Hospital Administration

• Train senior health executives of Murmansk in cost-effective hospital administration, quality assurance, and utilization management, and create a medical insurance system.

Cardiology and Cardiac Surgery

• Provide training and equipment necessary for the diagnosis and surgical treatment of cardiac disease, including pediatric heart disease.

The Murmansk-Jacksonville partnership received a limited grant award from AIHA in January 1999 to address Pediatric Cardiovascular Surgery.

• Provide training for surgeons, anesthesiologists and nurses in the surgical correction of congenital heart defects.
• Enhance skills for diagnosis and management of cardiac defects in infants and children.

Neurology and Neurosurgery

• Provide exchange of information in neurosurgery and neurology as well as updated equipment and training in the equipment use.

Orthopedics

• Provide training and equipment, especially in the area of external fixation devices.

Operating Room Management

• Enhance the education of operating room nurses, especially in the areas of modern sterilization techniques and infection control.

Laparoscopic Surgery

• Introduce and provide assistance in the development of minimally invasive surgery for both general and gynecological surgeons.
• Provide both disposable and non-disposable laparoscopic equipment for training and actual intra-operative use in the Murmansk hospitals. Provide training for surgeons and operating room nurses in the use of this equipment.

• Continue the training of surgeons, anesthesiologists and other operating room personnel in advanced laparoscopic procedures and provide training materials to decrease the infection and complication rate.

Gastrointestinal Endoscopy

• Enhance techniques in endoscopy and medical treatment of peptic ulcer disease.

Emergency Medical Services

• Provide training and information on the modernization of techniques and equipment used in pre-hospital emergency care.

Women's Health

• Improve maternal nutrition.
• Improve treatment of high-risk pregnancies.
• Educate women in Murmansk about the diagnosis and treatment of breast cancer.
• Develop a training program for the diagnosis and treatment of sexually transmitted diseases.

• Complete initiatives in the area of birth control, STD prevention, and obstetrical infection.
• Initiate activity in early detection of breast cancer.
• Introduce breast conservation therapy as a management option for breast cancer.

HIV/AIDS

• Provide advanced training in education, prevention, diagnosis, and treatment of HIV/AIDS; develop an outreach program for HIV/AIDS

Infection Control The Murmansk-Jacksonville partnership received a limited grant award from AIHA in January 1999 to:

• Facilitate the implementation of a comprehensive hospital infection control program.
• Provide training in the hospital infection control surveillance.
• Provide training in techniques to decrease infection rates, especially in Obstetrics.

(Note: AIHA also supported the further training of the Murmansk partners at Menchikov Institute as part of the AIHA infection control initiative)

• On September 25, US and Russian partners, signed the Memorandum of Understanding, marking the beginning of the hospital partnership under AIHA. The City Health Administration and Mayor of Murmansk participated in the ceremony.

• US partners donated a cardiopulmonary bypass machine and technicians from Jacksonville trained their Murmansk counterparts and vascular surgeons in the use of the equipment.
• In June, two US partners assisted and instructed Murmansk surgeons during five of the first ten laparoscopic cholecystectomies ever performed in Murmansk.
• In October, the US partners donated and installed fetal monitors in two Murmansk maternity homes and trained physicians and nurses in their use.
• Murmansk Regional Hospital received new equipment for their neurosurgery and anesthesia departments from the City Health Administration.

• In March, the partnership sponsored a multi-disciplinary international medical conference in Murmansk with more than 300 health care professionals in attendance. A conference of such proportion had never been organized before in Murmansk and drew unexpected interest from not only Oblast hospitals but from the Russian Northern Fleet. The conference participants included 16 US physicians and nurses and over 300 healthcare professionals from throughout Murmansk and Scandinavia. The conference focused on Advanced Cardiology Life Support Systems (ACLS), laparoscopy, neurology, epilepsy and nursing. Surgeons from Jacksonville held a workshop for participating surgeons using donated laparoscopes, light sources, video monitors and insufflators. As part of the conference, the partnership sponsored workshops on pre-hospital emergency care. The first workshop, a modified American Heart Association pediatric advance life support course, provided strategies for early recognition of infants and children at risk for respiratory failure and/or cardiopulmonary risk. A second workshop, "Trauma, Resuscitation and Stabilization," presented the fundamentals of pre-hospital trauma management. Approximately 100 professionals attended each of these workshops.

• In May, the Director of Jacksonville's Department of Disaster Preparedness and the Director of Emergency Services at Jacksonville's Level One Trauma Unit participated in a multinational disaster drill which was sponsored by the United Nations and hosted by Murmansk. Representatives from throughout Europe participated in this exercise.
• OB/GYN physicians and nurses from St. Vincent's Medical Center and Memorial Hospital have visited Murmansk and worked with their counterparts to improve the treatment of women with high-risk pregnancies. In September, as part of an advanced training program for the diagnosis and treatment of sexually transmitted diseases (STD's), lectures on STD's and infertility were presented to Murmansk physicians and nurses. A similar training program was also developed to educate women in Murmansk about breast cancer and the values of self-examination.

• An intercom system was provided and installed at Murmansk Regional Hospital to assist in intra-institution communication and to improve situation response time.
• In April, two surgeons and a gastroenterologist from Memorial Hospital conducted a one-week interactive train-the-trainer course in laparoscopic and endoscopic diagnosis and treatment for their colleagues in Murmansk. It was during this visit that the concept of bacterial etiology of peptic ulcer disease from bacteria known as H. Pylori and its medical treatment was introduced to Murmansk.
• Both US and NIS partnership nurses attended AIHA's Second Annual NIS Nursing Conference held in Almaty, Kazakhstan. The focus of this conference was on Nursing Leadership.
• The partners played a key role in explaining progress in laparascopic surgical at the AIHA Fourth Annual Partnership Conference for the Newly Independent States in Des Moines, Iowa.
• In November, Murmansk partners held a laparoscopic update seminar. This seminar, which was attended by nearly eighty surgeons from the Murmansk region, featured new instruments and techniques for laparoscopic cholecystectomy and introduced laparoscopic herniorrhaphy.

