1993-1999
Focus: Cardiology, Neonatology, Hematology, Oncology, Perinatology, Pulmonology, Toxicology / Poison Control, Emergency Medical Services, Infection Control
US Partner: The Tucson/Almaty Healthcare Coalition was established especially for managing the participation of US health professionals in AIHA's partnership program. Representing virtually the entire Tucson health care community, the Coalition comprised the following members: TMC Healthcare (formerly Tucson Medical Center); Carondelet Health Care Corporation of America (St. Mary's and St. Joseph's Hospitals); University Medical Center; University of Arizona Colleges of Medicine, Nursing and Pharmacy; Columbia Northwest and El Dorado Hospitals; Veterans Affairs Medical Center; Tucson/Almaty Sister Cities Committee; EnviroMed; and Tucson General Hospital. Additional active supporters were: Pima County Health Department, El Rio Neighborhood Health Center and, Arizona-Kazakhstan National Guard Partnership. The Tucson/Almaty partnership was built upon an existing Sister Cities relationship.
NIS Partner: The Kazakh Research Institute of Pediatrics was founded in November 1932 as the first children's consultation clinic in Almaty. It was formerly named the Institute for Maternity and Infant Protection. The Institute consists of approximately 200 beds and eight specialized departments, and serves as the main teaching institution for pediatrics in Kazakhstan.
The Almaty City Emergency Medicine Hospital (ACEMH) was founded in 1896 as the Red Cross Society Hospital with 15 beds. One of the first two hospitals to serve the city, ACEMH is now one of the biggest medical institutions in Kazakhstan with 25 clinical and diagnostic departments and 600 beds. The ACEMH has a staff of 1100, including 200 physicians and 450 nurses. ACEMH is also the home of the Republican Toxicology Center.
The Almaty Regional EMS Training Center was created in October 1994 through the partnership project. The Center is run in cooperation with the Almaty City Health Administration. The Training Center provides EMS training services to the City of Almaty, as well as to the entire country.
Almaty Medical College was founded in 1992 on the site of the Secondary Medical College in Kazakhstan. The Medical College is a pioneer in nursing education in the former Soviet Union, implementing a four-year bachelor's degree program. Eleven other medical colleges in Kazakhstan have implemented the Almaty College's curriculum.
The Almaty Women's Wellness Center (WWC) was created in 1997 as a result of the partnership's objectives in women's health. The WWC, part of a network of centers throughout the NIS and CEE, provides comprehensive health consultations and services in an outpatient setting to women of all ages.
Additional NIS participants included the Almaty City Perinatal Center, the Almaty City Health Administration, and the Ministry of Health.
Emergency Medical Services
- Assist in the development of a pre-hospital care curriculum for ambulance teams.
- Train faculty in the skills and knowledge requisite to teaching the curriculum; evaluate and support their continued professional development.
- Establish and equip an EMS training center.
- Assist with modification of curriculum for special groups, such as medical students, physicians from receiving departments, and nurses.
- Support future sustainability of the center by developing special courses to be offered to outside groups for fees.
Infection Control
- Develop a program to reduce nosocomial infections in city hospitals.
- Conduct a seminar on surveillance-oriented infection control for the heads of city hospitals and health facilities.
- Conduct a train-the-trainers course in hand washing and basic infection control for nurses.
- Convince the MOH and the Sanitary Epidemiology Service to adopt a surveillance model of infection control, jointly develop a program to implement a national infection control and surveillance program, and establish a training center.
- Establish infection control committees and pilot studies in three partner hospitals to demonstrate efficacy of the surveillance-oriented model.
- Co-sponsor a national conference with the MOH to give an overview of patient-focused infection control management programs and provide updates on infectious diseases and nosocomial infections.
Nursing Reform in Education and Clinical Practice
- Assist the City Health Administration and hospital partners in reforming nursing education and practice and introducing the role of "nurse manager.
- Support the development of a four-year baccalaureate program in nursing.
- Utilize partner hospitals as demonstration sites for new roles for baccalaureate nursing graduates.
- Assist in developing a curriculum for nursing education designed to enlarge the scope of nursing practice.
- Demonstrate a broader and more professional role for nurses as part of the healthcare team, in areas such as patient and community education, extended role practice, and administration.
