lived the good life and enjoyed a fancy dinner at a renowned restaurant named Zaza’s. We all returned to Bunk Hotel after our dinners by taking the train back to Utrecht Centraal Station.

All in all, we had a wonderful experience exploring Amsterdam and can’t wait for more adventures tomorrow!

Thank you for following along!

Krisha Mehta, Izzy Ferrazza and Sofia Perrone

By: Laney Herndon & Carmen Maria Canino

The group began their day at 9 am at the Bunk Hotel Cafe. The most popular breakfast today was a dish called “Smash!” which was two poached eggs with smashed avocado on a piece of toast.

After breakfast, the group caught a train to Deventer, a place where Paul once studied and worked. We walked around town and Paul showed us his old fraternity house where he was once the president. The town contained many historical buildings that were beautifully decorated. The center of the town has a gigantic fountain with detailed angel statues, and there were many small shops and restaurants surrounding that area.

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We ended our tour of the town at the University of Saxion of Applied Science. We were welcomed to a beautiful meeting room with complimentary coffee, tea, and biscuit snacks. About 20 Dutch nursing students met us in the meeting room shortly after we arrived. Professor Ingrid gave us a brief presentation on the Optimizing Palliative Care Education project. She explained that this project aims to educate upcoming nurses and doctors about palliative care and pain management methods. Currently, the Netherlands has a program to educate students who are studying palliative care, and this program also offers continuing education on this topic for medical practitioners that are already licensed. The course is based on a book called Quality Framework Palliative Care Netherlands (2017). Some of the themes in the palliative care management are sharing decision management, advance care planning, symptom managements, euthanasia, palliative sedation, and interprofessional collaboration.

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The Dutch and Dickinson students were divided into four groups for a “speed dating” activity. In each of these groups, specific euthanasia/the end-of-life topics were discussed. Some of the topic discussed were: private/public insurance and how that influences the end-of-life care quality, euthanasia versus palliative sedation, Dutch students’ experience as a home care aid, the Dutch perspective on aging and dying, the work quality as nurses in Netherland, and more. In our discussions with the students, I found that many of them prefer palliative sedation over euthanasia because of the easier access to this type of care. Sometimes, the euthanasia process can last months and even years while palliative sedation is offered during the last two weeks of a patient’s life. Interestingly, euthanasia is covered under the basic insurance package in the Netherland, so people from all socioeconomic background have equal access to it. However, only Netherland citizens have access to euthanasia. Furthermore, Dutch students also feel much more trusting towards their general practitioner due to the doctor’s often close relationship with the patient and their family. They feel like they would be comfortable to talk about the end-of-life topics with their doctors.

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After talking to the Dutch students, we moved to another classroom to meet with Dr. Kris Vissers. He is a pain and palliative care specialist who has experience in emergency medicine, intensive care medicine and anesthesiology. We were on a zoom meeting with him for two hours, and he was able to answer and explain many palliative care, palliative sedation, and euthanasia questions our class had. Palliative care is relatively new in Netherland, and it was introduced around 1994. This type of care is now widely accepted in Netherland. Dr. Vissers further explained that only about 4% of patients receive euthanasia every year. In our class, there was a lot of confusion surrounding the topic of palliative sedation and how it differs from getting morphine drip treatments. Dr. Vissers explained that morphine is not part of palliative sedation. Palliative sedation is often treated with Midazolam, a drug that can induce unconsciousness state in patients to alleviate “annoying” symptoms. Palliative sedation can alter a patient’s conscious state by titrating the drug concentration given to the patient. This can be especially helpful for some patient. For example, some Muslim patients may want to be woken up at certain times, so palliative sedation can be lifted during those moments. This way, they are awaken to be with their family to pray to Allah each day. Other patients want low dosage of Midazolam so that they can be semi-conscious, but their negative symptoms from their disease is lessened or eliminated. This is often the best-case scenario for the family, so they can interact with the patient during their last few days.

Our day ended with traveling back to Utrecht via the train system. Today was incredibly educational and rewarding because we were able to have personal interactions with Dutch students, professors, and doctors on the topic of death and dying.

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It’s our fourth day already! We packed up and left Etten-Leur early this morning and took the train eventually to Rotterdam (with many scenic stops in between!). 

Our breakfast consisted of pre-packed sandwiches we assembled last night, courtesy of our Etten-Leur hosts Jan and Ietje. 

We arrived just before noon at Hogeschool UAS Rotterdam School of Nursing and met with Annemarie, a nurse and instructor at the school and Jan and Ietje’s daughter. 

Annemarie and her colleagues gave us a quick tour of both the school and Rotterdam. This included ferry trips in the canal, and a beautiful view of an original Dutch windmill.

We also were able to practice our nursing skills through four separate stations. Station One tested your hand washing abilities with a UV light so you can see where you missed! Station Two was a simulation of old age, with heavy weights and movement restricting pads. Station Three taught us how to suit up and down for surgery, while Station Four taught us how to use machinery to lift a patient who may be immobile or unconscious.  We also watched a few short presentations from the school’s faculty before leaving for Utrecht. 

When we arrived at Bunk, the hostel we’re staying in, we quickly unpacked our belongings into our pods and stored our valuables in storage lockers. Instead of traditional beds, Bunk offers small sleeper pods with customizable lights and a shared bathroom. 

