This blog chronicles my travels as a 2016-2017 Thomas J. Watson Fellow exploring cultural attitudes towards health technology around the world. Starting from and returning to New York City, USA, I am traveling to Sweden, Qatar, India, Singapore, Japan, and Botswana over the course of one year.
Today, I found myself overwhelmed with gratitude as I left the second of the two project meetings I had today. I’m not sure what I’m so grateful for – the fact that both meetings went so well, or the kindness and openness of strangers, or the amazing opportunity of the Watson overall. Probably a healthy mix of everything.
I forget how amazing this all is sometimes, like this morning as I struggled for a place on the elevator on my way out of the subway and into the pouring rain. But then I remember that I wasn’t going to work, but that I was going to a meeting I set up all by myself and that turned out to be super interesting, and also, I’m in Sweden!
Throughout the Watson application process, there were many times when I thought I wasn’t right for a Watson Fellow. I thought I’d be better suited to life at a tech company, or that I was too much of a homebody…but then I’d think of those high school days when I Googled flights to Perth because it was the furthest place away and I’d know it was right. And I don’t think, anymore, that we should always do what were “better suited” to do.
Last fall, I expressed my worries to one of the Swarthmore professors who interviewed me during the internal selection process. I didn’t think I had been doing well. He told me that it should be okay because the Watson Foundation looks for people that have the ability to grow. (In other words, “You’re right that you’re far from perfect. But that’s a good thing.”). So I suppose it’s important to question yourself a bit. There’s so much to learn and so many ways to grow. It’s certainly a humbling experience to work like crazy in the U.S. to get this fellowship and then realize that most of the world has never heard of it, as you try to explain what you’re doing to each new person that you meet.
Wanderlust level of the day: happily satisfied and still in wonder.
My first project meeting here in Stockholm was with Veryday, a design consultancy firm that does ergonomic, or user-centered, design for client companies (similar to IDEO). I talked to Tara, who is a Designer/Design Researcher on Veryday’s Healthcare team and has done her PhD in human-centered research on the cancer patient experience of radiotherapy.
Veryday, which was called Ergonomidesign until 2012, has focused on “user-driven innovation” for over 40 years, working on products to improve people’s lives day to day. In 1969, Veryday’s first year, the company consulted with Permobil to design a battery-powered wheelchair. Healthcare has always been an important sector for Veryday’s work; they have since designed operating rooms, clothing for disabled people, ambulance stretchers, crutches, asthma monitors, and more (http://veryday.com/history/).
Tara is from the U.S. and moved to Sweden about 6 years ago, so I had a unique opportunity to ask her to compare the two countries’ approaches to human-centered design. “There is a human-centeredness that is embedded within almost every aspect of Scandinavian culture,” she said. “You don’t have to fight for it.” She said that everyone in Sweden wants to improve patient experience; in the U.S., while companies would certainly be open to having that discussion, nothing would move forward without monetary incentives.
Tara said that when hospitals in the U.S. do focus on patient experience, they usually do it to differentiate themselves from other hospitals, competing to be the best. However, Sweden’s nationalized healthcare system makes competition between the hospitals unnecessary. The result is not nationalized mediocrity but rather a nationwide discussion of how all the hospitals can be better for all Swedish citizens. If a patient experience is improved in one hospital, how can that be extended to the whole nation? Tara was speaking from her experience working on the Swedish Testbed for Innovative Radiotherapy, a joint effort by university hospitals, companies, and regional cancer clinics to improve the radiotherapy experience for all cancer patients.
The tough aspect of this is that, while designing for the patient is an obviously good thing, it’s hard to measure the effect on the patient’s medical outcome. A few days ago, the UK medical journal The Lancet published a study ranking nearly all the world’s countries according to 33 health indicators such as under-5 mortality rates, death rates due to disaster, rate of HIV infections, and alcohol use. It’s a hugely comprehensive study funded by the Bill & Melinda Gates Foundation, and it’s far better than the “10 Healthiest Countries” list from USA Today that I was perusing when I formed my Watson itinerary. I’ll probably reference this study, called “Measuring the health-related Sustainable Development Goals in 188 countries,” many more times, but today I want to say it ranks Sweden as the third-healthiest country in the world, and none of the 33 factors that put Sweden so high on the list relate to human-centered design or a patient-focused approach (as I said, these things are hard to put into numbers).
