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ChisinauMinneapolis

Chisinau, Moldova / Minneapolis, Minnesota

1994-1999


Focus: Emergency Medical Services, Nursing Reform



The Partners

US Partner: Hennepin County Medical Center (HCMC), located in Minneapolis, Minnesota, is a major public teaching and research facility. A member of the National Association of Public Hospitals, HCMC has 910 licensed beds and admits more than 21,000 patients per year. HCMC offers a full range of complete inpatient and outpatient services, including regional programs for kidney disease, rehabilitation and community outreach programs. As the first Level One Trauma Center in Minnesota, HCMC provides service to more than 87,000 emergency patients annually, with specialists on-duty 24 hours a day.

NIS Partners: The City Ambulance Hospital is a 645-bed hospital specializing in emergency and trauma care. The hospital's ambulance units serve the entire city of Chisinau as well as a large portion of the country. The Republican Clinical Hospital, a 1,200-bed facility, is the only cardiac surgery center in the nation, performing both pediatric and adult surgery. In addition, it provides kidney transplantation and dialysis service to the Republic in its specialized units. The Republican Hospital serves as a tertiary care facility for the Republic in many specialty areas. The Medical University of Moldova is the primary center for medical education in the country and is located in Chisinau, Moldova's capitol.


Partnership Objectives

Emergency Medical Services (EMS) & Trauma Care

  • Develop EMS-specific curriculum and training centers in Chisinau to improve first responder, pre-hospital and emergency room care and reduce emergency related mortality and morbidity.


Cardiology & Cardiovascular Surgery

  • Introduce therapeutic invasive and bypass procedures.


Dialysis & Kidney Transplantation

  • Improve dialysis techniques.


Nursing

  • Develop leadership skills and expand the role of nurses.
  • Increase nursing documentation.
  • Provide models for continuing education, clinical competency and accountability.
  • Establish National Nursing Association to support development of the profession.programs.


Infection Control

  • Expand prevention, health maintenance and infection control in all areas of the partnership.
  • Collect data on infection control statistics.
  • Work with the Ministry of Public Health to revise and implement guidelines/protocols for infection control.
  • Decrease post-operation infections.
  • Update monitoring techniques during and post-surgery.


Medical Education

  • Assist in medical curriculum, admission standards and licensing.
  • Provide greater access to on-line medical information and textbooks.
  • Introduce concept and principles of Family Practice.
  • Develop computerized residency tracking system.

Women's Wellness

  • Establish a model comprehensive, primary care clinic and related programs focused on the needs of women.


Surgery

  • Introduce laparoscopic surgery to improve quality of outcome and reduce post-operative infection rates and hospital length of stay.



Key Events

  1993
  • A Department of Emergency Medicine was established at Moldova's Medical University in August.

  1994

  • In May, simultaneous conferences on infection control were held at the City Ambulance and Republican Clinical Hospitals for their staffs and guests from neighboring hospitals.
  • In July, the Director and five faculty members of a newly established EMS Training Center traveled to Worcester, MA to participate in a "Train-the Trainers" course. They received hands on training in EMS and extensive practice in training methodology and interactive classroom lecturing based upon a common methodology and curriculum developed jointly through the collaboration of multiple AIHA partnerships.
  • The Regional EMS Training Center opened on November 7 in Chisinau, Moldova. Its first training session was held for 78 people in that same month.
  • On November 9, the partners celebrated the signing of the Memorandum of Understanding between Hennepin County Medical Center on the US side, and the Ministry of Health, Chisinau Emergency Hospital, State Medical Academy, and Republican Clinical Hospital in Moldova.
  • In December, the first angioplasty on a pulmonary artery stenosis was performed in the Republic.
  • In the last quarter of 1994 a new "903' emergency response dispatch system was installed.
 
  1995

  • In September, Hennepin County donated over $520,000 in surgical goods and equipment, including 16 surgical monitors, 2 endoscopy systems and five heart valves. 70 engineers, physicians and nurses received training in the operation, maintenance and trouble shooting of this equipment.
  • Faculty from the Chisinau EMS Training Center participated in the train-the-trainers conference "Hazardous Materials Management in Disaster Management" from May 10-17 in Tallinn, Estonia.
  • The Moldovan Nursing Association was founded in October.

