Hospital Management and Administration

• Reduce hospital overhead costs and increase revenue.
• Train health care managers in grant writing, informed decision-making and financial management.

Nursing

• Expand nurses' role in the delivery of health care in Kyrgyzstan and encourage nurses to take on leadership roles.
• Increase nursing documentation.
• Provide models for continuing education, clinical competency and accountability in nursing practice.

Neonatology

• Reinforce neonatal resuscitation of full-term normal weight infants.
• Train physicians in "train-the-trainers" seminars to become instructors of neonatal resuscitation.

Family Medicine

• Develop a curriculum for training family practitioners at medical schools and post-medical institutes.
• Institute a family medicine internship at selected training sites in Bishkek.

Blood Banking

• Improve the efficacy of blood banks in Bishkek, with emphasis on blood bank management and infection control.
• Reorganize donor recruitment, materials management, and standard operating procedures, including introducing a computer with word processing, database and accounting software to the Regional Blood Bank.

Pediatric Cancer Registry

• Establish a national pediatric cancer registry in Bishkek to track cancer morbidity and mortality rates in Kyrgyzstan.

Laparoscopic Surgery

• Teach techniques of laparoscopic surgery.
• Provide knowledge of the care, maintenance and proper use of laparoscopic equipment, including sterilization techniques to the operating room staff.

Hospice

• Support establishment of a hospice program at the Institute of Oncology and Radiology by providing training for physicians and nurses in basic hospice care services and by providing necessary equipment/supplies for the care of terminal cancer patients.
• The Partnership also addressed a number of secondary priorities related to prosthetics and orthopedics, physician training and continuing education, catastrophic emergency and burn care, and respiratory diseases.

• The partnership organized a shipment of supplies for the Burn Care Center in Bishkek.
• Ten nurses from major Bishkek health care institutions, including the partnership institutions, attended six- and nine-week courses in Nursing Administration and Nursing Education at KUMC.
• The partnership initiated laparoscopic surgery techniques at the Institute of Oncology after a two-week on-site training course conducted by KUMC specialists.
• Two technicians from the Bishkek Pediatric Cancer Registry attended database and software training at KUMC.

• Five Nursing Learning Resource Centers were opened in Kyrgyzstan - three in Bishkek, one in Kara-Kol and one in Talas as part of AIHA's Nursing Initiative. Equipped with computers and international nursing training literature, the NLRCs serve as training centers for nurses interested in expanding their clinical and administrative roles.
• The KUMC partners conducted two Train-the-Trainer seminars on neonatal resuscitation techniques, attended by more than 180 medical personnel from throughout Kyrgyzstan.
• Blood Donor Registries opened in Bishkek and Jala-Abad.
• The Kansas partners organized shipment of a 20-foot container with donated supplies for the Burn Care Center in Bishkek.
• The US and Kyrgyz partners collaborated to present a nursing conference for more than 200 participants in Bishkek. The conference was a visible part of the Partnership's efforts to expand the role of nurses in health care administration and delivery of health care services.
• Twenty-two nurses from throughout Kyrgyzstan attended 9-week courses in Nursing Administration and Education at KUMC.
• Twenty Kyrgyz surgeons attended a seminar on head and neck tumor removal conducted at the Institute of Oncology by KUMC surgeons.
• In May, partners hosted a conference in Bishkek for chief nurses from each of the Central Asian Republics (CAR). Over 120 nurses participated in the "CAR Leadership in Nursing" seminar, which specifically addressed management and administrative issues pertaining to the region.

• Ten specialists from the Kyrgyz Institute of Obstetrics and Pediatrics attended a two-week training seminar at KUMC on pediatric pulmonary infections.
• Fourteen Kyrgyz surgeons attended a training seminar on general tumor removal conducted at the Institute of Oncology by KUMC surgeons.
• The Kyrgyz Nursing Association was established as a result of partnership efforts related to nursing.

• A team of five experts from KUMC taught 2 seminars on burn care in Bishkek and Osh for over 200 participants. The team also set up two burn units, one each in Bishkek and Osh, using medications and equipment donated by KUMC.
• Two seminars on disaster preparedness were conducted in Bishkek for over eighty fire fighters and first responders.
• Two Kyrgyz students received a graduate fellowship in Immunology at KUMC.
• The partnership shipped another 20-foot container of donated supplies to the Burn Care Center in Bishkek.
• The partners collaborated to present a nursing conference for more than 200 participants in Bishkek.
• KUMC professors conducted bedside teaching and a lecture on Angioplasty at the Institute of Cardiology in Bishkek.

• AIHA awarded the partnership a limited grant award in January to build upon programs related to hospice and burn care and to strengthen the sustainability of partnership accomplishments.
• In September, three nurses from KUMC attended the Oncology Conference in Bishkek and presented two papers on hospice care.
• A gymnasium was built for exercise and rehabilitation for burn victims at Hospital No. 4.
• A nurse was hired to set up the burn registry and training was provided. Computers were donated for the burn registry.

