Nurse, farmer, mechanic, ... by Natalie

Nurse, farmer, mechanic, ... by Natalie Becker 2

Only a few of Denmark’s small islands still have a resident nurse or doctor. The island Lyø still has a nurse, at least until Hanne Windeleff will have to retire in 2015.

nother quiet day on the island Lyø begins. But just as Hanne Windeleff sits down at the breakfast table with her husband, the cellphone in her pocket rings. One of her neighbours is ill. In the elderly couple’s bathroom, Hanne tests the urin sample with a test stick and confirms the suspected urinary infection. She phones Doctor Kensmark in Faaborg. As the patient’s wife still has antibiotics left over from a recent infection, Hanne asks the doctor if he can start with that today. The doctors agrees and prescribes more antibiotics. He will send an order to the pharmacy in Faaborg to have the medicine sent to Lyø by ferry. The patient can later pick it up at the little shop on the island. At the kitchen table, Hanne

e xplains to the patient how to take the medicine, chats a bit and returns to her house. Without a nurse on the island, the patient would have to travel to Faaborg, which takes between 30 minutes and one hour, depending on the route the ferry takes. Hanne Windeleff is 67 years old and has been the nurse for Lyø’s about 100 residents since May 2005. She grew up on a farm on Møn and was trained both as a farmer and a nurse. Later, she worked on her farm, in a hospital and in a nursing home. However, after she injured her legs, she had to give up farming. At the same time, the island Lyø was looking for a new nurse.

“Even the smith calls the nurse if he doesn’t know how to fix an engine”

Elise Hansen

“Here on Lyø, I have many small jobs”

“The municipality hired me for 20 hours per week to work as a nurse. But here on Lyø, I have many small jobs, like being the librarian, looking after the church, helping my neighbour milking the cows and driving a horse carriage for the tourists in summer,” says Hanne. The house “Damgaarden”, has become her office, her home and a community centre, where the islanders meet in different clubs. Everyone knows Hanne and appreciates her talents. “Even the smith calls the nurse if he doesn’t know how to fix an engine”, says Elise Hansen, a long time resident of the island Lyø. Monday is the busiest day of the week. Hanne puts on her nurse’s vest and the red jacket of the Faaborg-Midfyn municipality. She loads her bag on the 4x4 to take a tour of the island and visit her patients. With the medicine scheme from the doctor she sorts the different pills that her patients have to take into little boxes for each day of the week, divided up in „morning“, „afternoon“, „evening“ and „night“. It is a routine task, just like taking the patient’s blood pressure, a routine that gives the patients the good feeling that someone is looking after them. Hanne visits those patients whose doctor decided that they need regular care once a week or every second week. That is the work the municipality pays her for. However as it does not fill out the 20 hours, she also works in Faaborg one day per week. Hanne enjoys the chance to meet her colleagues one day a week, but she also doesn’t mind working alone on the island. Officially, only the people on the municipality’s „visiting

list“ are Hanne’s responsibility, but as the only nurse on the island, she helps everyone who needs her help. Most of the year, it is very quiet on the island. If the islanders call Hanne, they really have a problem. Life becomes more busy for Hanne in summer when 40,000 guests per season visit the island. They need the nurse’s attention a lot more often than the islanders, for bee stings, sunstrokes, when they are injured from falling off a bicycle or getting hit by a minigolf club. She is there to give first help and to call 112 for a helicopter in cases of emergency, when there is no time to transport the patient to the doctor in Faaborg or the clinic in Svendborg by ferry and car.

