Norway in a Nutshell

Helloooo from Norway!

The fun thing about traveling is that you get to hear every countries little cutsie tourist catch phrase. I don't even know how many "golden circle's" and "golden triangles" I have been to. And here I am in Norway where it is "Norway in a Nutshell."

So now I will begin the task of 1st giving you some fast facts about Norway and then summarizing my experience here "in a nutshell."

• It has been said that Norwegians work less than 160 days/year.
• Norway has repeatably been rated as the #1 country in the world for quality of life.
• Women get 1-year (yes, you read the correctly) of maternity leave and males get 5-weeks of paternity leave. If you don't use it, you lose it. Not only that but if you decide to take an extra year off after having a baby (after you already had a year off), you still have job protected leave and get 80% pay. Also, you get FULL pay if you work part-time for up to 2 years after having a baby.
• Norway has the highest fertility rates in the Western World (1.81 children per family).
• Average age of marriage is 28 (I actually did notice there are a lot of mom's well into their 30's).
• Education (including University) and healthcare (almost ALL medical needs) are covered by the government.
• Taxes average about 35-40%, and depending on your income bracket can get up to 49% (can't get more than that though).
• They are one of the VERY few countries that de-nied entrance to the European Union.
• They have almost negligible unemployment and poverty.
• Here's the biggie - they are the 3rd largest OIL exporter in the World! And the oil is NOT going anywhere anytime soon. Norway was actually a country that was going down fast in the 1960's BUT with the discovery of oil you get the image of all Norwegians throwing money in the air exclaiming, "we're rich! We're rich!" And yes, they are actually one of the richest countries in the world because of that.
• The government created a fund to put aside to protect the welfare of the people which all investments have to be made abroad BUT cannot invest in companies that abuse human rights, child-labor, environment, etc (bye bye Wal-mart and sorry Myanmar!).
• 70% of Norwegians have blue eyes. And really, I did a self-study and almost thought it was more than that. At least I fit in somewhere!
• Norway contributes the most foreign aide and refugee programs in the world.
• Norway is considered one of the best places in the world to be a female. It is actually RARE and almost unheard of for a mom or woman to stay home. Again, this is probably because of the outstanding benefits mom's have AND childcare is definitely reasonable and affordable.
• The life expectancy for female Norwegians is the highest in the world at 82.46 y/o and for males it is 80 (ish) y/o.
• The magic age number to retire is 67 y/o.
• Once "the season" is over (the "season" is May-September when there are looong sunny days), it is almost unreal how everything shuts down either completely or super early. Not only that, but most all of transportation schedules change (which I found out 1sthand with my experience going to and in Bergen).

My own impressions:

• 2 things you can't go to Norway without:
• 1. LOTS OF MONEY! It is soooooooooooooooooooooooooooooooooo expensive here! Probably one of the most expensive places I've ever traveled to.
• 2. An umbrella. Seriously. It rains here. And it rains a LOT.
• Norwegians are not only super casual but also really laid back. Especially in apparel, everyone dresses fairly casual (at the hospital where I was at most people, including doctors, wore jeans and sandals with socks). They are also extremely sporty and fairly fit (I hardly saw any large people here), you'll hear most people talking about how they are going hiking over the weekend and of course in the winter downhill and cross-country skiing is a must.
• Norwegians (also Scandinavians) have GREAT skin. They hardly wear make-up, and actually, don't really need it. Most people it seems have fair skin and again, great complexions. I think it must be the air (it is soooo fresh, really. I love it!), the water (pure and awesome) and probably the long winter months and all the rain, this non-sunbathing society leaves minimal sun damage risk. But then again, that is just my opinion. :-)
• They looooooove using credit cards and it is probably the most wi-fi/internet friendly place I have been to.
• They also love their dogs and this is a very dog friendly society. They are EXTREMELY well-behaved and I've hardly even heard a dog bark. I even mentioned this to a local and they said that if a dog misbehaves or are aggressive, they are put to sleep. Interesting. I've also seen dogs on buses and ferries and trams, and it is no problem.
• I would also have to say that Norway is probably the most tourist friendly place I think I have ever been to! It's not just because most EVERYONE speaks not only English but GOOD English, but also that sooo many things are specifically catered toward tourists and it made it a pleasure to travel around. Good job Norway!
• Pertaining to the above, they are SUPER SUPER efficient. Especially with modes of transport, everything is organized so that you get off one mode of transport (i.e. a bus) and a ferry or tram is right there waiting for you. And also everything is labeled and REALLY easy to get around. For someone directionally challenged as myself, it is too good to be true!