- Assist in the development of and access to training and educational materials and teaching methodologies based on western educational models.
- Assist in development of a short-term certificate course at the Almaty Medical College for post-baccalaureate training of nurses in case-management skills related to family health and tuberculosis; provide a faculty development course to train faculty to teach the curriculum at the graduate level.
Pediatrics and Children's Surgery
- Provide physician training in pediatric pulmonology, hematology-oncology, intensive care and surgery.
- Improve clinical management of pediatric patients with respiratory diseases, such as asthma and bronchitis.
- Decrease the morbidity rate for children with leukemia.
- Improve clinical management of pediatric gastroenterological diseases.
Perinatal Care and Neonatal Resuscitation
- Provide training in neonatal resuscitation, and develop a course and staff of trainers, through the Almaty State Post-Graduate Training Medical Institute, that can replicate the training throughout the country.
- Provide training to physicians and nurses in the management of high-risk maternity patients.
- Introduce the concept of family-oriented maternity services.
Physician Training
- Provide extended US-based training programs for three physicians in their specialties.
- Provide English language training for the physicians to prepare them to study in the US.
- Utilize the new skills of the physicians in changing clinical practice in their home hospitals.
- Provide physician training in the areas of cardiology, surgery, toxicology and intensive care.
- Implement a laparoscopic surgery program utilizing donated equipment and supplies.
- Introduce new surgical and diagnostic techniques and treatments in obstetrics and gynecology.
Toxicology
- Implement a Toxicology Program that includes clinical treatment and a toxicology information center for health professionals and the general public.
Women's Health
- Collaborate with other AIHA partnerships in the development of a model women's reproductive health center.
- Prepare the clinical staff to deliver women's reproductive health services in accordance with American medical standards and modes of service delivery.
- Select, purchase and deliver equipment and supplies for the center, and supplement these with donated items.
- Introduce new technology and contraceptive methods.
- Assist in the development of a business plan for self-sustainability.
- Provide technical assistance to the center in order that it can serve as a model for clinic services and a training site for health professionals.
- Reduce the abortion rate through the introduction of new contraceptive methods.
- Prepare the staff to provide education and counseling based on a principle of patient choice.
- Introduce the roles of the nurse manager and the nurse educator.
- Prepare the staff to provide community education in areas of reproductive health for all ages.
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1992
- Within the first year of partnership activity, the Ministry of Health and the City Health Administration recognized the potential of the partnership program and invited Tucson partners to expand the scope of the partnership to include three additional areas of importance: infection control, improvement of maternity services, and reform of nursing education.
1993
- On May 24, the partners celebrated the signing of a Memorandum of Understanding between the Tucson/Almaty Healthcare Coalition on the US side, and the Kazakh Research Institute of Pediatrics, the Almaty City Emergency Medicine Hospital, and the Almaty Medical College in Kazakhstan.
1994
- The Toxicology Information Center opened at the Emergency Hospital in May. The Center was equipped with a computer donated by Intel and a toxicology data system worth $50,000, donated by Micromedix.
- A surveillance-oriented infection control program was presented in Almaty and a train-the-trainers course on infection control was presented for chief nurses in July.
- The Institute of Pediatrics appointed the first infection control surveillance committee and implemented a program to reduce central line infections.
- The Emergency Medical Services Training Center opened in Almaty on October 3.
1995
- The Tucson/Almaty Partnership played a key role in attracting a major donation of medical supplies and equipment from the U.S. Department of Defense, through the decommissioning of military medical facilities in Europe. A $12 million mobile hospital unit was delivered to Almaty hospitals, including the Emergency Hospital, Institute of Pediatrics, and Perinatal Center. The donation was closely monitored by the US partner institutions, which provided additional training on equipment as necessary.
1996
- The Center for Endoscopic Surgery opened at the Emergency Hospital in April, serving as a training site for surgeons from various Almaty hospitals. Olympus and Johnson & Johnson donated the equipment and supplies for the Center.
- Almaty was selected by AIHA as one of the first eight Women's Wellness Centers to be opened in the NIS. The City Health Administration agreed to dedicate staff and to remodel a portion of the Perinatal Center for the Women's Wellness Center.
- The first baccalaureate nursing class graduated from the Almaty Medical College. Partner hospitals in Almaty provided job opportunities and mentoring programs for the new graduates.
