Maternal and Child Health

• Train a minimum of six health professionals in the Buryatia Region in neonatal resuscitation.
• Create a neonatal resuscitation classroom for training and re-training in neonatal resuscitation procedures in the Buryatia region.
• Involve neonatal resuscitation-trained health professionals in the Buryatia region in a network of colleagues throughout Russia to improve problem solving and the dissemination of neonatal resuscitation information.
• Continue design/implementation of a schedule in the Buryatia region for systematic training and re-training of health professionals in maternal and neonatal health.
• Establish a baseline and then continue measurement for assessing newborn health and developmental progress for normal, high-risk, and impaired infants.
• Enhance maternal and child health clinical skills for physicians, midwives and nurses.
• In 1999 the partnership received additional funding to focus on enhancing the knowledge and skill development of physicians, midwives, and nurses regarding maternal and neonatal health during pregnancy, delivery, and postpartum period.

Neonatal Resuscitation

In 1999 the partnership received additional funding to focus on the following additional objectives:

• Oversee ongoing neonatal resuscitation training courses for obstetricians and pediatricians from community hospitals in Buryatia.
• Monitor the teaching and practice of the neonatal resuscitation training course.
• Continue assisting in the collection and interpretation of data regarding neonatal morbidity, mortality and outcomes of the neonatal resuscitation initiative.
• Continue assessment of current practices on the stabilization and transport of sick and distressed newborns.

• In May, a US obstetrical nurse visited Ulan Ude and gave lectures to a mixed audience of over 50 health professionals. The lectures included the role of nursing in: labor support; newborn resuscitation; initial newborn care; treatment and prevention of hypothermia and hypoglycemia in newborns; signs, symptoms and treatment of premature labor; hypertension in pregnancy; infection control and hand washing; and postpartum care. She also gave mini-lectures and demonstrations to groups of 3 to 10 health professionals on newborn assessment, thermal regulation, glucose regulation hyperbilirubinemia, prophylactic use of Rh-Immune globulin for mothers, and prophylactic use of antibiotic eye ointment in newborns.

• The Vice-Minister of Health of Buryatia visited Rhinelander in February to explore aspects of clinical/bio-medical engineering and financial management for his institution. Staff from various clinical departments made recommendations regarding the most cost-effective and useful types of equipment for Buryatia.
• Two nurse midwives from Buryatia traveled to Tallinn, Estonia to present at the Fourth World Conference on Childbirth Education, which was held in May. The conference, sponsored by Magee WOMANCARE International, provided the midwives an opportunity to enhance both their knowledge and instruction techniques. Experts from the US and Lamaze International also presented new teaching techniques.
• In June two government officials from Buryatia traveled to Rhinelander to review health codes and regulations pertaining to the rights of mothers and infants.
  

Maternal and Child Health

• As a result of partnership training, the Buryats began using erythromycin eye ointment prophylactically against conjunctivitis in newborns. They found this practice to be so successful that it has since become the official standard of care in the republic.
• In 1998, 21 Buryat health professionals successfully completed the first NRP provider course at the newly opened NRP Training Center at the City Maternity Hospital. Nine of the graduates successfully completed the NRP Instructor course. In 1999, 88 health care workers trained at the NRP Training Center, 7 courses were conducted; in 2000, 6 courses were taught for 86 participants. In 1999-2000 six of the graduates completed the NRP Instructor Course.
• As a result of their participation in the 3-day Childbirth Education Conference, the Buryat midwives made significant changes and improvements in perinatal care practices. Both the Republican Hospital and City Maternity Hospital #2 have developed family-centered birthing rooms. At the Republican Hospital, in 1999 there were 330 births (20% of total number of 1,650 births) at the family-centered birthing rooms and in 2000, 437 births (25% of 1,751 births). At the City Maternity Hospital #2, in 1999 there were 2,520 births (72 % of 3,500 births) at the family-centered birthing rooms and in 2000, 2,555 births (70% of 3,650 births).
• At City Maternity Hospital #2 a woman can have her husband and/or family members present for labor delivery and can choose a particular midwife and obstetrician for an extra 3000 rubles. Both institutions also offer the option of rooming in and provide for early contact between the mother and child in the first 24 hours after birth. These new options represent the beginning of a fundamental shift from government-controlled services to a consumer-driven model.
• Lutheran Social Services (LSS) has provided funds to support a facility for mentally retarded children in the Zakamensky Region.
• With the help of one of the adoptive parents who is a dentist, LSS established the "No Tears Dental Program" to provide all Buryat orphans with basic dental care using novocaine.
• LSS has provided a fund to the Neonatal Center of Children's Hospital #1 (for newborns age 5 days to 3 months and to Maternity Hospital #2 (for newborns for the first five days of life), and for refusniks (abandoned children). The funds are used to purchase drugs, supplies and baby food for abandoned children. LSS has also established Foster Care Sponsorships for abandoned children.
• LSS has established a Birth to 3 Training Program for caretakers of pre-school children at homeless shelters, orphanages and special care facilities.
• In 1999 -2000, 102 midwives got advanced training in maternal and neonatal health.

Neonatal Resuscitation

• A NRP Training Center was established at the City Maternity Hospital #2 in Ulan Ude. Since opening in March 1996, 361 people have been trained-49 neonatologists, 130 nurses, 40 midwives, 86 pediatricians, 30 OB/Gyns, and 26 anesthesiologists.
• The Neonatal Resuscitation techniques taught at the NRTC have become the standard of care for resuscitation at the Ulan Ude City Maternity Hospital where 3,500 babies are delivered each year.
• NRP data collection was begun in May 1998. A system whereby useful data can be collected, reviewed, and researched has been established to evaluate the impact of the NRP on quality of resuscitation, mortality and morbidity. Neonatal mortality rate (NMR) decreased from 9.9% in 1996 to 8.6% in 2000; early NMR rate decreased from 8.0% in 1996 to 6.3% in 2000; and perinatal mortality rate decreased from 15.9% in 1996 to 13.4% in 1998 to 12% in 2000.
• As a direct result of neonatology training exchanges, the Buryat Ministry of Health has sent two pediatricians from City Maternity Hospital #2 to Moscow for a year of advanced training in neonatal intensive care. Both of the chosen pediatricians had received NRP provider and instructor certification during the initial AIHA-sponsored training course in 1998.