  1996

  • As a result of partnership training and donation support, the first coronary artery bypass surgery in the Republic was performed.
  • In April, a national nursing conference entitled "Professional Issues in Nursing" was held in Moldova, which over 600 nurses attended. Traditional and new innovative models of care were discussed, as well as protocols, guidelines and standards for nurses. Participants worked to develop a five-year plan on establishing nursing as an independent profession, including new licensing, credentialing and Continuing Medical Education guidelines.
  • At an AIHA-sponsored NIS-wide nursing conference in Kazakhstan in April, the President of the Moldovan Nursing Association made a presentation on the changing roles of Nurses in the Republic.
  • In the summer, the EMS center developed a more-in-depth three-week course to be incorporated into the mandatory curriculum for fourth year medical students.

  1997

  • Moldova's first comprehensive Women's Wellness Center "Dalila" opened on June 14. Focusing on preventive health care, the Center is open to women of all ages, In addition to general primary care, counseling and family planning services, it conducts gynecological exams, pregnancy testing and STD screening.
  • A special three-week intensive training course for the Women's Wellness Center's staff was provided in the spring of 1997. Twelve staff members received advance training instructed in counseling, use of teaching methods and materials, patients' rights, contraception and infection control.
  • Part I of the In its first year of operation the new Women's Wellness Center established "partnering" agreements with the World Health Organization, Soros Foundation, Romanian Nurses Association, IPPF, JHPIEGO, AVSC, Peace Corps, UNICEF and other international organizations for education of patients and medical personnel.
  • In October, four instructors participated in a two week train-the-trainers course on nuclear accident response at the Oak Ridge Radiation Emergency Assistance Center and Training Site (REAC/TS) sponsored by AIHA and the International Atomic Energy Agency.
  • In November, EMS instructors from Chisinau traveled to Armenia to participate in Echo 1, a follow-on to the REAC/TS "train-the-trainers" course on nuclear accident preparedness.

  1998

  • In early 1998, the Hennepin County Medical Center hosted a ball that raised $50,000 for Juvenile Diabetes research and care in Moldova.
  • In total, Chisinau hospitals received donated medical equipment and supplies worth approximately $2,581,000. Included in these shipments were cardiac monitors, anesthesia machines, operating lights and tables, ventilators, IV suppliers and poles, patient beds, medical textbooks, operating room supplies, endoscopic equipment and antibiotics.
  • Two conferences on emergency medicine were held in Chisinau in 1996 and 1998. Over 300 physicians and six feldshers attended.
  • A Republic-wide disaster drill, incorporating military, fire and police and emergency centers was staged and videotaped for use in future instruction.
  • In 1996 and 1998 Republic-wide nursing conferences were held with guests from the US and Romania. A total of 12,012 nurses attended. The conferences focused on nursing's independent, dependent and interdependent roles and future trends for nurses in the NIS.
  • In early 1998, the Women's Wellness Center began training seminars to disseminate information to colleagues throughout Moldova and surrounding countries interested in establishing similar centers.

  1999

  • The Chisinau-Minneapolis partnership received a limited "sustainability" grant award from AIHA in January 1999 to strengthen the sustainability of partnership achievements and relationships by building upon their previous accomplishments in emergency medical services, residency administration, and women's health.
  • In January, the Dalila Center organized a national conference on domestic violence, entitled "Domestic Violence - a Multidisciplinary Approach," with the cooperation of Connect, USA (an American NGO) and with funding from the United States Department of State.
  • In April, an Emergency Medical Technician from Minneapolis traveled to Chisinau to meet with the EMS partners and assess readiness to start using Automatic External Defibrillators (AEDs) on their ambulances.
  • A delegation of emergency care physicians and specialists from HCMC visited the City Emergency Hospital in August to assist with installation of AEDs and provide related training. The partners installed eight AEDs and trained approximately 60 emergency personnel.
  • In October, a physician and nurse practitioner from Hennepin County Medical Center visited the Women's Wellness Center to continue work on clinical practice guidelines and quality assurance standards, and observe educational practices at the Center.


