Jackie Kennedy in Birkenstocks

Following the NRK TV news report on Tuesday, May 26th, announcing that I had been approved to work as a midwife, and that SAK will now start using the European Credit Transfer System (ECTS) to evaluate educations outside of the EU/EØS, our local newspaper in Lillehammer ran a very short article stating the same. We had been hoping it would get a little coverage, as I am repeatedly asked by strangers and acquaintances alike if anything has changed with my work situation. We thought that a little article in the paper would allow me to avoid explaining what has happened over and over again. The little article was short and succinct and we thought that was it. 

Then a journalist called me a few days later. She had written the very first news story about my situation, about 3.5 years ago. She wanted to do a more in-depth interview for the "portrait" portion of Saturday's paper (there is no Sunday paper) when they do a profile on a local resident who is doing something different. I quickly looked up the previous Saturday's profile: a 42 year old nationally renowned female artist, who has bought an old hotel and is using it as an artist's colony, has lived and trained in Iceland and Berlin, and has just opened a new art exhibit in a new gallery in town. 

And so it came to pass that I was interviewed for the local paper, and the following Saturday the following article, awkwardly translated with the help of Google Translate, was published: 

On the front page, with picture: "Approved and Ready. American Emily Stange has lived in Lillehammer for five years and has had to contend with bureaucracy. Read about the midwife who didn't give up in GD's Saturday's portrait/profile."*

Headline: "Midwife Emily: Emily Stange is experiencing a bit unfamiliar feeling. She is optimistic and looking forward to the future. This has not been so for the last five years.

The day is five years ago. In the delivery room at at hospital in New Hampshire a happy set of parents looks at their little daughter for the first time. The mother, a yoga teacher and former Olympic athlete for the USA in kayak, still has contact with the midwife on duty that day (they are friends on Facebook). Now sitting later in a red house in Søre Ål, she tells about the birth with stars in her eyes.

- “It was such a positive and inspiring experience of a natural birth without medication. The mother was a strong woman, who knew her body well. It is a great honor that this was the last birth I attended”, says Emily Stange. Unknown to the midwife at the time, there would be an involuntary break of many years until the next time she could assist at a birth.

It is not Jacqueline Kennedy that welcomes us in the door along with a wagging four legged American blend that answers to the the name Tika. But Emily’s classic good looks mean that she must endure the comparison, though jeans, striped cotton sweater and Birkenstock shoes certainly does not match the first lady's outfit.

None of this is why many people, both in Lillehammer and elsewhere in the country, recognize 40-year-old from Søre Ål.

Her status as a (minor) national celebrity is because she has fronted the fight against authorization authorities (SAK) for healthcare professionals with education done outside the EU / EEA can work in Norway. There have been many rounds of applications and rejections, with overwhelming support by professionals, politicians and, not least, Kari and Ola Nordmann**. Words such as abuse of power, uncultured and arrogance are used.

Last week came a "turning point", as it is called in main character's native language (a phrase I did not use in my interview, neither in my native or second language). The practice should and will be changed. Education will increasingly be assessed from the total number of credits and total study time rather than the number of teaching hours.

Thus can Emily Stange, who has a nursing degree and masters in midwifery and 12 years of practice, finally use her education to work in Norway.

Thus, one would think it is an exuberant and completely happy lady who has fired up the soapstone stove this rainy day and welcomes GD for an interview.

But it is not quite so. Emily Stange thinking about, sighs tiny bit when she answers this question about how she is now:

- “It's hard to explain. I am very relieved that we (husband Erik has also been involved) can put what happened behind us. It's good to think that all the energy and effort we have put down will open the doors for many other nurses and health care workers. Meanwhile, we had the feeling of being in a fight over the last four and a half years. Thus, it is difficult to feel completely satisfied and happy”, says Emily, who is quick to add how heartwarming it has been with all the support she has received from known and unknown.

On social media, people are overwhelmingly supportive, and people from  Lillehammer congratulated the woman behind the counter at Atelier Kakao*** and told that they supported and rejoice in the authorization, which Emily says is tremendously appreciated.

