Complementary therapies in Iceland Lowana Veal

... attitudes to complementary health have changed considerably over the last 3-5 years.

Training for chiropractors, osteopaths, and acupuncturists all takes place outside Iceland.

Lowana Veal Urdarstekkur 5, 109 Reykiavik, Iceland

(Requests for offprints to L~9

Iceland is a small, volcanic island with an area of 103000 square kilometres and a population of 257000. Of these, about 150000 live within the Greater ReykjavN area, or towns within 50km of Reykjavfk. The second largest town in Iceland, Akureyri, has a population of only 15000. The other major towns, [safj6r0ur in the northwest, and EgilstaOir and H/~fn in the east, have l e ~ than 4000 inhabitants.

The centralization of the population around Reykjavl'k is important because nearly all the informa- tion, training, further education establishments, etc. are based in ReykjavN. Thus, Reykjavfk tends to be at the forefront of new ideas and, for this reason, most complementary health is also based in Reykjavfk.

There is a general feeling in ReykjavN that atti- tudes to complementary health have changed con- siderably over the last 3-5 years, and especially since the beginning of 1996. Many more people are now turning to complementary therapists as a result of dissatisfaction with orthodox treatment. In addi- tion, Icelandic people like to try out new things, whether it is the latest dance, therapy, computer, or mobile phone. This means that there is a ready take- up of new ideas: people are not sceptical of the potential efficacy of a novel treatment. Thus, fringe therapies such as kinesiology, healing, reiki, and cranial-sacral osteopathy have all become popular.

There are two health magazines in Iceland. Heilsuhringurinn is a serious magazine that was first published in 1977 and now comes out twice a year. It carries snippets about the latest research in comple- mentary therapies, e.g. using the co-enzyme NADH as a treatment for Alzheimer's disease. It also carries general articles on the different fields of complemen- tary health and organizes two public lectures a year. The other magazine, which was first published in 1945, is published six times a year by the Nature Health Association of Iceland. The latter is aimed at a younger reader and is perhaps more accessible in style and content than Heilsuhringurinn.

THE HEALTH SYSTEM

Iceland has a very good, comprehensive health care system which ensures that the Icelandic people have

one of the longest lifespans in the world. However, it is an orthodox system and there is no opportunity for medical students or recently-graduated doctors to undergo any training in complementary therapy, There are about five doctors in Reykjavfk who offer a complementary medicine besides allopathic medicine, but the State social security system does not cover any of the alternative therapies. However, the State does subsidize the residential health care system at Hverager0i and, in order to stay there, patients must be referred by their own doctor.

The attitude of doctors towards complementary therapy may seem to be prejudiced, e.g. homoeo- pathy was banned in 1930 and it is still illegal to practise it or sell homoeopathic remedies. However, their viewpoint is largely based on ignorance and in reality they are (now) quite tolerant of complemen- tary therapies. Nevertheless, there are only a few doctors who actually refer patients to complementary therapists. Lay practitioners of any type are not sup- posed to advertise their services, but advertisements do appear in the complementary health magazines.

In order to practise, a practitioner should first be granted a licence by the Government. Three years ago, when the first chiropractor came to Reykjav~, it was quite difficult for him to obtain a licence and his practice was actually closed down twice by the medical authorities. The situation has now improved and there are three chiropractors currently practising in Reykjavfk. The first two osteopaths came in 1995 and they are still the only ones. However, there was a short course last year (1996) in cranial osteopathy which created a great deal of interest. Approximately 15 people now use cranial osteopa- thy along with massage or psychotherapy. There are four acupuncturists, and a few people who practise shiatsu, touch for health, polarity therapy, or puls- ing. Many of these practitioners have not been given a licence to practise, but have not been closed down either. There is a centre for Chinese therapies and soon there will be an Ayurvedic clinic.

Training for chiropractors, osteopaths, and acupuncturists all takes place outside Iceland.

There are a few practitioners who use Bach flower remedies in their work, although the reme- dies themselves are not available in the shops and

Complementary Therapies in Nursing & Midwifery (I 997) 3, 12-15 �9 1997 Pearson Professional Ltd

Complementary therapies in Iceland 13

Reflexology is one of the most popular, and old- est, complementary therapies and is one of the few in which it is possible to train in Iceland. So far, over 200 people have been trained in reflexology, but less than 100 are practising it. The training course is 1 year, soon to be extended to 2, and it is also possible to train in Akureyri and Egilssta~/ir. Many reflexolo- gists also practise other forms of massage or other complementary therapies.