So, there it is, Norway in a nutshell! Now with me, to answer the question you are probably asking, what am I doing here? Loooong story short is that a family friend knows a physiatrist (a MD of PT, also known as PMR doctor) that works at one of the best rehab hospitals in Norway. I knew I would be in Europe and why not visit Scandinavia? I contacted her and fortunately she was willing for me to visit not only her hospital to do sort of an externship there, BUT also to stay with her and her family. SUPER nice and generous and I am forever thankful and appreciative. Once I included Norway in my "sabbatical" as I like to call it, THEN I explored things to do around Scandinavia and fortunately, came across the Arctic Circle M/S expedition trip that I just came back from. So there you have it! As you see, I'm trying to combine fun and leisure travel with enriching my career, contrary to the popular belief that I am freely galavanting the world, ha ha. Okay fine, partly true :-)

I spent the 1st weekend in Norway doing power sightseeing, and boy, did I run around! Fortunately I did 2 smart things... one was before I set sail to the world I got an International Student ID (ISIC). Yes, I'm not a student, but hey, I only have so many years left before I will look too old to pull off being a student. It can save you TONS, especially in MEGA expensive countries like Scandinavia and I recommend it to anyone. The 2nd smart thing was I got a 24-hour Oslo Pass that included ALL museums and ALL transport. With the discount of the student ID, I realized I saved about than $100, woo hoo! Also fortunately Oslo is a small capital and it is fairly easy to get around, so I was able to see everything I wanted in just 2 days.

1st day I went to the Norwegian Museum of Cultural History where they had 122 traditional houses from all over Norway,

and traditional folk dresses,

as well as the turf huts of the indigenous people of Norway, the Sami (who with the Norwegians founded Norway. They are also in Finland, Russia, and Sweden),

then headed to the Norwegian Maritime Museum which showed Norway's great love of the sea, then took off for the Polar Ship FRAM museum, which I had a particular interest because it not only has the world's strongest wooden ship,

but also the one that sailed the furthest North and South with great explorers like Roald Amundsen who was first to reach the South Pole AND who was 1st to fly over the North Pole via an airship. Why was I interested? Because we not only saw the place where he launched the airship in Ny-Alesund (I was soo there!):

but also learned all about these great explorers on the M/S Arctic Circle expedition trip I was on. Of course the museum had to tempt me with these nice up-close and personal polar bear figures. Much better than my white specs! I still can't get over the size of them!

From there headed next door (these 3 museums were literally right next to each other) to the Kon-Tiki Museum which featured boats,

and exhibits of yet another famous scientist, adventurer, and environmentalist, Thor Heyerdal. It also was interesting because they also had a great Easter Island exhibit with a copy of a 10-meter (didn't realize they were so tall!) statue from the islands. The Maui were constructed (so they think) around AD 1300 and it is one of those mysteries were they have NO idea of how (stone picks?) and why they built them, there are something like 800 of them ranging from 1-21 meters.

Of course reading about all of that I know have to add it to my list of places to go! It keeps on expanding!

Finally came the Viking Museum, "here come the Vikings" I always sing in my head, which had displays of the best preserved Viking Ships ever found. The ships were found in 3 royal burial mounds by the Oslo fjord and were buried more than 1100 years ago to carry their royal owners to "the other side." Kinda interesting those Vikings!