It makes you feel safe

“To have a nurse is an important factor for the island,” says the island’s chairman Rasmus Andersen, „for the families, the elderly people and for the tourists. It just makes you feel safe to know someone is close who knows what to do in an emergency. But it is going to be hard to get the municipality to say yes to hiring a new nurse when Hanne retires, because the neighbouring island Avernakø does not have a nurse anymore since 2006, and somehow they get along.“ The numbers of nurses and doctors on small islands have decreased in recent years, just like the numbers of teachers and priests. Out of the 27 small islands in the Association of Danish Small Islands only six islands still have a resident doctor, and a few more have nurses. Tunø

has a doctor in the summer and will have a new nurse who starts in April 2013, after they did not have a nurse for the past two years. The Danish Health Act states in § 138 that the local council is responsible to provide free home care on doctor’s orders to persons residing in the municipality. „It is the regions’ responsibility to maintain a good health care system, but there is no requirement that it has to be done in a certain way, as long as it meets medical standards. People are therefore not entitled to uniform treatment throughout the country“, explains Caroline Adolphsen from the Department of Law at Aarhus University. Young families move away from the islands or choose i slands where the ferry only takes a short time. Lyø has about 60 percent of residents elder than 60, according to Lyø’s chairman Rasmus Andersen. It is a general trend. The percentage of elderly people on the islands is increasing faster than in Denmark’s population in total. The aging population demands more care by medical professionals, but the question is where this care should be given. While the island Laesø has a very well equipped care system with two general practitioners, a nursing home, several nurses and a dentist, most municipalities can’t afford to invest in such good care for smaller islands. Most general practitioners on small islands are over 60 themselves. For Lyø it will be 2015 when Hanne turns 70 and has to retire. It is not certain whether the Faaborg-Midfyn

Hanne Windeleff

unicipality will hire a new nurse again and it is also a m problem to find a nurse who wants to live and work on the island. “It is a rather special position, so it’s difficult to find someone who has a broad experience and can imagine to live and work on an island. You can’t just go to the cinema here, whenever you like,” explains Hanne. The people living on islands without a doctor or nurse had to adapt to the situation or move away. „Most of the islands have an emergency response group of volunteers who help their fellow citizens in case of accidents or sudden illness until the helicopter arrives,“ explains the chairman of the Association of Danish Small Islands Kjeld Tønder Hansen. There is a general lack of medical professionals in remote areas not only on small islands, says the Danish patients organization „Danske Patienter“. They point out that there is a need to find solutions to secure good access to health care throughout Denmark. This may include solutions like telemedicine and more flexible ways to own or hire a clinic, in order to attract young doctors and nurses to remote areas.

Remote controlled

The general practioner Lars Kensmark works in Faaborg. He does not live or work on an island, but he came up with an idea that can be part of the solution to ensure health care on small islands. As the laws on access to medicine were tightened, nurses

“It just makes you feel safe to know someone is close who knows what to do in an emergency”

Rasmus Andersen

are not allowed to store certain medicines like antibiotics, antihistamines and strong pain relievers anymore. So he invented a remote controlled medicine cabinet. There are two of them now, one on Lyø in Hanne’s office and one on the island Avernakø, where a group of citizens was trained to operate the medicine cabinet in case of emergency. During week days, Hanne Windeleff can call the doctor in his office and have medicine shiped to Lyø by ferry. But if there is an emergency at night or on a weekend, she calls Lars Kensmark on the cellphone. He decides about which medicine is needed and gives Hanne an access code that she uses to open the medicine cabinet. For his helpers on Avernakø, and for Hanne’s two helpers on Lyø, who are no medical professionals, there is a smart phone in the cabinet to send a photo of the medicine to

Lars Kensmark so he can double check that the patient receives the right medication. Two times a year he comes to the island himself to check the supplies in the cabinet. To stock up the supplies in the time between, the doctor can also send the medication by mail. This way, Hanne receives a small envelope from Lars Kensmark with a new box of penicillin. She calls him to get the access code to the medicine cabinet. Antibiotics are in the second drawer. She punches in the numbers and the drawer opens for her to put the package inside. As she closes the drawer Lars Kensmark locks the medicine cabinet again by remote control. That was the last thing on her list for today, unless someone calls her.