Dubna, Russia / La Crosse, Wisconsin
1992-1999
Focus: Pediatrics, Substance Abuse and Dependence, Emergency Medical Services, Infectious Diseases, Women's Health, Diabetes, Home Care, Rehabilitation Services
- The Partners
- Partnership Objectives
- Key Events
- Achievements
- Partnership Data
- Participating Institutions
- Partnership Contacts
The Partners
US Partner: Gundersen Lutheran Medical Center is a 402-bed regional medical center that provides both primary and specialized medical services, including a Level III trauma center and an air medical transportation system. Gundersen Clinic, Ltd. is a 275-physician, multi-specialty group practice, connected to Lutheran Hospital. Gundersen Clinic has 24 branch and satellite clinics located throughout western Wisconsin, northeast Iowa and southeast Minnesota, as well as 32 outreach centers. Franciscan Healthcare System provides a number of health care services, including a rural hospital, nursing home care, home care and services for the elderly. Franciscan Health System operates St. Francis Medical Center, a 346-bed regional medical center and the largest member of its system. Skemp Clinic, connected to St. Francis Medical Center, is a multi-specialty group practice of over 70 physicians. It also operates family practice branch clinics in six other hospitals.
NIS Partner: Bolshaya Volga Hospital is the oldest hospital in Dubna, serving largely the elderly and impoverished population of Dubna. Half of the facility provides inpatient care, while the other half is dedicated to the Children's Rehabilitation Center, which is largely supported by parents of children with disabilities (cerebral palsy, hearing impairment, diabetes). This part of the hospital is called the "Christmas Center." Hospital No. 166 is a facility that provides 17 medical specialties. The hospital is 40-years old and has approximately 300 inpatient beds. Hospital No. 9 was built to provide care to workers at the prestigious Joint Institute of Nuclear Research.
Partnership Objectives
Women's Health
- Develop and implement a comprehensive family planning program, including education and services, for women in the Dubna regional healthcare area.
- Familiarize Dubna gynecologists and nurse/midwives with family-centered prenatal care, including emphasis on wellness, prevention, family planning, family participation, and breast-feeding.
- Promote family planning options and introduce the concept of primary care and prevention for women within Women's and Children's Centers.
- Promote safe, low-cost, family-centered prenatal care and birth options; to encourage expanded roles for nurse midwives.
- Coordinate sex education delivery in Dubna schools.
- Establish a comprehensive Women's Wellness Center as a Phase I pilot site in Dubna to provide ambulatory clinical and educational services for women that address women's physical, social and psychological health.
- In 1999 the partnership received additional funding to focus on the following additional objectives:
- Evaluate the administration and operation of the WWC in Dubna.
- Monitor medication inventory and appropriate distribution of medications for patients of the center.
- Evaluate equipment and supplies operation and maintenance purchases.
- Ascertain the effectiveness of the computer documentation and data tracking of Center services.
- Assist in implementation of a marketing plan for services.
Alcohol
- Develop a comprehensive multidisciplinary program including prevention, intervention, treatment and aftercare to deal with problems of alcohol and substance abuse.
- Assist in developing the necessary model community resources to implement an effective comprehensive alcohol and substance abuse treatment program in the Dubna area.
- Expand the comprehensive multidisciplinary program approach to four other cities in Russia.
Dialysis & Kidney Transplantation
- Improve dialysis techniques.
Pediatrics
- Identify methods to improve the delivery of healthcare to infants and children at healthcare facilities in Dubna.
- Reduce the incidence of brain damage secondary to asphyxia (hypoxic encephalopathy).
- Decrease the number of birth defects documented in the Dubna area.
- Clarify the immunization needs of children and health care professionals in Dubna.
- Begin planning for the establishment of a Children's Center in Dubna.
- Teach pediatric advanced life support (PALS) and monitor results of previous classes in Neonatal Advanced Life Support (NALS).
Physical Rehabilitation
- Implement a comprehensive multidisciplinary physical rehabilitation program for CVA and other related disabled patients in Dubna.
- Provide the Dubna Regional Health Referral System with orthotics/prosthetics resources to support their physical rehabilitation programs.
- Develop the clinical skills necessary to implement the use of orthotics and prosthetics for disabled individuals.
- Determine the feasibility of developing and financing an Orthotics Center in Dubna.
- Oversee the overall functioning of the Orthotics Center, including enhancing skills in diagnosing patient conditions and other orthotic needs. In 1999 the partnership received additional funding to focus on the following additional objectives:
- Train NIS physicians in the appropriate diagnosis and referral for orthotics.