The reader must not understand us to mean that there is a sullen, moping American we have before us sitting in the unique rocking chair in the bright living room, where there is no doubt that toddlers also live.

Emily Stange laughs often and happily. She doesn’t give up and serves us coffee with great serenity, in large cups on the coffee table, neither of which are A4****. It's the fact that she at a college in Minnesota a handy guy, who crafted fine furniture to the couple's home in various states. They moved over the pond in 2010 and the furniture allows the family of four (plus Tika) to feel extra homey in the house they have spent years renovating in the south of Lillehammer.

- “Some day, I want to move back to Norway”, said Erik Stange to his girlfriend. The active skier was in the country for two years the mid-90s, partly as a student at Voss folk high school.

Emily thought it sounded exciting, but put Trondheim limit to how far north they could move. When a job as a researcher at the Norwegian Institute for Nature Research (NINA) was in the bo for Erik, they moved on, satisfied with living in a city with ski trails and of Lillehammer size. For a nurse with many years of work experience to find a job would be the least of their problems. Or so they thought. . .

They could have moved back, something they have considered quite often as an alternative when everything around Emily's job situation was so difficult.

At the same time they felt that the time had not come to give up.

- “We have invested so much here. My husband has great job satisfaction. We thrive in Lillehammer. Kids have it well in daycare and school. We have friends, good neighbors, have renovated our home. . .”

Says Emily, and boy she completely voluntarily used the verb she hates. “Trives” (thrive)*****. Taking the short version is not easy when people ask if you thrive in Lillehammer.

- “The “Yes-we-thrive-here” version is not quite true. Mostly because of the job situation, which has been a huge financial and mental strain. But we could not stay here as long as we have if we did not enjoy it”, says Emily, and repeat the list from earlier with pluses for a good everyday life.

-“I can stand in my kitchen window***** and see my kids playing out in the garden and think about how lucky I am. Life is so good!”

Whoever is looking for a humorous and aptly satirical look at the life and realities here in the north, you can click onto lillestange.blogspot.no. Where describes Emily "The Lille-Stange’s" new life in Lillehammer, Norway. Here you can read, in detail (!), everything from Norwegian culture and daily life to Bergens language test and how to raise a Viking (series of pictures where her son Henrik is packed in layers into a "burrito-baby" to sleep outside). This is not easy to understand “over there”.

My poor blog, sighs Emily. It has not received much attention in recent years, largely because the writer thought the message became so negative about everything that happened on the job front.

- What has puzzled you most here in Norway?

Pause. Emily is among those who think about before answering.

“Russ” celebration is something she thinks is strange and not particularly positive.

- “I've also thought about Norwegians' relationship to summer vacation. Three weeks in the month of July which everyone has free and even entire departments of hospitals close. For me it's unbelievable. Meanwhile, it is also very positive that Norwegians are so protective of their free time.”

Where is home? There is uncertainty surrounding the response from the mother with two small children when we ask her to describe the feeling of having two countries.

- “We talk about “if” or “when” we will move back. But it is also a question of where home is in the USA, because we’ve lived so many different places. When we are in Minnesota, we miss Norway”, says Emily, telling that her daughter Greta on holiday in Italy missed Norwegian milk and wanted to go “home” to Lillehammer.

- “Although she was born in the United States, knows that she is American, has an American flag and cheers for the Americans in the Olympics, she is also very Norwegian. Henrik (two years), also has a US passport, but he is more Norwegian than all of us and will not recognize the United States as home. I think it is a little difficult. But it's also kind of cool. . . “

“I never liked children and babies ... “ The midwife has started to answer to why she chose this profession itself. GD journalist proposes an “always” rather “never”*******, to hearty laughter. “I always have liked children and babies, I mean!”

Actually, it's unfair to mention this little blunder, for Emily is good at speaking Norwegian. But it fosters interesting reflections on the experience of not being able to use one’s mother tongue.

