• Improve the health status of maternal and neonatal patients by improving the care provided to high-risk mothers and premature and sick infants.
• Implement a perinatal system of care based upon centralization of specialty services at a Center of Excellence and referral of patients to facilities offering appropriate levels of care.
• Advance the knowledge and skills of obstetricians related to complications of pregnancy.
• Promote improvements in techniques associated with neonatal resuscitation.

• Expose hospital administrators and those managing outpatient programs to principles and practices of health care management and assist them in implementing measures to improve the efficiency and effectiveness of their health facilities and services.

• Expose Uzbek nurses and their supervisors to the model of nursing care as practiced in the US.
• Promote the professional development of nurses in Uzbekistan through the establishment of nursing-specific journals and a professional association.
• Assist in the development of education programs to prepare Uzbek nurses to assume expanded roles.
• Provide guidance in the restructuring of the formal education of nurses and promoting higher education (college or university-level) for nurses.

• Promote improvements in the medical education of physicians, preparing them to function within a reformed health system which places greater emphasis on primary care and more adequate preparation of specialists.
• Restructure the education system for medical students.
• Improve testing procedures and the means of assessing the level of knowledge and skills gained by students during the educational process.
• Improve graduate medical education and continuing education programs for physicians.

• Establish a Women's Wellness Center (WWC) that can serve as a replicable model for extending primary and preventive services on an outpatient basis to women throughout their life cycles.
• Establish a second, satellite WWC in Tashkent in order to provide greater access to services provided by the WWC.

1992

• On December 11, the partners celebrated the signing of the Memorandum of Understanding between the University of Illinois at Chicago Medical Center on the US side, and the Second Tashkent State Medical Institute in Uzbekistan.

• The partners participated in a major international health symposium and micro-hospital demonstration in Samarkand, Uzbekistan. Over 700 NIS health care professionals received hands-on learning through micro-hospital exhibits prepared by the Chicago and Tashkent partners on postpartum infection control, neonatal resuscitation, and fetal monitoring.

• UIC neonatologists, led by the UIC Director of Neonatology, delivered a series of seminars on "Critical Conditions in Neonatology" in Tashkent in October. During the seminars, new approaches to resuscitate newborns were discussed. Nearly 250 physicians from throughout Uzbekistan attended the seminars.
• UIC faculty conducted a training seminar entitled "Asphyxia in Newborns and Intensive Therapy," in Tashkent in October. The seminar, attended by 150 physicians and 50 nurses, focused on asphyxia and the provision of emergency care.
• The Partnership sponsored an international neonatology conference, "Current Issues in Neonatology," in Tashkent in October. The conference disseminated the learning from partnership exchanges in neonatology to over 200 health care professionals from AIHA partnership institutions in Kyrgyzstan, Russia, Turkmenistan and Ukraine, as well as from TashMI II and various oblasts across Uzbekistan.

• The partnership equipped a new neonatal intensive care unit (NICU) within the Children's Hospital.  The unit was staffed with physicians trained in two-month intensive training sessions at UIC. The Uzbek trainees subsequently instituted their own training sessions at TashMI II for nurses and physicians, utilizing lecture materials and videos developed in Chicago. Since TashMI II is a teaching facility, the model NICU is utilized for training medical and nursing students.
• To support Partnership activities in perinatology, the Ministry of Health of Uzbekistan allocated five million Uzbek som (approximately US $200,000) to TashMI II to renovate facilities for a high-risk pregnancy center based upon modern perinatal models. The Center for Extra-Genital Pathology has responsibility for identifying and treating women of childbearing age who are at high-risk for pregnancy complications that could affect their health and the health of their children. This Center operates within TashMI II's Maternity Hospital, and is designed to be a referral center for high-risk maternal patients for antepartum, labor and delivery, and postpartum care.
• The US partners delivered a series of seminars, "Newborn Care and Hemolytic Disease of Newborns," to over 100 physicians in Tashkent in October. The seminars were devoted to exchange transfusion and its effectiveness.
• TashMI II registered as a subscriber of the National Medical Library of the US. This provided them with access to medical information free of charge through the computer system "Medline."
• A quarterly scientific journal, "Patologia," was initiated by the Uzbek partners with AIHA support. The journal fills a void in medical research literature by covering medical developments in Central Asia and internationally. Several US partners serve on the Board of Editors of the new journal.

