GSE report:  Beginning in Bergen

      We shall be brief as this is the first glimpse of sun we have seen since our arrival four days ago. The chill and moisture in the air has been moderated by the warm velkommen of the Norway people. There is little room for despair when every room is straight out of a Scandinavian Design catalog complete with votives and fresh flowers. We were most impressed by the tidy hospital break room, free of paper, dirty coffee cups or any semblance of clutter. 

     Remembering that this is a vocational exchange in of pursuit of greater understanding about end-of-life and palliative care in Norway, we have already visited the following care settings: The Regional Center of Excellence for Palliative Care, Haukeland University Hospital, and Bergen Department of Health. We have toured a cancer center, a regional palliative care center and an intensive care unit. While details in the actual health care delivery differ, the quality and quantity of care are similar. Specifically and most obviously, all Norwegians are covered by the National Health Care system. Though this requires high taxation, Norwegians are quite content with the tradeoff.

Connie Holden-Smith
GSE Team Leader
Boulder Rotary Club

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Beginning in Bergen

    We will preface this installment from Bergen by saying that we shall be brief as this is the first glimpse of sun we have seen since our arrival four days ago. We must say however that the chill and moisture in the air has been moderated by the warm velkommen of the Norway people. There is also little room for despair when every room is straight out of a Scandinavian Design catalogue complete with votives and fresh flowers. We were most impressed by the tidy hospital break room, free of paper, dirty coffee cups or any semblance of clutter. 

     Our trip began with an unplanned excursion to downtown Amsterdam thanks to the striking Northwest mechanics and five hour layover.  We then settled in and have enjoyed being privy to the knowledge of our seasoned tour guide, Liv, the wife of our team host, Erik Hjorth. Sights have included the fish market and smoked whale; the home of Edward Grieg; central Bergen; waterfalls; a 12^th Century wharf; brown cheese; lots of fish including fish pudding; and most memorably liverwurst and caviar paste for breakfast.

     Remembering that this is not only a cultural but a vocational exchange in of pursuit of greater understanding about end of life and palliative care in Norway, we have also visited the following care settings: The Regional Center of Excellence for Palliative Care; Haukeland University Hospital; and Bergen Department of Health. We have toured a cancer center, a regional palliative care center and an intensive care unit. Our observations thus far are that while details in the actual health care delivery differ, the quality and quantity of care are similar. Specifically and most obviously, all Norwegians are covered by the National Health Care system. This of course requires high taxation, but Norwegians are quite content with this tradeoff.

     Norwegians appear to be very reasonable people that make use of common sense regarding health care. Staffing levels appear to be higher but as in the U.S. nursing shortages are challenging. As in America only 30% of Norwegians die at home with the remainder spending their final days in nursing homes and hospitals.  Stay tuned for weekly updates as we are just beginning to formulate impressions about end of life care delivery in Norway.

     Did we mention the sun is out? Well, we are off to enjoy.

Hat de bra!

Pa gjensyn!
 

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Voyaging to Voss

     Norwegians value their heritage and exude pride in the country. They use Kroner instead of Euros and relate their memories of World War II. They are well aware of their ties to the U.S. with more Norwegian descendents in the Midwest than in Norway.  We visited the Western Norway Emigration Center. This church, previously located in North Dakota, was moved en bloc to Norway as a memorial to all who emigrated to the U.S.

     Norwegians respect family life. There is an 8-month paid maternity leave called “mother permission.” They also take “holiday” very seriously with closure of almost everything, including some hospital wards, for a six-week period during the summer months.

     While in Voss we were privileged to have a guided tour of a 750 year-old church by the minister. The previous day, this Rotarian, took us on a hike down the slippery, steep slopes of Voss. Our tour today, “Norway in a Nutshell,” with fiords and waterfalls aplenty, included a train, a ferry, a steep bus ride with 23 hairpin turns on a 20% grade.

     Oh yes, we also have some more refined thoughts about end-of-life care in Norway. Discomfort with death and dying is as prevalent in Norway as in the U.S. One notable difference in end of life care however is that hospice in Norway focuses primarily on cancer care in contrast to the U.S. where there is more diverse set of diagnoses.

     To date we have presented at four different Rotary Clubs. The presentations have stimulated terrific discussions about death and dying.

     A sincere tussen takk to the numerous Rotarians that have provided transportation, organization, sustenance and hospitality. We thank DG-Einar Hope for a dinner in his home and DGE-Astrid Klove-Graue for serving as our retreat coordinator in Voss. More as it happens….
 

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(9/18/05)

To my friends and family,
I know I speak for the team when I say that the warm hospitality of the Norwegian Rotarians and so many others, makes up for the fact that we have had more exposure to moisture in 3 weeks than we normally do in a year. We have had a sunny day here and there and fortunately they were on our sailing day and on a day when we did a 5 hour hike above Voss. This scenic hike had us within view of the Hardangerfjord, surrounded by grazing sheep. We have also enjoyed stays in the homes of Rotarians and have enjoyed conversations well into to the night. We are so grateful that they speak English so well. They do so appreciate our efforts at Norwegian.(Vi and Ilona, you would be proud of us.)

