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ArmavirGalveston

Armavir, Armenia / Galveston, Texas

1999-2004


Focus: Disease Prevention, Emergency and Disaster Medicine, Breast Cancer, Primary Care, Diabetes



The Partners

US Partner: The University of Texas Medical Branch at Galveston (UTMB) is a major academic health science center dedicated to health education, patient care, research, and community service. Inpatient services are provided in 6 facilities with John Sealy Hospital, a 364-bed tertiary hospital serving as the hub. Other hospitals include a Children's Hospital, John Sealy Annex, Rebecca Sealy Hospital, R. Waverly Smith Pavilion and the Texas Department of Criminal Justice Hospital. Ambulatory patient care is provided through a network of 43 community-based and 44 campus-based clinics. Collaborating with UTMB is the Galveston Partnership for Better Living (GPBL). GPBL was established in 1997 as a 501c3 organization dedicated to bringing about systemic community change in an inclusive and collaborative manner. Additional community collaboration is provided by the JesseTree, a 501c3 organization dedicated to the coordination and more efficient delivery of social and health services.

NIS Partner: The Armavir Regional Health Care Administration is responsible for the management and coordination of health care delivery for the population of the region (Marz). The department implements federal and municipal health care programs initiated by the Ministry of Health and the regional administration and conducts data collection and analysis. Armavir Policlinic, serving 15 districts in Armavir, is also a member of the NIS partner team.


Partnership Objectives

The overall goal of the partnership is to improve the health of the population in Armavir Region through the implementation of primary care principles and practices. The partnership is employing a train-the-trainer approach that emphasizes lifestyle changes and health provider practices. Specific objectives are to:

  • Train health professionals about disease risk groups, including cardiovascular/stroke, breast cancer and diabetes.
  • Conduct mass media campaigns to educate the region's population on healthy lifestyles related to breast cancer, diabetes, and cardiovascular disease/stroke.
  • Collaborate with the Armenian Professional Nursing initiative (former AIHA partners) to provide continuing education for the nurses of Armavir.
  • Improve record-keeping by documenting patient's blood pressure measurments and other prevention screening activities as an addendum to the patient's health card.
  • Develop a multidisciplinary approach to disaster preparedness.
  • Develop a program to evaluate the health of the population of Armavir and the outcomes of the partnership's activities in the Marz.
  • Develop in-service training programs in respiratory disease management, and child and adolescent health.
  • Assess current diagnostic lab capabilities and identify opportunities to expand lab capabilities including lab management, calibration of lab equipment, blood safety, and infection control.
  • Develop written policy and procedures, and assure appropriate training of staff, for lab management, infection control, and patient safety.
  • Formalize an Armavir Marz Community Health Advisory Board that meets on a regular basis and provides input and oversight to the Armavir Health and Human Services Director.
  • Provide train-the-trainer courses to cover depression, vision, cervical cancer, substance abuse, infection control, personal safety, and reproductive health practices.


Key Events

   2000

  • The partners conducted a six-week train-the-trainer course in primary care in May focusing on the following topics: cardiovascular disease/stroke, breast cancer, diabetes, and disaster preparedness. Training was based upon clinical practice guidelines developed in these areas.
  • A program of ongoing staff training began in Armavir after the partners equipped a training center with essential audio-visual equipment, teaching aides, and Russian-language health promotion materials. Training in four areas-cardiac disease prevention, cancer prevention and screening, diabetes, and disaster preparedness-continues to be conducted by core trainers who participated in the TOT held in Galveston.
  • In November the partners to begin developing a multidisciplinary disaster preparedness program. While in Armenia, the Galveston partners held several planning workshops, met with local officials responsible for coordinating disaster relief and established a three-year program for disaster planning.

  2001

  • The American University of Armenia conducted a survey on behalf of the partnership to determine the general health of the population and establish a baseline to measure specific outcomes.
  • A second train-the-trainer course was held in Galveston from April 27-May 11 for three physicians and two nurses from Armavir. Major disease groups covered were asthma, diabetes, and respiratory/GI infections, with a special emphasis on pediatrics.
  • Carelift International delivered a large donation of primary care equipment and supplies necessary to provide model primary care services.
  • A Sister-Cities relationship was launched between the City of Galveston, TX and Armavir Marz in September. The signing ceremony took place in Galveston, with a teleconference with participants in Yerevan and Washington DC. The agreement was signed by the Mayor of Galveston and the Governor of Armavir Marz.

   2002

  • The partners conducted a successful “functional disaster” exercise during an exchange trip to Armavir in February. In addition to the exercise, the partners conducted response training on hazardous materials and burn treatment.
  • The partnership hosted a community health fair on April 19. Over 950 people from the Armavir region attended. Visitors received information about hyperglycemia, hypoglycemia, strokes, high blood pressure, breast health, and eye care. Specialists from Yerevan provided the vision screenings and breast health information. Around 300 patients were given follow-up vision care, including glasses and treatment when necessary.
  • The Visionaries film crew filmed a disaster drill, the health fair in Armavir, and several partnership activities of the Armavir/Galveston partnership. The film debuted in 2003.
  • A full-scale disaster drill was conducted in Armavir on October 3. Key emergency agency personnel, fire officials, first responders, medical personnel, and government and healthcare officials from the region participated. Representatives from USAID/Armenia, AIHA, and various international organizations, as well as members of the press observed the drill.

   2003

  • In March, five physician leaders and one nurse leader participated in leadership development courses at the University of Texas Medical Branch-Galveston. Courses included grant preparation, strategic planning, leadership styles and physician leadership, health fair planning, educational outreach, continuous process improvement, and mental health issues in disaster planning.



