Our visit to Iceland in 2009 was our first to this ‘Island’, a word which itself is the country’s very name in Icelandic. With only 330,000 people, it is the smallest and most northerly nation yet to receive us, and was reputedly the springboard for the discovery of America (‘Vinland’) by Leif the Lucky, son of Eric the Red who settled Greenland. We had a mutually instructive scientific programme at two hospitals. This included an endoscopic hernia repair on closed circuit television, beautifully executed by Dr Fritz Berndsen (“I am the chief surgeon of this hospital – I am also its only surgeon”) in Akranes – population 18000 – just north of Reykjavik. Here we also heard about bariatric surgery in Iceland (from Bjorn Geir Leifsson, born to Icelandic parents in Copenhagen) as well as papers from our own group, including our Secretary Terry Irwin’s experience in Africa repairing hernias under local anaesthetic in primitive conditions supported by his wife Jenny in Operation Ghana, a venture organised by TSS member Professor Andrew Kingsnorth.
This visit to Iceland – attended by 43 of whom 21 were TSS members, under the Presidency of David Ralphs and his wife Diana – was the first to include Travelling Fellows on the new Price Thomas Bursary: David Jayne (Robotic Colorectal Surgery and Transanal Rectal Resection) and Tim Lane (on genetic aspects of prostate cancer) gave further academic weight to a scientific programme well supported by the TSS, both at the hospital in Akranes and at the next venue where in a plush amphitheatre at the Landspitalinn (one of Iceland’s two teaching hospitals which have over 400 beds between them) we heard eclectic presentations. Surgical training was overviewed by junior female medical staff, encouraged by the Professor of Surgery, Professor Tómas Guðbjartsson, a cardio-thoracic surgeon whose team also discussed atrial myxoma. His brother Hákon later gave us fascinating genetic insights into the work of the company deCode which we toured briefly on our final day. This enterprise, which has yet to make a profit, is currently analysing the gene signature of a number of diseases in anonymised blood samples (stored at minus 23˚C) from the relatively static Icelandic population. Hospital care in Iceland is delivered by consultants supported by energetic house officers whose subsequent middle-grade training is received abroad, mainly in the United States or Scandinavia; Iceland has all major surgical specialties and little is transferred out.
Our social activities included a reception at the British Embassy (the British Ambassador Ian Whitting had been at the embassy in Greece in 2008 shortly before we visited there), whale watching by boat, and a visit to the Blue Lagoon. On a blustery day everyone braved an early start for a one-day foray north by plane to Akureyri (on the coast a couple of hundred miles short of the Arctic Circle) and thence by coach to its snow-encrusted environs where the scenery was breathtaking: we shivered by the twin waterfall Godafoss, yomped along the edge of Lake M’vatn (Europe’s largest bird sanctuary – we even glimpsed the rare Barrow’s golden-eye), walked gingerly in the snow amongst the brooding lava rock formations of Dimmuborgir (Dark Castles) and were resuscitated with Brennivin (Icelandic schnapps) and cubes of pickled shark meat. During a heavy lunch at a lakeside hotel there was an impromptu promotion (including detox and colonic irrigation) of complementary medicine. Finally we inspected volcanic craters and open-air spring baths in which the more hardy bathed after we had picked our way amongst bubbling sulphur mudpots and fumaroles in an almost extra-terrestrial landscape.
Back in southwest Iceland we toured the Golden Circle, taking in Thingvellir (the site of the Athling, the world’s oldest democratic parliament, founded in 930 AD), the great Strokkur geyser, and the Gullfoss (Golden Waterfall, one of the most impressive in Europe). We also learned about geothermal energy in the recently-opened glass-fronted industrial plant harnessing hot water on Iceland’s oblique belt of two tectonic plates (the American and European, drifting apart 2 cm a year) which are responsible for hardened lava streams, several active volcanoes and over a thousand earthquakes a year. Iceland’s geology is certainly very unusual.
Our Hotel Borg was on Reykjavik’s Parliament Square in the centre of the city: the harbour was within walking distance and so – almost – was the modern National Museum, beautifully laid out to illustrate Iceland’s history. At the Hotel we had a meeting of varied presentations, including Bill Thomas on the History of Surgical Sutures and Brian Ellis on What Surgeons Can Learn from Pilots, Hjortur Smarason on What Even Surgeons Should Know About New Social Media, and a discourse by the one-time medical student Andri Snaer Magnason, now a poet and author, who had produced a documentary on Iceland called Dreamland. He later entertained us between courses at our dinner in the Silfur Restaurant of the Borg Hotel, an evening which began with champagne and a couple of folksongs on guitar by the daughters of two local surgeons. Our own former-Secretary Roger Marcuson followed with a surprise reprise of his student visit to Iceland fifty-five years previously. It was a most colourful day, in the very best tradition of our Society.
Throughout our visit our guide was Thorsteinn McKinstry from Iceland Travel. With a wry sense of humour and many a shaggy dog story, he accompanied us on all our leisure activities, including our final journey beside moss-bedecked lava to Keflavik international airport on the south-westerly tip of Iceland “to ensure you all depart”: we did so with hearts uplifted by a fascinating week, quite different from anything so far experienced in 85 years of surgical travelling and a tribute to the ingenuity and organisational skills of our Secretary and his wife, Terry and Jenny Irwin.