I asked Tara about this, who replied, “All I can say is that healthcare in Scandinavia is top in the world, but I don’t know if that specifically has to do with them putting patients first, or if it just has to do with some of the interesting dynamics that happen with nationalized healthcare where everyone has access. There’s no disparity of rich and poor.” I think she’s right: from my experience in the past couple months, I would say that the two most important factors contributing to Sweden’s high health standard – both in practice and in the eyes of the Swedish – are 1) the nationalized, nearly-free healthcare for everyone, and 2) the user-centered approach to design and patient care. I think only the latter factor affects success and adoption of medical devices, though (to tie it back to the main focus of my project).
Also, the concept of eHealth (electronic health) simply seems more widespread in Sweden. Tara showed me the 1177.se website, which is Sweden’s national online healthcare service. I couldn’t believe I hadn’t heard of it before. It has lots of healthcare information for many different diseases, illnesses, and conditions, as well as personalized advice based on various symptoms. Users can also log onto the site and book appointments or call the number “1177” to get advice about your symptoms and book from there.
This way of booking appointments contributes to one of the differences between the Swedish and American healthcare systems. If you have a medical issue in Sweden, you book an appointment via 1177 and end up with a doctor you’ve never seen before and will probably never see again. In the U.S., you call the office of your family doctor or general practitioner to book an appointment. There’s a greater emphasis in the U.S. on staying “in the system” and meeting with someone who knows your family history. In Sweden, Tara said that it is considered to be beneficial to see a doctor with whom you have no previous relationship. I thought she would say that it is for a medical reason, so that the doctor isn’t biased when making a decision, but she said that it is a privacy issue. The Swedish “want that separation between the patient and the doctor,” she said, “with no blurring.”
Finally, I asked Tara what the biggest medical issue in Sweden is, or what disease Veryday seems to be working with the most. Since Veryday’s work is project- and client-based, however, their portfolio doesn’t necessarily form a comprehensive picture of Sweden’s most pressing diseases. Tara said that she has noticed a demand not for solutions tailored to a specific condition, but rather for connecting physical devices with digital cloud-based services. For example, pairing an insulin pump with a cellphone app is a specific solution for diabetes patients, but it’s an example of an overall trend of merging platforms to make daily life easier for someone with a chronic illness. It’s about supporting individual patients more fully in their conditions and integrating the services around those individuals, rather than focusing on one specific disease.
I really liked talking to Tara, and there’s far more I could add from our conversation, but I’ll leave it here for now. Tara helped me think about my project, noting that designers like her would have a hard time answering my questions about the medical outcome resulting from user-centered design. Also, since Veryday is a design consultancy, companies come to them for help with projects and ideas. So while Veryday is all about working closely with users to develop the right device for the right problem, I can’t strictly say that all companies in Sweden care about patient-focused design of medical products. Companies still have to make their own effort, whether that’s conducting user research themselves or deciding to work with a company like Veryday.
I arrived in Stockholm just over a week ago, and wow, the time has flown by! Stockholm is definitely bigger and busier than Göteborg or Malmö. There are lots of different neighborhoods, spread out yet connected by a proper underground subway system. As per usual, I spent my first full day in Stockholm walking around the city, although I underestimated its size and walked over 14 miles (!). This is mainly because I spent my first week here in an Airbnb in Farsta, a borough 8km south of central Stockholm.
I started my day with a 45-minute train-and-bus ride to the U.S. Embassy, northeast of central Stockholm. I was there to give the embassy workers my filled-out “overseas voter” form, which they said they would send to the New York City Board of Elections for me. Annoyingly, although I am already registered to vote in NY, I have to do an additional registration to vote from abroad before I can request a ballot. I should get a confirmation email soon, after which I can request an electronic ballot to vote in this year’s presidential election!
From the embassy, I walked along the water to northern Stockholm (“Norrmalm”), then down through central Stockholm, Gamla Stan (the “Old Town”), and southern Stockholm (“Södermalm”). This is where I should have stopped and gotten a train home. Instead, I kept walking along the long bridge Skanstullsbron towards the Ericsson Globe, and then onto the cemetery Skogskyrkogården (that was an accident; I got lost there), and finally, 14 miles after starting at the embassy, I returned to Farsta. I wouldn’t recommend the latter portion of walk to anyone, as it involved walking along highways and getting stuck in dead-ends. Whoops! The maps below have mouse-over captions:
The full walk, start to finish.
Zoomed in to show central Stockholm.
After central Stockholm, I walked along the super-crowded pedestrian street of Drottninggatan (“Queen Street”) towards Gamla Stan, which is mostly located on the island Stadsholmen. Stockholm, apparently called the “Venice of the North,” is comprised of 14 islands and has over 50 bridges connecting these islands.
