1 Problem solvers Læsø is Denmark’s smallest municipality. Unlike some other remote areas in Denmark Læsø can still maintain a relatively high level of infrastructure. But the future is uncertain. by Natalie becker
Læsø is an island in the North of Denmark and it is Denmark’s smallest independent municipality. Starting from the work of the general practitioner Gunda Bech Nygaard on the island and the question of the medical infrastructure in a remote area the reportage explores the living conditions of this island. The infrastructure today is still quite good for a remote area, but it is obvious that the community will face the challenges in a few years because of the demographic development.
Text of Problem solvers
ProblemsolversLæsø is Denmark’s smallest municipality. Unlike some other remote areas in Denmark Læsø can still maintain a relatively high level of infrastructure. But the future is uncertain.
by Natalie becker
When the last ferry has left the helicopter is the only way to take an emergency patient from Læsø to the clinic in Aalborg or Hjørring
It has been a long day, Gunda Bech Nygaard and her hus-band Lars drive through the low evening sun from Gun-da’s clinic in Byrum in the centre of Læsø to their home in Vesterø. Normally she works together with her colleague Niels Thøgersen, but this week he has a week off and she is the only doctor for the 1839 Læsø residents plus the tour-ists, who visit the island. When they reach the small town of Vesterø Gunda’s cell phone rings. It is a patient, so Lars turns the car around and drives back to the small clinic „Lægehu-set“ next to the church in Byrum.
The patient is a 23-year-old young woman who temporar-ily works on a farm on the island. She had severe abdominal pain since 4 pm in the afternoon. Now it is almost 10 pm and she is very nervous. Gunda first suspects a peritonitis or ap-pendicitis. She examines the woman’s stomach, takes a blood test and a urin sample. There are no signs of an infection, the reason for the pain remains a unclear. Gunda gets some paracetamol from the wooden medicine cabinet in the hall-way and writes down her phone number for the patient. But the woman does not feel well at all, she gets dizzy when she tries to get up. So Gunda tells her to lay down again while she phones the specialists on the mainland and the ambu-lance.
Out in the Kattegat
Very short after this two falck men arrive with an ambulance van and drive the patient and the doctor out to Læsø airfield where a large helicopter just landed. It is a helicopter from RCC, the Danish rescue coordination centre. The helicopters that come out here to Læsø have to have stronger engines
than the normal rescue helicopters because they have to fly accross the sea in every kind of weather. It is 10.50 pm and almost dark when the helicopter lands. Together they move the woman from the ambulance van into the back of the he-licopter. The load noise of the rotors stirrs up hot air on the empty and dark air field. The two falck men watch the he-licopter take off. Finally Gunda and the falck men get to go home for the day while the helicopter takes the patient to the abdominal department in the hospital in Aalborg.
Six people work for falck on Læsø in three teams with a paramedic and a driver in each team. With the helicopter it takes just about 15 minutes to get to Aalborg. During day time when the ferry sails, the falck ambulance would take the patient on the 90 minutes trip with the ferry to Frederikshavn and then another ambulance would take over for the 70 km drive to the hospital in Aalborg or 35 km to the hospital in Hjørring. For a patient who has to go to the hospital for an examination that is at least a day trip.
„If I would have been on the mainland, I would have told her just to go home and take some painkillers and phone me if she got worse, but I couldn’t do that here, not if she is alone and feels so bad“, Gunda explains later on. She likes to work in a small community and know all her patients. Like many professionals on the island she has many years of ex-perience. After working in a hospital in the beginning of her career, Gunda worked in small communities in Norway and Iceland. The economic crisis in Iceland forced her to return to Denmark four years ago. „You need to have experience to be out here, there are a lot of quite hard decisions you have to make and so I completely understand that young people don’t want to work here at least not on their own“ explains Gunda.
Gunda Bech Nygaard with emergency patient
“You need to have experience to be here, there are a lot of quite hard decisions you have to make.” Gunda Bech Nygaard, 63
Anker Juul Strøm and Thomas Birch Johansen work for falck on Læsø
“I don’t know yet what I want to study, but I don’t plan on coming back”Sarah Seip, 15
Læsø girls’ soccer team One of the three houses is for sale, like many houses on Læsø
All is there – but for how long?
So far the infrastructure for the about 1839 residents on Læsø is rather good, and everything can be reached easily. There is a kindergarten, a school up to grade 9, one priest for three churches, a library, a free bus, supermarkets, a cinema, good sports facilities and an elderly care centre which has received awards for its quality. There are two resident general prac-tioners, two physiotherapists, a dentist, a midwife as well as many nurses and social and health care assistants.
However a change is about to come. Since the last veteri-narian retired a couple of years ago no new one has been found. The priest is retiring this year. Both general praction-ers, the midwife and the dentist are elder than 60 and about to retire in the next few years. It will be up to the municipal-ity and the region to decide which positions they can keep up. And they will have to find someone who wants to work there. Tove Veiss who has worked as a midwife on Læsø for the last 6 years only has half a job as a midwife and for the other half she works in the geriatric care.
This seems symptomatic. On the island Læsø people tra-ditionally give birth at home, but with so few children being born it is not sure if the municipality will hire a new midwife after Tove Veiss will retire in 2015. She says in 2012 eight new Læsø residents were born. At the same time the number of residents over 60 years is above 800.
Except of some of the nurses, all medical professionals and a number other persons in important positions in the commu-nity are not originally from the island. While the elderly care centre ranks very high in standard the school ranks low. A lot of improvement has been done and teachers do what they can, but being the only school on the island they have to inte-grate all children. Teacher Søren Schmidt is very happy with his grade 8 class because all 15 students are almost at the same level. „But you can meet classes with 2-3 years between the best and the last. It is very difficult“, he tells, „we are sup-posed to teach every student after their specific needs. But in practise it is more or less impossible“.
