Wednesday, November 21, 2012

A Random Act of Kindness in Oslo

I was walking to class today--my last day of class--which started at noon with an exam review/prep. It's a 20 minute walk from Majorstuen to the Pilestredet campus of the Høyskole i Oslo/Akershus. I stopped in to a bookstore kitty-corner from the nursing building to buy a notebook (yes, on my last day of class) but when I got to the counter to pay, my wallet wasn't in my backpack. I clearly remembered sticking it in the outside pocket when I packed up this morning; I also remembered reaching back to pull out my hat and gloves from the outside pocket 5 minutes into my walk, and noticing that the outside pocket was unbuckled, and thinking nothing of it; but I also remembered flipping through the collection of free coffee cards stored in my wallet as I sat at the kitchen table this morning.

Did the wallet fall out when I pulled out my hat? Was it sitting on the kitchen table in the apartment? Was it sitting on the sidewalk somewhere along my 2km route?

I left the store, unable to pay, and stood on the corner wondering what to do. My class was starting now. It wasn't mandatory that I be there, but since the other four weeks have essentially sucked, and this one was discussing how to prepare for the final exam--the only thing that actually counts towards passing or failing this course--it was probably one of the more important classes to attend. My phone rang; I pushed the ignore button and sent it to voicemail. If I walked all the way back to the apartment--20+ minutes and back again--I'd miss almost the entire review. And if I found the wallet in my apartment--a strong likelihood--I'd be ticked at myself. My phone rang again and I let it go to voice mail again. It was probably work or the midwife's office trying to change an appointment.

I'd go to class and unpack my backpack in a dry, secure environment and listen to the review. My phone rang again. Suddenly I realized: this might be important.


"Er det Emily Stange?"  (maybe this is obvious, but "Is this Emily Stange?")

"Ja, det er det. . . "  (Yes, it is. . .)

"Har du mistet lommaboka di?"  (have you lost your wallet?)

"JA! DET HAR JEG! Har du fant det?"   (YES! I HAVE! Have you found it?)

(We continue in Norwegian, which is not my favorite thing to do on the telephone, especially in conversations that are very important!)

"I'm in Majorstuen," (where I had just walked from), "Where are you? I'll bring it to you."

"I'm on Pilestredet, at the college campus."

"I'm near Bislett stadium, coming down Pilestredet. . . what store is near you?"

"Uhhh. . . Akademika bookstore (there are only about five of these in the vicinity, as they spread out their subjects into different stores). I'm on the corner of (I sprint across the street) somethingsomething veien and Pilestredet."

"I'm at Deli de Luca, I think I'm just around the corner. . . "

"I could meet you at Deli de Luca, " (again, only about a hundred million of these convenience stores in Oslo, so while I knew where the closest one, who knew if it was the one he was driving past at that exact second).

"I'm coming to a light. . . Yes. . . that's me in the Porsche."

That's right: my wallet-rescuing-Oslo-hero/angel was driving a gray convertible Porsche, with the top up. He rolls down the window, a ruggedly bearded guy in his late 30s, and hands my wallet to me.

I gush my thanks to him, and ask him where he found it.

"On suchandsucha-veien. . . " he explains, and I have no idea where he's talking about, but I'm standing in the middle of the street, and the light begins to turn. 

"Tusen tusen takk!" 

"Ingen problem. . . " 

I text Erik a very abbreviated version of the story, and he responds by telling me how very very lucky I am. I text back that it changed my whole perspective of the day.

His response: "Yay Norway!"

Yay Norway, indeed.

***How did he get my cell phone number, you ask? In Norway one just goes to and type in a person's name and you get a phone number (including cell phone) and address. Or type in their phone number and get their name and address. Pretty simple.

Monday, November 19, 2012

Introducing. . . maternity care in Norway

Jeg er gravid. . .  Jeg har baby i magen. . .  Vi venter et barn!
All Norwegian expressions meaning:
I am pregnant. . . I have a baby in my belly. . . We’re expecting a child!
All true, my friends. All true.