I crossed another bridge over another canal to get to Södermalm, southern Stockholm. This is supposed to be the “edgy” part of Stockholm, and I definitely got a sense of hipster Brooklyn while I was there.
I powered on through Södermalm (missing most of it) with a mission in mind of getting to the Ericsson Globe. It’s a huge indoor sports arena and concert venue, and it’s the largest hemispherical structure in the world. I didn’t know that at the time, though. The reason I read about it months before arriving in Sweden is because it is supposed to represent the Sun in our solar system. Sweden is home to the world’s largest scale model of the solar system, spanning the entire country at a scale of 1:20 million. The Ericsson Globe represents the sun in Stockholm, and models of Mercury, Venus, and Earth are also in the city. The other planets, as well as moons and comets and so on, are scattered around the country. Anyway, I think this is super cool, so I had to see the globe up close.
After reaching the Ericsson Globe, I was definitely far from central Stockholm. I kept going south and ended up in a large park, which was actually Skogskyrkogården, Stockholm’s “Woodland Cemetery.” I later found out that it’s a UNESCO World Heritage Site and where Greta Garbo is buried, though I didn’t find her grave while I was there.
And that’s all! A couple miles later I found my way back to Farsta. Overall it was a good walk, but I missed some interesting parts of central Stockholm and saw too many highways. The next day, I followed my Lonely Planet Guide’s 3-mile walking tour of Central Stockholm for some more controlled sight-seeing. I have to say, it’s been nice so far to have Lonely Planet books as a resource.
Last week in Gothenburg, I was able to visit the Sahlgerenska University Hospital, which is a huge hospital in Sweden with many departments and one of the six places in the country where people can study to become doctors. I met with a doctor named Axel who got his PhD at Sahlgrenska and is now doing his residency there. He gave me a tour of the hospital campus, a large and beautiful place with lots of red-brick buildings. According to the hospital website, there are 16,000 employees at Sahlgrenska and over a million outpatient visits there each year.
The various departments at Sahlgrenska seem to cover every aspect of health, from basic care to various specialist treatments. Sahlgrenska’s departments include dentistry, acute care, trauma, cancer, cardiovascular care, rheumatology, oncology, neurology, ENT, gynecology, geriatrics, diabetes, urology, Parkinson’s, reconstructive surgery, child care, and more. Axel pointed out a ward for patients who have attempted suicide, who can be legally kept under supervision for 24 hours or more depending on the case. He also told me that Sahlgrenska is the only hospital in Sweden with the ability to transplant any organ.
Later, sitting down with Axel, I asked him about his opinion of medical technology. He said, “if it doesn’t help the patient, [at least] it helps the doctor.” Personally, I was happy to hear this view because I’ve only heard from companies and academic institutions so far. Both have focused on the functionality of medical products, user-centered design, and how users can access medical devices. Very few people have mentioned the opinions or involvement of doctors. This is probably because I’ve been focusing on medical devices for use outside of hospitals (home care, eHealth, wearables, etc.), which doctors never need to use. They can provide an expert opinion, however, especially when it comes to medical devices used for inpatient care.
Axel said that the future of medical technology in Sweden will be telemedicine. As an example, he told me about a small home care machine used by some patients with inflammatory bowel disease. If these patients have a worrying symptom, they can place a sample of their feces on a dish in the machine. The machine analyzes the sample and then flashes a red light if the patient should come into the hospital or a green light if there is nothing unusual to worry about. This saves time and money for everyone.
Axel suggested that Sweden’s health care system is so successful because it is free for the public and well-organized (rather than because of its access to technology). Since Sahlgrenska has departments spanning so many aspects of care, there is a standardized care chain. For example, if you need a surgeon, your doctor will know exactly who to contact. If someone is sent to the hospital in an ambulance, their ECG is taken in that ambulance and sent immediately to the hospital’s acute coronary care division so that the doctors there are ready for the patient’s arrival. If someone needs an x-ray, they can get it within 7 days. (If for some reason the wait is longer than 7 days, Sahlgrenska has relationships with private medical imaging companies and can use their services). The different doctors involved in one patient’s care can all sit together and have a conference about how to proceed with treatment, and they do.
I asked Axel about different types of patients, as one of my questions for this project is whether or not cultural attitudes towards medical technology differ between generations. He said that older patients tend to take the doctors’ recommendations most seriously. He has found that younger people fall into one of two camps: either they don’t care at all about what the doctor says, or they have read too much on the internet and have committed to a self-diagnosis (often thinking that their condition is far more serious than it actually is, which happens to me whenever I go to WebMD.com).
