The city of Stockholm has a silence to it. Created by quiet streets frequented primarily by pedestrians, ancient buildings that seem to absorb sound into their storied bones, and a light breeze that ruffles the numerous green trees and carries excess sound away over the Baltic Sea. A peaceful place to call home, especially during the seemingly endless days of summer. And I do mean endless. When I arrived in early June, I was welcomed by a warming sun that rose at 1:30 in the morning and then just sort of hung there, lazy-like, for about 23 hours. A true midnight sun, beautiful, eerie, and utterly confusing to my jet-lagged mind.
With my workday schedule varying between the research lab at Karolinska University Hospital, visits to the hyperbaric medicine chambers, and shadowing with my mentors in the ICU, the endless daylight hours allowed me to wander the city after work. Taking advantage of the extra daylight (and likely recovering from its inverse in the winter months) the streets were filled with people enjoying the restaurants and parks late into the evening. I fell into a habit of late “night” walks, exploring a city that has housed inhabitants since Viking times, a span of years that I struggled to wrap my head around at times. Sweden is truly a beautiful country, and the architecture of Stockholm reflects the natural beauty of the islands that are its foundation. With crenellations and meringue-shaped domes decorating the towering spires of the old town, the city appears frosted, and with the smell of cardamom and cinnamon wafting from the open doors of bakeries, mixed with the ubiquitous European cigarette smoke, the experience of Stockholm can be borderline confectionary.
One of my favorite things about moving to a new country is the opportunity it creates to relearn the foundational activities of daily living in a different way. How do you… bathe, get from point A to point B, acquire, cook, and preserve food, keep warm, wash your clothes…the same basic behaviors of life, done differently, often in a way that reflects the ecological or historical setting of the place. The degree of difference can range from subtle to shocking but it’s universally interesting. During my time in Stockholm, I was struck by many such differences. From the way people get around, (in the words of one kind gentleman who assisted this lost American with directions, “it is best to go by feet”), to the way food was historically preserved that persists culturally into the present (salty, salted, salt-cured, salty, salt, salt fish), to the way clothes are dried (in a mysterious sauna-like box), the experience of rediscovery was everywhere.
Beyond these smaller differences, I was also struck by larger shifts in the structure and pace of Swedish life. Famous for its nationalized healthcare and excellent paid family leave policies, (new parents get 18 months!!) I was struck by the ways Sweden has not only subsidized healthcare but actively subsidizes health. I got most of my exercise in beautiful (free) outdoor gyms made from tree-size lincoln-logs (with skinny-American and Viking-sized options available). I walked an average of four miles per day just getting to and from work, and the public transportation system is deftly designed to support a car-free lifestyle. Swedish grocery stores are much smaller than in the US, and there is significantly less of everything inside. This is likely because most people walk to the grocery store, but I was also surprised by the effect it had on my mental health. During my first few days in Stockholm, I needed to buy soap. I went to the store and found, to my surprise, that there were only two kinds. Pink, or blue. I chose blue and moved on. It may have been pet soap for all my understanding of Swedish at that point, but the stress-free shopping experience stayed with me. The subsequent boomerang effect when I found myself at Vons upon returning to San Diego, facing down an aisle with 40 different kinds of cereal flashing mystifying marketing slogans like “made with real* strawberries”, was decidedly unpleasant.
Prices were also different. Alcohol, tobacco products, and processed foods were significantly more expensive, and in the case of alcohol, highly regulated. Fresh produce was almost frighteningly cheap, in part due to something called the value added tax, which is a taxation program that raises the cost of highly processed food while lowering the cost of fresh fruits and vegetables. This policy is a stark contrast to the US, where the government subsidizes companies like Kraft and General Mills, companies which heavily process crops into cheap, nutrient-poor foods that are directly implicated in the American obesity epidemic that so disproportionately affects those who already struggle to afford healthy food. Observing the way structural changes in policy can affect the way health is experienced within a population was one of the most valuable takeaways from the summer, and it made me rethink many tenants of American healthcare that I had previously accepted at face value.
During my last weekend in Sweden, one of my colleagues from the research team was kind enough to invite me to visit her family in the Swedish archipelago. I was welcomed with one of the most delicious meals I’ve ever had: hand-foraged chanterelles, crayfish, and incredible hospitality that included an after-dinner session in the “bastu”, or sauna, interspaced with freezing cold dips in the Baltic sea.”
I am deeply grateful to have had the chance to study and work abroad within this particular historical moment, in the context of a foreign healthcare system during a global pandemic. Sweden is a beautiful country with a long and storied history, and the kindness and hospitality of its people were overwhelming at every turn. I cannot wait to go back, and I already miss the incredible people that welcomed me so warmly into their lives.
Working alongside an amazing team of dedicated, curious, creative scientists and physicians to develop new insights into the disease that has shown us just how connected we are, I am reminded that every nation and culture has something to learn- and something to teach. The more I learn in this field the more I realize that global health is a team sport, a collaborative exchange collectively working together towards a healthy globe. Gaining experience of other cultures’ approaches to pursuing health, both individually, and collectively through policy and governance, feels like a crucial piece of the puzzle, and I’m grateful to be part of a program that offers medical students the opportunity to experience this so early on in our training.