Although I am now much further along than when I originally wrote the following post, at 10 weeks gestation back in late July. You’ll have to forgive me for keeping the news off the blogosphere for a few months.

I promise this will not morph into a mommy-blog, or a pregnancy-blog, but will try to keep it true to its roots of an American-Woman-Making-Her-Way-Through-Life-in Norway-blog. But as an American midwife, with many friends and colleagues back in the States in the baby business, my experiences and impressions of pregnancy care in Norway are a big part of my ex-pat experiences in general. So here goes a back-dated-July blog:

I had my first svangerskapkontrol (pregnancy appointment) in mid-July at 10 weeks. I should point out that while insurance is "free" in Norway (supported by their hefty taxes), general medical care to adults is not free. Care for children and for pregnant women is, however, 100% covered. Midwives attend approximately 70% of all births in Norway, leaving the complicated pregnancies and births to the physicians. Midwives are, by law, required to be available to a pregnant mother in every community in Norway for her prenatal care as well. Most midwives seem to practice either in the clinic setting providing prenatal care, or in the hospital setting providing care surrounding birth, but not both, as most midwives do in the US. Either you are employed by the kommune (community/city) for prenatal care or by the public hospital for labor/delivery/postpartum care.

Despite this overwhelming presence of midwives, it is normal for a woman to have her first prenatal appointment with her fastlege.  A fastlege is her family doctor, whom she may or may not have had many options in choosing. I had a decent fastlege, but thought he was a bit too male for my liking, and switched to a female fastlege who had helped my own dad with some dental pain. But just four days before my first appointment with her to diagnose and treat a sinus infection, she began her maternity leave. I was then automatically switched to a third fastlege. Another male.

So at 10 weeks gestation, with Erik in tow, we go to meet my fastlege for my first prenatal appointment. This pregnancy was much like my first—virtually undetectable, virtually asymptomatic—of which I dare not complain. That said, there is something very reassuring about symptoms, however unpleasant they are—you realize that something is in fact developing deep within your body.

Last time around, I was well-connected to (ok, employed by) the obstetric department at a major regional medical center and teaching hospital, and started off the pregnancy being reassured by rising serial hCG levels (pregnancy hormones) and two early ultrasounds to help in dating our somewhat surprise pregnancy. All of which were medically justifiable, in my mind. So, despite any symptoms of nausea or fatigue last time around, I knew things were OK. This time around, without any medical reasons for hormone levels or ultrasounds, I just had to trust nature and my body and my training that everything was proceeding as normal. And I was OK with that, too. Honestly, I was! (Ok, I was a little uneasy about it. . . but that's normal, too).

At 10 weeks into a pregnancy, a health care provider could be able to hear a fetal heartbeat (as my midwife was able to do when I was pregnant with Greta), although admittedly this is not always possible. This is really the only reason why I dragged Erik along to this otherwise rather boring and routine appointment. My fastlege, however, had no intention of attempting to hear the heartbeat. “It won’t give us any useful information,” he informed me.
“Uhhh. . . yes it can,” I countered, getting a little testy, and trying to express myself calmly in Norwegian. “For one, it can reassure me that everything is OK! And, it would give you some idea whether my dates are accurate or not.” I wasn’t asking for a ultrasound, for Pete’s sake, just a heartrate check.
“Well. . . we don’t actually have the capability of doing that here at this office anyway,” he responded. Which, it occurred to me later, is probably bullshit. Even though most women see the midwife for their prenatal care, some do choose to see their fastlege and most women go back for at least one or two visits with their fastlege during the course of the pregnancy. And if a pregnant woman is showing up at her fastlege for a routine prenatal visit, would the physician not check the fetal heartbeat? I think not. Somewhere in that damn office was a handheld Doppler ultrasound. I just knew it.

My blood pressure was rising, can you tell? Five minutes into this visit and I was not impressed with maternity care in Norway.