He also mentioned Sweden’s increasing immigrant and refugee population, which can be difficult to manage because the Swedish doctors don’t know the different cultures and languages of their own patients. I’m not sure what Sweden is doing to mitigate this problem.
Despite Sweden’s high level of care, Axel told me that people complain, mostly about having to wait on line at hospitals. Axel himself said that having to deal with bureaucracy and administration is the most frustrating part of his job. When someone comes to the hospital, he can figure out what they need and where they should go after a simple 10-minute exam. But then he must spend 30 minutes registering the person into the hospital’s computer system, assigning them to a particular ward, getting charts for them, and so on. The large size of the administration makes these tasks more complicated than they should be.
Axel said that maybe 6-10% of Swedes have private insurance in order to get treatment and operations on a faster timeline (according the newspaper “The Local,” it was 10% in 2014: http://www.thelocal.se/20140117/hospital-queues-tied-to-insurance-trend). This reminded me of my conversation with Mårten at Emmace (the inhaler company), when I first heard that the main problem with Swedish hospitals, and perhaps free healthcare in general, is the long queues and waiting times for even simple operations.
I steered the conversation back towards medical devices then, asking Axel what makes a good device. He said there are three main requirements:
Reliability. This means that it has been thoroughly tested with trustworthy results.
User friendliness. “Of course,” he said.
Physician’s preference and experience. It must be recommended by physicians and perhaps have been developed with physician input.
He said that low cost is not a requirement, though it is a benefit; if a device is good enough, Sahlgrenska will purchase it regardless of the cost.
I asked him if there were any medical devices he hated. He laughed at this and said that he gets frustrated by mechanical heart pumps – specifically the HeartMate II, a left ventricle assist system, and the Berlin Heart, a bi-ventricle assist device. Ventricle assist systems help patients with advanced heart failure, often seriously ill patients waiting for heart transplants. Axel told me about a patient using the Berlin Heart, which comprises of a big box controlling two pumps that connect to four tubes attached to the heart. It stopped working in the middle of the night once and needed to be hand-pumped. Then this happened two more times. It sounds like a terrifying scenario; these are large, highly invasive devices, and of course it can be dangerous to hand-pump a patient’s failing heart.
On a more positive note, as I mentioned earlier, Axel thinks that the medical technology of the future – for both rich and poor countries – will be telemedicine and home monitoring devices. For Sweden specifically, telemedicine can help the problem of long lines at hospitals, as doctors will only have to see patients that have been recommended after an at-home screening.
During my last week in Gothenburg, I did a “last blast” of tourism, visiting the remaining places on my to-see list when I wasn’t having project meetings. Now I can safely say that I’ve seen far more than the average Gothenburg tourist or even local when it comes to the city sights!
First, Mölndal. I was already in Mölndal to go to AstraZeneca, so that afternoon I decided to see its main tourist attractions: Kvarnbyn, the old industrial area of town, and the Mölndal stadsmuseum (city museum). Overall it wasn’t much to see, but it was still cute.
Next, I traveled to Korsvägen, a main square and transport hub in Gothenburg where some big attractions are located, including Liseberg. I went to the Universeum, a science museum with a “living rainforest” (regnskogen) and a few other science exhibits. I had heard great reviews, but I thought it was a little too expensive for the quality – or maybe I’m just too old for this museum! It was definitely for schoolchildren.
Also located near Korsvägen is the Världskulturmuseet, or the World Culture Museum. It’s fairly small and I only spent about an hour there, but they had a couple interesting exhibits. There was a photography exhibit about the Afghan burqa, which covers the whole body except for a net over the eyes. It displayed photos of Afghanistan through the eye net, showing how difficult it is to see and navigate the world with such reduced vision.
A few days later, I visited Gothenburg’s botanical gardens, a beautiful 430-acre area that was lovely to walk through (although not as large or fantastic as Longwood Gardens in Pennsylvania, the most recent botanical gardens I visited).
The Botanical Gardens are very close to Gothenburg’s Natural History Museum, the last museum on my list (really, I think I saw all the museums in Gothenburg. I’ll miss their policy of free admission for people under 25!).
On my last weekend day in Gothenburg, I visited the country house Gunnebo Slott with the family. It was like a mini-castle, with a sweet outdoors café – perfect for a fika on a warm day. I would love to live close enough to a castle and gardens that I could spend my weekends there, reading and drinking coffee.