Hospital Management and Administration

• With the guidance and support of the Kansas partners, the Institute of Oncology and Radiology closed one of its hospital wings in order to reduce the number of beds in service. The Institute then renovated the closed wing and re-opened it as a low-cost hotel for family members and friends visiting patients at the hospital. The effort removed an entire facility from ongoing upkeep costs and turned it into a profit center to supplement the provision of care at the Institute.
• Introduction of outpatient chemical therapy had reduced hospital stays for cancer patients from 3-4 weeks to 10-12 days by mid-1998 at the Institute of Oncology and Radiology.
• New standards of care plans have been implemented at the Kyrgyz partner institutions to improve the quality of care provided and the professionalism of health workers. Patients now fill out a "care" survey before they are discharged that is reviewed as part of a continuous improvement effort.
• The recently formed Tender Committee reviewed the old purchasing programs for medicines. As a result, a new medicine procurement program was implemented at the partner hospitals.
• The income generated for fee-for-service care at the Institute of Oncology and Radiology has increased nearly 7 times since 1993, when it was 164,000 soms to 1,132,454 soms (approximately $35,000) in 1998.

Nursing

• US partners developed the "Kyrgyzstan Nursing Administration Course" at KUMC, concentrating on management skills for Kyrgyz nurse administrators. The Kyrgyz nurses received a general overview of the structure and function of the US health care system, especially nursing education, clinical skills, and the role of the nurse in the administrative structure of the hospital. The Kyrgyz partners accompanied US nurse managers on the floors, visited nursing skills labs, and observed the work of the home health nurse, who provides health care in a home setting. The nurses also attended lectures on standards of patient care and infection control. Ten nurses from Bishkek took this course in 1994, and an additional 22 representing every oblast (region) in Kyrgyzstan were trained in Kansas in 1995.
• The Ministry of Health and Ministry of Labor approved in 1995 the creation of nurse administrator/ manager positions in all Kyrgyz Hospitals with 300+ beds. In addition, a US trained nurse has been appointed to the newly created Senior Nurse Administrator position in each oblast. Senior Nurse-Administrators receive a salary comparable to that of a Chief Physician.
• To replicate the training the Kyrgyz nurses received in the US, KUMC donated equipment for five nursing laboratories at the Bishkek School of Nursing.
• The partnership also worked with medical education leaders to establish a Department of Nursing at the Medical School. The new department grants a master's degree following a 4-year post-graduate course to train teachers for the 10 nursing schools in Kyrgyzstan.
• As of 1997 the Nurses' Training Center had provided continuing education classes for 102 nurses, 590 students at the medical college, 130 students in junior courses at the Kyrgyz Medical Academy, and 119 students from the Center of On-going Preparation of Medical Workers.
• In 1997 a three-year nursing program was implemented at the School of Nursing in Bishkek. To provide modern training materials, Kyrgyz nurses wrote and published with the assistance of their Kansas colleagues 1,000 copies of a nursing textbook entitled "Nursing Care and Obstetrics in Kyrgyzstan."
• The Kyrgyz Nursing Association was established in 1996 by nurses trained through the Kansas City/ Bishkek partnership, providing a forum for the continued advancement of the nation's nursing profession.
• The partnership institutions in Kyrgyzstan served as demonstration sites for the nursing initiative. At the Institute of Oncology and Radiology, new teamwork methodologies allowed nurses in selected departments to reduce work time and cut down on the number of orderlies required for each department. Also, the number of complications resulting from nurses' errors decreased since the inception of the Partnership nursing initiative. Accidental vein punctures declined 30%, and the number of infiltrates has been minimized from an average of 40/year previously.

Neonatology

• A series of seminars on thermal regulation, intubation, and general diagnostics were conducted for over 110 physicians from ten of the twelve birthing units in the Kyrgyz Republic. The Partnership translated textbooks on neonatology to distribute to the participants to increase their knowledge base.
• Training in neonatal resuscitation resulted in reduction of neonatal infant deaths by 30% across the Republic, according to KUMC staff.

Family Medicine

• A post-graduate program in Family Medicine was launched at the Medical Academy in Bishkek, with the assistance of the University of Kansas Medical School and family medicine program. The program supplements the Kyrgyz Government's efforts to redirect scarce health care resources to preventive and primary care. Graduation of the first class of family physicians was anticipated to take place in 2001.

Blood Banking

• Based on a comprehensive assessment of blood banks in Bishkek and JalalAbad, US community blood bank specialists made recommendations to their Kyrgyz colleagues regarding donor recruitment, materials management, and standard operating procedures.
• Kansas community blood bank specialists donated and installed a computer with word processing, database and accounting software to the Regional Blood Bank in Bishkek, and trained personnel on its use.
• The Republican Blood Bank became an international partner of the American Association of Blood Banks. The Kyrgyz partners receive literature on blood service improvement monthly. Kyrgyz officials are now holding consultations with the Association to build a plant for plasma fractionation.

