At this time of year Sweden is engulfed in darkness. We all long for light. Candles burn in every window. Candles are a part of Swedish winter, and especially at Christmas.
Today I read the following article in the journal of the Swedish Medical Association, Läkartidningen. It brought tears to my eyes. This is an English translation, but the original article can be found here.
Like angels in the darkness
Mariko Yoshinaga Galvér
General Practice registrar, Uppsala, Sweden
My name is Mariko Yoshinaga Galvér and I am a GP registrar in a health centre in Uppsala. I came to Sweden twelve years ago from Japan, where I studied medicine.
I have never written before but I feel compelled to tell the story of something special that happened yesterday.
Yesterday I received a patient, an unaccompanied refugee child.
The referral that came with her said she was tired, and she had been booked in for a 45 minute appointment, with a telephone interpreter. I saw in the medical records that the child had experienced every imaginable horror in her homeland. I realised that this was going to be a challenging meeting and as I went out to the waiting room my steps were slow and deliberate.
The girl sat alone, looking tense. I discovered that she can speak Swedish, so we dispensed with the interpreter. Seated in my office she spoke slowly and calmly; I was amazed by her calmness. I examined her. I saw the scars on her little body.
For the first time in my life I thought of God, there in my office. I am not religious, I come from a Buddhist land, though I did marry in a Swedish church. But for the first time I thought of God and I prayed: please God, help her.
And then I heard children singing, quietly and calmly. We looked at each other, my patient and I, her glance confirming that I wasn’t just hallucinating.
We went out of the room. We saw many beautiful children, dressed in white, candles in their hands. Suddenly I remembered, today was Lucia and the children before us were the Lucia train. They looked just like angels in the darkness. The staff were happy and listened as the children sang. One of the nurses fetched a chair so that a mother bearing a child in her arms could sit and listen.
The angels looked us with their beautiful, beautiful smiles.
I am convinced that this girl will be happy here. Things like this don’t happen in Japan. Maybe they don’t happen in other countries either. She will be happy in Sweden.
I cycled home. And I began to cry as I thought about the day’s Lucia.
You know God, that I have also been happy here, in Sweden.
AUSTRALIA has agreed to support a 240-strong medical team to fight the Ebola epidemic in West Africa after striking a deal on medical evacuations. The assistance will take the form of funding for a 100-bed field hospital in Sierra Leone, staffed by up to 240 volunteer health workers, including an unknown number of Australians. Prime Minister Tony Abbott today announced a $20 million commitment to the mission, which will be managed at “arm’s length” through a private operator, Aspen Medical. Mr Abbott said it was anticipated that Canberra-based Aspen would have some staff on the ground in Sierra Leone within days. The British-built Ebola treatment centre would have 240 staff, he said. “Most will be locally engaged, and it is likely some of them will be Australian.” Aspen Medical’s website was already advertising for medical personnel this afternoon.
Julie Lambert, Medical Observer, 5 November 2014
After my last blog, it was encouraging to read this article recently in the medical press. It was published 10 days ago and how far the process has come since then I don’t know, but it responds to an urgent need, and it looks as though Aspen Medical is not wasting time. I worked for Aspen briefly some years ago, in Australia. Since Aspen provides medical services to the Australian Armed Forces, the company was my employer when I did a four week locum job at the Cairns naval base in tropical North Queensland. My brief contact with the organisation was positive. It is encouraging to see that they are willing use their expertise and experience with medicine in remote locations to coordinate the deployment of volunteers as well as their own staff. They are certainly the right people for the job in Sierra Leone from an Australian perspective and will hopefully be able to provide a quality service to the people of West Africa at the same time as keeping their own people as safe and secure as possible. Maintaining the health of people (usually military) in remote locations is their specialty.
It is heartbreaking to read the reports of the Ebola epidemic coming out of Sierra Leone and West Africa. Our time with Mercy Ships back in 2001-2003 gave us some insight into just how much suffering has afflicted the people of that part of the world, and though our contact was fairly superficial we still feel some kind of connection to West Africa. When we arrived in Freetown at the end of 2001 on board the Anastasis the country was coming out of a decade of civil war. The war ravaged city bore the marks of a suffering people. UN vehicles were a common sight, the sound of helicopters overhead frequently broke through the buzz of the city streets. We were moored alongside a British ship, a fleet auxiliary vessel that served as a dormitory for British soldiers. Despite all this and the fact that most of our work was on board our hospital ship, we had frequent opportunities to disembark during our 3-month stay, and get to know the city and its beautiful surroundings, not least some of the wonderful beaches.
