41 Health Research and Health Professional Education in Greenland

Communities in Greenland continue to encounter significant challenges in healthcare, including a critical shortage of health professionals (nurses, doctors, etc.), a lack of well-trained health workers from the North, recruitment problems, unfilled positions, continuity and responsibility, and cultural barriers. Building local capacity through the University of Greenland is an important step to addressing these challenges. In response, higher education has been actively developing programs over the past decade to address these challenges, of which three are demonstrating notable success: 1) specialist education for Medical Doctors, 2) nursing education, and 3) the creation of the Greenland Centre for Health Research. In this chapter, I will describe each of the programs, outline their successes, and the future direction for these programs in order to continue build capacity.

First, doctors working in northern hospitals and health centers are regularly confronted with problems and situations that are not a part of their university medical education. The Specialist Education for Medical Doctors in Greenland as General Practice is a supplementary educational program that focuses on the health and wellbeing of residents in the circumpolar region, health culture, and the delivery of health care and wellbeing services in the North to strengthen the skills of physicians wishing to work in Arctic hospitals. The program is offered at the Nuuk hospital and provides doctors an additional five years in specialized training to become doctors with a specialty in family medicine. Specifically, medical doctors have to stay 2½ years at two different District Centre in Greenland, and 2½ years in different specialist departments at the National Hospital in Nuuk. More than 30 doctors have had a five-year contract with the Greenland Health System for training as specialists in General Practice. Around 50% of the Medical Doctors in Greenland with a permanent employment are educated under this program.

Greenland is further using a novel approach to keep — and educate — doctors in Greenland. Specifically, the specialist training program offers students an opportunity to study with specialists at the Nuuk hospital, instead of remaining in Denmark. Greenlandic medical students study at universities in Denmark. After those students finish their eight years of studies, they are encouraged to return to Nuuk to continue their specialized training, instead of receiving their training in Denmark. This has been helpful to combat brain drain and to provide better mental health services to Greenland’s residents. In particular, it has been observed that after Greendlandic medical students spend six months of their five-year training program in the mental health unit, they provide better mental health services to patients.

The University of Greenland has also offered a nursing education program for many years. The nursing program constitutes a four-year bachelor’s degree and it alternates between theoretical and practical studies, where practical and clinical education accounts for approximately 1/3 of the content. The main subject in the theoretical part is nursing. In addition, there are subjects from health, natural, human, and social sciences. The clinical studies are a long-term course in health care in Greenland. Nursing students gain experience at Queen Ingrid Hospital in Nuuk, in the hospitals and health centers, and in villages at nursing homes on the coast around Greenland. Nurses are recruited from the high schools in Greenland with a possible uptake of 14 students. Every year, 8-10 nursing students graduate. Since the start of the of the Nursing education program in Greenland, more than 150 have graduated and more than 90% of the nurses are still working in Greenland.

Finally, the University of Greenland is increasingly approaching research as a means to building capacity. The Greenland Centre for Health Research was established in 2008 and became connected to University of Greenland in 2013. The vision for the Centre is to improve the health status in Greenland through initiation and coordination of health research; facilitate exchanges; disseminate and apply scientific knowledge; create national and international networks; build local capacity through mentoring and PhD programs; and improve community involvement and local partnerships. PhD courses have been completed from Greenland Centre for Health Research include: 1. Research and Communication; 2. Health, Society and Environment in Relation to Large-Scale Industrial; 3. Ethics in small population; 4. Research method in small population; and 5. Research Cohort, Reproduction and Environmental Health, Community Involvement, Population Trends across the Arctic, Multidisciplinary Research.

Moreover, the Greenland Centre for Health Research has agreements with 7 professors, which all have been involved with health research in Greenland for more than 10 years and their research cover a broad perspective of health research, including: infectious diseases, diabetes, environmental medicine, health and population survey, health cohort, patients with chronic disease and their relatives in relation to their everyday life and rehabilitation, and ear diseases and hearing problem among children. At the moment, five PhD students are enrolled at the Centre and they have a network and collaboration with PhD students at Universities in Denmark working with Health Research in Arctic.

In addition, the Greenland Centre for Health Research focuses on network-building between universities in the Arctic region through UArctic Thematic Networks. The mission of the Network on Health and Well-being in the Arctic is to improve the sustainable development of health and wellbeing in circumpolar regions by promoting research projects on health people, and by organizing research training and distributing scientific information. The main task of the network is to increase the quantity and quality of scientific research carried out at the circumpolar area by the means of the graduate school, and the international Master and PhD programs for Circumpolar Health and Wellbeing.

In conclusion, education for all levels of personnel working in the health system have been given high priority. Living in a country with 56,000 inhabitants, we still have to recruit personnel from abroad, especially highly educated personnel. To also focus on the attainment of high education by our own citizens will have a huge impact at the development of the health system and the development of society over time.