• A series of training seminars, "Application of Technology in Neonatology," was delivered in Tashkent in May. The seminars, which were attended by 120 physicians and 50 nurses, were devoted to the use of respiratory equipment when infants are born with respiratory distress syndrome.
• In November, the partners established a nurse-managed unit within the Hospital of Chronic Disease at TashMI II, where nurses have primary responsibility for patient care. One of the most experienced and qualified nurses, who was trained at UIC through the Partnership, was appointed the unit’s chief (rather than a physician).
• Gynecologists from UIC collaborated with their Uzbek colleagues in delivering a series of seminars on issues in gynecology in Tashkent in April. New approaches to hormonal and non-hormonal treatment of menstrual cycle abnormalities and new directions in gynecologic surgery were reviewed.  Approximately 30 physicians and 15 nurses attended these seminars.
• In October, UIC physicians delivered a series of seminars focusing on hormonal treatment of menopausal symptoms and prevention of osteoporosis in elderly women. The seminars and were attended by 39 physicians, 17 medical nurses, 26 students and 10 clinical interns.

• In April, the partners officially opened a Neonatal Resuscitation Training Center at TashMI II at the site of the specially equipped NICU. The center trains physicians, nurses, and midwives from both TashMI II and other health institutions in the region through monthly courses in neonatal resuscitation. This center stimulated interest in developing a similar center at the Maternity House of Khorezm Oblast Hospital at Urgench, near the Aral Sea.
• Neonatologists from UIC delivered a series of seminars entitled "Respiratory Distress Syndrome” in Tashkent in April. The seminars, which were attended by nearly 200 physicians and 100 nurses, addressed the use of surfactant in cases of respiratory disturbances and variable.
• UIC faculty presented a seminar "Use of a Respiratory Bag in Newborn Resuscitation" in Tashkent in April.
• Professors from UIC delivered a series of lectures focusing upon high-risk pregnancy and childbirth in Tashkent in April. The seminars, which also addressed management of pregnancy and delivery of women with diabetes mellitus, were attended by 11 physicians and 10 nurses.
• As a result of assistance from both UIC and TashMI II, the partnership extended its neonatology activities to Urgench, training a team of neonatal specialists at UIC in July.
• Developing from the Partnership's efforts in nursing, Uzbek nurses formed the Republican Association of Nurses and established a journal, "Hamshira," to advance the nursing profession in the country.
• TashMI II officially opened a Women's Wellness Center (WWC) in November. This opening was especially noteworthy due to the participation of First Lady Hillary Rodham Clinton. The WWC offers a full range of preventive, primary care, diagnostic and treatment services to women of all ages.
• WWC staff established a continuous quality improvement committee to monitor the quality of care, discuss and clarify the causes of treatment complications, review adverse outcomes, consider the complaints of patients or their relatives, and monitor and improve staff competency.

• In May the partners officially opened a Neonatal Resuscitation Center at Urgench and UIC and TashMI II specialists collaborated in providing an initial round of training in neonatal resuscitation in the new Center. Instructors at the new center were prepared through training programs held in both the US and in Tashkent.
• In May the partners officially opened a Nursing Learning Resource Center to support the nurse-managed unit. The Ministry of Health and the Nurses' Association have endorsed the Center.

• In January, AIHA awarded the partnership a limited grant award to strengthen the sustainability of partnership achievements and relationships by building upon their previous accomplishments in the area of women's health. Partners identified and prepared the site for a new Women's Wellness Center and ordered necessary equipment. The partnership received a donation from Welch Allyn, Inc. during AIHA's Annual Partnership Conference in November. The donated colposcope and video monitor are used for teaching tool as well as for patient services.

• The satellite Women's Wellness Center was officially opened in April, in a ceremony attended by US Secretary of State Madeleine Albright.

