• Develop cancer screening and prevention programs.
• Develop cancer registries at selected sites, including development of software, training registry staff, and ensuring quality control of data.
• Provide training in clinical pathology related to oncology.
• Develop relationships with relevant international organizations and agencies that focus on cancer.

Health Care Management and Finance

• Implement improvements in health care management, finance, and decision-making within each hospital.

Nursing

• Strengthen nursing education and training in targeted clinical areas.
• Improve professionalism of nursing through development of a nursing association.

Maternal and Child Health

• Improve maternal and child health through improved training of OB/GYN physicians and pediatricians.

Continuing Medical Education

• Develop semi-annual Continuing Medical Education (CME) conferences (spring and fall).

Public Health Education

• Develop public health initiatives aimed at health education for the general population.

1995

• On April 10, the partners celebrated the signing of a Memorandum of Understanding between the Methodist Hospital and Baylor College of Medicine on the US side and the Semipalatinsk Regional Administration in Kazakhstan.

1996

• In October, the Semipalatinsk Nursing Association held its First International Nursing Conference, with participation of US partners.

1997

• The partnership organized a workshop on Health Effects of Environmental Radiation Exposure in Kazakhstan in November in Kurchatov, together with the Kazakhstan National Nuclear Center, the Ministry of Science, and the Regional Administration. This workshop, the first of its kind in Kazakhstan, was attended and supported by the US National Cancer Institute, the Department of Energy, the Department of Defense, the Centers for Disease Control & Prevention, the National Institute of Environmental Health Sciences, and the National Aeronautics and Space Administration.
• The Semipalatinsk Nursing Assocation (SNA) held its second International Nursing Conference in September in Semipalatinsk.
• The SNA, AIHA and the Partnership established a Nursing Learning Resource Center at Zhamilya Hospital, providing facilities for learning clinical skills.
• A medical education specialist from Baylor College of Medicine presented an anti-smoking program on local TV in November in Semipalatinsk.

1998

• The Partnership held a second cancer registry international conference for oncology specialists from Semipalatinsk, Ust-Kamenogorsk, and Pavlodar.
• A TCH/Baylor oncologist and a nurse practitioner held a two-day seminar in Semipalatinsk on leukemia treatment. More than 100 physicians and nurses from the entire East Kazakhstan region and Pavlodar attended the July seminar.
• Partners conducted a two-day neonatology seminar for pediatricians and nurses from Semipalatinsk, Pavlodar, and Ust-Kamenogorsk in June.
• Partners held a series of workshops on medical effects of ionizing radiation for health professionals, disaster management, public policy and monitoring, surveillance and rehabilitation of those exposed to nuclear testing.
• The Semipalatinsk Nursing Association held its third annual conference in May with nursing leaders from all of Kazakhstan. Participants agreed to create a new national nursing association that would be eligible to join the International Council of Nurses.

1999

• In January, AIHA awarded the partnership a limited grant award to complete activities and strengthen sustainability of partnership achievements in the areas of oncology (cancer registry) and nursing association building. The partnership subsequently received a no-cost extension through June 2000.
• Partners conducted an East-Kazakhstan Regional Cancer Registry Conference in February, attended by over 80 health care professionals from the region. During the conference, US partners held special sessions on epidemiology and quality control, performed demonstrations on partnership-developed and upgraded cancer registry software, and provided consultations at two of the cancer registry sites.
• In May, three physicians from Pavlodar and Semipalatinsk attended the 2nd World Conference for Cancer Organizations in Atlanta, Georgia. Together with a US oncologist, they presented cancer registry software developed by the partnership.
• The 4th International Nursing Conference was held in Semipalatinsk in November, with three US partners participating. Over 280 nurses attended the conference titled "Healthy Lifestyles - Healthy Nations."

