Norge på langs – the preparations

In August 2016, while crossing Hardangervidda, I met two women walking something called Norge på Langs. The first woman explained that she had hitch-hiked through numerous tunnels and walked a lot on the E6 highway. I immediately knew such a trip was not for me. Then, waiting for the bus at Haukeliseter, I met another woman. So, how many tunnels did she walk through? Only one, she said: The North Cape tunnel. And she walked in the mountains. Later I looked her website up, where her itinerary was posted. An itinerary I, in fact, ended up largely following for the Northern half of the trip.

First of all, there is no established route nor any set rules for Norge på Langs. Accordingly, depending on priorities and goals, almost everyone end up doing it their own way. Some aim to do it in less than 100 days, some walk only in Norway, some occasionally takes a boat ride or lets other carry their luggage, some cycle parts of the route etc. etc. Thus unsurprisingly, I, for one, have never heard about anyone completing Norge på Langs exactly as I did. According to a private list, 433 people have completed the trip since 1951, but there are more. Me, for example. And others.

Based on previous experiences, I now know myself reasonably well as a hiker: Ideally I get up around midday, walk through the afternoon and evening, often after midnight, especially in the midnight sun. In the  mountains I average about 2,5 km/h (breaks included). I don´t usually walk more than 20-25 km/day in the mountains and 35 km on road is about enough as well. On the mental aspect, I know that I will not get lonely, in fact walking day after day in the wilderness without meeting anyone is uplifting. I do not like to be offline more than I have to: Social media, football results, listening to podcasts etc. in the evening are all essential parts of a trip. I do not want to push myself physically by aiming at a fixed daily hiking distance. Hiking is about freedom. If I am tired, I take a break. If it rains heavily, I will probably not want to walk. If I find an extraordinary campsite after 10 km, I will stay there.
Finally, I have come to have some rough ideas of my weak and strong points: My main weak point is (lack of) physical strength. Followed by: Tolerance for freezing. My strong points: Rational thinking, solid judgement/risk assessment, perseverance.

My main goals for Norge på Langs were: 1) to walk 100% of the route, 2) as much as possible in the mountains, with 3) no preplanned supply parcels/support.

The concept:

  1. Walk 100% of the way. In this context “walk” equals “walk with my backpack”. Thus, no motor boats allowed (with specific reference to the boat services over Akkajaure and Namsvatnet).
  2. Not skipping any major mountain section and I walking mainly in the mountains. In case of adverse conditions preventing me from passing through, I will simply wait or, worst case, return at a later stage to complete the trip. I have driven the length of E6 before. I see no reason to walk it as well.
  3. I do not send food/resupply parcels. Mainly because I would lose freedom and flexibility by doing so and secondly, because I, after doing the relevant research, did not find it necessary. It is also a big hassle as well as expensive.
  4. I will not rely on outside help. If I have logistic issues needing me to go off-trail, I will do so myself. I will not ask anyone for food unless an emergency (defined as: > 48 h without eating).
  5. I will not set daily targets. I will walk at whatever pace I am comfortable with and stop whenever I like.

Where to start? North or South?
Most people start at Lindesnes. Quite frankly, I do not understand why: Starting in the South means that Ryfylkeheiene, Hardangervidda and Skarvheimen will be reached in early/mid-June, quite possibly the worst time of year, in the middle of snow-melting, with deep rotten snow and huge rivers, a nightmare on ski as well as on foot. Of the numerous people starting from the south in recent years, with or without skis, including an Olympic skiing champion, all I am aware of have given up on the mountain route during or right after Ryfylkeheiene.
On the contrary, in the North, Finnmarksvidda is normally fine to walk in early June, which I confirmed by studying snow data on senorge.no. The main issue starting in the North is the notoriously late snow-melting a bit further south, in the Narvik and Sulitjelma Mountains, often as late as late July. Furthermore, I quite simply love the Northern spring with the midnight sun, gone by late July.
So, this was an easy choice: The starting point is Knivskjellodden, the northernmost point on Magerøya, ~1,5 km further north than The North Cape.

