• Continue to train a cadre of physicians and nurses in adult family-centered primary health care.
• Establish model primary health care services to be replicated in other regions.
• Incorporate women’s care into the service mix at Polyclinic #5 and access to women’s health screening in the region including: providing Pap smear screenings to adult women and conducting and teaching breast exams and providing mammograms to women with suspicious findings.
• Provide patient and community education and continue using previously developed education pamphlets (smoking cessation, child safety, hypertension, breast exam, asthma, chest pain and cholesterol). Develop new flyers on diabetes, contraception, and sexually transmitted diseases.
• Develop capacity in monitoring and evaluation, including monitoring of issues of quality and adherence to guidelines, the proper use of forms, and statistics from health fairs.
• Improve accessibility of care in targeted regions, including the provision of free blood pressure screening to at least 20,000 citizens of Lori region.
• Provide basic cardiac life support programs to firefighters, police, teachers, parents and others.

• The partners jointly conducted a Health Fair in Vanadzor in mid-September. The fair offered a wide range of primary care clinical and educational services, including cholesterol and hypertension screenings and information on disease prevention and health promotion. Five hundred twelve (512) local residents of all ages took advantage of the services offered. Data collected from the screenings will be analyzed and used to guide future partnership directions.
• Partners from Los Angeles consulted with local health officials to treat a gastrointestinal infectious disease outbreak in Stepanvan, northern Lori region. The US partners assisted in distributing appropriate antibiotics and providing training to medical professionals. The spread was contained, with no new cases reported since the interventions were initiated.
  
  

• The Vanadzor clinic received special permission to treat patients outside of its traditional catchment area.
• Carelift International delivered a donation of primary care equipment and supplies necessary to provide model primary care services.
• The partners conducted their second annual Community Health Fair. Over 700 citizens attended the fair, receiving a wide range of clinical and educational services, including: blood pressure screening, height and weight measurement, breast exam, cholesterol and blood sugar testing, vision screening, dental hygiene, and patient education. In conjunction with the fair, the partners also hosted a grand re-opening ceremony for their clinic, and a one-day primary health care conference for local healthcare workers. The events were covered extensively in the Armenian press.
  
  

• The partnership sponsored the third annual Vanadzor Health Fair as well as a first annual Spitak Health Fair in August. Participants received free screening services, including tests for blood pressure, diabetes, cholesterol, dental, and vision acuity. Female participants received breast screening and ultrasound.
  
  

• A gynecologist and a cytologist from the Lori/Los Angeles partnership completed cervical cancer screening training at the Erebuni WWC.
• The partnership celebrated the official opening of primary healthcare satellite offices in the Stepanavan, Tashir, Alaverdi, and Spitak polyclinics from July 7-10.
  
  

Clinical Organization and Capacity Building

• The Lori/Los Angeles partners at Vanadzor Polyclinic #5 began seeing their first primary care patients in 2000, and the model family medicine clinic at the facility was officially completed in 2002. During the second half of the partnership, renovations were completed on replication sites in the regional communities of Alaverdi, Dashir, Spitak, and Stepanavan which have also adopted primary care methods and began utilizing guidelines developed at Polyclinic #5.
• Clinical training organized by the partnership reached all the physicians and nurses at Polyclinic #5 as well as staff from other clinics in the region. The staff were trained at UCLA, in the Los Angeles Armenian community, and in Armenia. Training included one-on-one clinical experiences, classroom education, and conferences. Topics included comparisons between primary care and family medicine, public health, infectious diseases, budgeting, guidelines, patient education, accessibility to health care, home health care, medications, immediate and advanced treatments, supply and equipment use, preventive care, promotion of health, and screening for diseases.
• In close collaboration with the Armenian Ministry of Health, the partners jointly developed clinical practice guidelines for hypertension, chest pain, diabetes, and asthma, all of which were identified as key health concerns among the local population at the beginning of the project.
• Nearly 100 individuals from Vanadzor Polyclinic #5 and the replication sites in Alaverdi, Dashir, Spitak, and Stepanavan received intensive training from Armenian trainers in primary care and management of hypertension, chest pain, diabetes, and asthma. The newly-trained staff have monitored 490 patients with hypertension, 326 with chest pain, 192 with diabetes, and 9 with asthma.
• In a collaborative effort with the Erebouni WWC, the partnership developed women’s health services at the polyclinic. The facility now has trained personnel and the necessary supplies to provide Pap smears, clinical breast exams, contraception counseling, STD diagnosis and treatment, and other basic obstetrical and gynecological care to the women of the Lori region. Almost 150 patients received obstetrical and gynecological care at the polyclinic through mid-2004, and around 13% of those who received cervical cancer screening had abnormalities. Over 260 women in Vanadzor and Margahovit received breast screenings. None were diagnosed with breast cancer, but many were referred for further investigations.
• CPR instructors from the nearby Akhourian CPR Training Center trained over 25 Lori region doctors and nurses in the American Heart Association’s Basic Life Support Course for professionals. The trainers then held training sessions for community members, such as teachers and first responders.
• Partnership representatives participated and made professional presentations in several international conferences including the Armenian International Medical and Nursing Conferences and AIHA Annual and Regional Meetings.
• Patient visits to the clinic have increased by 50 percent since the partnership trained the staff and the popularity of Vanadzor Polyclinic #5 has increased tremendously as word has circulated that the medical staff is American-trained.

Community Outreach

• The partnership’s reach into the Lori community was widespread and has had an impact on the health of more than 10,000 people. Through annual health fairs that took place over a three-year period, some 3,000 individuals were screened for chronic conditions—more than 25 percent of them had high blood pressure, elevated cholesterol levels, vision impairment, and/or dental caries.
• Health education activities were held for the community on topics such as healthy lifestyles, substance abuse prevention, and maternal and child health.
• The partners also coordinated with the organization Analysis, Research and Planning for Armenia (ARPA) to train teachers to conduct “healthy living” programs for over 800 students in ten Lori region schools. Students in the program were given pre- and post-tests which showed 30% improved knowledge on health-related topics.
• In conjunction with World AIDS Day the partners conducted several educational HIV/AIDS related activities. For example, the polyclinic exhibited educational posters, distributed brochures and conducted courses on AIDS issues at secondary schools in the region.
• The partnership, in collaboration with Vanadzor Optic Center and with the Armenian Relief Society (ARS), has conducted a vision screening and eyeglass provision program. Approximately 300 people received eyeglasses through the program.
• As part of the dissemination activities during the final year of the partnership, over 8,000 people from the Lori region received blood pressure screenings, and approximately 16% were diagnosed with elevated blood pressure.