Just over a week ago, I went to the medical company AstraZeneca. I met someone at their Mölndal research facility, south of the Gothenburg city center. I’ve been trying to meet with AstraZeneca since arriving in Sweden, and it took me 2 months, but I finally found a way. The company is too big to contact by cold-calling or cold-emailing; my messages via their “Contact Us” page received no response. I ended up talking to a Swattie who has a family friend that works at AstraZeneca Mölndal, and with this friend’s direct email address I was able set up a meeting.
AstraZeneca is probably the biggest medical company in Sweden. When I first arrived here, I kept hearing about it when discussing my project. Later, as I mentioned to people that I wanted to visit AZ, everyone seemed to have heard of it. AZ self-describes as a “research-based biopharmaceutical company,” developing drugs to treat people with asthma, heart failure, diabetes, cancer, and more. Beginning in Sweden over a hundred years ago, the company is now party British-owned, with its headquarters in the UK. The Mölndal campus is the center of its Research & Development in Sweden with 2500 employees.
The man I met there – I’ll call him J, for privacy reasons – explained the AstraZeneca product pipeline to me. The timeline for a product is 10-12 years from conception to sales. This is divided into two main phases: discovery (5-6 years) and development (5-6 years). J works at the beginning of the discovery phase, when scientists work in labs to improve upon or develop new treatments for various diseases. Once a compound is discovered as a treatment for a disease, it must be tested in the development phase. The development phase starts with animal testing and then proceeds to 4 stages: a clinical trial with healthy people, just to make sure that the drug has no negative side-effects; a clinical trial with a small group of real patients; a clinical trial with a large group of patients from different countries; and finally the post-release stage, when AstraZeneca follows up with its products that are on the market. Though I was curious about this stage, it is about 10 years down the pipeline from J’s work. He told me that in the beginning of the discovery phase, the biologists like him aren’t thinking about end products or users; they work on a molecular level. His group is focused on CVMD, cardio-vascular and metabolic diseases, which include heart failure, diabetes, and kidney failure.
J described this as a streamlined and compartmentalized pipeline with the flexibility for researchers to return to various steps along the way and iterate solutions until they were completed, which is of course necessary if something goes wrong. Unsure of how to learn about cultural attitudes towards medtech from a biochemist working in early drug discovery, I asked J what he pictures as the future of his work. He said that the future of medicine will be more personalized health care; he has seen in some AstraZeneca clinical trials that the same drug can work wonders for one group of genetically similar people but do little for another group with the same illness. He thinks that future medicines will be developed accordingly, with a certain genetic profile in mind.
The funny thing about this whole meeting is that I realized, after months of wanting to meet someone at AstraZeneca, that I actually wasn’t interested in their products. I’m interested in cultural factors that lead to the success of medical devices and, in Sweden, how the Nordic ergonomic design tradition might lead to user-focused medical technology that directly improves the user experience and patient outcome. But AstraZeneca is a life sciences company, focused on the biology of creating new drugs and medicines, and not on how the patients get those treatments or if there is patient-doctor compliance. I started to realize that a couple days before meeting with J, when I went onto the AZ website to look at various products I could ask him about. When I saw that they were all pharmaceutical drugs, I knew that I would only be able to ask him about biology, not tech design.
To put it another way, I was partially inspired to do this Watson because I had been working on a “smart” pillbox design in my last engineering internship. I’m more interested in how people take their pills – and how we can encourage people to be better about taking their pills, and thus healthier – than how those pills are actually made. However, it would be amazing if pills could be combined. I saw in my internship that people taking 5 or more pills a day have to deal with pills that can only be taken at night along with ones that can only be taken in the morning, pills that need food and others that don’t, and so on. So if all 5+ pills could be wrapped up into one, that would make everything much easier. I asked J about this, and he said that AstraZeneca is definitely working on combining drugs for such patients, but that it takes a long time. A combination of 2 drugs is a new drug and thus requires a full 10-12 years in the pipeline of discovery and development. Adding a third drug to the mix adds another 10-12 years, and so on.
It might seem like a waste, but it was actually relieving to realize, after trying for months to meet with one of the biggest medical companies in Sweden, that I didn’t need them for my project. Even though AstraZeneca’s medical products do not fit the type of medical technology I’m interested in for my project, I’m still glad I met with them.
I leave for Stockholm tomorrow, and I just can’t believe it. I have really grown to love Gothenburg and feel at home here. I still have quite a few blog posts I want to write for Gothenburg, including some health posts, as I’ve had multiple meetings for my project in the past week. But right now I’m feeling sad about having to pack and can’t muster up the energy for a project post, so I thought I’d tell you about my weekend fun instead. I spent Saturday afternoon at Liseberg Gardens, a huge amusement park right here in Gothenburg and apparently the biggest in Scandinavia. It’s Gothenburg’s #1 tourist attraction, and it’s expensive, so obviously I avoided it like the plague. An amusement park? On the Watson? No way. But after hearing about it for 5 weeks, I figured that I wouldn’t want to regret not going.