The island’s youth needs to leave the island after grade 9 to continue their education. Today’s teenagers don’t plan on coming back. 15-year-old Sanne wants to become a doctor or a midwife and her classmate Lærke plans to train as a nurse. These professions are needed on the island, but they don’t want to return to the island after their education. They plan to work on the mainland. People who stay mostly only have a rather low qualification, that is especially the case with the elder generation. Many elderly people tell that it just wasn’t necessary to go away to get an education because in the past you could just start work somewhere on the island. So many people have a low level of formal education.
16-month-old Elias Poulsen sleeping during a meeting of the mothers’ groupOne of the three houses is for sale, like many houses on Læsø
In the old days
Many elderly people tell that it just wasn’t necessary to go away to get an education because in the past you could just start work somewhere on the island. So many people have a low level of formal education. Richard Sørensen came to Læsø in 1946 with his family when he just turned 18. It was normal for a teenager to just help on the farm, so he did not do an apprentice ship. On Læsø he became a fishermen, who went fishing on the boat of his father-in-law. Having a small number of minks was also very common on Læsø. So he had a few minks and later took over the mink farm from his father-in-law. Today three of his four children have left the island. „The island is nice for pensioners, but children need to go where they find work“, says Richard Sørensen.
In the past that was not a problem because there was al-ways someone who had work when his friends or relatives were looking for work. Islanders just needed to be creative and have a network of people. Stanly and Ida Thomsen are 75 years now and lived on Læsø for their whole life. The list of jobs they did is long including driving an ambulance, or a garbage truck, or a bus, having a mink farm, working in a spinning mill, or in different restaurants, having a renovation business and a taxi business. They still run their renovation business today even though they are pensioners. „I don’t think about moving from here“, says Stanly Thomsen, „my children also live here on the island, and the grandchildren and great-grandchildren live on the mainland.“
There is a strong sense of community which holds some of the families here. „Out of the 38 students I went to school with 9 are still on the islands“, tells 38-year-old Susan Poulsen. However her 14-year-old daughter Amalie goes to grade 7 together with 20 students and her 12-year-old son Ulrik only has 11 classmates. When the youngest brother, 16-month-old Elias, will start school, he will be in one class together with grade 0 to grade 2. The Poulsen family is happy to live here anyway, both mother Susan, who works for the school, and father Erik, who is a fishermen, grew up on Læsø and don‘t want to miss the peaceful island life and the friendly com-munity. For the children it is soccer that holds them together. Amalie is the keeper in Læsø‘s girls soccer team. Almost all children and teenager on Læsø are in the sports club and most of them play soccer. It keeps them together. There are nine girls in the girl’s soccer team. To compete in tourna-ments with a 7-player-team they need to stick together.
Other families see the island more critical. Jeanette Ram-tung and Tonie Larsson have moved to Læsø because they liked the island so much and to be closer to Jeanette’s moth-er who had opened a gallery on Læsø. It was a dream of a peaceful island and wonderful nature. Tonie was lucky to find work as a cook, but now that they have 10-month old Ol-ivia they also realise the downsides of island life. They wish for more oportunities and choices for their daughter. By the time Olivia starts school they want to live somewhere else.
Stanly and Ida Thomsen, 75
„I don’t think about moving from here“Stanly Thomsen, 75
9Richard Sørensen, 85
Læsø forsamlingshus Bus stop between Vesterø and Byrum
10Jeannette Ramtung with daughter Olivia
The most difficult thing about Læsø is finding work. When new professionals move to Læsø for work they either need to be single or the spouse also needs to have a profession suit-able to find work on the island.
There are some jobs in the fish industry, in the elderly care, in the municipality and in tourism. The proportion of unem-ployed Læsø varies widely due to seasonal work. „There can be 150-160 people unemployed during the winter, while in the summer months only around 40 people are unemployed“ tells Lena Sterner from Læsø job centre, „the largest employ-er in Læsø Læsø municipality itself. As a young person, it can be difficult to find full-year employment on Læsø, especially if someone has a low qualification, and then it depends a lot on what qualification some has.
Læøs has one of Denmark’s lowest levels of education. It is possible to get an apprenticeship in a craft, in sales, as a secretary or as social and health care assistant here on Læsø. The profesionals Læsø currently needs are for example a vet-erinarian, a biologist, educators, nurses and social and health care assistants.“
“Læsø looked like a perfect paradise to us, but later I want my daughter to have more opportunities and choices”Jeannette Ramtung, 30
Læsø is aging
The prognosis of population figures for 2025 prospects 57 children under 6 years, 102 children age 7 to 16 years, 44 young people age 17 to 25 years. 455 residents will be be-tween 26 and 59 years old and 800 elder than 60 years. That make a total of 1458 people. Many people choose to retire on an island like Læsø, therefore the number of seniors stays high while all other groups are decreasing. As long as the infrastructure is kept up as it is now or as long as the people are rather healthy it seems perfect to live on such a peaceful island with lots of nature around. The island is very attrac-tive for people to get a summerhouse there and make it their permanent home once they retire.
Nobody can tell exactly where the threshold in population figures is, that a municipality needs to function and to pro-vide the people with what they need. Plans are made how to create more employment on the island, but only time will tell if the population pyramid can be kept in balance with so many seniors and so few young people.
Gunda Nygaard won’t be on Læsø anymore by then. She will retire in 2017 and move away from the island, but her mentality will remain because it is typical and very necessary for people working in a remote area: „We are problemsolv-ers. We just think how to solve the problem, we don’t think always about the exact rules. We just solve the problem.“
Tonie Larsson and Jeannette Ramtung with daughter Olivia