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Another Swede's breast removed in vain

TT/The Local/kh · 30 Jul 2011, 09:17

Published: 30 Jul 2011 09:17 GMT+02:00

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A woman recently had one of her breasts removed at the University Hospital in Linköping only to learn after the surgery that she did not have breast cancer.

“It's a very unfortunate error,” the University Hospital’s Chief Medical Officer Hans Rutberg told local newspaper Norrköpings Tidningar.

According to guidelines from the National Board of Health and Welfare (Socialstyrelsen), a tissue sample should have been discussed during a special round of doctors, but this was not done.

Recently, two similar cases occurred at Gävle Hospital in eastern Sweden when a 47-year-old woman had her breast removed after a contaminated test led doctors to believe she had cancer and a 34-year-old was misdiagnosed.

Officials there blame the mistakes on a shortage of pathologists at the hospital.

The National Health Board is notified of all events.

According to the Board’s 2009 statistics, breast cancer is the most common cancer in women and constitutes 29 percent of diagnosed cases in Sweden. The average annual rate of increase for breast cancer was 1.2 percent over the past twenty years.

Although science has made advances in breast cancer treatment, critics claim it currently does not adequately address the psychological effects of losing a breast nor the effects of a misdiagnosis of cancer followed by unnecessary treatment.

Story continues below…

According to recent studies, a diagnosis of breast cancer forces women to consider living without their gender-defining curves and to re-evaluate their lives from every aspect, causing immense psychological stress.

TT/The Local/kh (news@thelocal.se)

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Your comments about this article

10:21 July 30, 2011 by Strongbow
Breast removed in van in South Central? Not news.
10:55 July 30, 2011 by Dalia1
the doctors who did this to her should have their genitals "unfortunately" cut off, and then maybe Swedish doctors will try to actually do their job.
11:17 July 30, 2011 by jacquelinee
Well, thank god they are only mutilating women by malpractice and not trying to save an injured hedgehog or they might have actually been charged with something!

Of course, they were probably veterenarian janitors, dental hygenists and maybe grocery store clerks doing the consulting and surgery seeing as they let everyone in the whole blo- ody country go on holidays at the same time (July) so no one left has a clue what they are doing.

What a screwed up country this is.
11:40 July 30, 2011 by Streja
Yeah it is just as screwed up as the countries in this simple google search: http://www.google.se/search?source=ig&hl=sv&rlz=1G1ACPW_SVSE400&=&q=doctors+removed+wrong+breast&oq=doctors+removed+wrong+breast&aq=f&aqi=&aql=&gs_sm=e&gs_upl=1266l6296l0l6843l28l27l0l20l20l0l163l707l4.3l7
12:18 July 30, 2011 by jacquelinee
@ Streja

As replied to another post....

Yes, occurances happen like this all the time. But in countries that are purported to be some of the greatest countries to live in with the best laws, cutting edge technology, advances in medicine etc. (Sweden, USA, Australia, Canada etc) the instances should be far less. I come from Canada and we have these bizzarre things crop up in the news too from time to time. But, it is NOT a daily occurance like it is in Sweden and the poulation in Canada is over 116% larger (Canada-34,533,000 vs Sweden - 9,440,588) So...you do the math. Like this morning (if I may quote)

"A woman had one of her breasts removed in south central Sweden and was told after surgery that she did not have breast cancer. This makes it the nation's third such case during July

According to guidelines from the National Board of Health and Welfare Socialstyrelsen (more like SociallyRestin'), a tissue sample SHOULD HAVE BEEN DISCUSSED during a special round of doctors, BUT THIS WAS NOT DONE."

Was there any mention in this article something to the effect of --- However, as Swedish law prohibits medical professionals from mutilation of patients due to not following the proper medical proceedures and protocol the law decrees, the doctors and/or hospitals involved should end up with criminal charges? NOPE! Just a statement from officials saying how unfortunate it was.