As it turns out, I’m so glad I went. I only spent a few hours there, but it was a beautiful, sunny Saturday afternoon. Families with young children and day passes could easily spend a full day or two and have lots of fun, but I only bought enough coupons for one ride, and I could only spend so much time walking around the (admittedly large) grounds by myself.
Liseberg surprised me; it was a spacious whimsical world rather than a set of flashy rides. Well planned out and immensely charming, it reminded me of Disneyland without the characters and merchandise. Like Disneyland, it had a main street, Storgatan, with old-fashioned candy shops and colorful store fronts. Some of the stores even sold fancy ceramics and jewelry.
There was something for everyone there. In fact, I was so impressed by the range of rides and things to do that I started making a list: roller coasters, arcades, futuristic steampunk rides (à la Epcot), lazy rivers, the not-so-lazy “Colorado river” ride, a retro section with bumper cars, a fake waterfront area with a harbor and a haunted hotel, a log flume, a Ferris wheel, princess castles, a mirror house, spinning teacups, and even a playground made to look like a birdcage. This was all in addition to a beautiful garden!
Wandering around Liseberg by myself, surrounded by groups of high school friends and families with small children, I kept thinking about goodbyes; saying goodbye to Gothenburg and Sweden as a whole. I think I was hyper aware that I had, in a way, saved Liseberg for last, and so going there meant the end of something.
Gothenburg will always be the first place I visited on my Watson year. Of all my time in Sweden, I am spending the majority of it here. It’s also one of the few places to which I’ll have returned over the course of this year. I’ve been so lucky here meeting great friends and staying with a lovely family. I’m off to Stockholm now, but I’ll only be there for 3 weeks before heading to Qatar; leaving Gothenburg feels like the beginning of saying goodbye to Sweden. I’m excited to see Stockholm, and I’ve achieved all my project-related goals here in Gothenburg, so it’s time to move on. But it’s still hard, and I’ve felt somewhat listless these past couple days even though I’ve stayed busy. (Full disclosure: I saw a poster for a big Halloween event here in Gothenburg, and I felt myself get choked up. On October 31st, I’ll be in a totally different country that doesn’t celebrate the holiday, and if I’m seeing advertisements already, that means Halloween is in the very near future…and I will have to confront my fears about Qatar sooner rather than later.).
I don’t have a picture of the ride I did, but it was the Balder, the old-fashioned wooden roller coaster. It was the only ride recommended to me, and it seemed perfect, since New York’s old wooden Cyclone is the first roller coaster I ever enjoyed (all previous roller coaster attempts had been scary and unpleasant). It seemed like I found most of Sweden in line for the Balder – the wait was a full hour. That hour gave me plenty of time to reconsider. I seemed to be the only person waiting in line by myself, and I wasn’t sure if it would be any fun to do a roller coaster solo. I had never done that before. As the line moved forward, I wondered if I should turn back.
Of course, I didn’t, and with all my anticipation and nerves built up, I finally climbed into the roller coaster with an empty seat beside me. We took off, and I’m pretty sure the whole thing took 60 seconds, but wow, it was worth it. The ride was a blast and I (almost) forgot I was alone.
And now to be totally cheesy: it is hugely worthwhile to do the things that you want to do by yourself, even if you think that you would never want to do those things alone. Maybe it’s eating out, going to a movie, or going on a roller coaster with no one in the seat next to you. It’s true that it might be less fun by yourself. But if you can find the self-confidence to do it and still have fun, well, it feels pretty awesome. And most importantly: roller coasters are ten times the fun if you throw your arms up in the air.
I’ve been in Gothenburg nearly 5 weeks now, and sometimes I feel like I’ve seen it all, but sometimes I just have to go in new directions. Now that I have outstayed the typical trip by a few weeks, I’ve started to venture out to the less-visited and more random places (though I did save some of the truly touristy, and thus expensive, attractions for last – I wanted to make sure they were worth going to and that I could fit them into my budget). Anyway, here are some photos from early last week.
While on Hisingen, I also visited the Lindholmen Science Park, where various technology companies focus mainly on environmentally-friendly electric transport. They also collaborate with University of Gothenburg and Chalmers University of Technology, which has its Lindholmen campus here across the river.