- Train NIS physicians to prescribe orthoses for adult stroke patients in Dubna.
Cardiac Rehabilitation
- Establish a comprehensive state-of-the-art multidisciplinary approach to cardiac care, aimed at improving quality of life and reducing healthcare costs in the Dubna regional healthcare area.
- Establish one center for Phase III cardiac rehabilitation with the addition of a model prevention program.
- Roll out the education model for heart disease prevention into two additional communities in Russia.
Nursing Education, Hospice and Home Care
- Develop a comprehensive program for enhancing the skills and roles of nurses and other allied healthcare providers in the Dubna Regional Healthcare System.
- Develop clinical/professional standards of practice for nursing/social services/volunteers/other disciplines.
- Sponsor a nursing conference in Dubna for the regional service area.
- Expand the delivery of home care and hospice care, and develop leadership skills of hospice and home care professionals in Dubna.
- In 1999 the partnership received additional funding to focus on the following additional objectives:
- Evaluate the program's efforts to increase accessibility and efficiency of care through nursing outreach/home care in Dubna.
- Assess and document the changing roles of nurses in Dubna resulting from partnership activities and changes in health care system.
Infection Control
- Increase the knowledge of Dubna health care workers in the area of infection control.
- Establish a working infection control committee within each participating healthcare facility that will assume responsibility for education of healthcare workers, employee health needs, data collection, and evaluation systems and infectious disease needs within their respective hospital areas.
- Develop a model employee health program to deal with acquired infections and general health problems.
- Develop a work "Safety and Prevention" program to prevent injuries and illness in the workplace.
- Assist in offering hepatitis B vaccines to employees who work with blood and body fluids.
- Establish positions for an infection control specialist and associate infection control nurse within each of the Dubna hospitals.
Diabetes
- Identify the incidence of diabetes and establish a diabetic center for 150 diabetic patients and families that will include educational materials, lectures and teaching conferences to enhance understanding of diabetes and modern treatment methods, provide support systems, and enhance self care and responsibility.
- Establish an organization (including local, regional, and national chapters/groups) committed to a prevention, education and intervention program for diabetics and their families.
- Continue to develop the Diabetes School as a model training center for others in Dubna and other parts of Russia.
- Working with AIHA and the Minister of Health, replicate the Diabetes School throughout Russia.
- Expand the exercise and nutrition program as a means of the treatment of Type I and Type II diabetics.
- In 1999 the partnership received funding to focus on the following additional objectives:
- Plan and conduct a two-day seminar for representatives from each of the four diabetes schools.
- Assess status and progress of each of the replication sites.
- Develop a business plan for future marketing and model replication.
- Document historical perspective of model development to include efficient steps for replication.
Renal Dialysis
- Assess feasibility of developing a renal dialysis center for patients in the Dubna region, including the need for staff training, pure water supplies, dialysis supplies, equipment, and facilities.
- Develop a future plan for implementation of a peritoneal dialysis program in Dubna.
- Establish a program with hypertension prevention, diabetes, alcohol and nursing groups to work on preventive measures to control disease entities that lead to kidney failure and the need for renal dialysis.
- Provide technical assistance in the development of a three-station dialysis unit in Dubna, including training unit personnel.
Emergency Medical Services
- Contribute to the development of an EMS Training Center in central Russia, focusing on training of pre-hospital personnel in order to increase the quality of emergency services offered in Dubna.
- Identify and develop programs that result in the reduction of social problems such as domestic violence and recurrent alcoholism.
- Incorporate police and fire departments into a first responder role to assist ambulance personnel.
- Coordinate a plan for disaster services for Dubna with those being developed by AIHA project in Moscow.
- In 1999 the partnership received additional funding to focus on the following additional objectives:
- Evaluate the ability of trained CPR instructors who provide classes for health professionals.
- Evaluate the quality of emergency care focusing on diagnostic capabilities in the filed versus in the hospital.
- Deliver self-contained breathing apparatus to Dubna fire-fighters and train in their use.
- Oversee community-based CPR instruction in Dubna.
Administration/Management
- Develop a management training and leadership development program to support the enhancement of healthcare delivery and its plan for regionalization.
- Develop a Health Science Resource Center in Dubna to service the Dubna Regional Healthcare System.
- Integrate aspects of management training into other partnership priority areas.
- Oversee the implementation and evaluation of project activities and the incorporation of health education programs into a school of health education at the University of Dubna.
- Develop and oversee a videoconference studio for distance learning between La Crosse and Dubna. Create studios at Gundersen Lutheran Hospital in La Crosse and at the University of Dubna in Dubna.