The next day I headed to Oslo again to find... the Oslo Marathon going on!

Although I am far far away from being remotely in shape, in my previous life I was a marathon runner and since I retired (ha ha) I still like to run and it was sooo fun seeing it! I immediately wrote all my Chicago friends to send my luck for the upcoming Chicago Marathon on 10/10/10. The other funny thing was that again, I was pow-wowing around Oslo and literally went everywhere around the city, and pretty much everywhere I went, I would see the Marathon runners! I guess you only have so many places to go in a small city and to run 26.2 miles through it!

I 1st went to the Nobel Peace Prize Center, which I thought would be interesting not only because Alfred Nobel is Norwegian but also I knew they would have ample material about Nelson Mandela and South Africa. Which of course they did!

After being in South Africa, then seeing Invictus flying from South Africa to Ghana, to reading his great book "A Long Walk to Freedom," to now seeing an accumulation of his achievements, I have even more respect and awe for him. The other "special" exhibit that they had was none other than Barack Obama. I actually heard that Norway got a lot of crap for selecting him as a winner after a mere year on the job just because they hold the selection process there and they had to fight that "it was the committee that decided." ha ha. But alas, the 3 things they say NEVER to talk about when traveling (and the 3rd one was added by an expedition leader on our Expedition trip) is politics, religion, and global warming. :-)

I then headed to the Olso Opera house, which I have to say is one of the most spectacular opera houses I've seen. Sorry Sydney Opera House! It took 5 years to build and is literally built on a concrete platform IN THE WATER and is just amazing. They built it to be skate-board friendly, with all the angles and made it especially acoustically friendly as well. It is a MUST see and I would have loved to have gone to a performance there!

Then came the Munch Museum and the National Gallery. Both were great, and although the Norwegian Edvard Munch is world renowned, it was interesting to get more background on him. His most famous pieces of work is Scream and Madonna. Scream epitomizes life prone to anxiety, loneliness, and alienation, all the things that led him to have a nervous breakdown and in which he commited himself to rehab for 8 months. He actually experienced the specific scene in the painting in which he was taking an evening stroll in a town near Oslo with his companions and he lets out a scream of despair and his companions didn't even notice and remained focused on the sunset and the view of the fjord across town. Interesting.

Then below Madonna depicted passion and the miracle of life and a woman's role as the source of new life (or at least that's what the cue card said!).

The National Gallery also had an impressive collection of artwork, from Munch to Picasso to Nordic traditional art. After a quick stop at the Botanical Garden of Oslo (needless to say, it't not great at this time of year!), but I did manage to see some pretty flowers,

and after all this museum time, I stopped by the Royal Palace, and totally by luck came just in the knick of time for the changing of the guards! Although cheesy, I know, it is still fun to watch.

After that I was dying to spend some time outdoors and went to the famous Vigeland Sculpture Park, which is the largest sculpture park in the world by one single artist. The sculptures generally depict simple human pursuits such as running, dancing, holding hands, but others are... uhh... let's just say a little graphic. It is an absolutely beautiful park and a cool place to hang around and enjoy the art around you.

The next weekend, with my student card at hand, I did the famous "Norway in a Nutshell" trip from Oslo to Bergen, the trip known for it's breathtaking scenery. It consisted of a train from Oslo to Myrdral,

a train from Myrdral to Flam on the famous Flam railway where we stopped for photos at a waterfall,

which is one worlds steepest railway lines with a 1/18 gradient, then a ferry starting at Aurlandsjord, the narrow Naeroyfjord from Flam to Gudvangen,

then a bus from Gudvangen to Voss,

and then a train from Voss to Bergen. It literally took 12 hours, BUT, it fortunately was a beautiful sunny day and the scenery was spectacular.

Unfortunately, wasn't so lucky the rest of the weekend when it was cloudy and rainy. Oh well.