Reflexology is

one of the most popular,

and oldest,

complementary

therapies and is

one of the few in

�9 which it is

possible to train

in Iceland.

Fig. 1 Central Reykjavik.

cannot be legally imported by practitioners because of the alcohol that they contain. Bach flower remedies cannot be sold in the shops in Iceland because the alcohol laws prohibit the sale of drinks with an alcohol content of 5% or more to State liquor shops. There are currently 12 trainee homoeopaths who are being trained in Iceland by someone from the Practical School of Homoeopathy in London, UK. Their course consists of one weekend a month for 3 years, and a longer spell in London in the summer. They will graduate in February 1997. Until now, homoeopaths have been self-trained and only short courses have been held. Homoeopathic remedies are not easily available in the shops.

Massage of all types is popular in Iceland, includ- ing aromatherapy, reflexology, Swedish massage, and deep tissue massage. Many practitioners use a combination of these, depending on the needs of the patient. The quality of the essential oils available in the shops is not up to professional standard, so prac- titioners who use essential oils import them from Denmark, Germany, and the UK. Several years ago, an aromatherapy course was taught by an English aromatherapist on a once-a-month basis for a year, but since then aromatherapists have had to train out- side of Iceland. However, training in aromatherapy massage is available as part of a general massage course.

M I D W I F E R Y

The birth process in Iceland is highly medicalized in that virtually all births take place in hospital. There are never more than two home births per year. The high proportion of hospital births occurs because doctors have instilled into pregnant women the fear that their babies may die if they give birth at home. In line with this thinking, any pregnant woman out- side of Reykjav~ is flown into the capital if she suf- fers from high blood pressure, diabetes, or other

health problems. In1960, a midwife named Hulda Jensd6ttir stood

up for her profession and told the doctors that birthing need not be medicalized. She established the 'birth home', a place that had as little medical input as possible and which allowed mothers the choice of how to give birth. Essential oils, homeo- pathic remedies, massage, and other therapies were used. Unfortunately, the home was finally closed in 1995 because it was too expensive to run, and, although a group of midwives wanted to run the cen- tre themselves, the medical profession said that it was better for women to give birth in hospital.

There is now only one midwife, Anna EdvarOsd6ttir, who uses complementary therapies in her work. Anna teaches massage to pregnant women, and also gives them a specially prepared blend of essential oils to use themselves while giving birth. Anna herself uses reflexology and electro-acupuncture on birthing women, and has

Fig. 2 Angelica growing in Hornstrandir, uninhabited NW point. Angelica is also used medicinally in Iceland.

14 Complementary Therapies in Nursing & Midwifery

The unspoilt,

unpolluted

environment

has been used

by several

companies to

promote herbal

products and

cosmetics.

Fig. 3 Geyser at HveragerO i.

great success. One of the chiropractors in ReykjavN also works a great deal with pregnant women and with women who are unable to become pregnant.

HERBALISM A N D THE HERBAL INDUSTRY

The medical effects of some Icelandic plants have been known to the local people for centuries. Iceland moss, Cetraria islandica, has been used for diges- tive and respiratory complaints since the 17th cen- tury, and, at the turn of the last century, Icelandic people had a low incidence of thyroid problems because they ate a considerable amount of dulse, Pahnaria palmata, which was freely available on the sea shores. Dulse is now marketed in both cap- sule form and as dried algae and Iceland moss has become extremely popular. Cetraria islandica, which is actually a lichen, can be bought in super- markets, health food shops, and other places and is also used commercially for making a variety of 'flatk6kur', a type of bread that is popular in Iceland. A small company has been set up purely to produce Iceland moss throat pastilles, skin cream, capsules, and the milled herb itself, and the company also pro- duces recipe leaflets for the use of the herb. Iceland moss is now being exported to Germany as, although the plant also grows in other countries, the Icelandic variety comes from a less polluted envi- ronment.

The unspoilt, unpolluted environment has been used by several companies to promote herbal products and cosmetics. Shark oil is also being

manufactured, both in capsule form and as a cream combined with Icelandic herbs, and is promoted as a way of strengthening the immune system and dealing with psoriasis, eczema, and gout.

The health food shops in Iceland all sell a consid- erable range of health products, including vitamin and mineral supplements, as well as the herbs them- selves. At least two health food shops have a herbal/nutritional specialist present at certain times who will offer detailed advice free of charge. This service seems to be widely appreciated. However, herbal tinctures are not easily available due to the difficulty and cost of importing alcohol into the country.