Save an injured hedgehog though and it is--"The woman (who rescued, cared for and saved the animal) is now suspected of crimes (get that? CRIMES) in violation of hunting laws and risks fines or imprisonment for up to one year.

conclusion? Cut off a bunch of womens breasts without cause by malpractice and it is unfortunate,


I repeat. This country is Wacked!
12:21 July 30, 2011 by johnny1939
Why even remove the breast because of cancer? Lumpectomy according to research is just as effective. Removal of entire breast does not prolong your life.

ps don't have a problem of any kind during the month of July in Sweden. It does not matter if it is your health or your plumbing or your drycleaning..you are sh*t out of luck!!
12:41 July 30, 2011 by engagebrain
12:18 July 30, 2011 by jacquelinee wrote

But, it is NOT a daily occurance like it is in Sweden and the poulation in Canada is over 116% larger (Canada-34,533,000 vs Sweden - 9,440,588) So...you do the math.

NO the Canadian population is around 350% of Sweden's. ....as you say - you do the math. It's easy to make mistakes.
12:42 July 30, 2011 by Streja
jacqueline, just because it happened twice in July does not mean it's a daily occurrence.

What has the hedgehog got to do with it all? Do you think it's ok for people to maltreat animals because there was a horrible error in a hospital? I'm not sure I follow.

I agree with you that our countries should have high standards, but unfortunately Sweden has been closing down hospitals since the 90's.
12:58 July 30, 2011 by Addendum
Jacquelinee, please keep shouting and sharing the truth!
13:00 July 30, 2011 by Streja
Shouting doesn't help. I think jacqueline seems to care a lot and should contemplate joining an organisation.
13:06 July 30, 2011 by cogito
The excuse is always the same: Everybody does it. It happens everywhere.

As engagebrain (#7) says: Do the math.

It has been this way for decades. But before, the mistakes went unreported. Sweden has had to become more open about its failures now that Swedes travel abroad more and can see how much better health care is in other countries.

Swedish health care is dangerously hit-or-miss.
13:11 July 30, 2011 by krrodman
I am a physician and I have been involved with physician "quality assurance" for over 20 years in the USA. While I have never practiced in Sweden, I have several friends who practice medicine in Sweden so I am familiar with the Swedish system.

Let me start from the beginning. I am NOT an apologist for American medicine. In the USA, we do many things well and many things, shall we say, less than well.

That said, we are 10 years ahead of Sweden in monitoring quality issues, and attempting to improve policies and procedures to avoid errors. The reason, I believe, we are ahead is primarily that the attitude towards medical errors in Sweden is very different than in the USA. In Sweden there is a level of acceptance that "doctors are trying their best and that, after all, they are only human" that does not exist in the USA. In fact, with the appropriate policies and procedures, many errors can be avoided.

This case is a perfect example. Identifying cancer in a pathology specimen is often difficult. The standard of care is for 2 independent pathologists to review a specimen so that there is always a second opinion on a sample. If there is a shortage of pathologists in Sweden, than perhaps there was no second look before the patient was given the diagnosis of cancer. (I suppose it is a matter of money, as well. Insufficient funds equals no second opinion.)

The solution is straightforward: No surgery without a review of the pathology specimen by a second pathologist to confirm the diagnosis of cancer. Will that eliminate all errors? Of course not. Will it cost extra money? Absolutely. Will it reduce the number of medical errors? Absolutely. Is it worth it? Absolutely
13:18 July 30, 2011 by jacquelinee

you are right...guess that is why I said "you do the math". I surely I have all the qualifications needed to be a surgeon in Sweden I guess.Now all I have to do is print myself out a betyg from Google and I too can practice medicine in Sweden.

@ Streja

3 times in July, not 2. And I am not insínuating it is just radical misdiagnosed mastectomies that happen daily. It is Elderly abuse, ambulance refusal, misdiagnosis of melanoma, breast cancer (oddly enough, not so many misdiagnosis of testicular or prostate cancer) and just one thing after another. Plus the total disregard for any kind of consequences from the law or from SociallyRestin' only perpetuates this lazy and incompetent mindset and further medicial (among other) crimes. 3,000 reported malpractice complaints since 2009 and ZERO investigated?!?! Do you see anything wrong with that picture? It is not just the closing of hospitals, it is the lazy, incompetent mind set of so many of the medical professionals and no reprocussions for their medical errors. It is also mediocre education passed off as exceptional education because of a betyg driven ( rather than expertise driven) educational system.

The reason for the comparision with the hegdehog, is that the authorities are GUNG HO to hop on the "old stick to the law/ justice system" when it involves one poor singular citizen trying to save (NOT maltreat) an injured animal.