Which route?

I wanted to walk the most beautiful and interesting way, not necessarily the easiest and fastest way. The choice of road until Børgefjell was easy (more or less E1, Nordkalottleden, Nordlandsleden). After Børgefjell, the easiest and most popular route would include Røros, Rondane and Eastern Jotunheimen. However. I was less motivated by these areas and preferred the fiords, the deep valleys, Innerdalen, Breheimen and Central Jotunheimen. In the end I decided to leave the Southern route decision until after Børgefjell.

I knew, that the combination of 1) not relying on resupply parcels or 2) outside help, as well as 3) intending to walk a more western route, most likely meant that I´d have to split the trip over two seasons. Ideally I´d complete it in one, but I´d much rather do two seasons than skipping central sections like Skarvheimen, Jotunheimen and Hardangervidda. In the end the choice between “one season with hundreds of km on paved roads” or “two seasons almost only in the mountains” was easy.

I ended up walking the below route over two seasons, the break-off point being Trondheim. All supply points in the North as well as all the huts are marked on the map above. Further details in separate post.

What to bring?
The equipment is described in detail in a separate post.

The planning phase
Intuitively I would say I didn´t plan anything, but that would would be wrong. As I did not send any resupply parcels, didn´t purchase any new equipment and didn´t preplan neither daily stages nor the route, there was not a lot of formal planning, no excel sheets etc.
However, I spent countless hours looking at ut.no, studying route options, in particular potential difficult river crossings and ways to circumvent them. I needed to be sure that it was possible to resupply with food without sending parcels, and I identified the two most challenging sections in this regard: The Narvik mountains, and Lønsdalen-Hatfjelldal, each requiring 10-12 days food to be carried and I would have to leave the trail to resupply. I studied the snow development several times a day for months on senorge.no and I watched YouTube videos as well as looked at Instagram posts and various web sites studying previous trips as well as the areas I´d be passing. The final decision to go was taken only a couple of weeks before the departure, after a final check of the snow conditions, around mid-May 2019.

Physical preparation:
Unfortunately, I did not train a lot (read: I did not train at all) and I was in quite miserable shape at the beginning, not able to run 5 km without stopping, to give an example.

Web ressources used frequently, before and during the trip:
ut.no – for route planning. All DNT routes and cabins as well as most, but not all, free cabins are marked.
ut.no or norgeskart.no: Navigation during the walk, when needed. Also works offline.
yr.no: Weather forecast. I find it the most reliable of the online providers.
senorge.no: Follow the snow situation and compare with previous years.
bratt.no: Steepness. Especially useful when heading off-trail.
Lantmäteriet: Online free hiking maps for the Swedish sections.
National Land Survey of Finland: Online map of the Finnish section.
Interactive map with open Statskog cabins.
Restless kiwi adventures: Both a blog and a YouTube channel, but I found the daily videos of the Northern section particularly useful in assessing the geography.
The website by Tine Larsen detailing the route she walked. I met her in Haukeliseter parking lot and she was the one inspiring me to walk Norge på Langs in the first place.

Other recent trip reports:
In 2019, both Gina Johansen and Anne Line Pedersen completed Norge på Langs and wrote extensive trip reports (in Norwegian) on their websites.
Links to many previous trip reports on norgepaalangs.info

the girl who stumbled while playing outside

Inside the operating room, Aden, Yemen

Aden, Yemen, 2012.

It was late afternoon and I was standing on the roof of the brand-new MSF (Doctors Without Borders)  hospital in the outskirts of Aden, the main city in the south of Yemen. It was the beginning of May and already around 30 degrees Celsius while the muezzin called to prayer in a nearby mosque. Due to the tense security situation we were not allowed to leave the hospital at any time and the entire team was installed in rooms on the 2nd floor. If you needed a breath of fresh air you had to go to the roof. Only brief roof visits were allowed though, due to the risk of shelling.