Neonatology and Perinatal Medicine

• A round-the-clock post was opened in the TashMI II Neonatal Resuscitation Department and a special intensive care unit was organized.
• Partnership efforts led to changes in relationships between patients and their care givers. Patients now have the opportunity to choose their physicians and nurses.  They also have the right to receive information about procedures, status of their health, and the physician's prognosis.
• A Commission on Treatment Effectiveness was established as a result of the Partnership Program. The Commission, which analyzes the activities of staff physicians, consists of the most experienced clinical specialists, faculty members and administrators. The materials relating to the Commission activity are discussed every month at a meeting of physicians.
• As a result of the Partnership program, the following treatments and procedures were introduced into neonatology clinical practice at TashMI II: infusion therapy, monitoring critically ill newborns, patient assessment using blood-gas indicators, application of state-of-the-art resuscitation techniques, use of the "Butterfly" needle, and endoscopic and bronchoscopic examinations.
• As a result of partnership training, the staff of TashMI II mastered intubation and extubation techniques, umbilical vein catheterization techniques, and skills associated with resuscitation.
• Nurses mastered central and peripheral vein catheterization techniques; necessary skills for work in the intensive care department; skills associated with respiratory equipment, cardiac monitors and defibrillators; and skills for the care of premature and critically ill newborns.
• As a result of the Partnership, recommendations on the organization of work in the resuscitation departments of the Maternity Homes of the Republic of Uzbekistan were established and implemented. These recommendations were developed jointly by personnel from the Medical Center of the University of Illinois at Chicago and specialists of the Ministry of Health.
• Urgench opened a Neonatal Resuscitation Training Center in addition to the one that opened at Tashkent. TashMI II deserves credit for cooperating in and supporting extension of partnership activities to Urgench because such activities were not originally encompassed in workplans for this Partnership.
• Since their openings in 1997 and 1998 through 2000, the Tashkent and Urgench NRTCs provided training to 1,133 and 298 health professionals, respectively.

Hospital and Clinic Administration

• The Uzbek partners improved the financial viability of TashMI II hospital facilities by retiring 50 percent of the Institute's beds, opening an outpatient/day hospital unit, and shifting non-acute care from inpatient to outpatient settings. General overhead costs associated with inpatient services have been decreased, while the level of patient care delivered in more appropriate outpatient settings has grown.
• One-day inpatient units were created. As a result, the average length-of-stay in the inpatient units decreased. For example, the average inpatient length-of-stay decreased from 13.6 days in 1996 to 12.5 days in 1997 within the nurse-managed unit at the Chronic Disease Hospital. Patient examination is performed at a pre-hospital stage, which both cuts the time of a patient's stay and reduces costs. Overall hospital costs have decreased and laboratory-diagnostic services are used more rationally; as a result, the quality of medical services has improved.

Medical Education

• The faculty of TashMI II reorganized the system of teaching and student evaluation based on observations in the United States and consultations with their US partners:
• The first Test Center among medical institutions of the Republics of Central Asia was established at TashMI II and equipped with up-to-date computers.
• Working groups consisting of the most experienced teachers at the Institute were formed in order to establish testing and training programs in different disciplines.
• Presently student and physician evaluation, including entrance exams, government-mandated final exams, and clinical competency exams are conducted using the new testing methods. Clinical interns, post-graduates, probationers and clinic physicians are tested at this Test Center.
• To support the Uzbek Government's Healthcare System Improvement Program, which envisions a step-by-step transition to primary care services, the Partnership assisted in developing a curriculum at TashMI II for preparing general practitioners (GPs). Graduates with a master's degree are currently in great demand in Uzbekistan, especially in rural areas. Useful experience with the US partners helped to accelerate the transition to the multiple-stage preparation of the medical workforce in the Uzbek Republic.
• The Partnership achieved reorganization of the hospital directorship and improved relationships between the medical institute and the clinical departments.
• An Uzbek neurosurgeon completed a six-month course of study at UIC.  Upon his return to TashMI II, he completely reorganized his department, which is now noted for its very high level of care.
• Regulations and normative documents for the certification of medical personnel have been approved and adopted.