After unpacking, we met up with Alana and Tomas, two Dickinson alums studying in Utrecht. We ate dinner at a street food restaurant and got a quick tour of the town. Utrecht is a university town with more than 30,000 students and lots to do! A busy but fun day—here’s to more Utrecht adventures!

We started the day off having a delicious breakfast of eggs, ham, and homemade croissants at our host, Jan and Ietje’s, house. After breakfast we got a painting lesson from Jan about the ‘End of Life’. All students were spread around the property and after we completed our paintings we gave a short presentation of what they represented.

Workshop ‘End of life’ under the guidance of painter Jan de Werd

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After our art class we traveled 30 minutes by car to Zundert, the birthplace of Vincent van Gogh. We received a private tour of the church/cemetery of the family Van Gogh and got to see art inspired by Van Gogh. In the museum we learned about Van Gogh’s family and his relationship with his supportive brother Theo (photographed below in the sculpture).

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After the museum, we drove to Breda and was guided by the sight seeing spots around the city. After a guided tour students were allowed to explore the city of Breda. Many enjoyed the parks, shops, and desserts around the city!

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We all gathered to travel back to our hosts house to enjoy a traditional Dutch meal to close off the night!

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Hello Death and Dying fanatics – Welcome to Day #2 of Netherlands fun!

Today was an action packed day for us Dickinson students, faculty, and hosts. After an early morning wake-up call and breakfast, we drove to our wonderful hosts house that resides in beautiful country lands.

After a quick stop at the house, we made our way to a funeral home in the city “Breda” called Zuylen. Once there, we had a presentation from one of our hosts and then the director of this specific home, Roel. During his presentation, Roel explained some of the services the funeral home offers, which is everything from renting spaces for the viewing of the body/casket to beautiful family lounges where friends and family of the deceased can enjoy catered meals. Something really special about this funeral home is the emphasis it has on the families needs and wants – every family gets a key to the room where their deceased family member is being held and has full access at any time. Another special feature of this funeral home is the accessibility for its citizens – any religious denomination and income level is free to use their services. If someone is unable to pay for the minimum services they offer, the community will come together and raise money.

Embalming

Embalming is the science of preserving a a human body using formaldehyde to delay the natural process of decay after death. Formaldehyde is a well known carcinogen and requires regulation. The process of embalming the body of a deceased person is not allowed in the Netherlands. One must apply to the Ministry of of health to receive permission to do so.

Zuylen specifically has a commitment to sustainability so they try everything in their power to lower the amount of pollution and waste of materials in their facilities. The coffins they use are moving away from plywood to other types of woods with no other chemicals that can leach into the soil when buried and they plant many trees and other plants on the grounds to give back to nature. In the Netherlands, they don’t use embalming techniques on the deceased bodies, instead opting to leave the blood inside the bodies – this also is more sustainable because the embalming chemicals can leak into the soil and contaminate them. The last fun fact about Dutch cemeteries is that they most commonly rent out plots for a certain number of years before they reuse them for another person! Below are some pictures taken when we were given a tour of the cemetery grounds:

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Once our fantastic tour was over, we were served a catered lunch at the funeral home where we asked many questions to both our hosts and the funeral director – a huge thank you to Roel for setting up the amazing tour and lunch for us!

Dickinson students, faculty, and hosts then hopped back into the cars and drove back to our hosts house where we then embarked on yet another journey! This time we took a lovely 30 minutes walk through the country side to see one of the very few people who hand-craft clogs in the Netherlands! He even gave us an in-person demonstration of how to make clogs over some tea, coffee, and pound cake.

Lastly, we headed back to our host’s house to have a backyard barbeque with all the students, faculty, and host family! We hung out, played with the animals, and chatted with each other by the fire until it got dark! We thank our host family for being so gracious to us so far in this trip and we can’t wait to see what comes next!

See you all tomorrow for another adventure!

by Izzy and Karina

Today is the day! We have finally arrived in the Netherlands. After a delayed flight from Dulles Airport in Washington D.C. for some of us, and a turbulent flight out of Newark, we landed in Amsterdam around 7:15am. We saw a beautiful sunset flying into the airport, as well as some interesting windmills in the ocean.

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We collected our baggage and caught a train to Breda, transferring to our second train to Etten-Leur. After a short walk to our hotel, Het Witte Paard, we checked in and settled down to recuperate after the long flights. From then on, we were free to explore Etten-Leur in small groups – some of us went to the mall, some went to eat lunch, and others walked around to explore the area more.

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We met back up at 4pm to go on a small tour with Jan de Waard leading us on a walk. We saw a Catholic chapel named ‘t Kapelleke and carried on through a short outdoor exhibit of Van Gogh related art. After that, we walked around a cemetery, looking at the differences in gravestones and plots compared to the United States. Many gravestones indicated a family that was interred there, similar to the United States. However, the gravestones tended to be a bit thinner and the cemetery was particularly small.

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After a nice walk we finished our small tour at a pub called Café Bar ‘t Klompke. After casual drinks, we headed over to a Greek restaurant, Grieks Restaurant Orestis, where we gorged ourselves on delicious pork, eggplant lasagna, tzatziki, fries, orzo rice, salad and more! Although we were stuffed from dinner, we couldn’t resist the allure of Prego Gelato. Our favorite flavor was strawberry cheesecake! We finished off the night with a recap of our itinerary. We were so exhausted, I’m sure most of us fell asleep before 10.

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by Sophia Perry