However, if it involves stepping on a few toes that are pretty much wearing some form or other of governmental shoes, a blind eye gets turned and blatant criminality in the form of abuse, neglect, or malpractice is merely "a frustrating misfortune." If you can not see the criminal hypocrisy between these comparisons, then you are pretty brainwashed as many are in Sweden.
13:48 July 30, 2011 by Maggie Malay
I'm wondering if I should leave Sweden forthwith... I want to keep both my breasts as long as they are healthy...certainly are grounds for lacking confidence in Sweden's medical profession
14:10 July 30, 2011 by cogito
@Jacqueline, You are spot on about brainwashing. The attitude has long been: We are best in the world. We do it best. This is how we do it Sweden.

A result of this indoctrination: anyone who complains or makes a fuss is deemed a "trouble-maker."

Another problem is the depersonalization of responsibility. Whenever there's a major cock-up, a bureaucratic flack creeps out with the same old assurances that they will now "look over the" routines."

It's always about the routines. Never is there is never a real live human held responsible.
16:07 July 30, 2011 by Mb 65
It's time to bring out the no win no fee lawyers as in America and the UK that will make them sit up and take notice.
16:50 July 30, 2011 by engagebrain
Mistakes happen, how Sweden rates compared to countries with similar economies requires evidence, not anecdote.

An overall measure good health is longevity - here Sweden is clearly a world leader. Admittedly longevity is far more than just medical competence.
17:05 July 30, 2011 by Abe L
It took a 4th incident before the nurse from SOS got fired. I guess one more victim needs to be mutiliated before someone gets fired for not requiring the correct skill set for medical practice.
18:02 July 30, 2011 by texaslass
The longevity argument is not necessarily logical. Yes, Swedes do have higher longevity rates than other countries, but there are reasons for this other than health care. One, is that there are few people own cars in Sweden, car accidents lead to deaths, which reduces longevity. Two, is that Swedes tend to shy from anything risky, like sports that involve risks and death. Third, is that Swedes are a peace-loving people who have a low level of military presence in the world, this increases the longevity figure. There are others, too. Anyways, the longevity argument sounds sweet, but is not reality. I believe it is a means for the state to facilitate the acceptance of a weak health care system in Sweden.
18:05 July 30, 2011 by jacquelinee

I may be " just an immigrant from Canada". But I have certainly lived in Sweden long enough to know I probably would never be allowed to "get in the Sven club" of any legitimate organization for change and even if I could, I would be just another immigrant trying to destroy glorious Sweden and the Scandinavian culture, Sweden and its historical perfect system. I would be accused of trying to annihalate Swedes as a people ....Sweden is the forerunner in all advances and on and on and blah blah blah . (which only proves the old story, If you tell people something often enough and repeat your story to them frequently enough they will believe you inspite of the truth)

I am outraged and gobsmacked and the fact Swedish people defend this is mind boggling.
20:31 July 30, 2011 by Mb 65
Jacquelinee I agree with you 100%. When i first came to Sweden and told them bad things that are happening in the UK they all said it will never happen here.
21:33 July 30, 2011 by Smallnose
At least the mistakes are openly admitted, we're making progress. A country cannot be the best in everything. Sweden still has so many other things to be proud of.
21:47 July 30, 2011 by Streja
Smallnose, don't say that! That's too honest and levelheaded. We must scream and shout and compare breast removal errors to other laws like last week someone got a speeding ticket.

I'm sure we can find a story from Canada about a medical error and then another one about someone who was taken to court for keeping a moose in his kitchen. They're totally related you see.
22:42 July 30, 2011 by dizzymoe33
This is a shame both the physical and emotional trauma this woman is suffering. Sweden needs to set up a better system by making sure there is some sort of biopsy taken and the results doubled checked. Maybe an additional biopsy and blood work taken to ensure there is a need for the surgery. This is sad.
22:46 July 30, 2011 by jacquelinee
@ Streja

"I'm sure we can find a story from Canada about a medical error and then another one about someone who was taken to court for keeping a moose in his kitchen. They're totally related you see. "

I am totally sure you could find a story like this it too. The difference is ........The doctor responsible for the medical error would be sured, fined and fired so they could never inflict this on another again. The hospital would have to answer to government inquiry. And the one who saved the life of the moose and had it in his litchen would be given a ctizens honour citation and be a local hero. THERE is the difference.
22:47 July 30, 2011 by Observour

Your longevity argument is a proxy to denial :) in addition to what taxaslass said Swedes have a far less stressful life and huge social cushion from day one of thier life than many countries. Even the grading system in sweden is pass or fail and anyone with a chain of distinctions risk being unemployed for not being ...is it Logom or whatever.

