Nanortalik

doctor in greenland – the basic facts

Greenland is a former Danish colony, now attached to Denmark via bilateral agreement. The population is 56.000. The majority of the island is covered by The Inland Ice, a massive icecap with villages and communities are dotted along the  coastline, with no roads connecting any of them. I have worked locums on the coast in Greenland regularly since 2004 in the following places: Qaanaaq (twice), Narsaq, Paamiut, Nanortalik and Thule Air Base.

Organization of the health care system in Greenland

Nuuk is the largest city with 17000 inhabitants and Queen Ingrids Hospital (DIH). The DIH is equivalent to a provincial hospital and provides basic functions in surgery and medicine. More specialized functions such as vascular, thoracic and neurosurgery, as well as interventional cardiology and burns treatment are transferred to Denmark.

Hospitals and health centers are spread along the coast from Qaanaaq in the far North to Nanortalik in the far South and up again on the East Coast to Ittoqortoormiit.  Sisimiut, the second largest city after Nuuk has 6000 inhabitants and 4-5 doctors. Nanortalik with 1300 inhabitants has 1 doctor.  The smallest village with a permanent doctor are Ittoqortoormiit (pop: 450) and Qaanaaq (pop: 635).

Nanortalik
Nanortalik

The doctors on the coast are normally general practitioners, however doctors from other specialties may be employed if they have sufficient experience within general medicine. In some of the larger villages, one of the 3-4 doctors should have surgical skills, mainly for Cesarean sections.

As a doctor on the Coast, you perform all medical duties, the majority being within the field of general medicine. Every village has a hospital-health center, where all consultations and examinations take place and, if needed, patients are admitted.  Minor surgery, such as abortions, may be performed depending on the local competences. Furthermore, smaller remote settlements in the area are visited on a regular basis. After normal day duty one of the doctors will be on call. If there is only one doctor you will then be on call all the time. The staff are generally very competent and used to dealing with most emergencies. Most emergencies during the night are related to alcohol and violence including medical examinations prior to detention placement, at the request of the police.

The generalists on the Coast have a close collaboration with the specialists in Nuuk: For non-urgent cases an online referral system and for emergency cases a doctor is on call within each specialty.
Furthermore, specialists visit the Coastal communities on a regular, often yearly basis:  Ophtalmologists, orthopedic surgeons, psychiatrist etc. As dental health is a major issue, dentists are present in all, but the very smallest communities.

At the coast level, basic examinations such as  X-ray and standard blood analyses may be performed.  Further investigations take place either in Nuuk or at the yearly specialists visit. Emergencies may be transferred to Nuuk with a chartered plane.

The doctor is either employed directly by Greenlandic authorities or via an agency. As I understand it, you need a Danish authorization to work in Greenland. For Scandinaves, the authorization is easily transferable, for other EU citizens some language tests may be requested. However dispensations may be given. It is a huge challenge for the health system to employ doctors in Greenland and many positions are covered as short-term locums. Also in Nuuk there may occasionally be a lack of certain specialists.

Glacier near Paamiut
Glacier near Paamiut

The challenges for a medical doctor are both medical and cultural and often a mix between the two:

Cultural considerations.

The level of spoken Danish is quite low among young people, problematic in terms of education as all diplomas above primary school-level require good knowledge of Danish. A translator is needed in approximately half of all medical consultations. Now, several educations (police officer, nurse, teacher etc) are offered in Nuuk (as opposed to having to travel to Denmark), but still Nuuk is far away from many villages. In Greenland there is a tendency  to live in the present, rather than by the European style of long-term planning. Thus many young people renounce on an education preferring to stay with their families. Generally speaking, one section of the inuit population seems to stay behind in the small communities while the other section often moves from smaller settlements to Nuuk or even Denmark. This pattern leads to a depopulation of  smaller settlements and creates social challenges. As an outsider, it is very difficult to get genuine insight into inuit, though the people are incredibly friendly.

Medical considerations

The disease pattern in Greenland differs quite significantly from the European mainland as outlined below:

While the incidence of hypopharynx cancer is increased, possibly related to viral infections, lung cancer is by far the most common cancer, related to a high incidence of smokers.

Due to the relative isolation down through the centuries, certain genetic diseases are endemic for Greenland such as Cholestasis familiaris Groenlandica and propionemia. Both may now be detected via pre-natal screening. Iridocyclitis and primary angle closure glaucoma also appear more frequently in Greenland.
Greenland has one of the highest suicide rates in the world,  and almost every Greenlandic citizen knows someone who took their own life. Special task forces/initiatives have been launched to battle the problem.

Qaanaaq
The Qaanaaq fiord

Tuberculosis is still a major health concern, with an incidence the level of several African countries, and attributed primarily to rough living conditions in small, remote communities.

Sexually transmitted diseases (STDs) are rampant, and increasing as of 2013 with 1 in 26 adult Greenlandic citizen suffering from Gonorrhea, 300 times as many as in Denmark. Syfilis is also present.

The transition from traditional inuit lifestyle towards a Western lifestyle and diet predictably has led to an increase in  the lifestyle-associated diseases (diabetes, cardiovascular). Lactose intolerance is relatively common.

High alcohol consumption has traditionally been associated with Greenland, however in fact the alcohol consumption in Greenland is on the decrease and is now lower than in Denmark. However, Greenland is one of the most violent countries in the world, and most of this violence is associated with alcohol.

Thule Air Base
Around Thule Air Base

Practical considerations on the coast

Living conditions – as a doctor you are provided with either a house or an apartment with modern facilities, heating, kitchen, shower, hot water, television. In a few communities there are no cloacal systems so toilets are emptied via a bag (Ittoqottormiit, Qaanaaq).

Daily amenities – All settlements has at least one  supermarket with  basic items, loads of canned and dry foods. Transport is by ship and in remote places only two ships pass every year. Brædtet is a place where local fishermen sell their catch.

Geographical considerations: There are no roads connecting the settlements and villages in Greenland meaning all transport is by air. Often weather prevents helicopters flying and people may get stuck on the way for days.

Weather: From the Arctic desert of Qaanaaq, where minus 40 degrees Celsius is common during the Arctic Winter to the  milder climates in the South resembling Southern Norway. The Polar Circle runs approximately through Kangerlussuaq.

Transport: The only all-year international airport is Kangerlussuaq, an old American naval base with flights to/from Copenhagen. Narsarsuaq (for Southern Greenland) is open in Summer. East Greenland may be reached directly from Iceland. From Kangerlussuaq and Narsarasuaq a mix of planes (Dash-7 or Dash-8) or helicopters then depart to the final destination on the coast. Due to the often changing weather conditions delays are common and may last a week if not more.

Outdoor activities: The scenery is unique and spectacular every where. However I have mainly worked in villages where I was the only doctor, thus I could not venture outside the village except in exceptional circumstances.

Other posts on Greenland:
Doctor 24/7 on call in Qaanaaq.
A typical day as a doctor in Nanortalik.
Life as a doctor on Thule Air Base.
The doctor visits  Siorapaluk, northernmost settlement in Greenland.
A visit to Alert, northernmost settlement in the world.

A photogallery of the places I have worked in Greenland is available on flickr.

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