Bergen is known to be a charming European city, and when I got there and started exploring, I could see why... the wooden houses, the small cobble-stone streets.

Back in the 1100's it was known as the center of the trade industry in Norway, then it was consistently known for the frequent fires that spread throughout the city, one of the biggest being in 1702 when 90% of the city was burned to the ground. Fortunately, after another big fire in 1916, they finally came to their senses with code restrictions. Bryggen, where the very first buildings of Bergen were situated, an area of Bergen, is a UNESCO World Heritage Site because it built on the foundations that had been there since the 12th century, meaning that it is basically unchanged despite the passing centuries.

So as it was "off season," aka. everything is either closed or closes early, there were no fjord tours going on and after Oslo I was museum'd out. So that left me to wander around, which was pretty nice. Wandered to the fortress and fish and flower market,

As I have had minimal to no exercise, I opted to do the 45-minute hike up Mount Floyen (320 m above sea level), one of the 7 mountains surrounding Bergen, which I hate to admit was kind of hard (darn it! I'm sooo out of shape!), but worth it - beautiful surroundings. changing of the fall leaves, etc.

Once on top and caught my breath, I still got some great panoramic images of the city, despite the rain.

I then got lazy and took the Floibanen Funicular cable railway back down. Ahh... much nicer.

I then did a walking tour around Bryggen where we got great information about the history of the town, the frequent fires and what they are doing now to prevent it, and the architecture challenges of preserving the historical buildings. For example, they used to get flooding in the wooden house area and they actually opened up the sea underneath it, and wa-lah, no more flooding.

Also, they are slowly but surely trying to "straighten" the famous triangle-topped houses. Cool stuff! And then of course had to do some little window shopping and souvenir shopping, I particularly love the little ugly trolls that are famous throughout Scandinavia. They sure love their trolls here!!

And here's a pic on the train (which I took direct!) from Bergen to Oslo... kinda crazy there were flurries and there are snow capped mountains. I almost had a brief panic attack that winter is approaching, which it is, but fortunately, I will be in hot climates in India come Nov-Jan. Phew! :-)

PT in Norway

So although it seems my time here was all fun, the above were just weekend experiences. I spent 2 full work-weeks at the Sunnaas Rehabilitation Hospital, one of the best rehab hospital in Norway (like for you Chicago people, the RIC of the USA). It was super interesting to observe/shadow the rehab there as well as the PT's there. I spent time going to the different specialties, like the spinal cord unit, stroke unit, pediatric ward, prosthetics and orthotics clinic. I have to admit I was fairly impressed with not only their equipment, but also impressed with their knowledge.

This is no Ghana, I'll tell you that! They were all curious to what I thought and were eager to how I compared it to the States, and although I haven't been in a Rehab setting in awhile, I thought it was fairly comparable. I joked with them that the main difference was the relaxed work hours, 8:30-3:30 with an hour for lunch. And no joke, that hour for lunch and at 3:30, you might as well hear a pin drop. As I mentioned in my bullets at the beginning, they all dress extremely casual and even call the doctors by their first name, which would NOT fly in the States. They have EMR's (electronic medical records) and a great multidisciplinary approach. I am fortunate and grateful for the experience of having this externship AND most especially for my hosts, who not only made sure I was occupied and seeing as much as I could at the hospital, but also let me stay (and eat!) with them. Hvala puno!!!!