1997
- The Women's Wellness Center opened in Almaty in November, with the First Lady of the United States, Hillary Rodham Clinton, presiding over the official opening ceremony.
- The Arizona Air National Guard, as part of a National Guard partnership with Kazakhstan, airlifted humanitarian aid to Almaty. The shipment included over $76,000 of equipment and supplies donated to the Women's Wellness Center by the Tucson partners.
1998
- In an international competition sponsored by the North American Congress of Clinical Toxicology, one of the staff physicians at the Almaty Toxicology Center received a prize for best abstract.
- The privatization unit for family-centered birth at the Perinatal Center expanded due to patient demand. Other birth houses in the city prepared to open similar services.
- Staff at the Institute of Pediatrics prepared for joint work in pediatric gastroenterology with the Children's Research Center at the University of Arizona College of Medicine.
1999
- The partnership received a limited grant award from AIHA in January to strengthen the sustainability of partnership achievements and relationships by building upon their previous accomplishments in infection control and nursing.
- The partnership conducted a National Infection Control Conference in Almaty from June 22-24. Over 120 participants from throughout Kazakhstan participated, including policymakers, leaders of oblast health departments, leading specialists from the regions, and leaders of national and oblast sanitary-epidemiology stations. Topics addressed at the conference included: patient-focused infection control, impact of the environment on infection control, disinfection and sterilization, role of the microbiological laboratory, community infections, and infection control in tuberculosis’s treatment facilities. In addition to presentations by US partner specialists in infection control, partners from the Kazakh Scientific Research Institute in Pediatrics and Children's Surgery, the Almaty City Emergency Hospital and the Semipalatinsk Emergency Hospital presented on pilot projects conducted in local specialty hospitals.
- On October 11, the Committee of Health within the MOH issued a governmental order to enact a new policy aimed at implementing new standards and practices to reduce nosocomial infections, based on recommendations that emerged from the conference.
- Within the first year of partnership activity, the Ministry of Health and the City Health Administration recognized the potential of the partnership program and invited Tucson partners to expand the scope of the partnership to include three additional areas of importance: infection control, improvement of maternity services, and reform of nursing education.
Emergency Medical Services
- The Almaty EMS Center, between its opening in October 1994 and March 2002, conducted 165 training courses and trained over 4,000 pre-hospital and hospital-level health professionals, as well as ambulance drivers, firemen and flight attendants. In addition, over 250 nursing students took the course. Through its entrepreneurial activities, fee courses were provided to workers of American companies such as Philip Morris and the American Embassy. The Center also collaborated with the AEA International Clinic, providing EMS training to corporate clients in Kazakhstan and Russia.
- The EMS Training Center participated in an international workshop for earthquake response, held in Almaty in 1999 and sponsored by the Arizona National Guard. The Center staff provided a field demonstration as part of the workshop's focus on improving the country's response to disasters. Their participation helped to solidify the role of the Center in the disaster and emergency preparedness system in Kazakhstan.
- A trip to Tucson by the chief toxicologist for Kazakhstan and the head of the toxicology department at the Emergency Hospital resulted in a collaboration with the University of Arizona Poison and Drug Information Center to train toxicologists.
- The Toxicology Information Center in Almaty was opened in May 1994.
- A staff physician at the Almaty Toxicology Center, received a prize for the best abstract presented in an international competition sponsored by the North American Congress of Clinical Toxicology. His research project on acute acetic acid poisoning was published in the Journal of Toxicology, Clinical Toxicology. Also, the director of the Toxicology Center earned his PhD degree based on his work at the Center.
Infection Control
- Three demonstration projects conducted by the partnership convinced the newly-appointed Deputy Minister of Health in charge of infection control of the efficacy of surveillance-focused infection control, and led to commitment to support national reform related to infection control practice and policy. Ministry officials prepared a joint proposal with the US partners for a national conference and training program in surveillance- focused infection control as a centerpiece of the MOH program to reform the health system in Kazakhstan.
- Participants of the National Infection Control Conference held in June 1999 in Almaty adopted a resolution recommending that the MOH review the existing regulations, standards, and practices regarding nosocomial infection control in order to bring them up to modern standards. As a result, the Committee of Health approved the nationwide implementation of a new policy on infection control, through "Prikaz" (government order) No.476, issued in October 1999. The new policy is based on the recommendations made by conference participants.
