• Mary's North-European Tour
  • If you are wondering why this newsletter is so late let me brief you about a few of the things that have been happening. Last June, 24 hours after leaving sunny Los Angeles, I flew low over spectacular blue fiords edged with jagged snow-covered peaks while landing in Tromso, Norway, 600 miles above the Arctic Circle.

  • The Tromso Arctic Chapel at midnight
  • This is so far north that even the Vikings never got that far! Norway is arguably one of the most beautiful countries in the world, if you are thrilled by wild, rugged scenery, but not too fussy about having perfect weather.

    It was my 3rd visit. The hospitable Norwegians treated me like an old friend, as well as a visiting celebrity. Who could ask for a more gracious welcome! The University Hospital of Northern Norway is the northern-most university in the world and its location on top of the world matches its academic achievements. The quality of pulmonary rehabilitation, medicine and research going on in this town of 60,000 people is very impressive, easily matching the standards of other more renowned centers you might think of. I was there during the time of the midnight sun.

    For 2 months the sun never sets, and for at least one more month it is always light, even at night. Of course in the winter there are 3 months of darkness! The loyal residents of Tromso remind visitors that they then have the moon, the stars and the Northern lights to enjoy during the dark night of winter. Besides, extensive outdoor lighting includes even the cross-country ski trails!

    Norwegian June seemed cold to a Southern Californian and I needed the beautiful Norwegian sweater presented on arrival. Much more useful than a lei would have been!

  • View from my Tromso hotel balkony at midnight
  • My long sleeve tops, plus a jacket, weren't warm enough. But can you imagine the thrill of seeing the sun shining at midnight on the snow-covered peaks across the fiords? Nobody slept much with the sun out all the time, including me.

    I had the pleasure of speaking to the great staff and rehab patients in the Tromso Elizabet Senter rehabilitation facility. Their five-hour rehab day includes lunch with the staff in a glass-walled cafeteria looking out at the spectacular scenery.

    All meals in Norway, even hotel breakfasts, seemed to include pickled herring, smoked fish of all kinds, and many variations of wonderful wild salmon along with boiled potatoes. Sort of a tough if you are on low sodium diet. All patients had the latest portable liquid oxygen equipment. They were as interested in American rehab and ways of doing things as we are in theirs. And almost everyone also talked about a relative they had in the States, so conversations were lively. Much of their rehab, started around 1990, is based on our programs, which started many years earlier. You would find everything comfortably familiar. Tromso is way ahead of us, however, in that they are concentrating on early intervention and now rarely see anyone with an FEV1 as low as 40% of predicted. They may have learned about rehab and portable oxygen from us but now it is time for us to emulate and learn from them!

  • Dining Room
  • We drove even further North to the Skibotn. This is an inpatient facility for various conditions including COPD. There was a fee but it seemed like wonderful value for the location and services offered. It was adjacent to a fiord and surrounded by alpine forest. Fish are guaranteed to jump on the hook as soon as you cast a line, ready for an evening barbeque.

    From Skibotn it was on the trip of a lifetime as we drove even further North to the Elgin Alps. You've never heard of them? Neither had I, but they should be declared the 8th wonder of the world! Seeing these snow-covered peaks plunge straight down into the fiords was an absolutely breathtaking experience shared with almost no one else on these deserted roads. Dr. Audhild Hjalmarsen also drove us up over the Finnish border onto the tundra where some Saami native people (Laplanders) still herd reindeer. The Saami are well educated and medically sophisticated. I once had a marvelous slide of a Laplander herding reindeer with the aid of his portable liquid oxygen!

  • Mary regains power
  • There is only a small sign marking the border of these two sister countries and the friendly Finns let the Norwegians drive medical supplies over this shortcut route to Russia. There are no problems with the Finnish border guards, who know all the doctors and approve of their humanitarian efforts. The Russian guards, however, are a different story, often demanding bribes despite knowing how desperately their country needs this aid.

  • View from Dr. Hjalmarsen's side porch
  • After 5 wonderful days in Tromso and points even further north, several of us flew about 1,000 miles south to picturesque, cold, rainy Trondheim. It was here that the 42nd Nordic Lung Conference was held. I had the pleasure of joining other pulmonary health care professionals as I spoke on pulmonary rehabilitation in the United States.

  • Spectacular scenery
  • Then I confess to playing hooky for the weekend. I flew down to Bergen for 2 days to take the famous Norway in a Nutshell train trip in addition to cruising some fiords. Again, spectacular scenery despite the cold and the rain.

    I was just getting used to it when I flew to Stockholm. The heat and humidity when I got off the plane reminded me of July in Connecticut. The Swedes loved it! I stayed with our friends, Dr. Margareta Emtner's family, in their 3rd floor bedroom. My bathroom was on the first floor. My glasses were always on whatever floor I was not. We also walked briskly to parties, to dinner, or to the nearby woods to pick wild flowers so you can be sure getting enough exercise was not a problem. There was lots of good-natured teasing and funny stories about Americans who expect to drive everywhere. I deserved it!

  • Uppsala University
  • To speak at Uppsala University I had to walk more than 2 miles since I was leery of riding a bike like everyone else. But I learned my lesson last year. This time I wore unfashionable walking shoes rather than heels. Heels are NOT the shoes of choice when you have to walk a couple of miles over cobblestones. And everyone walks or rides bikes, not matter how old or young or elevated their station in life. Tiny pre-schoolers stride down the streets with a pole in each hand, preparing for cross-country skiing, which is the national sport. Older people needing a cane, always use two instead of one, which makes wonderful sense and body mechanics. At first, it seems strange to walk everywhere, instead of jumping in the car, but I really missed this lifestyle when I got back Southern California.

    I have lots and lots to tell but you are probably interested in hearing about the renowned Swedish and Norwegian systems of health care and cradle to grave security. And it is very good care. No one is rich and no one is poor. However, Scandinavians will tell you it is not as ideal as we so enviously believe. They pay for all their dental care. There is a $500 deductible before you get medicines in the formulary of your particular area. As with HMOs in this country, you do not go to the doctor of your choice, unless you have private insurance. If you need surgery like a hip or knee replacement, there is often a wait of 6 months. MRIs have equally long waits unless you have additional private insurance, as most people do. And they pay for this "free" health care in a way that no American taxpayer would tolerate. There is a 25% sales tax on EVERYTHING including food, which helps make Scandinavia an expensive place to visit. This is on top of their income tax which averages about 50% but can go up to 95% if your income is high enough. Both Norway and Sweden have a serious, familiar-to-California, problem with immigrants and refugees. Because of this financial burden, there have been reimbursement cuts to hospitals as well as to other medical benefits, much to the dismay of the medical community. Their standard of medicine is excellent but they will remind the visitor that they are paying for it.

  • Uppsala University
  • I had a wonderful three weeks in these two great countries. They are clean and beautiful with educated, friendly, honest people who usually speak English, thanks to American TV. I was invited into homes, and to parties, and surrounded with warmth, fun, friendship and great conversations. As always in my travels, my life was enriched with new insights and information. If you get the chance to visit these countries, and are prepared for the expense, I promise you a wonderful experience with the best of health care available, should you need it. Many, many thanks to all the wonderful people I met!