BTW, the views from the hospital were beautiful and I had to include at least one:

One day I went to the Ulleval University Hospital to see an outpatient orthopaedic setting. So here I was ALMOST convincing myself that when I get back I'll look into a rehab setting, but then after about 5 minutes in outpatient I was thinking, "I LOOOOOOOOOVE IT!" Outpatient ortho and sportsmedicine is the reason I went into PT and getting back into it after so long was awesome! I shadowed 2 different PT's and I was really impressed with their knowledge, their critical thinking skills, and their practical and functional treatment plans. Definitely in-line with North American education. It was also interesting to learn about their system. Because they are part of a hospital they get all referrals there and meet with the MD's to discuss patients. Patients typically go to this setting after they had already attempted conservative rehab with their "local therapist" (typically a private setting) and primarily go if that fails so that they can get re-evaluated and an updated home exercise programs. They are definitely exercise based. They typically see patients 1/week, sometimes 2, up to usually 6-10 visits which they can draw out over a couple of months. Also, because they use electronic medical records, they get the MD's evaluation, so then when they get to PT, they don't have to repeat all the same things (but they can re-assess if they want) and can cut to the chase of right to treatment plans, which is always an hour, one-on-one. Again, most of the treatment seems to be patient education and demonstration and home exercise program instruction. I've become sooo accustomed to seeing patients 2-3x/week for 4-6 weeks and I think because we see them so often, I definitely don't cut to the chase because I have time to start from the basics and work up, although sometimes it may not be truly necessary. Not bad, but not always totally necessary. After seeing this way, although our evaluations may be more thorough, I feel we can do things to fill up space or to keep them busy. Also, they can only use evidence-based treatments and... this is a bit confusing to me, but possibly that the therapist would get paid more by using evidence-based treatment?They said that things like traction and even some modalities are more evidence-based than regular therapeutic exercises. Again, hmm....

It was also interesting, although a bit complicated, about payment and what not. Generally, the medical system has the government cover most things, and with some diagnoses, like post-op, it covers 100% and you can get up to 80 visits. But with things like general low back pain or neck pain, you have to pay some out of pocket. I learned about this "agreement" thing that started back in the day and went up to the 1980's. And that is that a therapist applied for this "agreement" and if they got accepted, patients would get a discount on therapy. This is mostly applicable to private settings. It used to be that when the "agreement" person retires, then someone else can apply for it, but I hear they are now trying to steer away from it completely. It kinda seems unfair because obviously most patients are going to look for the cheaper option and will seek an "agreement" therapist because then you will have to pay around $50-$60 USD per visit to see someone else. Ouch. So as you see, most "agreement" therapists have waiting lists that can get up to 2-3 months long. You can get private insurance, which is pretty uncommon, to bypass that or speed that up, but it just seems unjust to me. The private clinics also can chose their own hours and although it used to be that they can overlap with patients, now they are changing it so that it is one patient/hour (like how the outpatient hospital setting is. Which by the way, love it that they work from 8-2:30. Nice!)). Also, the private clinics have to market like we do.

I also learned that here in Oslo especially, depending on the doctor and/or facility, the doctors tend to over-image (x-rays, MRI) as we do. In the private setting, there is direct access (i.e. you don't have to get a referral from the MD), BUT then from what I understand you would have to pay out of pocket. Sooo.... all and all, there is no perfect healthcare system, and it was good to learn something new.

Here are some pics of the clinic AND this cool aparatus thing they have called the Trim Master that is GREAT for passive and active assist exercises (they also have this at the rehab setting, which is huge because it is sooo taxing on a therapist to passively move a paralyzed heavy leg or something). I also thought it was not only practical but also dynamic. For example, in the picture below we were working on scapular strengthening and stabilization, but with the help of the Trim Master, we also incorporated core and leg strengthening (you can't tell from the picture but we were simulating ski jumping. Norwegians definitely love their winter sports!). So that was new and something interesting that I wish we had in the States!

And here is another Trim Master example to the right, doing thoracic mobilizations (hmm... I'm beginning to sound like a sales person!):

Phew! I guess that was NOT a "nutshell" summary. Oops! See what happens when I'm not in a hurry and have good internet connection?

Next stop, Serbia for almost a month! This again will be half (okay, maybe more than that!) fun/hanging out and also I will be doing somewhat of a PT externship at Sveti Sava hospital in Belgrade.

Finally, I have to finish with a sunset picture, ahhh. Bye Norway!