Despite the apparent widespread use of herbs, there are only three qualified medical herbalists in Iceland. They all graduated from the same school in southern England. There is one family of four who have 'learnt the trade' from other family members, and a Canadian man who studied with various mas- ter herbalists in the USA but did not undergo formal training. In addition, a few people, mainly in rural areas, have become known for making one or two herbal remedies for specific complaints, and an Icelandic flower remedy is being produced in east Iceland.

THE HEALTH RETREAT AT HVERAGER~ I

The health centre in the greenhouse town of Hverager~/i is worth a special mention as it is unique in Iceland. The centre caters for 160 guests who may suffer from physical ailments such as back pain, heart problems and rheumatism, or a combination of psychological and physical problems associated with their lifestyle, such as obesity or smoking. Some people who have been recently bereaved or have been through some other bad experience are also referred there. The centre recently opened a day clinic where people can come for the day, without a doctor's referral, and take part in the centre's activi- ties.

The philosophy of the centre is positive. They reject the term 'patient' in favour of 'guest ' , as the former imparts too much of a negative, victim image. The nursing philosophy is based on that of Watson (1988): 'Caring is not only a good feeling, a sympathy and good intention. It also comprises knowledge, activity and consequences'. Each person is given an individual treatment plan, and it is also possible to go to lectures related to lifestyle, such as health and the mind, forgiveness, and life changes. Relaxation classes are taught on the basis that a relaxed, happy person has more 'natural killer cells' in the body. These help to build up the immune system.

Various types of massage are also used, includ- ing aromatherapy, one which alternates hot and cold water treatments, mud packs, and mud baths. The

Complementary therapies in Iceland 15

Fig, 4 Near Landmanndaugoar (uninhabited interior, hot spring area).

mud treatments are a product of the local high-tem- perature area. One treatment involves putting a soft, malleable pack of clay, paraffin wax, and volcanic ash on parts of the body for 20 minutes at a time, 2-3 times a week. The other involves lying for about 15 minutes in a clay/mud bath, at a temperature of about 40~ and then resting for 20minutes. This process is carried out 2-3 times a week and is partic- ularly good for rheumatism and pain.

The diet at Hverager0i is basically vegetarian, with fish meals once or twice a week. Grains, fruit, and vegetables are emphasized, much of the latter coming from the centre's own biodynamic green- houses. At the end of a 4-week stay, most guests return home revitalized, and may be well enough to stop taking asthma or heart medication.

M O R E O N M U D

Mud baths are also carried out at the main swim- ming pool in Reykjavlqc, using a similar process to that at Hverager0i. The Reykjav~ publicity litera- ture for mud baths promotes them as a treatment for acne and scabies.

A related type of treatment is carried out at the Blue Lagoon. This is a swimming complex immedi- ately adjacent to a geothermal power station which uses the cooling pond as a swimming pool. The water is 65% seawater, 35% freshwater, and has a greater quantity of silica, but less magnesium, than is generally found in seawater. The Blue Lagoon has become known for its beneficial effects on psoriasis and other skin diseases, and a special pool for psori- asis sufferers has been built. Patients may stay at the

adjoining hotel and use the pool three times a day, for 1 hour each time, for a period of 4 weeks. There is a marked improvement after this time, especially if a UV light treatment is also used.

The treatment at the Blue Lagoon is supported by the State and is covered by the social security sys- tem. Groups of people from places such as Denmark and Germany have also used the pool for psoriasis treatment.

Tubes of Blue Lagoon mud, mineral bath salts, and a moisturising cream are now being produced for people with skin ailments.

S U M M A R Y

In general, complementary health is blossoming in Iceland, although, as in other countries, many people do not realize the full potential of the different thera- pies in terms of the range of ailments that can be treated. Reflexology and other types of massage are probably the most popular therapies, but there is a general awareness of herbal medicine and the use of vitamin and mineral supplements.

ACKNOWLEDGEMENTS

I would like to thank all the people I interviewed for this article; in particular Anna J EdvarOsd6ttir, Gunnhildur Valdimarsd6ttir, Hallgrimur Magnfisson, Ingibjtrg Sigft~sd6ttir, Kolbnln Bj6rnsd6tti~, and l~6rgunna Io6rarinsd6ttir.

REFERENCE

Watson J 1988 Nursing: Human science and care. National League for Nursing, New York