Speaking of blood pressure, he then proceeded to take my blood pressure (surprisingly low, considering) and do the all-so-informative-yet-obligtory listening to a perfectly-healthy-woman-in-her-mid-30’s heart and lungs. ‘Cause that would give him so much useful information. . .

Next on his list was the gathering of Important Information to be entered into a computer database: my job, Erik’s job, my religion, was my first birth a vaginal or c-section delivery, how much she weighed, and what her Apgar* score was (although when I reported them as 8 and 9 (1 and 5 minutes), he said, “. . . and?. . . “ waiting for the 10 minute Apgar score. In the US, once you hit a score of 9 at 5 minutes, we don’t do a 10 minute score. Aside from a brief health history, that was the extent to which he was curious about my previous pregnancy. No questions about use of anesthesia, length of labor, breastfeeding, postpartum depression. . . 

He moved on, namely to the issue of prenatal genetic testing and/or screening, specifically for Trisomies 18 and 21. As I will be (full disclosure here) right around the ripe young age of 38 when this baby is born, I automatically have the right to genetic testing, provided and paid for by the Norwegian health care system. Apparently, if you are under the age of 38, you are not offered these tests (although I’m sure there are some extenuating circumstances). In the US, it’s really available to any woman of any age. . . given that your insurance pays for it, of course! 

In my previous job, the midwives used an increasing amount of time of our 60 minute first prenatal visits counseling our patients on the different options of prenatal testing, so I was quite informed on what the options were, what information they gave us, how accurate they were, etc. So, I was a bit surprised when my fastlege told me we’d have to hurry to get me into the ultrasound to measure the nuchal translucency (neck thickness), because time was getting late. “Odd. . . “ I thought. “That’s usually at 12 weeks. I’m only 10 weeks. Do they do it earlier here? Is this test somehow different? Am I not remember this correctly?”

So, I asked him, and inquired about which hormones they measure along with the ultrasound—is this a first trimester test only, or a combined test with more labs drawn in the second trimester? The tests are becoming more extensive and therefore more accurate in the US—the more hormones you measure, the more information you get, and the more accurate the screening becomes. His response, “You’ll have to talk to the doctor about that when you get your ultrasound at the hospital.”

Huh? This is the doctor that I am sent to when I encounter a “complication” in my pregnancy, unless it’s too complicated, and then I’m sent to the obstetrician? But he can’t adequately counsel me on a screening test done immediately following my first prenatal visit? Assuming I knew nothing about these tests, I would have to base my decision on whether or not to do this screening based on this crappy counseling? And what if I get to the ultrasound/screening visit and decide I don’t want the test after all? What a waste of everybody’s time!

As you might guess, 15 minutes into this visit and I was even less impressed with maternity care in Norway. I was quite furious when I left the office, although I really tried to keep it in perspective. I had high expectations, or probaby more accurately, I had high standards. To add to my frustration with the whole system, I knew that the care, reassurance, and counseling that I provided women during their first prenatal visit was highly superior to what I had just received. If I dare say so myself.

Coming soon: my screening tests (more confusion) and first visit with the midwife (she’s wonderful!). So a mix of annoying and good.

*Apgar score:  a score of 0-10 given to a newborn at 1 , 5 and possibly 10 minutes of life, evaluating their transition to extrauterine life. Their color, tone, respiratory effort, pulse and reflexes are given points of 0, 1 or 2. A low score indicates that the baby needs assistance and possibly resuscitation to transition to life outside the uterus. 

Sunday, November 18, 2012

If only I had a guest blogger. . .

I am beginning week four out of four of my bachelorette month in November. The month has gone by relatively quickly, with weekends at home in Lillehammer and weeknights filled with meeting blogging and Oslo Facebook friends. The nasjonale fag kurs (national nursing course) has been about what I expected: a waste of time and money. But more on that later, like when I find out that I've actually passed it and there aren't any repercussions for telling the truth on the matter.

In the meantime, there have been some interesting developments regarding my new found media fame as Lillehammer's out of work American midwife. This is where I wish I had a guest blogger--Erik specifically--as he has had more contact with the journalist and media in the last few weeks, as I've been off drinking cappuccinos in Oslo.

