Women's Health

• Conduct training courses focusing on issues such as childbirth education, breast self examination, prenatal care, contraception, breast feeding, nutrition, stress reduction, and smoking and alcohol abuse.

Pediatrics and Neonatology

• Conduct training courses for physicians and nurses focusing on newborn assessment, APGAR scoring and neonatal resuscitation.
• Establish a Neonatal Resuscitation Center in Dushanbe.

Infection Control

• Present basic infection control techniques to healthcare professionals.
• Create an Infection Control Committee and establish monitors for trending nosocomial infections.
• Provide and install a washing machine for hospital linens.

Hospital Administration and Finance

• Provide training in hospital management and inventory control and management.

Nursing Reform

• Strengthen the role of nurses in Tajikistan through education reform, the establishment of a nursing association and annual nursing conferences.

Medical Education

• Reform medical education in Tajikistan and reduce the enrollment of medical students.

Biomedical Engineering

• Install an intensive care unit at the City Medical Center and train staff in the basic repair of biomedical equipment.

Endocrinology

• Conduct a course for hospital staff and medical students in endocrinology and provide glucose monitors and insulin to the NIS partners.

Critical Care

• Train physicians and nurses in basic critical care and provide the City Medical Center with model intensive care unit.

• On January 4, the partners celebrated the signing of the Memorandum of Understanding between Boulder Community Hospital on the US side, and City Medical Center, the Tajik Medical University, and Tajik Medical College in Tajikistan.
• In December training courses in newborn assessment, APGAR scoring and neonatal resuscitation were presented to physicians and nurses from City Medical Center and other city maternity hospitals, as well as to medical students from the Tajikistan Medical University. A course was also presented on identifying and caring for infants with hypoglycemia and controlling temperatures of sick and at-risk infants.
• Health care managers from Dushanbe participated in a series of AIHA/AUPHA financial management seminars. Partners also assessed the nature and effectiveness of hospital operations at City Medical Center, as well as its personnel management system (pay structures, the role of unions, employee benefits, and hiring practices).
• A Tajik Nursing Association was established with support and guidance from the partnership.

• As part of the partnership's continuing effort to reform the role of nurses in Tajikistan, six nurses from Dushanbe and one nurse from Boulder participated in AIHA's NIS-wide nursing conference held in Almaty, Kazakhstan, in May. Soon thereafter, in June, partnership efforts culminated in a nursing conference in Dushanbe, which united over 250 participants from throughout Tajikistan. This conference focused on increasing the skill level and professionalism of nurses in the Republic, with a special emphasis on patient assessment. Sessions covered team building, risk management, role negotiation, and conflict resolution. Each participant was presented with a stethoscope donated by staff at Boulder Community Hospital.
• Training-of-trainers courses in women's health issues, including contraception, breast cancer and breast self-examination, pregnancy-induced hypertension, labor and delivery, postpartum hemorrhage and infection control, were presented to obstetricians and midwives in Dushanbe.

• In May and June, biomedical engineers installed all equipment necessary for a state of the art Intensive Care Unit at City Medical Center. All equipment and supplies were donated by Boulder Community Hospital. Education of City Medical Center engineering staff continued with special emphasis on equipment maintenance. The total amount of the equipment container shipped to Dushanbe was $150,000.
• A second nursing conference was conducted in Dushanbe. One hundred thirty-six nurses attended the conference on Emergency Nursing, which was led by U.S. and Tajikistan nurses who were trained in Boulder. Boulder Community hospital sponsored fifteen nurses from other regions in Tajikistan.
• Boulder Community Hospital conducted a one-week course in endocrinology in conjunction with City Medical Center and Medical University. Special emphasis was placed on patient teaching. Bedside glucose monitors (9) and Insulin were donated by Boulder Community Hospital.

Medical Education and Nursing Reform

• With significant input from the partnership representatives, the Ministry of Health of Tajikistan has proposed major changes in medical education, some of which have already been implemented. Highlights of this reform program include a reduction of medical school class size, a focus on family medicine, and retraining of under-employed physicians. Another important aspect of the reform program is to require three years of nursing education, with an additional one-year specialization for nurse practitioners, public health nurses, and feldshers. Discussions are still underway for the creation of a four-year University-based nursing education program. The U.S. partners have assisted in the articulation of curriculum development principles and methodology for objective examinations.
• A Tajik Nursing Association was established in 1995 with the support and guidance of the Partnership, providing mechanism for the long-term development of the nursing profession in Tajikistan. The association has approximately 1,200 members.

Pediatrics and Neonatology

• The US partners conducted assessments of neonatal units at City Medical Center (CMC) and made recommendations for further technical assistance. In addition, they gathered baseline statistics regarding infant and maternal morbidity and mortality in order to accurately measure future outcomes. Neonatal monitoring equipment was donated and CMC staff members were educated in the use this equipment.
• Partnership efforts in the areas of pediatrics and neonatology resulted in a reduction in the neonatal mortality rate at City Medical Center from 10.7% in 1996 to 7.6% in 1997, using the baseline statistics prepared through the Partnership. The rate remained same in 1998.
• "Rooming-in" of babies and mothers was implemented in 1997 at City Medical Center to combat hypothermia, overcoming years of tradition that separated newborns from their mothers immediately after birth.
• A Neonatal Resuscitation Education Center was established in 1996, and over 100 neonatologists, nurses and medical students were trained there by the end of 1998.

Hospital Administration and Finance

• Based partially on Partnership activities in health care reform, a law was adopted in 1998 to legalize fee-for-service medicine in Tajikistan. Discussions are ongoing with the Ministry of Health to develop a fee-for-service clinic.

Infection Control

• A committee on nosocomial infection prevention was established in 1997 at the City Medical Center.
• Based on training received through the partnership, the Senior Nurse of the Department of Infectious Diseases at City Medical Center has developed an action plan for infection control measures in the hospital, including surveillance and education. The Infection Control Program has been severely challenged with the current Typhoid epidemic.

Women's Health

• Training courses in women's health issues, including contraception, breast cancer and breast self-examination, pregnancy-induced hypertension, labor and delivery, postpartum hemorrhage and infection control, have been presented to obstetricians and midwives in Dushanbe. Those individuals trained are expected to serve as trainers for other colleagues in the health profession.

Critical Care

• BCH provided equipment, supplies, installation and training necessary to establish a state-of-the-art Intensive Care Unit at City Medical Center. Physicians and nurses trained at CMC agreed to support expanded role for nurses in new ICU.

Biomedical Engineering

• Together the partners have inventoried hospital equipment and taught basic repair techniques to City Medical Center staff. Several units have already been repaired, including infusion pumps, infant warmers, and sterilizers. Partnership discussions have also focused on the importance of establishing vendor supply lines for the procurement of equipment, equipment parts, and medical supplies.

Endocrinology

• Boulder Community Hospital conducted a one-week course in endocrinology in conjunction with City Medical Center and Medical University. Special emphasis was placed on patient teaching. Bedside glucose monitors (9) and Insulin were donated by Boulder Community Hospital.