The health system needs to be looked at again and people need to be responsible for their actions.
00:44 July 31, 2011 by Smallnose
According to the WHO, despite these breast mistakes, Sweden is still a top 10 country in medical care. France and Italy are number 1 and 2. My theory is: the less reliable their car brands, the more reliable the health care.

To all the critiscs out here:

I am still proud. Volvo although not the best car, still good. Ice Hockey: no world champion, but still going strong. Women football recently, not champion, but still good. Eurovision song contest, not winning but at least in the finals. We have so many things to be proud of.

(reading back my last paragraph, maybe i have the tune down my Swedish pride a bit).
02:38 July 31, 2011 by caitnor
Yes, but it seems that Swedes also need to be more pro-active with doctors and not just accept what doctors say.

Doctor: "You have cancer"

Patient: "What is the standard of care for determining that?"

Doctor: "At least two pathologist have to look at it and come to the same conclusion"

Patient: "Do both of those doctors have to be Swedish pathologists or are you sending my samples abroad for determination? Is pathologist a pre-defined term, i.e. do they all meet the same standard of education? Can I see both of the reports on this sample? Is there a reason the whole breast has to go? etc..."

It is tricky for doctors when patients take this attitude. At least in the U.S. doctors can often tell a benign growth in a matter of seconds, they can often diagnose a kind of rash at a glace, in these instances it can feel to the proactive patient that they aren't really taking an interest, which is not usually true, it is just that they are really good at it because they do it all day everyday. Doctors in the U.S. are learning that if they only touch a lump for three seconds the need explain *how* they know it is not cancerous, not just tell the patient they are fine.

Many Swedes have such a trusting attitude of: "well, the doctor must be right, it is their job to be right." Of course the truth is they often are right, but being involved in one's own care can be helpful in certain circumstances!
04:16 July 31, 2011 by anonymous33
In the USA people having surgery have to mark the area to be operated on themselves. One factor of mistakes is often due to the fact that new doctors graduate in May or June. They can often be inexperienced. Best results of surgery are often after the month of August when the more experienced doctors and staff return from vacations. This is a shame worldwide.
10:55 July 31, 2011 by canam
@ Smallnose

Did you really try and bring in sports, of which neither you are dominate in, and EUROVISION, into a discussion regarding health care?? Even the list you pulled up as the "best of the best" still aren't really that great.

Health care is far more serious than that. I'm glad you're proud no matter what but keep your distinctions clear.
12:03 July 31, 2011 by jacquelinee
@ Smallnose

Maybe Sweden is in the top, but that is partially because very little of the actual incompetence ever makes it past the border. There is very little if any accountability for medical error which makes for a very laissez faire attitude towards patient care.

I personally have been misdiagnosed twice and had a prescription written for a skin problem without the doctor even taking a casual glance at the problem. I have had a doctor ask me what a topical skin medication I was inquiring about actually was because he had never heard of it before and they sell it at Apoteket. I have had a doctor tell me to come back tomorrow to check something and when I went to see him ask me "Why did you want to see me today?" I have had a skin lesion that turned out to be a benign skin lesion diagnosed as excema (fortunately and hopefuly the lab reports are right...one never knows here.) And these are just MY instances, One person.

But any kind of incompetence, to a greater or lesser degree, if it manages to "leak" out, will be played down to a fault and the action of the authorities will be to say " It is frustrating, but we will look into it". Of course, they never do look into it, so it perpetuates. But on the other hand, if you have hardly no recorded instances of problems within your medical system , to the outside world, your medical system looks like a top knotch, cutting edge leader in world medicine.

In typical Swedish style, it looks really great on paper, has a shiny diploma, certicifate, Betyg....but don't look deeper, or don't get ill because (if you live) it will scare you to death anyway.

11:38 August 1, 2011 by Streja
jacqueline, check the stats on Canada. Apparently many patients don't report malpractice so they don't get their compensation they're entitled to.