Oncology

• The Semipalatinsk Cancer Registry was established in July 1997 and a cancer registry conference for oncology specialists from Semipalatinsk, Ust-Kamenogorsk, and Pavlodar was held. The following year, the registry was expanded to include these two cities. Partners developed and implemented new bilingual (English/Russian) computer cancer registry software that includes abstracting, coding, staging, treatment, follow-up, and quality management. Partners worked on ensuring complete and accurate data collection that complies with international standards. By mid-2000, the sites had entered over 5,000 records.
• The Houston partners provided new computers for the Semipalatinsk and Ust-Kamenogorsk cancer registries.
• Partners established a Regional Association of Cancer Registries and published an article in the Journal of Registry Management (February 2000) about the Semipalatinsk cancer registry.
• Skin cancer, prostate, and thyroid screening forms were translated and distributed among physicians in Semipalatinsk. These forms are now used as part of a patient's routine examination.
• As a result of an assessment of needs in Semipalatinsk and partnership training, two protocols were developed for Children's Acute Lymphoblastic Leukemia (ALL) treatment, including cost assessment for drugs and support.
• The Head Nurse of Semipalatinsk Children's Hospital, after being introduced to Texas Children's Hospital's Parents Educational Program for pediatric patients with leukemia, modified and implemented the program in Semipalatinsk. The chief nurse of Semipalatinsk Oncodispensary modified and implemented within her dispensary cancer prevention programs learned at Baylor College of Medicine.
• Because Semipalatinsk was a nuclear testing area under the Soviet Union, there has been great interest in cancer incidence and proper classification of tumors for comparison with the rest of the world. The partnership focused on clinical and anatomical pathology of thyroid disease. Thyroid enlargement is endemic in the region and has been over-treated in the past by surgical excision, at great expense and morbidity. A relatively simple fine-needle biopsy technique was introduced in Semipalatinsk through training by an endocrinologist and a pathologist from Houston. Masses, which are now found to be benign by fine needle biopsy, can be followed safely without surgery.
• Clinical and anatomic pathologists were trained in Houston and Semipalatinsk to perform procedures utilizing equipment donated by the US Department of Defense. In addition to general training, clinical pathologists were trained in procedures for leukemia cases; anatomic pathologists were trained to work with the cancer registry and they developed and implemented pathology abstracting forms. Two clinical lab physicians were trained in all aspects of clinical laboratory science, including performance and interpretation of special stains to differentiate various types of leukemia.
• Partners from Kazakhstan were introduced to the American Cancer Society, its structure, programs and principles of work.
• US partners coordinated the donation of $120,000 worth of pharmaceuticals used to treat leukemia and other cancers. The drugs were donated through AmeriCares and were used according to protocols established by the Partnership. These drugs had not been available in Pavlodar for treating adults since 1986 and since 1994 for treating children.
• Partnership activities stimulated contacts that resulted in independent scientific research projects funded by the US National Cancer Institute and other agencies. Collaborative research projects related to prostate and thyroid cancers that have resulted from the Partnership were accepted for publication and presentation at national meetings in both the US and Kazakhstan.

Health Care Management and Finance

• The Houston partners hosted a Semipalatinsk surgeon who received a US Department of Commerce Special American Business Internship Training Program (SABIT) Fellowship. SABIT fellows learn about new technologies and innovative management skills necessary to support the transition to free-market economies. The fellow from Semipalatinsk focused his training on hospital and health care administration.
• The Houston partners hosted a 1997 study tour for management-level physicians from Kazakhstan, Kyrgyzstan, and Uzbekistan, in conjunction with health reform initiatives in Central Asia. This tour was funded by USAID through Abt Associates, the Academy for Educational Development, and AIHA.
• The Partnership developed computer software for drug inventory control and management.
• Each Partnership hospital developed model general and intensive care units, emphasizing leadership skills, clinical practice, education, infection control, and safety management on the units.
• All NIS partners who traveled to Houston received management training in topics including hospital financial planning and budgeting, managed care, strategic planning and quality improvement.
• Training was provided for improving food service delivery to local hospitals in conjunction with a local Semipalatinsk businesswoman. This unique effort demonstrated the cost effectiveness of out-sourcing this type of service while improving quality and improving nutritional status of patients. This program has also attracted the attention of Houston business leaders and the World Bank's IFC.