Pediatric Cancer Registry

• KUMC and Kyrgyz partners established an academic exchange program and a national pediatric cancer registry in Bishkek, allowing the partners to collect more accurate data on cancer morbidity and mortality rates in Kyrgyzstan.
• The partners initiated a comprehensive cancer screening and treatment project in the township of Malli-Say, which in 1993 was struck by an earthquake that reopened an abandoned mine containing uranium waste. At the request of partners at the Institute of Oncology and Radiology, KUMC diagnostic teams examined residents for radiation-related illness, collected data, and treated patients. Together, the partners analyzed data to assist in the long-term treatment of the victims of this disaster.
• New treatment protocols were established for children with leukosis, complicated by stomatitis and bleeding. Through the Partnership, 240 Kyrgyz mothers were trained by the end of 1997 to care for their children suffering from these symptoms at home.

Laparoscopic Surgery

• Surgical operations were modified in the Head and Neck Department and the Department of Abdominal Surgery at the Institute of Oncology and Radiology to incorporate the use of laparascopic technology.

Physician Training

• New treatment protocols were established for patients with tracheostoma, gastrotomy, episitomy and colonostomy, resulting in a decline by the end of 1997 from 10% to 2-3% of patients suffering from hyperthermia, swelling around the wounds, and other complications.

Hospice

• A wing at the Institute of Oncology and Radiology was renovated to create hospice rooms for 40 patients.
• The Kara-Kol affiliate of the hospice established.
• The partners at KUMC collected and shipped a forty-foot container of equipment and supplies to equip the hospice wing. (Burn care supplies were also included in this shipment.)
• Hospice staff in Bishkek received training on pain management and comfort care.

Catastrophic Emergency and Burn Care

• Through the Partnership's efforts in burn care, comprehensive burn departments were established at Hospital No. 4 in Bishkek and the Oblast Hospital in Osh. All necessary supplies for these departments were donated through a coordinated humanitarian aid effort of twenty Kansas hospitals. The supplies were packaged by Kansas firefighters and shipped by the US State Department.
• Clinical exchanges introduced hydrotherapy at the Kyrgyz burn clinics, as well as early rehabilitation, early scar excision, and outpatient treatment. By the end of 1997, 100% of the physicians and 34% of the nurses had mastered the methods of early rehabilitation. As a result, the rate of complications also decreased -- for example, pneumonia was reduced from 23% of cases to 14% of cases,  and contractures were reduced from 18% to 12%. Due to all the above-mentioned interventions, hospital stays for severe burn patients decreased from as much as one year to several weeks between mid-1995 and early-1998.
• Upon their return from an exchange to the US in early 1999, the burn care teams from Bishkek and Osh put into practice state-of-the-art burn care techniques, including hydrotherapy, debriding, early ambulation, and splinting to prevent contractures with physical and occupational therapy.
• Facilities and programs for exercise and rehabilitation for burn victims were established at Bishkek hospital No. 4 and Osh Obalst Hospital.
• A burn registry was initiated.
• A multi-disciplinary team of physicians, a nurse and a firefighter trained and was deployed to outlying areas to provide instruction to local first responders on the care of  burn victims and referral protocols.
• Kyrgyz Association of Physicians/Combustiologists established.

Other

• Collaborative research papers published by the US and Kyrgyz partners were an unexpected outcome of the Partnership. Two  papers have been published , including one presenting a comparative study of newborns  and calcium blocker measurements.
• The partnership worked with a local Kansas charitable organization, "Heart to Heart," to organize major donations of medical equipment and supplies to the Kyrgyz partners in 1994, 1995 and 1997. The Heart to Heart donations were a statewide effort, involving service organizations, business and school children who collected donations of medications and surgical and hospital supplies to be dropped off at special collection stations. The total value of the equipment and supplies donated is estimated at over $8,000,000.
• Upon the request of the Ministry of Health, AIHA assisted in establishing a computerized network, KyrgyzMedUz, which is designed to collect statistical data from all six Oblast Health Administrations of the country.  Vital statistics data are collected and analyzed (and published twice a year) by the Republican Medical Information Center.

Additional Developments Since Partnership Graduation

• The NIS partners continue to interact with their US partners by e-mail on a regular basis.
• The hospice received additional equipment and supplies from the Kansas partners.
• In December2000, the Kara-Kol affiliate of the hospice was officially opened.
• The Kyrgyz Association of Physicians/Combustiologists was established in September 2000.
• The Burn Care Center received equipment (computer, color printer, scanner) and supplies from the Kansas partners.
• The NIS partners established access to the Internet independently.
• Continued development of the burn registry occurred.
• Training on burn patient care is being provided to general practitioners at the burn centers.