20.11.2018: This year, 40 years have passed since a total reform of Italian psychiatry took place. How has it progressed and what can we learn from it? In line with the recommendations from the World Health Organization (WHO), Norwegian psychiatric services have become increasingly decentralised over the last 20 years (1). Service provision at the district psychiatric centres (DPS) and in primary care units has been expanded, while the number of inpatient beds has been reduced, all according to the Opptrappingsplanen for psykisk helse [The escalation plan for mental health] (1998–2008) (2). According to...

13.09.2018: How key leaders in the effort to eradicate smallpox, and an international group of ophthalmologists, created a unique pioneering project for prevention of blindness in Nepal, to which Norway made an important contribution. Variola, known as smallpox due to the appearance of the typical pustular rash, has been the cause of fatal epidemics for thousands of years (1). From the early 20th century to when the last case of smallpox was detected in 1977, the disease had killed between 300 and 500 million people (2),(3). In 1967 more than 10 million people were infected and 2 million deaths were...

05.03.2018: Around half of the births in Nepal take place with no trained birth attendant present. Maternity waiting homes, where mothers with high-risk pregnancies can stay during the final period before their due date, can make it practically possible for more of them to give birth in hospital. The measure is particularly beneficial for young, primiparous women. Is it medically prudent to give birth at home? This topic was recently debated in the Journal of the Norwegian Medical Association (1). In this article I wish to provide some perspectives from a rural district in Nepal. Viewed from here, the...

03.11.2015: The migration over the Mediterranean has developed into one of the deadliest sea voyages of our age. Cynical people-smugglers are sending migrants into a predictable maritime distress situation on a daily basis. In summer 2015 I served as a ship’s doctor on the vessel MS Siem Pilot, assisting in the search and rescue of migrants left helpless in the southern Mediterranean. I have previously shared my experiences of medical work in Afghanistan (1, 2) and Syria (3) in the Journal of the Norwegian Medical Association. The tragedy now unfolding in the Mediterranean has left an even deeper...

06.10.2015: The global shortage of qualified health workers is particularly severe in low-income countries. The experiences from the recent Ebola outbreak in West Africa demonstrate how lack of capacity and fragile health services may rapidly have global consequences. Long-term, joint efforts to develop robust and well-functioning health systems may also be a source of learning for high-income countries such as Norway. International, institution-based cooperation in postgraduate training for doctors can unite solidarity with mutual benefit to society. The Global Health Workforce Alliance and the World...

24.03.2015: In October 2014 I underwent cataract surgery at Geta Eye Hospital in western Nepal, performed by eye surgeon Suresh Raj Pant. The reason for choosing this somewhat exotic location for my operation lies in the impressive priority the Government of Nepal has placed on eye health, and a hospital which is an example of successful Norwegian medical cooperation over a period of 30 years. Nepal is one of the poorest countries in the world, half the size of Norway with a population of 30 million, one quarter of whom live below the poverty line (1). In 1980–81, the WHO, together with the Nepalese...

11.11.2014: Chemical weapons are developed for the sole purpose of ruthless, blind, mass destruction. Technology and medical science are misapplied to destroy and terrorise society. A series of nerve gas attacks in Syria in the spring and summer of 2013 demonstrated a capacity and willingness to employ chemical violence in the conflict. In accordance with resolutions by the UN Security Council (1) and the Organisation for the Prohibition of Chemical Weapons (OPCW) (2), the Norwegian Armed Forces supported the dismantling of the Syrian chemical weapons programme in autumn 2013 and spring 2014. The Armed...

19.08.2014: Generous donors help provide local hospitals and health centres in the poor regions of the world with sophisticated diagnostic and therapeutic equipment. The users receive training in how to use the equipment, but maintenance and knowledge about the hazards of using electrical systems are not considered. Medical-technical equipment can thus represent a health risk to patients and staff alike. Tromsø Mine Victim Resource Centre (TMC), of which I am the director, has provided training in pre-hospital trauma care in the Battambang province in north-western Cambodia since 1996 (1). The province is...