Achievements

  Clinical Organization and Capacity Building

  • Eleven physicians and nine nurses successfully completed train-the-trainers courses in the United States between the years 2000-2002, while workshops conducted at the partnership-established Armavir Training Center provided hands-on training to 183 physicians, 352 nurses, and 15 teachers during the same time period. Course topics included: cardiovascular disease/stroke, breast cancer, diabetes, and disaster preparedness; care for asthma, diabetes, respiratory and GI infections with an emphasis on pediatric care; health, personal safety, infection control and substance abuse. This Training Center also conducted primary care trainings for 14 physicians and 14 nurses from AIHA’s partnerships in Lori and Gegarkunik.
  • Statistical monitoring forms have been designed for patients with hypertension, asthma and diabetes. This form is being used by partners involved in the cross-regional cooperation project on clinical practice guidelines. The forms reflect the number of patients who refer to primary care providers on a regular basis.
  • Laboratory equipment and reagents were installed in the Armavir Polyclinic. Staff were trained in proper use of the equipment, related record-keeping, and infection control protocols.
  • In a patient satisfaction survey administered by AIHA in 2003, 73% of respondents felt that the services in the polyclinic had improved since the partnership was initiated and a majority felt that services at the polyclinic were better than at other government-run health facilities.

  Community Outreach

  • In coordination with the American University of Armenia (AUA), the partners will formally evaluate the changes in health status in the region since the start of the partnership by conducting two household surveys. The initial survey revealed that the poor socio-economic status of the region had resulted in low accessibility of health care and was a main cause of the unsatisfactory health status of the population. The partners targeted their interventions to specific problem areas, and provided free screenings and health education. The surveys compared health status and attitudes toward health in 2001 to three years after the partnership had been active in the region.
  • Baseline survey data results: In 2001, five times more respondents felt that their health status was declining vs. those who felt it was improving. In fact, 80% percent of respondents felt that their current health status was fair or poor. The most frequent conditions reported were high blood pressure, cardiac problems, gastrointestinal problems, vision impairment and kidney disease. Fifty-five percent felt that their health limited them from conducting “vigorous” daily activities, and 40% were limited from “moderate” activities. Fifty five percent were at probable risk for depression, and another 22% showed possible risk. Only 12% of respondents reported ever undergoing screening for high blood pressure, and 6% for breast cancer. Sixty-nine percent reported never seeing a doctor for a preventative check-up. Sixty-seven percent reported needing medical services, and not seeking them out, mostly due to inability to pay. Only 15% of heads of households were employed, and 82% reported a concern that their family would not have enough to eat.
  • In April 2002, the partners conducted a health fair at the Armavir Polyclinic, during which more than 1,000 patients were examined, eyeglasses were distributed to people with vision problems, and health promotion booklets were distributed. Specialists in ophthalmology and mammography came from Yerevan to provide screening services and free buses were provided to deliver patients from other parts of Armavir Marz.
  • Fifteen school teachers were trained in hygiene of adolescents, infections, emergency preparedness, domestic violence, and smoking cessation and educational materials on healthy lifestyles and emergency preparedness were published for secondary schools. All fifth grade students in the region participated in an anti-smoking campaign sponsored by the partnership.
  • Nurses now play an important part in patient education and clinical staff have learned to work with members of the mass media to increase public awareness about breast cancer, hypertension, and other illnesses. The result has been a steady increase in early detection—15 cases of breast cancer and 25 cases of breast abnormalities were detected in 2000, in 2002 those numbers rose to 23 and 49, respectively. The clinic has also observed a decrease in communicable diseases. For example, in 2001 the clinic registered 113 cases of parasites, whereas only 58 cases were found in 2002. During the same period, Hepatitis B cases were reduced by 38% (from 5 to 3).
  • A Sister Cities relationship was launched between the City of Galveston, TX and Armavir Marz on September 26, 2001. The agreement, signed by the Mayor of Galveston and the Governor of Armavir Marz, established an ongoing relationship to facilitate the donation of surplus medical and emergency response equipment to Armavir.

  Disaster Preparedness

  • The partners have created a comprehensive disaster response network that involves collaboration among local medical associations, the fire response service, emergency medical services, mass media, the regional administration, the Ministry of Internal Affairs, and the Red Cross.
  • In November 2000, the US Partners conducted emergency training in Armavir, which covered chief physicians of the Armavir partnership, representatives of Fire Response Service, Emergency Response Service, Sanitation and Epidemiology Service, Communication Service, media, Ministry of Internal Affairs, and Red Cross.
  • In April 2001, the partners carried out tabletop training that trained chief physicians of the Armavir partnership, representatives of Fire Response Service, Emergency Response Service, Sanitation and Epidemiology Service, Communication Service, media, Ministry of Internal Affairs, and Red Cross. In addition, a lecture on burns was delivered for 150 representatives of these services.
  • In February 2002, discussions on emergencies were conducted in Armavir, and the participants were supplied with a designed program on aircraft crash simulation followed by fire, toxic leakage and emergencies at the nuclear plant.
  • In May 2002, the Armavir Program Coordinator, chiefs of the Fire Response and Emergency Response Services of the Armavir region, and a representative of the National Security Service participated in a workshop on emergencies conducted at UTMB.
  • In October 2002, the US and Armenian partners held a meeting of the above mentioned services. A total of about 150 participants were trained to work with defibrillators, torches and radio telephones and learned about emergency experiences in the United States. Meetings were also organized in three schools, where the students became familiar with correct emergency responses.


Participating Institutions




Updated on August 12, 2004