Now, after only a decade of relative peace, Sierra Leone is once again plunged into chaotic upheaval, but this time the enemy is not armed conflict but infectious disease. Sadly, Mercy Ships has neither the experience or the expertise required to respond to this kind of medical emergency, and has been forced to revise its planned outreach this year to Guinea, sailing instead to Madagascar. Other organisations have thankfully made a huge impact, notably Medicins sans Frontiéres which has, as usual, provided an astounding contribution, though they too have been quickly swamped by the need. It is encouraging to see governments around the world responding at last, even if slowly.
Meanwhile, the local health services are doing their best in an overwhelming situation. One inspiring example for me has been Dr Sandra Lako, another ex-Mercy Ships doctor, who has made Sierra Leone her home, working now as a medical coordinator for the Welbodi Partnership. Freetown is perhaps not the epicentre of the Ebola epidemic in Sierra Leone but even there cases turn up regularly, and fear runs rife in the community, as Sandra’s blog bears witness to.
It is hard to know how to respond for those of us who for one reason or another can’t go to Africa to help in the response to this crisis. We can give our money, we can be interested by reading the updates that appear in the press, we can raise awareness by simply talking about the issue in our workplaces and homes, and we can pray. Sierra Leone, Liberia, Guinea… they are all places of great beauty and wonderful people, but just now places of fear and suffering. How can we help?
I’m here for the second time this year, but this time at a two day diabetes conference. It’s still winter, the snow is deep, the air crisp and icy, but the days are thankfully getting longer. Its evening and I am sitting in my room, one of 150 (Loka Brunn can house up to 300 guests) hotel rooms in the scattered buildings of this old spa resort. The building that contains my room bears the name Finnhyttan, and is a big old yellow wooden house dating back to the 19th century. But the history of Loka Brunn goes much further back, at least to the 1600s. Even in mediaeval times the springs of Loka were a much appreciated resting place for pilgrims travelling to the holy shrine of St Olaf in Nidaros Cathedral in Trondheim, the most important pilgrimage site in Northern Europe.
Loka really took off as as a health spa in the 1760s, when the king of Sweden, Adolf Fredrik, came to drink the waters. The king had long suffered from migraines which were cured after a two week stay at Loka following a prescription of 4-6 liters intake of spring water per day, as well as mud baths and cold water bathing. Massage was added later as part of the standard treatment regime.
The area grew into a little colony of houses during the 18th and 19th centuries, and new buildings were added throughout the twentieth, so that there are now over 50 buildings her, one of which is the spa centre or “Water Salon”. Although contemporary medical treatment is far removed from the treatments of the 1600s, Loka is still linked closely with health care through its use by the Örebro Health Authority for conferences and educational events, like the conference which I am currently attending.
And there are the added attractions of a relaxing spa or massage in the evening, and an excellent restaurant which serves gourmet meals, to look forward to after a long day of lectures and discussion.
Back in November I wrote a blog about conference centres in Sweden. A week or so ago I stayed overnight at one of the centres I mentioned in that blog. I drove out to Loka Brunn in driving snow, in the darkness of the evening. Loka Brunn is located in a valley between forested ridges. There is a lake on each side, but the water was frozen and the lakes were just wide expanses of snow. The centre has a rather newly built spa centre, but people have been coming here to “take the waters” for over a hundred years. In summer, of course, you can swim in the lakes, but it seems that every time I have been to Loka since my first visit around 5 years ago it has been winter. Loka feels to me a bit like the Narnia depicted in The Lion, the Witch and the Wardrobe – a place where it is always winter. The local health authority, which is my employer, often uses Loka Brunn for its educational events. It is a lovely place to spend a few days. But I have not had time to take advantage of the skiing tracks, or even the spa, on recent visits. I did manage a quick stroll around the grounds this time, and got a few pictures of the beautiful surroundings. The house above was the one in which my room was located, with one of the lakes beyond.
I am staying at Båsenberga Hotel and Conference Centre, near Vingåker in Central Sweden, about an hour’s drive from Örebro. This is my third visit here, this time for a 2-day GP training seminar. Once we came here with the vårdcentral (health centre) where I work for a 2 day professional development retreat. Båsenberga is a big old mansion, by a lake, in the Swedish countryside. It is one of many such grand old houses which are scattered across Sweden. Most were used for quite different purposes in past days but now they really only lend themselves to being used for conferences. The Swedes are good at conferences, and just in the area around Örebro there are several large venues like this with hotel facilities in beautiful locations. In the last year I have been to several others – Loka Brunn, Hennickehammar Herrgård and Kåfalla Herrgård – for various events. But there are others too: Karlslund Herrgård, Bredsjö Herrgård to name just a few.
