Health post: Barriers to Business

Yesterday I had lunch with Martin, the CEO of JoiceCare (the company that bought the Giraff last year), to learn more about the company and why the Giraff is only in 6 homes. Martin told me a lot about the influence of Sweden’s government on budding businesses.

JoiceCare has to work with many levels of the government to develop a product. There are 21 counties in Sweden which have the main responsibility of maintaining public healthcare. Subdividing further, there are 290 municipalities in the country that oversee more lower-level government services such as schools and emergency services. JoiceCare has to work with the government on both the municipality and county level to introduce the Giraff as a healthcare product. Beyond that, there are various government agencies and laws that affect eHealth companies.

Once a Swedish citizen is 65 years of age or older, they have the ability to request any number of services available to senior citizens. They receive a menu of options, which might include three visits a week from a health professional, home delivery of certain meals, and perhaps one day, the Giraff. This is the only way to “sell” a healthcare product. Since healthcare is free for everyone in Sweden, no one would buy a 10,000kr Giraff robot outright. The government has to decide to buy it and then offer it to the people for free. (This explained my confusion about the cost of the Giraff). Thus JoiceCare has to convince the municipalities and counties that the Giraff is worth the investment and cheaper than the alternative, which is sending health professionals to visit homes in person.

Getting on the “menu,” and thus getting the Giraff in the hands of real users, requires an extensive process of submitting “procurements” to the different government groups. It is far easier to get a Giraff in the hands of a university. According to the government, that is simply a “project” that JoiceCare is doing, and projects require less oversight. These universities have the freedom to do experiments with the Giraff and assemble groups of test users, senior citizens who live with the Giraff for a certain period of time. Then the universities can follow up with these seniors and assess the value of the Giraff, gathering data and surveying the users about their experience. There are currently about 30 Giraff robots in universities in Sweden and other European countries, meaning that there are at least 30 of these test users.

This way, the Giraff is in more than 6 homes. However, JoiceCare is not allowed to know about these other users. Due to privacy laws, JoiceCare cannot know the users’ names, addresses, or particular illnesses. JoiceCare does not get the specific results of the university questionnaires, but rather generalized results and suggestions. With the company not able to perform its own testing, I can imagine that adding this extra step to product development contributes to a much slower revision process.

A few days ago, I had asked Dan what JoiceCare is doing to advertise the Giraff, and he said he wasn’t sure. I thought it was crazy that a product ready to be deployed wouldn’t be advertised. Now I realize that companies cannot simply advertise such products, especially in the healthcare sector. By building a product that will be offered by the government, JoiceCare does not have the authority to advertise or promote the Giraff to potential end users. The government will choose whether or not to make it available, and how to present it as a choice, and then the people have to decide. There are no ads in this “menu” of care.

So how easy is it to submit procurements to these government officials? Apparently it takes 6-12 months for one municipality (out of 290) to approve a submission from Giraff. Martin also explained some of the struggles of dealing with government employees in healthcare. They can be reluctant to try new things because if they get something wrong, thus potentially endangering lives, they will get fired. It is safer to keep one’s job by doing nothing at all.

There’s a lot more to this healthcare conversation and more that I learned from Martin, but that’s enough for now. It’s all far more nuanced than I expected. Tomorrow, I head off to the southern city of Malmö!

P.S. In my research about the government structure, I realized that there is a King of Sweden. This is probably obvious public knowledge, but for some reason I had been unaware. There is a whole royal family here, though as part of the constitutional monarchy they have very little executive power. (I checked, and all single princes in the royal family are under 2 years old – shame!)

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Frolfing around

The other day I played frisbee golf, or “frolf,” with Lisa in Slottskogsparken, a huge park here in Göteborg. This must be the city’s version of Central Park; at one point, I got a glimpse of seals basking on a rock in the park’s zoo. There’s also a natural history museum nearby. I’ll have to check out both at some point.

When I played frolf at Swarthmore, it was very casual. We would walk around campus at midnight tossing discs at lampposts, bushes, and other random campus landmarks. At Slottskogsparken, there is a real frisbee golf course set up with 18 “holes,” baskets designed to catch small discs (smaller than the regulation discs we used on the Ultimate team), and marked teeing grounds. We walked through a decent amount of the park doing this course, running down boulders to catch wayward discs and hitting the occasional tree. It was a blast!

I’ve also done a bit more exploring of Göteborg along the main boulevard Avenyn, which ends with Götaplatsen, the “cultural square” of the city.