- “The hardest part is that I know that I do not portray my real self. When you have to think so much to find the right words and still not be able to be precise, it is easy to feel a little silly. Besides humor difficult in another language. But it's getting better and better. Speaking Norwegian becomes easier and more natural”, says the one who is proud to have attended a parent meeting alone, almost without need for help in understanding what was happening.

Back to the question we started. What is it with the midwife profession and Emily?

 She describes the experience of being present and help when hours of pain and a lot of hard work is replaced by the joy of being able to see your baby in your arms for the first time.

- “Being able to be present at such a process is a rich moment”, she, who, trained as a nurse in Minnesota and had her first job at the neonatal intensive care at a large children's hospital in Salt Lake City, Utah, explains. Then she worked on a maternity ward after a growing desire to have more contact with adults, and wanted to spend time talking with women, informing and answering the questions that arise during pregnancy.

- “The profession is an important part of my identity. It was impossible for me to think that I should start a new and higher education in Norway”.

The midwife has regained optimism, and finds it exciting to be on job hunt.

- Has it been worth the struggle for many years?

Thought.

- “We shall see. I think so, when I think of everything positive that has happened in the past four and a half years. We have bilingual children, I have learned to speak another language and I have learned how strong and resilient I am. Living in another country is incredibly exciting and rich”.

Emily Stange (40)

: Raised and educated as a midwife in the United States, residing in Lillehammer.

: Recently authorized as a midwife in Norway after nearly five years of struggle.

Married with Erik. Children Greta (7) and Henrik (2). Dog Tika.********

(end of article)

Footnotes:

 * Greta read this to me and said, "The midwife that didn't give up. When I read that I felt proud of you." To which I thought, "Ok, she's finally starting to get this."

**A Norwegian saying for “Jane and John Doe” or “the average Norwegian”.

*** The café where I’ve been working off and on since August.

**** A4 is the standard size of paper in Europe, so A4 is a Norwegian saying referring to “standard”. An A4 person is a average, standard, from the box person. People have sighed, hearing my situation as asked, “Why must bureaurcracies be so A4?” like everything has to fit neatly onto a standard form and they can’t think outside the box.

***** “Trives du her?” Norwegians ask me. “Do you thrive here?” I hate the question. Do you want the short answer? That depends on the day. On the weather. On how recently I’ve gotten a letter rejecting my education. On how empty my bank account is. On how many poopy diapers I’ve changed that day. On if I’ve been able to find quinoa at the grocery store or not. On how many days it’s rained in the past month. On how smiley my 7 year old is after spending the day outside. Or do you want the long answer?

****** The original article read that “I can stand inside and watch my kids play outside” and I thought it made me sounds like I was afraid to go out in the cold and play with my kids. Or I was this disengaged, distant mother. We specifically moved our kitchen from the front of the house to the back of the house, so that our kitchen sink looks out over our back yard. I can finish up the dishes and watch Greta and Henrik in the sandbox, sled down our little hill, pick berries, dig in the garden.

******* “Never” is aldri  “always” is alltid. So these words with complete opposite meanings can be pretty easily switched when one is not thinking and a little nervous.

******** Greta said this was her favorite line in the article.

GODKJENT! APPROVED!

I hope I haven't kept you in suspense for the last few weeks. As I wrote on the 19th of May,

Seeing is believing!
"Godkjenning autorisasjon"
Sykepleier og jordmor
until I'm 70 years old!

"all signs point to yes" and actually later that very afternoon my name appeared on the national registry of authorized health professionals, as a godkjent nurse and midwife. It was a little anti-climactic, following a week of suspicion and hope and signs in the right direction, to be notified via an online registry, of which I had been checking pretty obsessively all day long. Erik actually called me from Belgium to tell me he had seen my name. This was not the way I had imagined being notified.  