Achievements

Emergency Medical Services (EMS) and Trauma Care

  • Through the end of 2000, more than 147 two-week training sessions had been held for 4917 emergency and non-emergency personnel from Moldova. Three-week train-the-trainer courses had been held for 75 EMS instructors and directors from Ukraine, Russia, Estonia, Albania and Romania, establishing similar AIHA-supported EMS training centers.
  • As of December 2000, 100% of all emergency physicians and 35% of all feldshers in Moldova had received training at the EMS training center.
  • The Moldovan partners reported in February 1995 that the EMS teams were becoming more inclined to work with one another. The change was particularly noticeable in the drivers, who previously were not involved in caring for the patients. They related a story of one driver who saved his own son's life with the Heimlich Maneuver.
  • Mandatory data collection for emergency service teams was introduced in Moldova, including reports on implementation of new techniques, introduced by the EMS Training Center (i.e. use of defibrillators, cervical immobilization collars, etc.)
  • A 24-hour service called "Advice of the Physician" that encourages potential patients to speak with a doctor, before requesting emergency assistant had helped to decrease the number of ambulance runs from 226,404 annually in 1992 to 192,236 in 1998. Meanwhile, the number of calls for advice increased from 36,234 in 1996 to 52,439 in 1998.
  • Response time for ambulances decreased from 44.6 minutes in 1992 to 38 minutes in 2000, nearly a 15% decrease.
  • An EMS training course to certify feldshers was implemented countrywide.
  • An EMS training course was made mandatory for all sixth year medical students.
  • An EMS training course was made mandatory for all family medicine residents.
  • The existing Admission Unit of the City Ambulance Hospital was converted into an Emergency Room based on the US model.
  • Services provided in pre-hospital care have begun to include IV therapy, defibrillation, CPR, electrocardiograms, immobilization and C collars.
  • An advanced trauma course was instituted at the EMS Training Center in early 1998.
  • Automatic External Defibrillators (AEDs) were introduced in 1999, making Moldova a leader in the region.


Cardiology & Cardiovascular Surgery

  • Improved perfusion techniques introduced by the US partners decreased the time patients needed to be on cardio-pulmonary bypass machine.

Dialysis & Kidney Transplantation

  • Due to donated equipment, the numbers of needle biopsies to diagnose renal dysfunction began to increase in 1995.


Nursing

  • The Moldovan Nursing Association, founded in 1995 through the efforts of the partnership, currently boasts over 13,000 members in all of Moldova's 11 judets. An estimated additional 12,000 nursing students have also participated in its activities. Its Board of Directors meets monthly.
  • The Moldovan Nurses Association organizes education seminars and conferences to share information they received through the partnership. They have also developed a 60-hour course on Universal Precautions, AIDS and other blood transmitted diseases for nurses. New patient care standards adopted by the Association have helped to decrease post-operative pulmonary complication from 12% to 5% and allowed for patient transfer out of ICU in two to three days. The Association's members have also published several articles about their activities in local journals and a nursing page in the Romanian newsletter "Mysteries of Health".
  • In 1996 the Moldovan Nursing Association became a member of European Forum of Nursing Associations under the auspices of WHO. The Moldovan Nursing Association has 38 branches and 8 professional groups.
  • During the last two years the Moldovan Nursing Association has developed and is now implementing a new project "Home Care" that is serving 100 bed ridden patients. A team of specialists is working within the project. It consists of a physician, social worker, six nurses, twelve volunteers and a specialist on equipment maintenance.
  • The position of "Head Specialist" for nursing was created in the Moldovan Ministry of Health in 1996.al.
  • In 2000 a Nursing faculty was opened at the Medical University.


Infection Control

  • In January 1995, US partners reported visible signs that infection control was improving. Both NIS partner hospitals began to use antibiotics prophylactically before surgery and for a shorter duration post-op. Hand washing techniques had also improved with more hand towels and soap available at hospitals.
  • Over the course of the partnership infection rates for post-surgical emergency patients decreased from 9.8% of patients treated in 1992 to 1.5% in 1998.