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There is a “Green World” project happening this summer along the Avenyn, in which various companies and student groups have designed pop-up parks to exhibit green living in the city.
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One of the pop-up parks focused on the benefits of honeybees.
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From inside a pop-up park, I saw a walking protest group clamoring in favor of an open border policy. They had a shouting match with a bunch of guys at a pub on the street who were clearly against such a policy. The two groups kept flipping each other off. I don’t know where I would stand on the issue as a Swede, but it was tough to see such aggression from both sides of the debate.

In the Götaplatsen you will find Konstmuseet, the main art museum of the city. I was wrong about Stadsmuseum earlier; this is the city’s Met.

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The Konstmuseet (literally “Art Museum”) is straight ahead.
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Naked Poseidon statue outside the Konstmuseet. At the time of his unveiling in the 1930s, scandalized Swedes demanded penile-reduction statue surgery – unfortunately, it’s quite obvious up close!
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I was happily surprised to see a Calder mobile in the Konstmuseet sculpture hall. It reminded me of the one we have on Swarthmore’s campus.
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Not the type of Picasso work I’m used to seeing, but beautiful nonetheless.

The annexed Hasselblad Center also had an interesting exhibit on surveillance photography.

I also visited Röhsska, Göteborg’s design museum. It was a quick, fun museum, with the main exhibit chronicling design trends from 1850 to the present. I learned that I apparently like postmodernist design (or, funky stuff from the ’90s).

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Cute ceramics in honor of Swedish designer Stig Lindberg’s would-be 100th birthday.
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This is the exact same kettle we have at home! I love it. You can see me taking the picture in the reflection.
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I was saddened to see that the original iPhone (2007) is now considered old enough to be in a museum.
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Exterior of the Röhsska museum. To the left, you can see the trunk of a pink Mini Cooper parked out front. I suppose when you work at a design museum, you have to drive a distinctive car!

Finally, I had been seeing “kanelbulles” all over Sweden and finally had to try one as a mid-adventuring snack. As it turns out, they are cinnamon rolls – though according to Wikipedia, Swedish kanelbulles have a distinct flavor due to cardamom in the dough. Also, the complete lack of icing distinguishes it from an American cinnamon roll!

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I had this kanelbulle at a 7-Eleven. Next I think I should go to a real bakery to have one, served warm!

Health post: Giraff

Yesterday I had my first official project meeting. I went to the offices of Giraff Technologies here in Göteborg, in an industrial area away from the center of town, to see the robot they have designed. This company is the first connection I made when applying for the Watson Fellowship. In response to Sweden’s large aging population, Giraff made a robot to live in the home of elderly people and serve as a caregiver. This allows the elderly to maintain their independence for longer without having to go to a full-service home.

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At this point I was worried that  I was trespassing! There are a lot of small tech companies in these industrial buildings.

I spoke with Dan, the acting project manager and programmer for the new-and-improved Giraff that will debut in 2017. This is the current version:

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The Giraff is a standing robot on wheels, meant to imitate a human. Whoever is remotely controlling the Giraff is able to video-conference through the main screen, so it is as though they are in the room.

The Giraff robot is a way for someone to virtually enter the home of the elderly. Dan explained that it is made to be very simple and easy to control by the nurse or family member on the other end. For example, you might get a Giraff for an aging family member and put it in their home. Then you could call that family member through the Giraff. If they accept the call, you can Skype with them while following them around the house.

This requires learning how to “drive” the Giraff using a computer program. There are 3 controls: where the Giraff is looking, the tilt of its head (it can be angled to look down or up at things), and location. The Giraff’s camera allows you to see the person you’re caring for as well as your general surroundings. By holding down the mouse in the map of the room, you can move all over the space. It’s fairly easy to drive the Giraff and the program is simple enough to learn in a couple minutes. I tried driving the Giraff myself, which was a bit odd as I had it coming towards me!

The Giraff is less common than I expected; it’s currently living in 6 homes. A couple of those homes are in Italy. The rest of the Giraff robots are in universities around the world, where students are analyzing their capabilities and usefulness. I would love to talk to a student who has studied this robot. I’m curious how Giraff Technologies has been attempting to expand and encouraging more people to adopt this robot; I’m sure it would have something to do with cultural attitudes towards medical technology. Dan wasn’t sure, but mentioned that one of the main challenges of getting Giraff into the home is that before someone considers it, their doctors, family, and friends alike have to be convinced that it is a good idea. It requires effort from all parties.