In Sweden the hospitals report malpractice because it's the law. Lex Maria. What is the Canadian law like? Interested.
13:16 August 1, 2011 by jacquelinee
@ Streja

hahahahahahah Streja you are such a lemming!

The Swedish hospitals report malpractice???????? Are you kidding me? You REALLY are that brainwashed? Obviously you read the news daily. Did you not read the article a week or so ago that says that 3,000 reports of malpractice complaints have been submitted since 2009 and NONE have been investigated? In case you do not understand the word none...it means 0, null, nothing ZERO.


Sweden 'swamped' by malpractice complaints

Swedish health authorities "HAVEN'T DEALT WITH A SINGLE MALPRACTICE CASE" since taking over responsibility for managing patient complaints at the start of the year. the number of serious written complaints has increased by 80 percent in the last five years,

Among the "3,000 UNHEARD PATIENT COMPLAINTS" are roughly 15 to 20 from 2009 which still have yet to be assessed

Since the start of the year, 700 new complaints have come in.

(Government/medical feedback)-

"It's frustrating for patients who think they've received the wrong treatment," she told the newspaper.

She added that the number of people who have been harmed in the Swedish healthcare system is "unacceptably high".

Frustrating? Yes it is frustrating to have perfectly healthy breasts removed or die from misdiagnosed cancer although I have stronger words than "frustrating" like CRIMINAL!

But keep your headed hidden up your a - - and spout off the praises of the "great " Swedish healthcare. After all, you have had THAT drilled into your head long enough that you believe it inspite of proof otherwise. (lemming) Pray that you never get really sick here Streja and if you do, I hope you have medical coverage in another country.
13:53 August 1, 2011 by Streja
Why are you so rude? I have been ill in this country and I do not think it's the best in the world. I was just stating what the law was and asked YOU for help in informing me on Canadian law, which you have not. So it seems to me that you are more interested in being rude to me just because I am Swedish. Stop shouting for a minute and tell me properly what Canada's system is like. Don't tell me things like doctors are fired. I want statistics because I couldn't find a good site on the net for Canadian statistics on malpractice. I wanted to know what was good about the Canadian system and if it could be used here.
14:48 August 1, 2011 by jacquelinee
Pulling out the old " You are picking on me because I am Swedish" card. I am so sick of that card being played when someone is losing a discussion. I am a permanent resident here ( I always hate to say I am a Swedísh citizen as Swedes continually take offence and get up in arms and strongly point out that I am not a pure Swede by blood)

Because I live in Sweden, it is Swedish medicine that concerns me (as it should you!) I am more concerned with statistics here at the moment, and they are poor. (Feel free to research Canada if you are so inclined, I am not doing the work for you) I apologise for evident rudeness. I am just so tired of Swedes being blind about the inadequate, lacking and worsening educational system, medicinal system etc just because they have it drilled into their heads incessantly that Sweden is the best , and they mindlessly believe it (like a lemming), inspite of the blatant truth that says otherwise.
15:09 August 1, 2011 by Streja
I am half Spanish Jacqeuline and I prefer the Spanish health system myself, because trips to the doctor are free. My sambo is an immigrant, my sister is an immigrant to another country.

I just wanted to know what the Canadian system was about since you are so upset. I was trying to find out what you thought was so good about it.

Noone has drilled anything into my head I can assure you. That is a myth that many immigrants to Sweden seem to think. The problem is when you start to criticise the health system by being rude. Noone likes that. Imagine what the countrymen of my sister's new country would think if she did that? Or what kind of reception my own immigrant mother would get if she did. The best remedy is to create discussion and join an organisation. Not to blame it on soem sort of notion that Swedes are brainwashed.

I actually think you and I are quite alike. We share similar views on many things like that man we shall not name in Norway who dserves no PR.
17:39 August 1, 2011 by cogito
"That is a myth that many immigrants to Sweden seem to think."

@Streja, If it is a myth, how is it that so many immigrants from so many different nations and diverse backgrounds have the impression that Swedes have been indoctrinated?

@Jacqueline, you are right to be upset. Everyone should be upset. Replacing ombudsmen and bureaucrats with malpractice litigators would be a start.
17:44 August 1, 2011 by Streja
cogito, because it is very common for any immigrant to any country to believe that its inhabitants are indoctrinated, simply because their home country is different to their own.