The next day I walked up to Skansen Kronan, a fort in the middle of the Haga district. It stands on one of the tallest hills in the city, built in the late 17th century as a military vantage point. There are still cannons lying on the grass around the fort.
The other morning, I attended a lecture at the Chalmers University of Technology here in Göteborg. I tagged along with Lisa, who is getting her Masters in Industrial Design Engineering there. The lecture, given by a user experience architect who used to be an industrial design student at Chalmers, focused on the way engineers can design for people with disabilities around the world. The day before this lecture, the masters students had done an exercise in which they traveled across town in a wheelchair, seeing Göteborg from the perspective of the mobility-limited.
The first part of the lecture, called “Alter the Wheelchair: Achieving Social Inclusion in Developing Countries Through User Centered Design,” was about the lecturer’s thesis project for the industrial design engineering degree. Along with another student, he designed a wheelchair for rural areas in Indonesia and Kenya. I was really excited to visit this lecture as part of my project for two reasons. First, a lecture provides me with a new, more abstract way to look at medical device design and development compared to the specialized, more commercial perspective I get from meeting with individual companies. Now I have the opportunity to compare cultural attitudes towards medical devices in both companies and academic institutions, which tend to illuminate certain ideals and traditions of theory.
Second, this would be a lecture taking place in a healthy, wealthy, “developed” nation about how to “fix” a problem in a so-called “developing” nation. I put these terms in quotes because there is always the danger of the white savior complex coming into play. I was curious to see how Sweden views the challenge, and perhaps the responsibility, of designing products for completely different and resource-poor environments; especially before I travel to such environments to see the difference in available medical technology. When I was studying in South Africa, one of my classes placed a large emphasis on “site-specific solutions,” meaning that for a product to be successful, it must be designed for its intended environment, and the resources in different areas require different techniques. For any problem, there is no “one-size-fits-all” solution that works everywhere, even if the problem is present everywhere (people need wheelchairs all over the world). Thus it can often be problematic when wealthy foreign designers try to apply the same products to areas working with a different toolbox. I was interested to see how Sweden tackles this complicated process.
I was impressed with the care and consideration the lecturer had put into the “Alter the Wheelchair” project as a student. He and his partner worked with Whirlwind Wheelchairs at first, a US-based company that builds durable wheelchairs for use around the world and emphasizes user independence above all. This is especially important when the wheelchairs are not motorized. Due to the lack of a reliable power grid in the rural areas of Indonesia and Kenya, the wheelchairs had to be manual (non-electric). However, this can mean that the person in the wheelchair needs someone to push them around more often than someone in an electric wheelchair might. So, the students were focused on enhancing independence so that everyone in a manual wheelchair could self-maneuver well enough to get around completely on their own.
Most importantly, the students were not creating their design from far away in Sweden. They traveled multiple times to their project sites in the two countries, observing the illnesses there that caused wheelchairs to be necessary, as well as where the wheelchairs would be used: inside, outside, on rough terrain, and up steep ramps. They discovered that ramps proved the biggest challenge for wheelchair users. While the ramps were put over stairs to make them accessible for wheelchair users, they were still often far too steep for manual wheelchairs to maneuver. Some of the patients were wheeling up to a ramp, only to hoist themselves out of the chair, drag themselves up the ramp, and then reach back to pull the wheelchair up behind them – a frustrating, often humiliating process that could take several minutes, just to get home.
Being industrial designers, the two students found a way to solve this. They decided to build the wheelchair seat so that it had two possible positions, forward and back/normal; this became the main aspect of their design. Users could shift the seat forward using levers, which moved their center of gravity closer to the front of the chair. With the center of gravity closer to the front wheels, the patients were able to get up steeper ramps than they had ever managed before, all by themselves. The students also interviewed community members via a translator during each of their visits, and they learned about unexpected benefits to this shifting seat. With the seat in its forward position, people had an easier time getting in and out of the wheelchair. This is because they laterally slide in and out, which is hard to do when they also have to lift over the tall back wheels. Sliding the seat forward meant that they didn’t have to hoist themselves over so much of the back wheels. This is all more evident with a photo:
Finally, the students wanted to make the wheelchair easy to repair, with parts that were easy to replace. This was another topic we talked about in South Africa. One of the reasons these projects fail when brought in by outsiders is because there is no way to sustain the projects. If cellphones are developed to a community, great; but what about 2 years later, when the cellphones fail? If there is no way to buy upgrades, or spare parts, or new chargers, the entire project fails. The Chalmers students considered this and made an effort not to use any specialty parts; in fact, the main body of the wheelchair can be replaced with metal bike parts. I was really thrilled to hear that they had considered the sustainability aspect of their project.