01.07.2014: Mutilation and death are daily occurrences in the lives of many Afghans. The police are especially vulnerable. They will often be the first to arrive at the incident site after an enemy attack, and they are frequently exposed to violence themselves. As part of the Norwegian Police Advisory Team (NOR PAT) – the Norwegian Armed Forces’ police advisory contribution to Afghanistan – I developed a model for reinforcing medical preparedness in the police in Mazar-e Sharif in Afghanistan in the autumn of 2013. Norway’s military engagement in Afghanistan has been controversial, and in this article I...

01.07.2014: Injuries caused by gunshots, explosions and traffic accidents account for a considerable proportion of the clinical picture in Afghan emergency units. Competence in anaesthesiology is essential to reduce morbidity and mortality in the population of this war-torn country. For many years, Norway has helped develop the anaesthesiology department at the public hospital in Mazar-e Sharif through the so-called Anaesthesia Project. In the context of my work related to police health in Mazar-e Sharif (1) and in close dialogue with the Norwegian Defence Medical Service (FSAN), I took the initiative to...

20.08.2013: Task shifting is a topic not only in Norway. In Africa, training of other groups of health personnel to perform tasks that are traditionally within the purview of the medical profession represents an important contribution to the provision of health services for the population. The aid organisation CapaCare was founded to undertake capacity-building and training of health personnel in areas where health services are in short supply. Task shifting is not a new concept in Africa. Antiretroviral treatment of HIV positive patients has largely been undertaken by nurses and assistant nurses, and a...

06.08.2013: Ethics and human rights are core values in medical activity. Doctors may become involved in situations where they are at risk of violating human rights, or they may become subject to such violations themselves. In 1991, the Norwegian Medical Association therefore established its human rights committee, which remained engaged in a number of international projects until 2012. There were several reasons why the Norwegian Medical Association established a human rights committee in 1991 (Box 1). In some countries, doctors have been accessories to torture, in others they have actively opposed...

27.03.2012: Three years ago the Russian authorities built a hospital for cardiac surgery – the Astrakhan Centre for Cardiovascular Surgery. It was intended to serve a population exceeding 12 million inhabitants who previously had no access to cardiac surgery. Areas of unrest such as Chechnya, Ingushetia and Dagestan are included in the catchment area. Since the early 1990s there has been close cooperation within the field of cardiac surgery between the University Hospital of North Norway together with the Oslo University Hospital on the one hand, and City Hospital No1 in Arkhangelsk on the other (1) – (3)...

06.03.2012: Despite a difficult starting point, processes of change are underway in the health services of Mongolia. In April 2011, I had the opportunity to study at first hand the establishment of palliative treatment of cancer patients. My impression is that access to morphine and an emphasis on communication have ensured a better quality of life for terminally ill cancer patients. Cooperation between authorities, the national medical community and international aid donors has been decisive. Until 1990, Mongolia was closely linked to the Soviet Union. The last 20 years have been characterised by post...

06.09.2011: Climate change represents a serious health threat. There is still a possibility of reducing the harm to life and health if the global community agrees on effective measures for bringing about rapid and substantial reductions in CO₂ emissions. Many of the measures involved, like choosing cycling and vegetables rather than driving cars and eating meat, will also promote health. Measures necessary to combat climate change will therefore fulfil environmental as well as health objectives. Greater emphasis should be placed on the health aspect when justifying, designing and implementing national and...

23.08.2011: Psychiatry in Russia is dominated by large psychiatric hospitals and specialized open services, while the primary health and social services are underdeveloped and offer little in terms of treatment to people with psychological problems. This contrasts with the structure in Norway and many other countries, where mental disorders are more widely treated in the primary health services, and where the role of psychiatric hospitals has been reduced in favour of decentralized provision. Here, we will share some experiences from the Norwegian-Russian collaboration in the field of psychiatry. The...