-
1992
- On May 24, the partners celebrated the signing of the Memorandum of Understanding between Gundersen Lutheran Medical Center and Franciscan Healthcare System on the US side, and Bolshaya Volga Hospital, Hospital No. 9, and Hospital No. 166 in Russia.
1993
- In September, a Diabetes School was established to provide screening, education and treatment for diabetic patients.
- First Alcoholics Anonymous (AA) meeting was organized and held in Dubna in December.
1994
- A hospice program opened in September with 2 nurses and 8 physicians.
- An intervention, treatment and aftercare program was instituted in Dubna for alcoholics and their families in December.
1995
- The first prenatal education classes were established in April at Hospital #9 and Central City Hospital.
- A comprehensive sexual education curriculum was established and taught by physicians and teachers in Dubna schools.
- Dubna Alcoholism 12-Step treatment model was replicated in the Russian cities of Sergiev Posad, Taldom, Zaprudnia, Dmitrov and Klin, Russia.
- Three discrete Coronary Care Units, staffed 24 hours per day, were established in March -- one in Hospital #9, one in Central City Hospital and one in Taldom, Russia.
- In June translated American Heart Association materials were incorporated into patient teaching at partnership hospitals.
- Two accessible Phase II cardiac rehabilitation programs, modeled after programs at Lutheran Hospital and St. Francis Medical Center, were developed in June.
- In April, a Health Information Advisory Council consisting of 5 members was established in Dubna to further develop, plan and implement a Health Resource Center.
- In May, the Russian government issued statute #220, which creates a hospital epidemiology position for each hospital in Russia.
- Three individuals were awarded Special American Business Internship Training (SABIT) fellowships and spent three months in La Crosse learning management and leadership principles.
1996
- The first family-attended birth at Central City Hospital occurred in February.
- Staff were hired and alcohol treatment centers were opened in Dmitrov, Sergive Posad, Klin, Taldom and Zaprudnia in January.
- The Dubna Orthotics Center opened in November and it reached an agreement to provide products to Moscow Oblast and federal rehabilitation hospital.
- A hypertension screening program was established in May in Dubna and hypertension screening technicians were trained.
- A community Resource Center located at the University of Dubna was developed to serve as a clearinghouse for all partnership activities.
1997
- A centralized dispatch service for Dubna was created in February.
- On April 27, partners celebrated the opening of a comprehensive Women's Wellness Center, based on AIHA's Women's Wellness model.
- Dubna AA group celebrated its 4th anniversary with a videoconference link with La Crosse AA group.
- A two-station renal dialysis unit was opened at Central City Hospital in November.
1998
- Collaborated with Dubna Rebirth Narcological Center to establish educational programs for the prevention of fetal alcohol syndrome and adequate prenatal care.
1999
- In March, representatives from the partnership's four Diabetes schools in Dubna, Krasnogorsk, Balashikha and Moscow attended a workshop sponsored by Measure 3, an initiative of USAID/Moscow. They discussed many of the common problems faced by the four schools, project assessment and means of replicating the schools in more communities at the workshop.
- In May, two partners from LaCrosse traveled to Dubna to assess the Quality Project in Dubna's health care institutions. They also established next steps for the AIHA sponsored sustainability project in the areas of Orthotics, Women's Health and Infection Control.
- Fifteen hundred delegates from around the world, including NIS and U.S. AIHA partnership representatives, attended the Sister Cities International Conference held in Little Rock, Arkansas, July 22-24. Representatives served on panels exploring the challenges of establishing and maintaining SisterCities relationships and presented the partnership's successes in the areas of sex education, substance abuse prevention, and diabetes education.
- In September, La Crosse sent one traveler to Dubna to review and evaluate the administration and operation of the Women's Wellness Center. The main goals of the trip were to monitor the medication inventory, evaluate equipment and supplies, and assist in the implementation of the center's marketing plan.
- Three U.S. partners traveled to Dubna in September to plan and conduct a two-day seminar for representatives from each of the diabetes schools. This seminar was intended to help establish a marketing program for further diabetes school replication and to assess the progress of the current schools.
- The partners also continued non-AIHA funded activities that included a September Quality Conference for Moscow Oblast and the development of a smoking and alcohol cessation curriculum for students in grades 7-12.
- In late October, two NIS doctors traveled to LaCrosse to study rehabilitation methods and techniques applied at Gunderson Lutheran Medical system to stroke patients and children with physical limitations. During their stay, the physicians shadowed the work of doctors, nurses and support staff from the orthotics department.