The medical team leader came up and told me he had received a call from another hospital 4-5 hours away, a smaller facility where surgery was not available: They had received an 11-year old girl who had fallen down from a 1 meter high rock while playing outside. She was not doing well, they said, on the outside there was nothing to remark, but she had severe stomach pain and could not move. Could we receive her? Yes of course.

5 hours later the girl arrived and upon examining her it was immediately apparent  that she had peritonitis . She presented with a classic peritoneal reaction upon palpation of the abdomen. Blood tests, apart from hemoglobin, were not available, no imaging possible, but none was really needed: She required immediate surgery. 15 minutes after she arrived, she was undressed and intubated and the surgery began. I had talked to her father via an interpreter and explained the situation, told him that I did not know what was wrong but she may need a stoma.
Immediately after opening the abdomen I noticed the 2*2 mm perforation on the surface of the small intestine approximately 40 cm from the ligament of Treitz. I remember telling the anesthetist that this was good news, the surgery  would be completed in less than 30 minutes. I hope so, she said. As said, I sutured the perforation and closed the abdomen. The anesthetist was specifically trained in pediatric anesthesia as well as pediatric intensive care management and took care of the prescriptions in the recovery room. When I woke up the next morning I went to the recovery room, where the girl was sleeping. She was lucky, it went well, I remember saying. The anesthetist looked at me with an odd expression on her face: She is dying. She has acute renal failure. And there is no access to advance therapeutics such as dialysis, the only possibility to save her life.

The almost 24 hours it took for her to gain access a hospital with surgical facilities turned out to be too long. She died later that afternoon.

Below a video of what a day may look like in this hospital:

The mola

 

Cesarean section in Ivory Coast, 2012

At around 10 am the midwife came to the Operating theatre where we had just started todays list after completing the morning patient rounds: Mostly minor cases, incision of abscesses, dressing changes. Now, a 19-year old pregnant woman had presented with continuous heavy vaginal bleeding. According to the midwife there was no fetal heart activity. According to the woman, she was in week 33. We did not have access to ultrasound. She needed a Cesarean section. With no obstetrician employed, this is the job of the surgeon.

10 minutes later the woman was in the operating theatre and we prepared for the Cesarean section. Probably a placenta previa I thought.  I opened the uterus and I still remember the subsequent moments of  confusion and disbelief when I removed handful after handful of what looked like small white eggs. There was no child inside. Instead this was a molar pregnancy, which the woman had carried undetected into the 33rd week  due to the lack of access to pre-natal counseling in the remote are where she lived. I removed the mola and closed the uterus. She was 19. She would be able to have more children.

However, the postoperative course was complicated, she kept bleeding. Was this perhaps an invasive mola?  We will never know exactly. I had to perform an emergency hysterectomy, but the vaginal bleeding persisted, however by now it was slowly diminishing. Was there perhaps also an element of coagulopathy? Possibly, but without adequate testing modalities, no way to know for certain and in any case no treatment would be available. After a few more days on the ward she was ready for discharge.

How does the future look, in this relatively remote part of the country, for a 19-year old woman, just married and  not able to have kids?

Not necessarily bad, I was told. In many such cases a childless couple would raise the children of other family members, such as her sister, as their own.

Obviously with access to appropriate prenatal care, the condition would have been detected far earlier and probably could have been treated.

Douekoué, Ivory Coast, 2012.

The boy with the bladder stone

I was standing in the courtyard outside the surgical ward, when a man approached me with his 14-year old son. Are you the surgeon, he asked? Then he went on to tell me how his son had suffered from recurrent urinary tract infections the past 4 years, resistant to the available antibiotics. They finally saved enough money to have an ultrasound examination that showed a 3*3 cm stone in the bladder. They came from a city 6 hours away by bus, and they had visited 5 hospitals already asking for advice, and everywhere they were met with the same answer: “No, this we cannot do. We do not do specialized surgery here.”