Herrgård could be translated “manor house” but Båsenberga has never really been a manor house in the generally understood sense of the term. In fact, Båsenberga was the poorhouse for this area in the 1870s, but it later became an old people’s home. It has been a hotel and conference centre for many years now. Hennickehammars herrgård where we had a vårdcentral meeting about 3 weeks back, was a real manor house. It is beautifully located in the forest of Värmland by a small lake. I am not sure of the history but I think it dates from the 1700s and was originally the home of a mine owner. Many of the big houses around this part of Sweden were associated with iron ore mining.
Loka Brunn, which is a favourite for conferences from groups in Örebro, was previously a health spa, built in the 1700s. People with chronic pain from rheumatism, arthritis and such diseases, went there to “take the waters.” Loka is still a popular brand of mineral water which can be bought al over Sweden.
Kåfalla Herrgård is near Lindesberg, north of Örebro, and was the location for the annual meeting of the Christian Doctors and Students Association back in April this year. The house itself is owned by the Evangelical Free Church, but it too was previously owned by a wealthy landowner. I am unsure of its history.
Karlslunds Herrgård is the local manor house in the west of Örebro, on the road that heads out towards the Kilsbergen hills. It is used for conferences, but it is many years since I was there for that purpose. It has a nice café which is open in the summer, and has some lovely walks in its grounds along the river and through the forest. It is also used for Christmas dinners and other large functions. It is beautifully located near the river, Svartån. Bredsjö is another old estate, up north near Nora. We were there for a vårdcentral function some years ago.
The other manor house that remains a lovely memory was the one where Maria and I stayed the night after we married. It is called Svartå Herrgård. It was cold when we were there, in April 1993; the snow was still disappearing. It is beautiful in summer. But now I imagine that it is like all the other mansions, fading into the autumn grey.
Läkartidningen (the Journal of the Swedish Medical Association) published on the web today contained an article entitled “Overseas trained doctors keep Swedish healthcare going” (Utlandsutbildade läkare håller igång svensk sjukvård, Läkartidningen, 20 August 2013). Since 2003 more than half the doctors receiving their registration in Sweden every year have been educated outside Sweden: the latest year with figures available is 2011, when 1010 Swedish educated doctors were newly registered and 1239 doctors educated outside Sweden were registered.
These doctors fall into one of three categories. First there are non-Swedish doctors who come from other countries within the EU and which is the biggest group, accounting for up to 1000 doctors per year. The reason for this growth is likely the extension of the EU to include several new member states where doctors earn significantly less than in Sweden. It is hardly surprising that such doctors move to Sweden, where the pay and the living conditions are better. Legally doctors from the EU are allowed to move freely between the member states. Their qualifications are recognized in Sweden and the only requirement for them to work here is to learn the language to a certain level and find a job.
The second group, which is also growing rapidly, is Swedes who go abroad to get their medical degree, in countries offering English language education such as Poland, Rumania and Hungary. In 2010 this accounted for 140 doctors who had gained their degree in an EU country.
The third group is doctors from non-EU countries, and this is the group to which I belong. In the last 10 years the number of these so called third country doctors has varied between 100 and 300 per year. It appears to go up and down from year to year dependent on a number of factors, one of which is the conflict situation in the world. The largest numbers appear to come from Russia and Iraq. I have yet to meet another from Australia. This group has the longest and hardest pathway to Swedish medical registration and specialist recognition.
For me the process has not been difficult but it has been long. My Australian qualification was recognized and I received Swedish registration after a provisional period under supervision for 6 months. However, to be recognized as a specialist GP, which I have been in Australia since the early 90s I was required to go through the full five year training program in general practice, a process in which I am still engaged. Training in general practice in Sweden is very enjoyable and very comprehensive. However, it has been hard psychologically to be a trainee again after so many years practicing, and it has had a very significant financial cost for me.
Swedish medical care, however, could not survive without us foreign trained doctors, and it appears to need more. In general practice there is a desperate shortage of specialists, but the reasons for that are more complicated than a lack of Swedish trainees and the length of time it takes foreigners like me to be recognized as specialists. But that will have to be the subject of another blog.