Being Norwegian

What does it mean to be Norwegian? Here's a few things I know so far...

Carnival is celebrated every spring in Norway by decorating trees with multi-coloured feathers

At Easter it is tradition, for many Norwegians, to retreat to their mountain cabins. They ski, they sit by the fire, British crime novels. It turns out Poirot is a favourite sleuth amongst my new Scandinavian friends, they're not so keen on 'the killing'...

Norwegians love lunch boxes. I've been told this now three times and have to say, I've been pretty impressed by some of the featured items turning up at communal meal times; the more compartments the better.

Lunch is served cold and brought from home. It will usually consist of crackers and some variety of fishy paste atop; if you must have bread, take your sandwich with one slice only.

Be thankful for the choice of food on offer; yes two avocados might cost you half of your shopping budget, but according to my sources only ten years ago you were lucky to have a fruit and veg aisle that consisted of two apples, a cucumber and a dodgy looking tomato.

Norwegians like their coffee hot, black and as frequently as possible throughout the day. Many are puzzled and a little distressed by my dislike of the stuff.

Norwegians love the outdoors...

This was a preconception I'd already formed in my mind before stepping foot in this great country but perhaps what I wasn't quite prepared for was the extreme nature of some of these outdoor activities and indeed of the elements themselves. Nothing is done by half here; when it snows it settles thick and when it rains you really know about it. It's the first country I've been to where most conversations start with 'you really need to get a better coat'. It's true, I may have turned up quite pleased with my selection of weatherproof gear, but in comparison to the average Norwegian I am definitely lacking. Outdoor clothing shops far outnumber other stores in the city centre and there is a sense of 'no nonsense' on entering. You might find the occasional fur lining or glitter motif but for the most part it is serious stuff that will do it's job and keep you warm. Not limited to shop shelves and racks, 'serious clothing' is the every day winter style here. Relieved to find I could legitimately wear snow boots to work on my first day, I now look forward to the removal of coats in the consultation room to see which brightly coloured thermal under layer that particular person is sporting.

Activities undertaken in this serious gear are no less extreme; a fact that has both interested and limited me during my time here! Seeing getting into the great outdoors as both a necessity in Norway and a good way to reach out to the community I approached the local university outdoors club following the huge success and fun I'd experienced after doing this in California. I was met with a warm response but, to my dismay, the information that to partake in their 'casual Saturday afternoon getaway' I would have to be proficient in ski touring with a large rucksack, cross country ski, downhill ski with the ability to turn in 'very small spaces' as well as have full experience of avalanche rescue procedure and kit…hmmm maybe not.

A little disheartened but still determined to get outside that first weekend I jumped at the chance to tackle the new skill and national sport of cross country skiing with my wonderful host GP, Anne.

Cross country skis are generally narrower than downhill skis, intensely slippery without enough wax and only half attached to your body. This combination perhaps goes some way to explaining the baffling fear that accompanied my putting them on for the first time and traversing mostly flat ground. Having become reasonably competent at downhill ski over the years it was both painful and humbling to be reduced once again to an out of control 'plough position' on any downward slope whilst being overtaken by small children who had probably skied before they could walk.

'One of my happier moments'

The day's efforts meant lunch was very well received and whilst tucking in to Norway's kit kat equivalent, I took the time to chat to Anne about general wellbeing in Norway and how physical activity does positively impact both physical and mental health here. We talked about how many people do take to the mountains at the first opportunity but also how many 'live by the weather' choosing to stay in and hibernate during the long winter months. The weather and the darkness is well known to influence the mood of people living here, many patients have talked about it during or interviews, and in that context we talked about the importance of getting outside when it is possible.

I'd reflected on this and how it might feed into resilience in the work place during my time spent in the practice. I'd been very surprised on finding myself free to go at 3pm on my first day in Frekhaug and on commenting on this had been told that 'time away from work with your family is important' and therefore leaving on time and indeed relatively early is a priority. After experiencing much longer hours back home in the UK, this had seemed like a breath of fresh air and on looking at the structure of the day, incredibly sensible.

The day starts with meeting for coffee at 8am. The first patient arrives at 8:30am and the day runs on until 12pm when everyone stops and eats lunch together. In contrast to the UK there are very few home visits undertaken, a difference I have come across now both here and in the US, and therefore 'lunch break' is genuinely a break. People sit around a large table and talk, it feels social and relaxing. As everyone has brought their own lunch (in their lunch box) no time is wasted on buying food and therefore half an hour seems quite sufficient. 12:30 sees the afternoon surgery start and run until 2:30/3pm. It is assumed that most will have left by 4pm. There are no evening surgeries and no weekend openings for this practice.

The day makes sense to me and I certainly see the benefits for those working it, but I suppose the implications of such a day and the extended appointment times as mentioned in an earlier blog, are longer waiting times for patients and perhaps the inconvenience of limited time availability.

Surprisingly, though, patients often talk about this in interview but most seem accepting: it is the way it is. The doctors I have spoken to also mention it as an issue, many would prefer shorter waiting times for patients, but have the attitude that it is the patient's responsibility to find the time and to prioritise their health in order to make an appointment.

Whether it is right or wrong, there is something to be said for a system that promotes the wellbeing of its staff through the acknowledgement that a reasonable schedule and indeed quality time away from work are essential. I've only been here three weeks and yet have already felt the effect of one sunny day after five rainy ones. I've felt the joy at managing an evening walk up Floyen mountain after work and have relished the feeling of being 'properly tired' on a sunday night in a physical way, not just mentally from staring at a computer screen.

Maybe patients do have to wait a bit longer and that is perhaps the first thing we see in the equation here, but I think we have to look at the benefits for patients that can come from a more resilient workforce, less prone to 'burn out' and more motivated to make change, and ask ourselves why we are not perhaps putting more value on that.

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