Hospital Duekoue Ivory Coast
Sterilized surgical equipment, Ivory Coast

In fact, the operation itself: A small incision, open the bladder, remove the stone and close again is relatively simple and takes no more than 15 minutes, however bladder stones are not common in the Ivory Coast and none of the general practitioners (with surgical competences) or surgeons had done it before. As recurrent UVIs may well harm the kidney on the longterm, there is good indication to remove the stone. I did not have access to ultrasound but I trusted the father´s description and scheduled the boy for surgery the next day where I removed the bladder stone uneventfully and inserted a normal Foley catheter. The only adverse event came after 7 days where it was entirely impossible to remove the Foley catheter as we could not empty the balloon, thus I had to open the bladder and puncture the balloon, remove the catheter, replace it with another Foley, wait another 7 days, after which this catheter was finally removed and the boy discharged. The last thing I remember was his father hiring a photographer for the money he did not have to take a picture of me together with his son as he was convinced that ”God and I had saved his life”:

Bladder stone Ivory Coast

March 2012, Duekoue, MSF supported hospital, Ivory Coast.

All stories and photograph with permission of the involved patients.

Life as a doctor on Thule Air Base

Thule Air Base is a strange place: The northernmost US Air Force base, located on top of Greenland and close to the historical settlement Dundas, which served as base camp for several famous polar explorers such as Robert E Peary and Matthew Henson as well as Knud Rasmussen who founded a trade station here and named it Thule. The original Thule trade station was moved and now serves as the museum building in the modern settlement of Qaanaaq, on the other side of the fiord. Upon establishment of the Thule Air Base in the 1950s, the original inuit population were forcefully evacuated to the present day village of Qaanaaq, causing ongoing lawsuits for decades until the matter was finally settled by the Danish Supreme Court in 2003.

Thule Air Base
Thule Air Base

In brief, the main purpose of the Thule Air Base is to support the Thule Radar, a part of the BMEWS system to detect a missile attack against the United States.

Around 600 people live on the base, 150 from the US military, the remaining 450 being service personnel, mainly from Denmark and Greenland. The service contract with the Thule Air Base is with the company Greenland Contractors, who hires the doctors (in my case via an Agency). This service contract is currently (2016) the center of a major controversy.

Thule Air Base
Thule Air Base

Two doctors are permanently stationed on the base, one needs surgical skills. However, I did not have to use mine as the work is centered around general medicine including health certificates and administrative reports. There were no emergencies the month I was there. The closest was a call from a captain on a Lufthansa flight located right over the North Pole presenting a patient had abdominal pain. In the end it was decided that emergency landing at the base was not indicated. Though not part of the health care system in Greenland, Thule Air Base doctors and authorities will nevertheless assist with medical evacuations from nearby settlement Qaanaaq if needed.

My office, Thule Air Base
My office, Thule Air Base

As a doctor you are provided with a car with a compulsory driving test at the base. I had a small apartment within the medical building/hospital ward, with no admissions during my time there. There is a small convenience store. The Top of the World Club (a bar/restaurant). And a fitness center. I was on Thule Air Base in August. The sun was never down and I covered the windows with plastic foil during the night.

Dundas
Dundas

The scenery is spectacular with ~20 km road to drive on outside the base. One of these goes up to the Thule Radar. And despite many visits to Greenland, this is the only time I have actually been standing on the Inland Ice. I climbed the iconic Dundas mountain and visited the old Dundas inuit village. And lastly, I visited Alert, the Canadian base, located only 817 km from the North Pole.

Around Thule Air Base
Around Thule Air Base

Other posts on Greenland:
Doctor in Greenland – the basic facts.
Doctor in Qaanaaq: 24 hours on call.
The doctors visit to Siorapaluk, the northernmost settlement in Greenland.
24 hours in Nanortalik.
Visiting Alert, the northernmost permanently inhabited settlement in the world.

A photogallery of my time as a doctor on Thule Air Base is available on flickr.