Near the end of our interview, I asked Dan to compare Sweden and Italy in terms of ease of getting people interested in the Giraff. Though it’s a sweeping generalization, I wanted to know if one country seemed more receptive to the Giraff than the other. He thinks that Sweden is more receptive because there is more contact with technology in general here. No matter what age people are, they are connected. “I was in Italy 2 weeks ago,” he said, “and you see a lot of elderly people don’t care about smartphones or tech like that. Here in Sweden, a lot of people use technology. It’s a mindset.”

I still have questions about the user testing aspect of Giraff’s development. I want to know how, if at all, the creators of this robot included public opinion in their design. I’m meeting with the owner of Giraff Technologies tomorrow for lunch, so hopefully I’ll get answers to these broader questions then.

Finally, Dan mentioned the small city of Västerås, where Giraff has another office. I had read about it last year when I first researched the Giraff and assumed it was pronounced as written – “vas-ter-as.” When Dan pronounced it, I realized that I had ignored the accents. It’s actually pronounced just like the main fantasy land in Game of Thrones – “Westeros”! That was a thrilling moment.

After a week

It’s been over a week now since I arrived in Göteborg, though I think it feels much longer since there has been so much that is new. I’m starting to love the apartment I’m staying in, the easy tram access to the rest of the city, and the long walks I take every day. In a few days, though, I’ll pack my bags and head south to the city of Malmö. This reminds me of my Watson interview, when I asked my interviewer what the most difficult aspect of his Watson Year was. He said it was the transitions – “finally getting settled in a place, only to uproot and move to the next.” I’m beginning to see why.

I’ll do another project post tomorrow, but in the meantime here are some photos that I haven’t had a chance to put up yet. The night before I left New York, one of my best friends told me to use my camera as my reason for being somewhere. I might have nowhere to go and no one to see, but if I’m wandering the streets with a camera, I can be an artist, a journalist – I’m going somewhere to see something. I’m on a mission to capture moments, which isn’t the same as being touristy. He told me when I’m alone, without big groups and away from national monuments and museums, my camera will be my guard. While I do feel awfully like a tourist sometimes (especially in the national monuments and museums!), I like thinking about what he said and feeling like I have a purpose when I record these moments.

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This is Feskekörka, the “fish church.” It’s a famous destination in Göteborg.
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Statue outside Feskekörka.
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Inside Feskekörka – there was some very fancy fish here!
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I met up with Lahod and Georgiana again the other night and tried an elderflower cider. You can see a bit of Lahod in the background!

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Not sure what this store is doing in Sweden – it reminds me of an east coast shore in the US.

I had read about the Saluhallen market, which is open every weekday in the heart of the city. I was looking for an outdoor green market, trying to see if that was a healthy and/or organic shopping method popular with any Swedes. This was the main result of my search, and to my surprise it was not at all like the farmer’s market I was imagining. First of all, it was indoors.

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Entrance to Saluhallen.
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A few of the shops inside Saluhallen. The whole market looks like this.

What I found inside was less like a green market and more like Reading Terminal Market in Philly, only smaller and more uniform. Perhaps it’s a bit like the food court in Grand Central Station in NYC. There were fancy lunch stations and butchers and fish spreads and bakeries. The closest thing I found to a green market was a group of stands just outside Saluhallen, selling a ton of flowers and a few berries.

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There’s also a sad bunch of carrots in a stall close to this one.
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I kept wandering to find an old-fashioned chocolate store in an adorable square nearby.
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Also in the center of Göteborg is Nordstan, a huge mall and by far the city’s largest shopping center.
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I found this in a bookstore in the mall, and I thought it was hilarious! Perhaps Sweden is too fashionable for Where’s Waldo?

Swimming and swinging

In the past few days, I’ve done two things I never expected to do in Sweden: I went swimming in the ocean, and I went swing dancing!

Apparently the Gulf Stream reaches the west coast of Sweden, warming the water enough for swimming in the summer. On Sunday, I met up with one of my contacts here in Sweden, the lovely Lisa. We explored the Southern Archipelago of Göteborg, a string of islands reachable by ferry. We decided to go to Vrångö, along with tons of other people – it was a hot day, and the ferry was packed.

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The ferry Lisa and I took, docking at Vrångö.

After walking around a bit, Lisa and I stopped for lunch at a fish stand by the water. I had a flatbread wrap with fresh, smoky salmon and roe spread, and it was delicious. I finally realized that this is what Swedes do on summer weekends – they go to islands, and they eat fish!