The day after the original report aired, NRK aired a follow-up report, in which they interviewed the leader of the Norwegian Parliament's health committee. He was quoted as saying he found it strange that it was so difficult for me to get authorization, especially since in the "US there is a high level of education", and he kind of laughed in an "that's-an-understatement" kind of way.

A few days after that, a radio report stated that another member of Parliament on the health committee announced that she had sent a formal letter to the Minister of Health Care Services, demanding that my case--and the appeals board process--be investigated. He apparently has six days to respond to this letter. This particular politician (according to what we are told, 'cause I honestly don't follow Norwegian politics too closely), is rather right-wing and her party has also been known to be rather anti-immigrant. She was questioned as to why she is supporting this (my) case, when they typically take a more anti-immigrant stand, and she essentially responded that, "Look, here is someone who came to Norway because they wanted to work and were not looking for handouts. She is highly trained, highly educated, speaks good Norwegian. . . Norway is never going to survive if we turn away people like this."

To say that this is all a bit surreal is the understatement of the year. I feel so detached from the whole process it's like this is all happening to someone else. I am not hoping for major changes in the law, as I feel that would both take too long to help me out at all (selfish reason), but also because I don't know that it's necessary. At this point what needs to happen is finding some way to enforce fairness and consistency in the way American nursing educations are evaluated.

More to come. . . but for now I need to go write a paper on Norwegian health laws. How ironic.

Wednesday, November 7, 2012

Amerikansk jordmor får ikke jobbe (American midwife doesn't get to work)

The news report on my 2 year long battle with SAFH and Helsepersonnelnemd was finally aired last night, first on the Oppland and Hedmark district news on NRK1 at 18:40 and then later in the evening (or so I'm told) on the national news around 9pm. It was replayed the next morning on NRK2 and also apparently turned into a radio report! To watch my NRK news debut, you may click here!

I will try to write a transcript of the report, but in the meantime here is my translation of the article that is printed below the news report.
The little family came to Lillehammer and Norway and it was the child-friendliness, ski life and nature that brought them here.

Erik got his dream job as a bioloist while Emily, as an American midwife, was not good enough for Norway. Therefore she is working as a health care assistant.

“It’s not a bad job, and I know there are many people who would want it. I’m glad that I have a job, but this is not what I wanted to do. It is a little depressing, “ said Stange to NRK.
Has delivered several hundred babies
Her dream was to work as a midwife. She has a bachelor’s degree in nursing from the Norwegian-American St. Olaf college, and in addition she has a master’s degree as a midwife and 12 years of job experience.
Emily has also taught both nursing and medical students.
In addition to the formal education, which was approved by NOKUT () she has taught nursing and midwife subjects. She is also a member of the international honor society Sigma Theta Tau because she graduated with top grades.
In six of her 12 years of experience as a midwife, she worked in a hospital and delivered several hundred babies. But, that’s not enough to work as a midwife in Norway.
She wishes she had researched even better before her family decided to move to Norway. “I spoke with midwives, nurses, friends and every said that ‘Norway needs midwives!’ They said that a master’s degree from the United States is actualy more education than what Norwegian midwives have,” she said.
Must begin her education from the beginning
In the course of the last two years Emily has been in contact with the Government authorization office for health care personnel to become authorized to work as a midwfe.
She appealed her case to the Government appeals board and a decision finally came before sommer: she must begin her nursing education from the beginning.
What did you think? “I didn’t think anything. I just cried,” she said.
In the decision from the appeals board they say that the American nursing education has too little theory and clinical practical training when compared to the Norwegian nursing education.
The director of the appeals board can’t comment on a specific case, but says they must take into account patient safety and that they handle all the cases the same.
“In this case our decision was completely in accordance with decisions we have made in similar cases. It does not stand out in any way,” says the director for the Government appeals board, Øyvind Bernatek.
According to statistics, Norway will be lacking 28,000 nurses and at least 200 midwives in the next 20 years. Elisabeth Hals, a midwife at the Lillehammer Hostpial, says the ned for temporary midwives is huge.
“Both with vacations and sick leaves. . . the need is big, “ she said to NRK.
Odd that she must do it all from the beginning
Emily Stange from the United States wonders if she should do more education (editors note: actually, I don’t wonder about this. I simply won’t do it.) She has contacted the College in Gjøvik where they educate nurses.
Study and research director Gunn Rognstad has seen the case and doesn’t understand why Emily doesn’t get authorized in Norway.
“The education she has from the US in case of academic level the same as a bachelor’s degree in Europe. It seems a little strange that she must begin everything from the beginning,” she said.
Rognstad has now sent a letter to the Appeals Board, in which she has asked how/what she can arrange for Emily.
For Emily and her family, their lives are put on hold. She has no desire to begin again with an education that she already has.
“If this doesn’t straighten itself out, and I have to begin my education from the beginning. . . we’ll move back to the US. I will not throw away 6 years of education and 12 years of work experience.”
NRK will follow the case further. 