Fortunately, I would be able to reenact the way I had always imagined being notified, as NRK (Norwegian broadcasting news) wanted to film the opening of the official letters, which did not arrive for another three days. And since it was a long three day weekend, we actually delayed the opening of the letters--and the filming--until the following Tuesday (one week after we really knew), when the news crew arrived at our house at 9am. Talk about anti-climactic! That evening, the report aired on both the regional 7pm news and the national 9pm news! Erik had even done a kick-ass live interview on NRK radio talking about my case and what it means to many others (I declined to do any non-editable interviewing in Norwegian). So that evening, after sitting on this secret for a week, we decided it was high time we celebrate and invited friends and neighbors over, opened a few bottles of champagne, ate cake and watched the news together. 

Erik testing the lighting in our kitchen before the filming

Yes,the footage you see is a bit staged. My reaction is a reflection of some good acting genes but probably more accurately finally living out the scene that I have played over and over again in my head for the last 4 years and 7 months, and some genuine emotion of finally seeing the words in print. 

We are repeatedly asked to comment on our reaction, something that we thankfully had a week to think about. We are grateful, of course, to have this nightmare behind us. I am optimistic about the future and finally being able to work in a field where I am trained to work. We are really proud of the fact that without our efforts, well, it probably would have happened eventually, but we know we were key players in getting the credit transfer system recognized. We are really pleased this will help many other health care professionals from outside of the EU work in Norway. But, I'll be honest, we are pissed as hell that this took 4 years and 7 months, cost us an unknown amount of money, and the amount of blood, sweat and tears it took--the first two mostly Erik's and the last mostly mine--to have people in places of power (politicians, academics, institutional leaders, journalists) recognize the wrongs and the see the need to right them. I know that wasn't a proper sentence, but I don't have the energy to make it into one. You get the point. So, to open a letter that says simply "Godkjent", after all that effort, time, energy, money. . . well, it's a little deflating. 

Congratulations from Erik's colleagues
"We say only CONGRATULATIONS WITH THE VICTORY!"

One of the nursing professors that has been such a strong and influential supporter called me to congratulate me (after sending me flowers!!!) and when I tried to express my weirdly ambivalent and not entirely happy feelings, she said, "It's like you've been sitting for exams for the last 4 years, using massive amounts of energy and adrenaline to prepare and prove yourself, and suddenly it's over." 

And so that's where I've been sitting for the last month: the fight is over. I'm approved to work. I can look for a job. It's time to move on.

Below I will provide a Google translated version of NRK's written online report.

Making the news again!
"Finally she is allowed to work"
Link to NRK news report

Finally she is allowed to work

"I am relieved and happy that I finally received authorization. Now I can finally work as a midwife here in Norway", says Emily Stange.

Waited nearly five years'

Sad for Norwegian health administration- On behalf of the family Stange I am now very happy, but on behalf of the Norwegian health administration I am sad. It has long established an uncultured in this management arm, says Kjenseth.

Nothing has changedLooking ahead

There have been many rounds of applications and discounts for Emily Stange and family. When they came to Lillehammer from Vermont in 2010, thought the job was the smallest problem.

Stange has a bachelor's degree in nursing from the American-Norwegian St. Olaf College, in addition to a master's degree in midwifery and 12 years of practice. She has also taught both nursing and medical students.

But none of the applications Emily has sent to the State Authorization for Health Personnel (SAK) has been approved. They have argued that rod education has not met the formal requirements of the law.

- Time The number of the applicant in her education, is far below the standard requirements of the EU. Long professional experience can not compensate for this, said Director of the Board, Øyvind Bernatek NRK one year ago.

But now Stange can work as a midwife in Norway anyway. SAK writes:

"After a new review of your education as a midwife, we consider that you meet the requirements for certification as a midwife pursuant to the Health § 48 subsection c)."

Several parliamentarians have taken up the cause to Stange. Ketil Kjenseth (V) sits in Health Care Committee and is disappointed over the process. 

THANK Emily's husband: Parliament Politicians Ketil Kjenseth (V) has been involved in Emily case and thanks her husband Erik Stange to have documented and fought against management practices in this matter.