• In November, Jacksonville partners delivered to Murmansk medical equipment and supplies consisting of heart valves and pediatric cardiac catheters valued at approximately $100,000.
• In March, the executive director of Planned Parenthood of Northeast Florida traveled to Murmansk where she gave lectures to physicians in hospitals and polyclinics, and had discussions with school officials and students on the prevention of STD's and teenage pregnancy.

• In the Spring of 1998, US partners sent a shipment of cardiovascular equipment and supplies consisting of cardiac catheterization catheters, a cell-saver and supplies, suture material, blood pressure monitors and portable defibrillators valued at $189,200.

• The Director of Surgical Services for the Murmansk Region and the surgeon responsible for the establishment of an outpatient surgery center in Murmansk traveled to Jacksonville in 1999. Both free standing and hospital-based ambulatory surgery centers were visited and the role of such centers studied. Following this exchange to Jacksonville, the Regional Director of Surgery and the general surgeon returned to Murmansk and established the first outpatient surgery center in the entire Kola Region. Their goal was to eliminate long hospital stays for patients by using procedures appropriate to this type of center and thus saving considerable resources previously spent for inpatient care.
• The early detection of breast cancer is a health care priority in Murmansk. The Jacksonville partners provided training, breast models, and visual aides on early detection of breast cancer.
• Partners from Jacksonville and Murmansk attended AIHA's 1999 Partnership Conference. While in Washington, partners met with Florida congressmen to discuss the strategic importance of the Murmansk region to US interests and sustainability of their activities after AIHA support ends.
  

Laparoscopic Surgery

• In the area of laparoscopic surgery, the Jacksonville partners were able to provide the top Murmansk surgeons "hands-on experience" in a United States operating room, working with equipment and personnel under the supervision of US surgeons. This was the first time a NIS partner performed actual surgery in the US under the AIHA program. The training and equipment provided to the Murmansk partners has allowed this procedure to be practiced in local hospitals in Russia. The partners continue to gain expertise and work with US doctors on perfecting this procedure. Three separate partnership conferences were held in Murmansk focused on laparoscopic surgery.
• Data reported by the Murmansk surgeons indicated that in both City Ambulance and Regional Hospital, approximately 350 chlecystectomies had been performed in each hospital with essentially the same complication rate.
• In 1999 U.S. surgeons traveled to Murmansk to demonstrate laproscopic ventral hernia repair using the latest in supplies - Gortex mesh. Surgical procedures were performed in both partner hospitals by Russian surgeons under the supervision of the American partners. The W. L. Gore Company and Memorial Hospital of Jacksonville provided the special equipment for this demonstration. Local television stations and newspapers covered the training.
• The Regional Director of Surgery and the general surgeon established the first outpatient surgery center in the entire Kola Region. Patient days have been reduced from weeks to days within the first six months of the center opening.
• The partnership was able to obtain through discounted purchase and donation two complete sets of laproscopic surgery equipment and associated supplies valued in excess of $200,000 to augment and/or replace equipment previously donated by the US Partners.

Neurology

• Despite traditional apprehension and fear of radiation, partners made great strides in promoting neurosurgery and use of a CT scanner. Many partnership exchanges included a radiologist, who conducted training on the donated scanner and continued to instruct NIS physicians at three different hospitals on improving usage and understanding data readouts. The focus on neurology and improved methods resulted in active treatment of patients and trained nurses who previously could not work in this medical area.

Orthopedics

• The US partners focused on increasing the availability of equipment and the level of care at the Murmansk Regional Hospital. Partners, using equipment donated early in the partnership, began new surgical techniques on patients in three different hospitals.

Prostate Cancer

• Working with the local Jacksonville Cancer Society, US physicians created a special protocol for diagnosis and treatment of cancer of the prostate for the Murmansk physicians. Brochures and information targeting detection were translated and distributed to the NIS partners in 1994, along with equipment and reagents for testing.

Women's Health

• Continuous materials and lectures on STDs, prenatal care, neonatological techniques, breast-feeding, post-partum hospital stays, and cesarean surgery were offered throughout the partnership exchanges in order to provide improved care in Maternal and Child Health.
• In September 1994, the partnership initiated a prenatal vitamin study in two maternity homes in Murmansk. This project was designed to improve the nutrition of mothers and newborns. Data collected from this study was somewhat inconclusive, but the participating Murmansk obstetricians felt that prenatal vitamin therapy had a positive effect and should be available to all pregnant women in Murmansk.

HIV/AIDS

• As a result of training in Jacksonville, the head of Murmansk AIDS clinic instituted procedures related to the diagnosis, treatment, and tracking of AIDS patients.

Cardiology

• As a result of training and equipment donations by US partners, surgeons in Murmansk were able to perform open heart surgery for the first time.
• Murmansk vascular surgeons were trained in pediatric cardiac surgery and in developing criteria and methods for patient selection.

Hospital Administration

• A delegation of senior health care administrators was introduced to cost effective methodology of hospital administration as practiced in the United States.

Operating Room Management

• The operating room nurses, surgeons and anesthesiologists at the Murmansk hospitals initiated modern sterilization techniques such as chemical and gas sterilization.