I don't agree with you on malpractice litigators. It's a question of revamping the health care system. The US system has not eradicated malpractice. It seems both systems fail.
18:56 August 1, 2011 by Polarbear
@ streja

Here is a good book for you. There are actually 2 similar books out right now comparing Canada and Sweden. Full of stats, many of which may not be liked or accepted here.
19:08 August 1, 2011 by jacquelinee
@ cognito- Right on the money

I am sorry Streja and I cannot speak of course for every single Swede as I have not spoken to every single Swede, but the ones I have talked to and befriended and married for that matter, certaintly are brainwashed. They are indoctinated (brainwashed) from the time they start "dagis" that Sweden is in the forfront of the world, I am not going through the whole thing again, as I have stated my case aready loudly and lengthily enough. My best friends son who moved here with her from North America excelled at school. (probably because he had learned to multi task lessons, study, so reports on his own not just copy from the internet) and graduated with honours. They then moved back to North America where he was placed two years back as his mathematics and sciences were well below the average, but here they were exemplory. Students are pampered so much it is ridicuolous. My stepson took classes in Gymnasium from 8:30 A.M. till 10:45, 3 days a week for 3 years. (He was 16-19) When I spoke with my husband about him getting a part time job instead of sitting on his hiney all day (no homework) playing "World Of Warcraft" my husband looked at me as if I had completely lost my mind and replied " That is way to much pressure for him. He is in school you know!" And it is not just him. That it the norm.

The health care system will not be revamped here. On paper, there is nothing wrong with it and very few open their mouths and the ones who do complain get their file put in "File 13" if you get me and told, " Yes it must be frustrating for patients who THINK they have gotton the wrong treatment" (THINK they have gotten the wrong treatment! When you look down and there are no breast there anymore it goes past "thinking" you have gotten the wrong treatment!)

The butchers and slackers and incompetants need to be made accountable. SOMEONE in this country needs to be made accountable for SOMETHING.
19:52 August 1, 2011 by Polarbear
Indocrination is called socialization here and it is an essential part of the curriculum from dagis up to gymnasium. Young Swedish citizens are taught about how they are number 1 at EVERYTHING (education, helathcare blah, blah, blah), how immigrants are just a whiney lot and they are maltreated because they deserved it. I was horrified when my stepson came home in grade 6 and told me his teacher had said the latter.
21:36 August 1, 2011 by cogito
Streja: While you are correct that you can't radiate malpractice, you can hold those who are careless responsible. And though monetary compensation (in the U.S. millions) is never adequate, it might mean, in this case, that next time they try to meet the minimum international standards (see Dr. Krrodman #12 above).

@ jacqueline. the health care system in Sweden will never be revamped because Swedes will always defend it, having thoroughly swallowed indoctrination lesson 1-A. "We are best. But if caught out not best, then It's the same everywhere. Everybody does it."

At worst, the butchers and slackers might receive a letter or reprimand. More often, as in the case of the nurses who abused those poor oldies, by stuffing vomit down their throats (see other thread), they will get leave with pay (a vacation), before being reinstated in their posts.

@Polarbear. Precisely. All us dumb immigrants are a whiney lot.
22:36 August 1, 2011 by Uggla
@jacquelinee: "SOMEONE in this country needs to be made accountable for SOMETHING."

These words could be applied to Swedish people in nearly EVERY issue I have with Sweden. Those words are perfect in every sense of the way, A perfect sum of the Swedish society.
22:56 August 1, 2011 by Streja
Polarbear, what books?

Jacqueline, I am a teacher at gymnasiet and if your son had that kinds of schedule it was a really bad school indeed. I don't know how the school would be able to fit in the subjects that are mandatory that way. My students have classes from 8-15.30 normally, Perhaps it was one of those modern free schools that should never have been allowed to start.
23:59 August 1, 2011 by jacquelinee
@ Streja

Well, those were the classes, and they certainly graduated a lot of lazy unmotivated young people.I don't know where you teach, but I haven't seen that kind of a schedule ever in Sweden. Are you teaching a swedish curriculum or at a "folk" or special language school.

@Uggla...you said it. I am gobsmacked and not in a good way.
13:26 August 2, 2011 by matona1
one action missing what a pity
15:45 August 2, 2011 by jacquelinee
@ matona1

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Syria's White Helmets: The Nobel Peace Prize would have meant a lot, but pulling a child from rubble is the greatest reward
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