Nursing Reform in Education and Clinical Practice
- Intense collaboration between the partners and the Ministries of Health, Education and Labor resulted in a revised nursing education curriculum. To support the new curriculum, which received full governmental approval, the Ministry of Labor established an official job position for graduates of the baccalaureate level program with compensation comparable to beginning physician salaries.
- The Almaty Medical College developed and implemented a night school program for head nurses. This course (requiring payment of tuition) provides a baccalaureate degree to head nurses through a two-year evening program. By the end of 2000, over 300 head nurses had graduated from the program.
- Partner nurses worked on faculty and curriculum development for nursing courses in tuberculosis treatment and education using Directly Observed Therapy (DOT) and case management.
Pediatrics and Children's Surgery
- Exchanges and collaboration between pediatricians from Tucson and the Institute of Pediatrics resulted in improved outcomes for children with leukemia and children being treated for asthma and other respiratory diseases. Hospital admissions for asthma were reduced by the use of steroids and pharmaceuticals provided through donations obtained by Tucson physicians. The medical Research Director at the Institute convinced the Ministry of Health to provide Hepatitis B vaccinations for leukemia patients and the medical staff.
Perinatal Care and Neonatal Resuscitation
- A neonatal resuscitation program, including a detailed Train-the-Trainers component, was developed through the partnership and delivered to over 50 participants in Almaty by the end of 1999. The Chief of Neonatology at the Physician Retraining Institute became the lead trainer for the program and began to offer the course throughout the country. Within the first year, over 100 neonatologists around the country received training, and the program passed its re-certification and evaluation with high marks.
- The Perinatal Center adopted a number of key policy changes, including rooming-in for infants with mothers, improvement in neonatal care and obstetrics, and the development of a family-centered birth program. These changes were implemented and have remained in place despite frequent changes of directors at the Center.
- Perinatal Center obstetricians learned an improved technique in cesarean section, which reduces surgery time by one hour and results in less blood loss and fewer infections. A special demonstration project was set up at the Center to perform surgery on 50 cases and to use revised criteria for blood replacement in order to reduce the risk of exposing the mother and baby to hepatitis and other bloodborne pathogens that occur with blood transfusions. Based on the positive outcomes of the demonstration, the revised practice was established as the standard among obstetricians in the city birth houses.
Physician Training
- Within the first 18 months of partnership activity, three physicians completed three-month courses of study in Tucson in cardiology, hematology-oncology, and pulmonology.
- Over 2,500 laparoscopic surgeries had been performed at the City Laparoscopy Center at the Emergency Hospital through March 2002. The surgeries were performed on patients who would not have survived conventional surgery, and results showed a decline in hospital stay from 14 to 3 days with a reduction in nosocomial infections.
Women's Health
- Partners established a comprehensive outpatient Women's Wellness Center in Almaty. Since the Center began operations in November 1997 through March 2002, over 84,000 patient visits occurred, including 27,000 primary care visits all of which involved breast examinations). Over 22,000 women had been trained in contraceptive use, including oral contraceptives. This shift to oral contraceptive methods is important because of the inappropriateness of IUDs for a patient population with high rates of pelvic inflammatory disease, syphilis, and anemia.
- The WWC prenatal education program overcame a major cultural barrier by preparing fathers and mothers together for pregnancy. Now many fathers accompany their wives through the delivery process.
- A breast self-examination program was implemented at the WWC, with 12,000 patients trained in conducting breast self exams as of December 2000.
- A variety of educational programs for women throughout the reproductive cycle and into the post-menopausal period have been held at the Center. Over 10,000 patients were trained in family planning and 3,290 in preparation for childbirth and breastfeeding through December 2000. In addition over 9,000 adolescents were trained in contraception, health promotion and healthy lifestyles by December 2000.
- The WWC has become the model training site for nursing students from the Almaty Medical College on the provision of patient and community education.
Other (Unanticipated Accomplishments)
- Development of Grantsmanship Skills: With the help of their Tucson partners and through grantwriting training provided by AIHA, the Almaty partners have become skilled at grantsmanship and have received grants from the Soros Foundation. Both the Toxicology Center and the Almaty Medical College received grants to expand their teaching programs and to provide public information and marketing for their services.