The second half of the lecture, titled “Design Meets Disability,” was about the intersection of fashion and assistive technology. The lecturer made a really interesting point about eyeglasses: they were once considered to be medical appliances. Now, designers call eyeglasses “eyewear,” and they come in lots of fashionable styles, some ridiculously expensive. The brand is almost more important than the functionality; we don’t consider people who wear glasses as being “disabled.” But as a user-centered device that corrects a medical issue, glasses nearly fit into my project as medical devices.
So, the lecturer posed the question: why can’t we do the same thing for hearing aids? Why is there no field of “hearwear?” Glasses were able to transcend their label of medical appliances, and now people can feel cool wearing them; why can’t hearing aids transcend their label as well? They correct a hearing impairment, just as glasses correct a vision impairment. And yet hearing aids are always designed to be invisible and hidden so that no one knows you wear them.
I thought that was a great point, except that he missed one thing: contact lenses. There are definitely people who need glasses but who would rather not show that fact. Still, despite this personal choice, the broader social stigma for wearing glasses is basically extinct, whereas needing hearing aids is still somewhat stigmatized. At least, there isn’t a brand of Dolce & Gabbana hearing aids. The lecturer suggested that we need both a change of attitude on society’s part as well as an effort on the part of industrial designers to make cool-looking hearing aids, just as designers have made cool-looking eyeglasses.
That’s enough for now. I’ll be going back to Chalmers next week for another lecture in the same class, “Ergonomics Design for All,” on the challenges of blindness. It’s both fun and weird to be back in a university setting, learning about these topics in an theoretical and academic context.
I finally have a few project meetings set up for this week, so I’m excited for that. Tomorrow morning, I’m even going to a lecture at the University of Technology here! But in the meantime I thought it might be fun to talk about some Swedish food customs that I have noticed while being here.
First is the tradition of “fika,” something that I read about before arriving in Sweden. It means to have coffee as a break, often with some sweet on the side. As I am not employed in Sweden or going to school here, I haven’t experienced a daily fika ritual. However, everyone I meet talks about it and practices “fika breaks” to some degree, and I have been invited to have coffee a few times, sometimes with a sweet and sometimes not. One common fika accompaniment is the kanelbulle, the cinnamon roll, apparently invented by Sweden.
Next – you will probably not read about this one – I have learned what constitutes a typical Swedish breakfast! Most Swedes I’ve met have the same breakfast every weekday: simple toast with butter and sliced cheese (usually a mild white cheese, sold in huge wedges at the supermarket). Even the word for breakfast, “frukost,” has the word cheese in it: “ost.” It’s quick, easy, and yummy, and yet no one in the US puts cheese on their morning toast. I suppose we’re all about the sweet jam back home.
My favorite of the Swedish food traditions I’ve learned about is lösgodis, or lördag godis, “Saturday candy.” I have read about this custom, seen it in practice, and partaken in it myself! Every weekend, Swedish kids can go to a candy shop to fill a plastic or paper bag with their favorites from the assorted bulk candy. These pick-and-mix sweets, called “lösgodis” (literally ‘loose candy’), are hugely popular in Sweden.
There are entire shops dedicated to lösgodis, lined wall-to-wall with plastic bins of licorice, chocolates, individually wrapped truffles, gummy candies, and more. Most supermarkets have a lösgodis aisle. Even corner bodegas and some stores having nothing to do with food have a small selection of lösgodis! Of course, not everyone limits their consumption to Saturdays, but it is certainly considered a treat to get this weekend candy – no matter what age you are.
Another indulgence I’ve noticed in Sweden, and finally tried with Lisa last weekend, is kebab pizza. The ultimate student (or hangover) food, it is a pizza topped with sliced kebab meat, tomatoes, kebab sauce, and lettuce, a mash-up of two very satisfying foods. There are a bunch of food shops in Sweden that advertise both kebab and pizza, an offering that makes sense when you enter and realize that you can get the two-in-one combo. Also, the kebab pizza came with a side dish of what Lisa called “pizza salad!” It was similar to cole slaw, and we added it to the pizza as another topping. Apparently every pizza in Sweden comes with this pizza salad, which I find hilarious. (A simple Google search for “Swedish pizza salad” reveals that I am not the only foreigner to discover this mystery).
Otherwise, the grocery stores are pretty standard, with mostly the same items you can find in the US. Overall the food is pretty similar compared to home. So no, Swedish people do not eat meatballs with jam every day.