Surgery

• Design and install a model surgical suite in the Niyazov Medical Consultative Center, which will set a national standard for surgical treatment in Turkmenistan.

Nursing Reform

• Provide continuing education for nurses at the Niyazov Medical Consultative Center.
• Upgrade capabilities for nursing management at the Niyazov Medical Consultative Center.

Hospital Administration

• Expand outpatient facilities.

• On April 22, the partners celebrated the signing of the Memorandum of Understanding between the Cleveland Clinic Foundation on the US side and the Niyazov Medical Consultative Center in Turkmenistan.

• The Consultative Center staff began giving lectures to staff from multiple hospitals, predominately in Ashgabat, on surgical techniques  that staff visiting the US had learned in Cleveland.

• US partners sent two 4216 Drake Willock dialysis machines to the Consultative Center in March. (These machines were older models but were selected for easy maintenance and anticipated durability with the use of Turkmenistan water.) Blood lines, catheters, dialyzers and other disposable supplies were also sent to support the use of the dialysis machines.

• Additional parts and supplies for dialysis were sent by the Cleveland Clinic to Turkmenistan in January. This included seven 4216 Drake Willock dialysis machines, needles, dialyzers, blood lines, pads, prep trays, caps, over shoes, razors, monitors and medical texts. The Consultative Center subsequently purchased new dialysis machines and a year's worth of disposable supplies from Germany.

• As part of the continuing effort to reform the role of nurses in Turkmenistan, six senior nurses from Ashgabat and one nurse from Cleveland participated in AIHA's conference on "Nurse Leaders Creating Change," held in Kiev, Ukraine during April.
• The Cleveland Clinic's Division of Patient Care Operations donated equipment to furnish the Niyazov Center's Model Surgical Suite, including operating room tables, anesthesia machines, infusion pumps, cautery machine and general and vascular instrument sets.

Surgery

• With improved surgical and post-operative management protocols, the partners demonstrated a reduction in surgical waiting time, decreased mortality and morbidity, as well as fewer post-surgical nosocomial infection rates.
• An Ashgabat surgeon trainee observed laparoscopic surgery during an exchange to Cleveland and bought a laparoscope upon his return home. By October 1995 he had performed 21 laparoscopic abdominal surgeries without significant complication. This represented a major surgical advance in terms of reduced risk of infection, shorter hospitalization and reduced cost.
• From 1993-1997, twenty-five physicians underwent training rotations in Cleveland in their respective specialties. These training programs focused on techniques of pre-operative medical care, specialty surgical approaches to complex multi-system illnesses, methods of post-operative infection control, and rehabilitation.

Nursing Reform

• Nursing management is a newer concept at the Niyazov Center. In July 1996, the Niyazov Center appointed a "main medical sister" in response to the Cleveland partner’s suggestion that nursing at the Consultative Center have a recognizable administrative head. Nursing exchanges from Turkmenistan to Cleveland resulted in the training of selected individuals in the basics of management principles, quality evaluation and control, and budgetary planning. Leadership nursing groups have been established at the Consultative Center.
• An area in the Niyazov Center was designated a study room for graduated nurses. Nurses are now more actively involved in patient education and home health care.

Hospital Administration

• The Niyazov Center has implemented a number of for-profit activities in order to supplement the funds allocated from the governmental health budget for the provision of health care services. These services include the use of the hospital's laundry facilities in the evenings, the rental of the hospital cafeteria and kitchen for catered banquets and receptions, and fees for parking. These services have provided approximately 10% of the Center's funding, representing a critical ongoing source of financing.
• Health care managers from Ashgabat participated in a series of training seminars held in Almaty on grantsmanship and introductory management skills development. The administrators of the Niyazov Medical Consultative Center  utilized this management training in the development and establishment of fee-for-service care for employees of foreign companies based in Ashgabat.

Others

• As part of the development of a dialysis program at the Consultative Center, the hospital water supply was improved to allow dialysis.US partners donated dialysis machines and necessary supplies. By October 1993, treated water was available to the dialysis unit three days a week. This water was passed through three additional inline filters before clinical use. NIS partners  made dialysate and initiated treating  patients. By October 1997, the Consultative Center was performing one to three cases per day and had saved many lives.
• The Learning Resource Center at the Niyazov Center created an electronic database for data related to endoscopic studies and clinically important cases.  The center is being used for training of young specialists, and serves as a consultation site for health professionals of the Clinic and the City.