- Collaboration between partnership institutions: When partnership activity first began, partnership institutions within Almaty did not have a history of working together. Over the course of the partnership, the entities worked together with significant synergy:
- Partner hospitals offered job opportunities to the graduates of the new nursing baccalaureate program and paid for their chief nurses to attend night school at the Medical College in order for them to obtain their baccalaureate degrees.
- Laparoscopic surgeons at the Emergency Hospital trained surgeons from the Perinatal Center, while the Perinatal Center donated equipment to the Emergency Hospital.
- The Women's Wellness Center became the model training site for training nursing students from the Almaty Medical College on patient and community education.
- The EMS Center provided training for nursing students.
- Residency Training Programs for Physicians: A formal residency course for OB-GYNs was implemented in September 1998 through the medical university. The Head of the OB-GYN Retraining Institute worked with faculty at the University of Arizona on the development of a program. The exposure of the senior professors and department heads to western residency training through the partnership and through collaboration with other international programs made the medical educators aware of the deficiencies in the clinical practice aspects of medical training. The partnership also stimulated efforts to develop medical residencies in other specialties.
- State Partnership with Arizona National Guard, Department of Emergency Management, FEMA and the Kazakhstan Militia and Committee for Disaster Preparedness: In 1995 a partnership developed between the above partners through the Partnership for Peace program. The US partnership coordinator provided advice and assistance to participants in the program. The National Guard flew two humanitarian aid missions for the partnership and packed containers and prepared other shipments of donated medical supplies and equipment.
- The Almaty City ambulance station, as a result of experience gained through the partnership, introduced a computerized dispatching service, modern immobilization and other techniques.
- The Institute of Pediatrics developed and introduced a continuing nursing education and training program for its nursing staff. The Institute served as a demonstration site for pediatric services.
Additional Developments Since Partnership Graduation
- In May 2000, the Kazakhstan Ministry of Health issued an Order to accelerate the implementation of infection control training at the Almaty Infection Control Training Center, which was established and equipped by AIHA. The Order mandates that heads of Oblast Health Departments and heads of health facilities and research centers ensure training of health care workers in infection control at the Almaty Center.
- The formal opening of the Central Asia Infection Control Training Center at the Republican Sanitary Epidemiological Station was held on January 22, 2001 in Almaty. The Ministry of Health certified this Center to provide continuing education for epidemiologists, physicians, nurses and microbiologists throughout Kazakhstan. A one-week long train-the-trainer course was held immediately following the opening.
- The Kazakh partners have contributed to the further development of the four-year nursing education curriculum developed through partnership work in nursing education. The Kazakh partners have incorporated management training and practice into the academic program to promote advanced practice nursing.
- Nursing leaders from Almaty have been inducted into the international nursing association Sigma Theta Tau and have received additional training. Kazakh nursing leaders have established contacts with counterparts internationally.
- The CAR Nursing Council was established by leading nurse educators of CAR countries, as an outcome of AIHA's effort to support nursing education reform. The CAR Nursing Council has succeeded in drawing the attention of nurse educators in CAR countries to address nursing education trends and the necessity of regional cooperation in improving the quality of nursing education.
- The Almaty Nursing Resource Center continues to provide faculty, students, and practitioners with nursing education resources and training aids to support alternative forms of learning.
- A private nursing institute has been launched as an outcome of the partnership's overall nursing education reform activities.
- In late-1999, the Almaty Poison Center was designated, by ministerial order, as the Republican Toxicology Center. Since then, the Center has established affiliates in several regions of Kazakhstan, with a view to ensuring nationwide coverage.
- Institute for Pediatrics and Children's Surgery, Almaty
- Almaty City Emergency Hospital
- Almaty Emergency Medicine Training Center
- Almaty Medical College
- Republican Medical College
- Women's Wellness Center, Almaty
- Tucson Medical Center
- University Medical Center
- Arizona Health Sciences Center
- Columbia Northwest Hospital
- El Dorado Hospital
- Carondelet Health Care of America
- Veterans' Affairs Medical Center
- Tucson General Hospital
- Almaty - Tuscon Asthma Chat Session
Updated on June 30, 2003
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