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We kept walking until we found a little bay for swimming. A ton of people were in the water, and we joined them. Swimming in the ocean, in actual saltwater in a Scandinavian country, is not what I thought I would be doing this year. I’m so happy I decided to pack a swimsuit! It was glorious.

After swimming, we went to a cute ice cream shop. Lisa told me that it was a classically Swedish place and that ice cream is very popular here. I had seen ice cream (“glass”) shops everywhere but wasn’t sure if it was a big deal. I suppose ice cream is popular everywhere, especially on a hot day! At the shop we went to, they had flavors like “blueberry-vanilla swirl,” “licorice,” and “egg liquor.”

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I played it safe with coffee ice cream and mango sorbet. People started boarding the ferry home as we were trying to finish our melting ice cream.
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Storefront of the ice cream shop. This is the first building you see when arriving at Vrångö.

Next, the swing-dancing group in Göteborg! Through some Googling, I found a group called the “West Coast Jitterbugs” that has social dances every Monday night. I did some swing-dancing in college, so I considered going yesterday and figured out the 30-minute tram ride that would get me there. But I didn’t know anyone there, and I didn’t even know if you had to pay, and a big part of me wanted to stay home and watch a movie. That’s how I knew I had to check it out; if finding a dance that I loved here in Sweden meant going out of my comfort zone, well then, that’s what this year is all about.

I took the train out to an area of town I had never been to before and walked along a quiet street for 10 minutes. Eventually, I was surprised by a square filled with shops and restaurants. I found the West Coast Jitterbugs building, walked up to the door, and it was locked. I turned around to go straight home and get back on the tram, but I had come so far that I didn’t want to give up. I went back to knock on the door, and someone let me in and showed me the passcode for next time.

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A fountain in the “Doktor Fries torg” area – not what I expected to see after a long tram ride in the opposite direction of the city center.

Long story short, I was swing-dancing in there for over an hour! It was a blast. I think I danced with 6 or 7 different people, and they were all lovely. They were surprisingly good dancers – who knew the Lindy Hop would be so popular in Sweden? I was a bit rusty, and they kindly gave me tips. I even made a connection for my project by dancing with someone who works on medical technology as a chemist. Next Monday I’ll be in Malmö, but I hope to go to one of their social dances again.

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Hello from Vrångö! (taken by Lisa)

Weekends in Sweden

With the Watson, there is just so much time. I think that is a blessing that can manifest as a curse. Especially now, I have even more time, as many companies and stores are shut down for part of the summer – it is definitely vacation time in Sweden. That said, I can use this time to adjust myself, to get to know Sweden. I initially thought the Watson was so anti-tourism, but it’s not entirely so. The fact that I’m spending months in each country, thinking about sim cards and meeting locals and what time the library opens, already means that I’m doing something different than the average tourist.

But it’s also okay to do the touristy thing, as previous Watson Fellows gently reminded me after I reached out during my initial freak-out. Part of getting your bearings in each country is sight-seeing and learning about important areas and buildings. One walk – even a 10-mile one – isn’t going to cover all that.

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Feeling more like a local with this library card! It gives me access to free wifi all over the city.

I decided to spend the weekend being a bit of a tourist while trying to figure out what Swedish people do during the weekend. I found that many museums in Sweden are free if you’re under 25 years old. After walking up super late and having coffee at the super-hipster Café Biscotti, I decided to check some of them out. What do Swedes do on the weekends, anyway? First I went to Sjöfartsmuseet, the maritime museum with an aquarium.

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Ship models floating in the void – this was one of my favorite parts of the museum.

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When an octopus visits your living room…
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They didn’t have any fish for this tank, so they put water pokémon! Turns out Pokémon Go is just as popular in Sweden as in the US.

I highly recommend Sjöfartsmuseet – it was a blast. Next I went to the famous church Masthuggskyrkan, where I ran into a Swattie! I had heard that despite Swarthmore’s small size, graduates have a tendency to run into each other all over the world. I didn’t think it would happen so soon, and at a Swedish church no less!

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Masthuggskyrkan. “-kyrkan” means church. The inside of this church was fashioned to look like an upturned boat, with wooden beams all along the length of the concave ceiling.

My next stop was the city’s main museum, the Stadsmuseum. It was in the center of the city, with a very regal exterior, giving me the impression that it would be like the Met in NYC. Well, it wasn’t. Except for a dark, creepy Viking room, there wasn’t a whole lot of interesting things in this museum.