Nursing Education and Training

• The Semipalatinsk Nursing Association (SNA) was established through Partnership efforts and has grown to more than 2,000 members in the Semipalatinsk Region. Partners jointly organized with the SNA four annual international nursing conferences on a variety of topics.
• The partners helped establish a partnership in 1996 between the newly-formed SNA and the American Association of Operating Room Nurses (AORN) to promote professional nursing standards in Semipalatinsk. The SNA and AORN jointly submitted a grant application to Counterpart, which subsequently provided $8,500 to support the First International Nursing Conference in Semipalatinsk.
• The SNA conducted several infection control seminars for nurses in the Semipalatinsk region.
• The Partnership hospitals developed and implemented the role of clinical nurse educator, responsible for orienting new employees, providing continuing nursing education, and addressing other areas of professional staff development.
• During their training in Houston, all Chief Nurses were introduced to hospital safety and safety education procedures. Based on this training, safety education programs were developed and implemented at all model nursing units in Semipalatinsk.

Maternal and Child Health

• US partners trained two OB/GYN physicians and the director of the Gynecological Center "Zhamilya" in general inpatient and outpatient treatments, pre- and post-surgery treatment, intensive care, and preventive medicine. The Director of Zhamilya attended a two-day NGO management training seminar conducted by United Way and a two-day training program at the Women's Crisis Center in Houston.
• Semipalatinsk pediatricians were trained in pre- and post-natal care as well as preventive medicine. They identified three kinds of express-diagnostic (bedside) tests to utilize in their hospital. The necessary reagents were purchased and distributed among all Partnership hospitals in Semipalatinsk.

Continuing Medical Education

• At the Semipalatinsk Medical Academy and Medical College (for training nurses), faculty from Baylor College of Medicine and the University of Texas School of Nursing conducted master teacher training programs on current concepts in teaching techniques and student evaluation.
• The Partnership conducted semi-annual continuing medical education programs for medical staff at the Partnership and other city hospitals in Semipalatinsk and physicians from Almaty, Kurchatov, Pavlodar, and Ust-Kamenogorsk on the following topics: cancer registry, pathology, neonatology, OB/GYN, children's leukemia, disaster management and health effects of radiation, and healthcare management.

Public Health Education

• The Santa Fe Gold Corporation (now Newmont Gold Mining Corporation) provided initial and continuing funding for the Semipalatinsk Prevention Center and other public health initiatives, such as production of monthly television programming and newspaper supplements related to preventive medicine. These efforts support the "Healthy People" initiative promoted by the First Lady of Kazakhstan.

Other (Unanticipated) Nuclear Medicine

• The Houston Partnership hosted a Semipalatinsk physician who had received an International Atomic Energy Agency fellowship. The physician received practical, guided, on-the-job training related to the effects of nuclear energy on medicine and the environment.
• The General Board of Global Ministries of the Methodist Church provided $15,000 for a research project to analyze data on the effects of nuclear testing in the Semipalatinsk region. It also created a joint US-Kazakhstan Foundation, as a non-governmental organization, to assist in addressing issues related to the impact of previous nuclear testing on the health and well-being of the region's residents.
• A scientist from Semipalatinsk participated in training and research at NASA in Houston to learn the application of modern techniques for determining chromosomal changes associated with radiation exposure to astronauts and cosmonauts. This information can be applied to better assess the impact of radiation on those exposed to nuclear weapons tests in Kazakhstan.

Donations, etc.

• As a result of Partnership initiatives, AmeriCares provided three humanitarian shipments of donated pharmaceuticals and medical supplies worth approximately $4,500,000. These were delivered with the assistance of the US Department of State through the Freedom Support Act.
• The US Department of Defense and the Department of State delivered medical equipment worth $6 million to Partnership hospitals and another $2.2 million of equipment to Ust-Kamenogorsk. Partnership personnel assisted in the training and use of the equipment.
• The General Board of Global Ministries of the United Methodist Church provided $35,000 for medications to treat five acute lymphoblastic leukemia patients in Semipalatinsk.
• Because The Methodist Hospital is a large purchaser of supplies and reagents, it arranged for partners in Semipalatinsk to receive a 35% discount from their suppliers in Europe.

Additional Developments Since Partnership Graduation

• The NIS partners continue to collect and enter data into the cancer registries at their respective oncology dispensaries, using the software developed collaboratively during the partnership. They also received software to upgrade their computers to further facilitate the compilation and analysis of data.  As of March 2001, over 7,000 entries had been recorded in the registries at the three sites.