He believes the problem is extensive and talks about a number of queries with similar experiences as Emily.

Also the Association of Norwegian foreign students ANSA react. They believe SAK wastes with high competence.

- I am very happy at Emily's behalf and for the authorization office has done that we have recommended for a long time, and now look at ECTS (credits) instead of number of hours. Now SAK should go through all similar refusal in recent years and treat them according to the same rules, says the president of ANSA, Madeleine Mowinckel.

Study and research director at the College of Gjøvik, Gunn Rognstad has supported Stange from the start. So has also has academic staff from colleges in Hedmark, Buskerud and Vestfold. "Authorization could just as easily gotten four years ago, after taking and passing a test in national health care. The main problem all the way to an unclear understanding of the calculation of the scope of the content of education between SAK, healthcare committee and health ministry about which rules should be applied to process applicants from abroad," says Rognstad.

- "We do not want to express an opinion on individual cases, but may state that some applicants of SAK was considered to satisfy the conditions for authorization after carrying out a specified period of supervised practice", says Anne Harseth Barlow in SAK.

She says that Emily Stange recently took 12 credits in geriatrics, and that this was decisive that she was granted authorization.**

- "I'm really looking forward to working with what I can and hope the work we have done can help others to get authorization on a more timely basis", says Stange.

**I haven't blogged about my 12 credits/8 weeks of geriatric clinicals that I completed in February/March and how enlightening and educational they were to my ability to work as nurse. Perhaps I should do that someday. 

Hope

Months have sped by, and my motivation to blog through the after-effects of my nursing course, Christmas preparations, two solid months of work, growing a baby and general day-to-day life busyness has been minimal. 

But I do owe you a few updates. . . 

The last real development in my quest for nursing/midwifery authorization was in late November, when a few members of Parliament spoke out in my behalf. But the buzz and momentum fizzled a bit after that, due to a combination of more pressing healthcare and other political events (hard to believe, I know) and Christmas break. 

I cannot be terribly specific in describing with whom we've been consulting, but after months and months of emails and phone calls and referrals from one person to another, we've eventually nailed down a few players in higher-up nursing/midwifery circles who are supportive, understanding, disgusted, and began working "undercover," so to speak. Many feel that they cannot officially come out and support me publicly, which has been a bit frustrating. It was also suggested that we form a Facebook "support group" where people can officially and publicly voice their support and let it be known to SAK (the artists formerly known as SAFH, the Norwegian authroization office for health professionals) that we ain't goin' away. Two who have supported the group include the local county/regional office of the Norsk Sykepleierforbund (the Norwegian nursing association/union) who is calling for SAK to reevaluate my application, based on the evaluation done by the local college research dean who judged that my bachelor's degree nursing education and work experience equaled (and exceeded) what her educational institution could offer me as a new nursing student. Also supporting the group is the member of Parliament who initially spoke out on my behalf. You can find the support group here: Støttegruppe for Emily Stange. 

Since then, Erik (and Greta) and I traveled to Oslo this past week, armed with binders of documents and correspondence, and met with the member of Parliament to discuss possible courses of action. We also met with two other powerful nursing figures who seem to have more connections than the Queen herself. For example, when we mentioned that we had been in contact with (names have been changed for the time being. . . ) Kari Nordmann, former head of a midwife organization, who cannot understand the reasoning behind SAK denying my midwife application, one of our two powerful nursing figures said, "Oh yes, she's my best friend. I'm having lunch with her next week. We'll contact this other Powerful Nursing Figure and get this straightened out." 

I have not allowed my hopes to get raised at all in the past few months, as they have tended to get dashed shortly thereafter. But even I will admit that these were very positive meetings with tremendous potential and--dare I say it outloud--I do have some hope for the first time in a very, very long time. 

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. 

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.

Numb in Paradise

This past week Norway burst its way into summer. Our apple trees are in full bloom, the lawn demanding attention and the lilacs are timing their arrival perfectly with my parents arrival on Friday. We hung a swing from the apple tree for Greta, who has been soaking in lots of Vitamin D. 