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When there’s nothing to do at a museum, take selfies with the old telephone props.

Luckily my trip to the Stadsmuseum got me to “inner city,” the center-city neighborhood of Göteborg, which I realized I had somehow missed before. It’s surrounded by the “moat,” a small body of water that separates the center city from the rest of Göteborg. It’s a mostly pedestrian area with fun shops and lively cafés and restaurants. I felt like I had finally found the Swedish people! The rest of the city had felt so quiet that morning. (Keep in mind that the population of the whole city is half a million, and probably fewer than that in the summer months).

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Found this hilarious tourist train in “inner city.”
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Tons of people waiting outside the Elite Plaza Hotel to see Bruce Springsteen, who is performing in Göteborg this week.
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I really can’t get over the cute trains here.
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I found the people! Check out this glitzy shopping center. I was telling a Swede about it later and she doesn’t like it.

 

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This is Homan – we shared a table under the awning at 7-Eleven when it started raining. I asked him what Swedes do on weekends and he said “Nothing! This city is dead!”

Lastly, I accidentally bought a rice pudding thinking it was yogurt, so I need to learn some more of the language!

Health post

Okay, I’m going to be honest – the other morning I woke up and freaked out about the Watson and my project. I had decided to start my day at this well-known café nearby, Röda Sten, and then they didn’t have wifi and there was no one there to talk to. My dinner plans for that night had fallen through, and I had already done my big walk of the city, so I was at a loss. Nothing to do, with 362 days left in the Watson? How was I supposed to move forward with no idea of what I was supposed to be doing, no plans, and completely no structure? I wasn’t sure how to ask strangers outright about their health and possible interactions with medical technology.

I’m still not so sure now, but I reached out to family and past Watson Fellows, and got some good advice. This will all take time. Perhaps I can start by simply observing. If I’m going to approach this project as a journalist, I need to be observant first. I need to get a big-picture idea of the Swedish lifestyle before I start asking specific questions. So, here are some things I’ve noticed so far.

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Street between my apartment and the waterfront.

There is a ton of green everywhere. Swedes seem pretty outdoorsy, at least in this lovely weather, and are taking advantage of the parks.

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Every street, especially all along the water, is split for pedestrians and bikers. People walk, jog, run, and bike everywhere.

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Here you can see that the right of the middle passageway is for pedestrians, while the left is for bikers. Cars and trams go on both sides of the passageway.

Bikes really are popular here.

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On the left, you see a regular bike rack. On the right, just further down the same street, you have the Styr & Ställ bikes, Göteborg’s city-bike system. If you buy a 3-day pass (under $3) for Styr & Ställ, you can use any bike for free for under 30 minutes. There are stations all over the city.

Next, there are a lot of McDonald’s around. I’ve also seen a couple Burger Kings, Pizza Hut, and a ton of 7-Eleven stores. They all seem pretty popular.

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I love this – a fit soccer team sits in front of a Burger King near Järntorget. A youth soccer tournament is currently happening in the city.

Despite the fast food, most Swedes look fit. I’ve seen very few overweight people here, and half of them have sounded American!

In fact, there are skinny, older guys all over the place. Every so often I’ll see a very thin man drinking a beer in the middle of a weekday. I think these men must be retired. Sometimes I’ll see a whole group of thin, older men smoking together somewhere. That’s another thing – smoking. There are definitely smokers here, more than in NYC but fewer than Paris, I would guess. I think there are a lot of nicotine patches, too. I’ve been seeing some people with fancy white disks taped to their upper arms, and I can’t imagine what that would be except for a nicotine patch.

Once I got into my investigative journalist mode, I decided to seek out the closest clinic to where I’m staying. When researching clinics, I found many results that weren’t actually health-related but cosmetics-related. Skin clinics, hair clinics, nail clinics, and even anti-aging clinics popped up in my search. I can’t possibly say (yet or at all) if Swedish people seem awfully concerned about their appearance. “Clinic” might just mean something similar to “spa,” and NYC certainly has skin spas and nail spas. I did find the closest health clinic, however, which looked like this:

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Front door. There is something different on each floor of this building. See the green cross to the right?

I walked inside and up a few floors to discover this lobby:

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Lovely. What you can’t see here is the random fish tank to the left.

I gave my number to a nurse working there and went on my way. Well, that’s enough for now! Hopefully as I spend more time here I’ll have a better sense of more health rituals, like what a typical Swedish dinner looks like and how often people go to the gym or exercise.