We have had very interesting vocational visits at hospitals, nursing homes, hospice programs and even the Leprosy Museum. I am even more convinced than ever that a single payor system is a good thing. Even though, the Norwegians know that their taxes are high, I have not heard much complaining and on Sept 12th they put parties in power who are likely to increase government spending(and taxes) even more. As you know, gas is heavily taxed in an effort to keep people out of cars and a serious effort is being made to not spend funds generated from the oil industry and to save it for their children....what a concept! When I hear people talk about this, I am even more chagrined about the debt that we are enmassing for our children.

Today is the last day of the District Conference and we will offer our presentation to this crowd of 250 people. Similar presentations at about a half dozen clubs have gone well and generated good conversation and questions about end of life care. We have much to teach each other about this. We are off to Stavanger for the last week of our exchange. We plan to visit the university hospital, a nursing home and a hospice. One Tuesday we have a long hike planned to an area called Pulpit Rock. Here's hoping for a dry day.

Be well, all of you,

connie holden....cari, autumn, heidi and karen, too

From Voss we voyaged to Balestrand and were greeted in royal fashion by the mayor and the fourth generation owner of the Kvikne Hotel. The area is famous for its first tourist traffic which included many famous artists and the infamous Kaiser Wilhelm. In fact, the Kaiser happened to be enjoying Balestrand when the first shots of World War II were fired. 

In Forde we never imagined how enjoyable a dark, rainy evening could be. The Forde Rotarians were not deterred for a minute by the weather and helped us to enjoy walking, trail running and collecting mushrooms in the torrential rain until all hours of the night. 

The following morning our departure to Kvinherod was punctuated by a Rotarian declaring, “I would not put my worst enemy on a catamaran today.” It proceeded to rain 7 inches over the next 24 hours washing several houses into the ocean. Fortunately, we arrived safely by alternate modes of transportation and immediately bonded with the Rosendall Rotarians over fiske (fish) soup and the roaring river just outside our quaint cabin.

The District Conference in Haugeson was the next destination. We were pleased to reunite with the Norway team and all of the Rotarians who had befriended us on our travels to date. Our presentation was well received with many a glistening eye in the audience. Their standing ovation will not soon be forgotten.  

Vocationally we are continuing to learn about end-of-life care in hospitals, nursing homes, high schools, senior and assisted living centers. A reality in Norway appears to be the geography. Clearly geography is an important consideration when the nearest hospital is two hours away and a home care visit involves travel by ferry, bus and then a good pair of hiking boots.    

Please look for our final installment, “Norway in a Nutshell.”   

Norway in a Nutshell -  GSE/SVE Team to Norway     (CLICK ON PHOTOS TO ENLARGE)

Since our last installment we have traveled to Stavanger, stayed in a Rotarian-crafted cabin in Strand and hiked to Pulpit Rock. We have learned how to cook sheep’s head and harvest crude oil.  

After paying $85 for a tank of gas, we asked ourselves why gas is so expensive in country with oil platforms directly off its coast? We were told that the money Norway earns from oil is being saved for the time when there is no more oil to harvest. A novel concept indeed – saving for future generations! This was also a hot topic for discussion during their election of a new government this month. As a further illustration of their rational use of resources, many of the Norwegians have spoken, shown or invited us to their summer cottages. These summer cottages are a wonderful way that the country has preserved farms abandoned by farmers seeking other forms of work in cities and abroad.    

Despite the many things that Norwegians can boast about, we have observed that remaining humble yet full of pride in their country is a pervasive Norwegian attitude. Nationalistic pride is best appreciated by viewing the attached photo of District Governor, Einer Hope and his wife, in their national costume. This costume is worn to special events such as weddings, holidays and in this case, the Rotary District Conference.

Vocationally, a major highlight involved visiting a drug and alcohol treatment center where we very impressed that there were 52 staff members for the 31 patients! Patients are treated with a non-punitive approach and have at least six months of treatment with paid leave from work.  Given the sparse use of social workers in Norway, we were also shocked that the center had five social workers.

We have also observed that there is an apparent absence of physician assistants or nurse practitioners and while the U.S. relies on specialized hospice nurses to care for dying persons, efforts in Norway are directed at training those in the front lines. General practitioners, nursing home nurses and home care nurses are the focus of educational efforts regarding palliative care. The Norwegians are off to a good start with this effort. There are certainly features of our palliative care delivery system that Norway would like to borrow from us and features we would like to borrow from them making this exchange just that, an exchange of ideas and best practices. 

Most of all, we have remained mindful of our theme song, Live Like You Were Dying, and in doing so have absorbed all we could from the people and places we have been privileged to experience. We hope to take back every morsel and channel our passion for palliative care to improve the care of persons at the end of life in the United States and abroad.