Nursing Development and Education

• As a result of participation in the many AIHA-sponsored nursing conferences, TashMI II nurses have been instrumental in providing direction to the development of standards for nursing practice; enhancing nursing roles; developing nursing leadership through skill-building; reforming the nursing curriculum; and increasing the visibility of nursing as a profession within Uzbekistan.
• Specifically, the Uzbek nursing partners established nursing performance standards at TashMI II and requirements that nurses pass clinical performance reviews in their specialty to ensure the quality of patient care. They also developed remedial training programs to improve the clinical skills of nurses whose performance was assessed as low. These efforts have helped promote nursing as a separate profession and raised the status of nurses within the medical community.
• New categories of nurses and a nurse/dietician were added to the nursing staff of the Hospital of Chronic Disease. Medical nurses now receive training in the patient assessment and interpretation of laboratory data.
• Contacts between patient and nurse has changed both qualitatively and quantitatively. Previously, medical nurses were merely the executors of physician orders.  Now, in the eyes of the patient, the nurse is a respected member of the patient's healthcare team.
• The Commission on Quality Control of Medical Documentation and Management was established at the Uzbek partner institution. The functions of the Commission are to monitor the quality of the case history and record keeping; the correspondence of diagnoses and disease classifications; and the timeliness of tests and treatment procedures.
• Seminars conducted for nurses related to diabetic care included "Introduction of National Diabetic Dishes" and "Cooking National Diabetic Dishes." Having mastered the cooking of national diabetic dishes, the nurses now teach patients about the preparation of healthier meals. A leaflet on national diabetic dish preparation is given to each patient before he/she is discharged from the hospital. During treatment, nurses also spend considerable time talking with patients about the importance of their diabetic therapy. As a result, the proportion of patients needing repeated hospitalization was reduced in one year from 21 to 17 percent (1996 to 1997).
• Establishment of a Nursing Resource Center contributed to organization of a Nursing Care Department at TashMI II and to improved training of nurses.

Women's Health

• The Partnership introduced the following improvements in services provided to women at TashMI II: screening and medical examination of women experiencing peri- and post-menopausal symptoms; screening and medical examination of women, including teenagers, with symptoms of pelvic inflammatory disease; and various gynecologic procedures resulting in improved care.
• Partners established a model Women's Wellness Center at TashMI II. Since its opening in 1997 through March 2002 the Center had a total of 57,000 patient visits. Of these, 9,700 were initial visits of patients coming from urban as well as rural areas. Among the comprehensive range of services provided at the center, the most utilized services were: ultrasounds, pregnancy tests and family planning services, clinical breast examinations and colposcopies. The Center is a replicable model for extending primary care and preventive services on an outpatient basis to women throughout their life cycles. As a result of the WWC, greater attention is being given to prevention activities directed at adolescents and the needs of underserved women such as postmenopausal and elderly women.
• The WWC had provided health education classes to over 9,000 women (as of March 2002) in topics such as contraception and family planning, menopause, menstrual disorders, and preparing for childbirth. Center staff also spent 50 person days delivering family planning courses in five regions of Uzbekistan.
• The Center instituted changes in enrollment policy, including registration of women regardless of their region of residence. Patients are issued cards upon registration at the WWC, allowing better processing of patient data using the AIHA-established database.
• Obstetricians and medical nurses have begun conducting health educational programs for patients, as well as outreach programs for teenage girls at high schools in the surrounding regions.
• Medical nurses have started to communicate more with patients during treatment and when solving social issues. Physicians have started to spend more time on disease prevention (e.g., related to cancer and STDs). Diagnostic and treatment protocols were established for preventive medical examinations for teenage girls and women of various ages, and for patients suffering from pelvic diseases.
• A satellite Women's Wellness Center was established in a populous area of central Tashkent. Since its opening in April 2000 through March 2002, over 3,000 patients were seen, for a total of over 10,000 patient visits. During the same period, the WWC also provided health education about the use of contraceptives and the performance of breast self-exams to over 800 women.
• The satellite WWC began collecting service fees and is now able to cover staff expenses with the revenue generated.
• Partners introduced the nurse manager role at the WWC in TashMI II with the intention of establishing a similar position at the satellite center.