- One American partner traveled to Dubna in December to conduct an end-of-partnership evaluation in each of the following areas: women's health, renal dialysis, alcohol treatment and prevention, diabetes, cardiac rehabilitation, orthotics, health care reform, emergency medicine, infection control, and project administration.
- On May 24, the partners celebrated the signing of the Memorandum of Understanding between Gundersen Lutheran Medical Center and Franciscan Healthcare System on the US side, and Bolshaya Volga Hospital, Hospital No. 9, and Hospital No. 166 in Russia.
Women's Health
- A comprehensive Women's Wellness Center was opened in Dubna on April 27, 1998 as part of AIHA's Women's Health Initiative.
- Oral contraceptive use has increased over the past six years. Therefore, the complications associated with long-term IUD use has decreased.
- Through open counseling to pregnant women and teenagers, a reduction in abortions has occurred from 677 in 1995 to 582 in 1997, and the number of abortions compared to live births has gone from 3:1 in 1992 to 1:1 in 1996.
- Center services expanded to include STD education for teens and all Center clients. Additional training was provided to nurse midwives in education about family center birthing practices. The frequency of family-attended births was maintained in 1999. Efforts are planned to increase the number of family-attended births in 2000.
Alcohol
- AA and Al-Anon groups were organized and are now regularly held in Dubna, Klin, Dmitrov, Zaprudnia and Taldom. Dmitrov, Zaprudnia and Dubna have had to add additional meetings in their communities to accommodate the number of individuals interested. Al-a-teen has been formed in Zaprudnia, Dmitrov and Dubna to meet the needs of teens affected by alcoholism, either personally or within their families.
- Perhaps the greatest accomplishment of the alcoholism treatment work through the partnership is the changing community attitude about treating alcoholism as a disease that affects not only the alcoholic, but his/her family. This stride has allowed for more services for the alcoholic and a medical environment for safe treatment and follow-up for the disease.
- As a result of partnership efforts, alcohol sales were restricted after 9:00 p.m. in Dubna liquor stores.
Pediatrics
- Neonatal Advanced Life Support and Pediatric Advanced Life Support equipment was sent to sustain training in both Dubna and Taldom, Russia.
- The Newborn Advanced Life Support Manual was translated into Russian and 15 copies provided to Dubna by Lutheran Hospital.
- Fifty-five professionals were trained in 2-day Neonatal Advanced Life Support training in Dubna and Taldom, Russia.
Physical Rehabilitation
- Based on a community assessment, an Orthotics Center was developed and opened in Dubna. The center has been fully operational since November 1996. The center assesses and fabricates ankle and foot orthoses for both children and adults.
- Reallocation of staff in exercise testing and patient teaching resulted in physiotherapist completing exercise testing and nurses conducting patient teaching.
- A Functional Independence Measure (FIM) scale was adopted as a data collection tool for use in Dubna hospitals; the tool was translated and distributed to professionals in Dubna.
- The physical rehabilitation center in Dubna now provides orthotics to the Moscow Region. The orthotics portion of services was recently moved to the physical rehabilitation center. Now patients can receive the whole spectrum of care at one facility. Goals for 2000 include expansion of the orthotics lab to include the manufacturing of not only ankle and foot orthoses, but other prosthetic services as well. Other services would also include occupational and "back-to-work" training for stroke and other physically disabled individuals.
Cardiac Rehabilitation
- Objectives in the area of cardiac rehabilitation services to outpatients were fully met with the development of community-based Phase III rehabilitation programs. Clinical and education protocols have been established for the Phase III program.
- Delivery of inpatient services was improved with the creation of discrete coronary care units at both Hospital #9 and Central City Hospital. Education of physicians, nurses and therapists helped to reduce the average length of stay for uncomplicated myocardial infarction patients significantly (from 30 days to 14-16 days).
Nursing Education, Home Care and Hospice
- A hospice care program has been created in Dubna and the terminally ill and their families have embraced hospice care as a tremendous adjunct to comprehensive health care. Hospice workers have been trained to work as partners in the health care field with physicians and nurses.
- Home care services have allowed for a quicker, greater emphasis on outpatient services in Dubna.
- Twenty nurse managers were instructed in developing job descriptions, roles and responsibilities. Refinement of job responsibilities has resulted in, among other things, an increase of home care services staff by 120%.
- Nurses continue to assume a greater role in direct patient care at Central City Hospital and Hospital #9. Leadership training for nurses has resulted in a number of changes, including increased pride, and involvement in a larger number of conferences, workshops and seminars.
Infection Control
- Infection control specialists were created in each hospital, and are present within most departments. A much greater awareness for infection control has occurred in the areas of nursing education, cardiac rehabilitation, renal dialysis, and pediatrics because of the infection control specialists' work.