Medical Education

  • New admission standards were implemented at the Nursing College in February 1995. All students must now have completed at least 12 years of high school and be eighteen years of age. Previously students as young as 14 years were admitted. More course hours are now also required and the curriculum has been extended from two to three years.
  • In the first quarter of 1995, admission standards for prospective doctors were increased. Students are now required to pass four written exams to enroll. In 2000, 492 students were admitted into the Medical University, compared to 950 three years prior.
  • Prior to the partnership the only residency program that existed was in surgery. In the 1997-1998 academic year a three-year residency was established for emergency medicine and most other specializations. A Residency Director has been named and has been trained in the US.
  • Residency Tracking database modeled after US System and meeting international standards established at the Medical University to track residents in each rotation and activity, enable the documentation of faculty teaching time, help establish written standards and competency objectives, and financial reporting and analysis (including internal audits), among other functions.


Women's Wellness

  • Since its founding in 1997, the Women's Wellness Center has reported a 30% decrease in the number of patients seeking abortions.
  • For the two-year period 1999/2000 the Women's Wellness Center recorded 32,099 total patient visits, which included 3,680 psychologist visits and 8,648 education class participants. The classes included sex education for adolescents, prenatal care for pregnant women, childbirth preparation for couples, and menopause for older women. In addition to courses, the Women's Health Center offers family planning, and screening for STDs and cancer.
  • The Dalila Women's Wellness Center, the Ministry of Health and the Moldovan Family Planning Association jointly sponsored Family Planning Awareness Week, November 3-9, 1997. The Center coordinated seminars for medical professionals, adolescents, and young mothers. In addition, medical staff and educators from Dalila participated in a roundtable with representatives from the Ministry of Health and the Republican Center for Mother and child to discuss the creation of a national school-based sex education program.
  • The Dalila Center, in cooperation with Connect, USA and with funding from the US State Department, organized a national conference on domestic violence, entitled "Domestic Violence - a Multidisciplinary Approach." The conference was so successful that it was later replicated in Russia and Ukraine.
  • The Medical University changed the curriculum in the medical school for obstetrics and gynecological care, based on what they learned through the WWC and new clinical practice guidelines.


Surgery

  • Post operative mortality began to decline in 1994, from its 1992 level of 12.5% to 8.8%. The same held true for operations on children with congenital heart disease. Their mortality rate decreased from 2.6% in 1992 to 1.4% in 1995.
  • In 1994, doctors at the Republican hospital noted that post-operative bleeds had decreased to two patients, down from ten the previous year. They believed this was due to the new HP monitors, IV lines and Hemochron 400 that had been donated.
  • Prior to February 1995, Surgeons at the two hospitals were only able to perform laparoscopic surgery for cholecystectomy's. Donated equipment now allows them to do endoscopic and laparoscopic procedures in gynecology, urology and thoracic endoscopy. The frequency of the procedures has also increased from once a week to daily.
  • Due to the introduction of urgent endoscopy and ultrasound examination, average length of hospital stay has dropped from 18.5 days for the rest of Moldova to 9.5 days (2000 statistics) in Chisinau Emergency hospital (data from Chisinau City Heath Administration Annual Statistics Report) and 7.8 days in the hospital's surgery units. The use of endoscopic procedures allowed a reduction in the length of hospital stay of such patients to 6.3 days.
  • The Moldovan partners reported a 0.93% decrease in mortality rates for patients that underwent surgery from 1993 to 1997, despite an increase from 1,993 to 3,695 in patients that were operated upon in that same period.
  • Total number of laparoscopic procedures increased from 237 in 1994 to 900 in 1997 (360 for 1999 and 430 in 2000).

Other

  • As a result of the partnership programs, the hospital now charges for some services. This brought in approximately 68,000 leis in profit in 1997, which allowed them to compensate for the lack of government funding for day-to-day operations. Amount of income for paid service in 2000 for the City Ambulance Hospital was 2,300,000 leu - or $230,000.



Partnership Data

Dates of MOU Signing: November 9, 1994  
Exchanges: NIS Partner Exchanges
NIS Partner Exchange Days
US Partner Exchanges
US Partner Exchange Days
Total Exchanges
Total Exchange Days		 134
2,619
146
1,820
282
4,487
Estimated Value of
In-Kind Contributions:		 Medical Equipment and
Supplies, Educational
Materials
Human Resources
Total



2,581,003
2,834,726
5,415,729

 

 

 


Participating Institutions