I posted this picture on Facebook, and a friend commented "you live in a fairy land". Looking out from our kitchen window, seeing my daughter scamper about in our generous-by-Norwegian-standards-yard with our neighbor's kids, enjoying our first dinner of the season outdoor under the apple tree, I'd have to agree. I responded, "I know. I see this and think, "I have to do everything in my power to make this work out here. How can I leave this???"


The answer to our appeal on my nursing and midwife license application came in the mail today, and it was not the answer to our prayers. Their final judgment--one we cannot appeal--is that I should enroll myself in nursing school, and try to get credit for some of the classes I took 15 years ago. 


We are stunned. Dumbfounded. I was numb. Erik was devastated and perhaps the angriest I've ever seen him before. I was worried he might punch a hole in a wall that he had framed, sheet-rocked, mudded, primed and painted with his own two hands. And then we crumpled in the middle of our living room floor together, and wept. 

Appeals board tomorrow

Tomorrow Erik and I will travel to Oslo to meet with the Helsepersonnelnemda (the Health Personnel independent appeals board) who will review both my nursing and midwife license applications for the last time.

It is a long awaited day. This process began in October 2010, when I sent in pages and pages of documentation of my transcripts from my bachelor’s and master’s degrees, along with long letters from my advisors and department chairs, explaining what topics were covered in each course, and how many hours and weeks were spent in each course and in every area of clinical practice.

This process was repeated again in February 2011, after SAFH (the folk who review these applications) concluded (after 4 months of contemplating their belly button) that I had a two year degree in nursing and not a four year degree. More papers, more letters, more documents.

And we repeated this process a third time in August 2011, when they decided a second time that my nursing degree was not thorough enough, and I needed more training in psychiatry and medical/surgical nursing. (Yes folks. . . I want to work as a midwife. This does not matter to them).

It was only after an article appeared in the local paper in November 2011, featuring my case and the long process, that SAFH quickly responded—with two decisions this time—the first time they even bothered to consider my midwife application. They denied both applications, stating again that I needed more training for a nursing license, and claiming that I since I didn’t document any of the patients I had seen as a midwife student, I could not be licensed as a midwife.

In January 2011 I sent in 45 pages documenting the over 800 patients I saw as a student midwife, clearly labeling how each patient fell into each category—prenatal, postpartum, high risk, birth, newborn. SAFH’s response, in February 2011, was essentially “there’s no way to prove these are real, as they don’t look official”. No letter from them stating “this looks like a lot of patients—could you somehow verify them.” No contacting my advisor or the chair of the midwifery department, despite offers from them both in the numerous documents they prepared on my behalf. It was almost as if they said “Shit. This is a lot of paperwork that we don’t want to deal with. Let’s just send it on to the appeals board. That’s what they are there for.”

So, on to the appeals board we go.  An independent appeals board, or so they say, and so we hope. More documents, more paperwork, more verification, more last minute panicky emails to my advisors, and several sob sessions on our living room couch, wondering what the fuck I was thinking getting myself into in this kind of situation.

I am not going to be so arrogant or so naive as to think that everything I learned in American nursing/medical training translates directly and smoothly to nursing and midwifery care in Norway. I acknowledge that some training time would be both valuable and justifiably required. But to go back and enroll myself in a university again for both degrees, and ask for credit on classes I’ve taken? I just might be so arrogant as to say “I’m not going there.”

Tomorrow is a big day. The appeals board decision will likely make those final hurdles clear—just how high they are, how many more, and how far away the finish line is. And then the toughest decision of them all: is it all worth it at the finish line? Do I even bother finishing this race? Or will I decide, “you know. . . I was prepared for a 100m hurdle race, I could suffer through a 400m hurdle race, but I will never do the steeplechase. I’ve got better things to do in life than run around this track a dozen times, jump over barriers and land in water on the other side, and end up soaking wet and exhausted at the end”.