Erik and I are quite pleased with the report and looking forward to the follow-up news report today and whatever else might come from this. Several people have contacted either me directly or the reporter to voice their support and frustration, or to share their own stories. It's lovely to have the support, but what we need now is someone willing to step up and take it one step further.

Monday, November 5, 2012

Breaking News on NRK 1 for Wednesday 6th of November

Finally, after several months of waiting, the news report on my nursing/midwife "case" is being aired on NRK1 Østnytt at 18:40. (this is a regional production of NRK's news, aired in just Hedmark and Oppland fylker in Norway. 

For any of you who are interested, you can go to NRK's Østnytt site tomorrow evening and watch the evenings news. It will be a 5 minute segment. We had originally hoped that the segment would be aired on the much-viewed national Saturday evening news program, but apparently the editors-in-chief kept changing their minds on what the main focus of the segment should be. We are happy at this point to simply have it on the air, and the journalist has said she plans on filming follow-up interviews beginning tomorrow.

I will post more tomorrow, after the segment airs. 

Saturday, November 3, 2012


It's Halloween in Norway, and although I was in Oslo and missed out on the goings-on at home in Lillehammer, I got the report, with pictures to boot. 

Erik bought what may have been the last pumpkin in town on October 30th for about $25. What is particularly amusing about the packaging of the pumpkin--aside from the fact that it actually comes with packaging--is that there are instructions on How To Carve a Pumpkin. Although I can't be so sure, it does sort of appear that #4 instructions the user to put a candle on the top of the pumpkin. . . 

We were struck with an early arrival of winter in Lillehammer, and had nearly 10 inches of snow on the ground for Halloween. This did not seem to damper the spirits of our little witch (whose costume was bought at Joanne Fabrics in the US a few weeks ago for about $5). As I wrote last year, Norway embraces the "gory" side of Halloween--the ghouls, skeletons, blood, creepy stuff--and it seems to attract mainly elementary school age kids. Having a 3-year-old princess walking around the neighborhood last year collecting candy was a bit of an anomaly--both because she was 3 and because she was a princess. This year she decided to be a witch, which sounded good to us, being a little more in line with the local "customs". (As if respecting the local customs of a 100% imported American holiday is important. . .)  Having a 4-year-old witch out trick or treating was strange enough.

Erik stuffed Greta into a snowsuit, stretched the cheap-o witch dress over the snowsuit and pulled her hair back with a black buff and skull cap to fit under the witch's hat. Top it off with some purple mittens (which, along with the purple snowsuit, blended quite nicely with the purple witch's dress) and Greta was set for trick or treatin' Norwegian style. They headed to a slightly more American/British-ized neighborhood where we had success last year, and collected an amusing selection of goodies. Among those were loose, unwrapped pepperkaker cookies (traditional Norwegian Christmas cookies, now being sold in the stores), a candy cane, Christmas chocolates, and a package of single-serving hot chocolate mix!