- As a result of the first Russian partner visit to La Crosse, a physician was appointed to form and head the city-wide Infection Control Committee, responsible for standardization of infection control practices in Dubna.
- Infection control practices were incorporated into emergency services.
Diabetes
- Diabetes incidence data collected in Dubna in 1993 resulted in identification of 160 Type I diabetics and 840 Type II diabetics.
- Working closely with WHO and the Dubna City Health Administration, a model school of Diabetes Disease Management was created in 1994. All faculty at this school have developed a train-the-trainers type of instruction which allows patients to receive the correct diagnoses of Diabetes-type. The curriculum developed by the partnership was approved by the Moscow Academy of Sciences and is being used in many Moscow schools. In addition, all trainers have been taught to use the WHO database DIABCARE for collection and surveillance of data. The success of this program and its curriculum produced a replication program into the Moscow Oblast, resulting in six diabetes schools in all.
- By November 1997, more than 1300 patients, family members and health care workers trained at the Diabetes School in Dubna. The Diabetes Schools established in the Moscow Region gathered for additional training and site update and assessment. Five of the six sites recently monitored appeared to have improved the quality and range of care considerably; patient and family education continue to increase at each site.
Renal Dialysis
- Four years of preparation, training, remodeling, equipping, and more training has resulted in the opening of a 2-station renal dialysis unit at Central City Hospital in Dubna. The US and NIS partners have created a program to supply competent dialysis services to patients in Dubna, preventing them from having to travel to Moscow for treatment.
Emergency Medical Services
- As a result of partnership efforts, a central dispatch has been created, ambulance personnel trained, and an EMS manual developed for use in Dubna hospitals.
- More than 50 nurses were trained in cardiopulmonary resuscitation (CPR) and 8 CPR mannequins were sent to Dubna. Police and fire personnel also received CPR training.
- CPR training for health care personnel continues. The CPR instructors remain current in their certification and motivated to continue training. Community CPR training was held with great success. More than 3000 individuals ranging in age from teens to older adult were exposed to the importance of CPR and viewed a demonstration of the technique.
Other
- The partnership has attracted significant additional resources to continue activities started by partnership work groups. These include: $500,000 from World Learning for alcohol treatment, $500,000 from USAID for health care reform, $80,000 for SABIT Management Interns, $ 80,000 from IREX for prevention activities, $70,000 from the Eurasia Foundation for municipal development, and $15,000 from Rotary International for community assessment.
- With support from AIHA, ISDN telephone lines were installed and satellite linkage established in order to develop a videoconference program between La Crosse and Dubna in several partnership program areas.
| Dates of MOU Signing: | Sept. 22, 1992 | |
| Exchanges: | NIS Partner Exchanges NIS Partner Exchange Days US Partner Exchanges US Partner Exchange Days Total Exchanges Total Exchange Days |
178 |
| Estimated Value of In-Kind Contributions: |
Medical Equipment and
Supplies, Educational
Materials Food and Lodging Human Resources Total |
|
- Dubna Health Care Department
- Medical Unit No.9, Dubna
- Municipal City Hospital, Dubna
- Bolshaya Volga Hospital, Dubna
- Lutheran Health System
- Franciscan Health System
- Gundersen Clinic
- Skemp Clinic
- La Crosse Visiting Nurses Association
Contact Information for Dubna, Russia / La Crosse, Wisconsin
Lipman, Meryl
On-Site Coordinator
Dubna Health Care Department
Dubna, Russia
Email: uz2@uni-dubna.ru
NIS/CEE Partners
Information Coordinator
Aborkina, Elena
Computer Specialist
Bolshaya Volga Hospital
Dubna, Russia
Email: diabet@dubna.ru
Information Coordinator
Boitsova, Irina
Dubna Health Care Department
Dubna, Russia
Email: med@uni-dubna.ru
NIS Partnership Representative
Dr. Ryabov, Sergei
Chief, Dubna City Health Department
Dubna Health Care Department
Dubna, Russia
Email: med@uni-dubna.ru
CEE Partnership Representative
Komendantov, Yuri
Deputy Mayor
Dubna Health Care Department
Dubna, Russia
Email: med@dubna.ru
US Partners
US Technology Contact
Choutka, Jay
Gundersen Lutheran Hospital
La Crosse, WI, United States
Email: jchoutka@gundluth.org
US Partnership Coordinator
McCormick, Sandra
President & Chief Executive Officer
World Services of La Crosse, Inc.
La Crosse, WI, United States
Email: smccormick@worldserviceslax.org
Updated on September 29, 2005
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