• Promote community involvement in health by establishing and increasing utilization of the Svetly Community Health Education Center by 30% of the community.
• Implement modern infection control practices and reduce by 10% targeted nosocomial infections at the Central Rayon Hospital, by gathering baseline data on all nosocomial infections for one year and training 65% of healthcare personnel at the Central Rayon Hospital in modern IC practice and the appropriate use of standard precautions to prevent occupational transmission of HIV.
• Train 50% of physicians and 50% of mid-level health personnel in use of the Learning Resource Center and the Internet.
• Increase access to primary health care by utilizing a primary healthcare model at family health clinics.
• Identify and develop 15 nursing leaders who would teach and mentor 35 additional nurses in the Rayon; the nurses will demonstrate a broader scope of practice and be more comprehensively integrated into healthcare services.
• Initiate the process for improving the emergency care system by identifying and training three key individuals at the Central Rayon Hospital who will serve as trainers in emergency medicine.
• Improve evidence-based practices in the area of cardiovascular health through increased screening for hypertension at the Central Rayon Polyclinic and improved control of blood pressure among hypertension patients.
• Establish two model, replicable programs in maternal child health: a rayon-wide neonatal resuscitation program and a breastfeeding support program that will improve breastfeeding rates by 10%.

2004 Sustainability Grant

The Tomsk partners were awarded a sustainability grant in November 2004 to replicate the community health education center in three additional communities and the successful breastfeeding education program as well. The neonatal resuscitation program was to be replicated in one location and the hypertension guideline and chart audit was also to be replicated in one location. In addition, a best practice conference was to be conducted.

The partners successfully replicated all the programs identified above and conducted the best practice conference in February 2004. The conference was attended by over 100 health professionals and information was provided on primary health care reform, maternal and child health care practices, and nursing leadership (the agenda and event report may be found here).

As part of its dissemination activities in the final year of the partnership focused on primary healthcare reform, the best practice conference focused on methods to establish primary care and community health education centers, breastfeeding practices, and nursing leadership. A meeting with the participants from the Community Leadership Development Program (an Open World program) was also conducted.

Infection Control

• Partner nurses in Tomsk began providing training in basic infection control techniques to other healthcare workers; the training included a computerized program with a test for the trainees. These nurses also implemented surveillance techniques including chart reviews and developed a database. Head nurses of the hospital and the polyclinic collected and analyzed data about nosocominal infections with focus on surgical site infections, nosocomial pneumonias and urinary tract infections.
• The Russian partners made substantial progress in decreasing nosocominal infections by instituting a hand hygiene program in their facilities.
• Two nurses from the Tymiryazievo Rayon Hospital completed a survey of 52 feldsers in the Tomsk Rayon on knowledge of proper infection control practices in 2002. After the survey, the nurses provided training on infection control practices.
• The Russian partners changed several routine infection control procedures including replacing hard brushes and disinfectant for hand-washing with an antiseptic hand gel. They no longer require nurses to manually clean needles before disposal.
• Nosocomial infections were reduced by 5% in 2003. According to the Sanitary Epidemic Center data, in 2001- 2002, 1,460 patients were treated in the surgical department and nosocomial infections were diagnosed in 118 cases or 8% of cases. In 2002-2003, 1,500 patients were treated and nosocomial infections were diagnosed in 45 cases, or 3% of cases.
• At the close of the partnership, 87% of the nurses were trained in modern infection control practices.

Learning Resource Center

• The Learning Resource Center at the Central Rayon Hospital conducted an open house for members of the Tomsk district community in 2002.
• Eighty-two of medical professionals (45%), received training in the use of the Learning Resource Center and the Internet.
• In August 2002 two partners from Bemidji evaluated the potential for developing a long distance computer based educational program. They visited three sites in Tomsk Rayon (Kislovka, Svetli and Tymiryezievo) that have established Learning Resource Centers, four colleges and universities, and a large Oblast Hospital in Tomsk to evaluate their computer capabilities. They found that the three Learning Resource Centers were the most advanced and best utilized of the eight facilities they visited. The partners from Bemidji also found that the personnel at the LRCs were most positive and optimistic about the usefulness and value of the Internet.
• A new computer, printer, scanner and copy-machine were purchased for the family medicine clinic in Kislovka. The medical director of the clinic uses the computer to provide training to the physicians and nurses working for the clinic on how to perform research about new treatment techniques, and to communicate with other physicians. Clinic personnel also worked on the development of patient databases and on processing data generated from population surveys on general practice and health related issues.
• In collaboration with the staff of the Center for Evidence-based Medicine at the Siberian State Medical University, the LRC staff at the Central Rayon Hospital in Tomsk organized 13 evidence-based practice workshops for health care professionals in the Tomsk region. Five workshops were conducted at the main LRC site and eight other seminars took place at the “mini LRCs” in the villages of Svetly, Oktyabrysky and Loskutovo.

Primary Health Care

• Partners celebrated the opening of the Family Health Clinic in Kislovka in March 2002. The event was given significant attention by the local media. A second Family Health Clinic was opened in Zonalny in 2003.
• The Kislovka and Zonalny Family Health Clinics in Tomsk are utilized as clinical training sites for new family medicine medical students by the Tomsk Medical University. The Tomsk partnership coordinator reports that the Tomsk Rayon is receiving financial support from the Rayon administration to equip two additional family health clinics.
• The Kislovka Family Health Clinic has collected clinic utilization rates by age, gender and diagnosis since January 2002.
• A family health physician at the Kislovka Clinic worked with focus groups to determine priorities for the local community in healthcare services and, as a result, recommended new working hours for the clinic.
• Members of a Family Health “team” and health providers completed the development of clinical modules. Partners worked on clinical and administrative education and training in family practice and the delivery of rural health care.
• Equipment for the second family health clinic in Zonalny was purchased in Russia and distributed. Medical professionals from Zonalny clinic (together with their colleagues from Kislovka clinic) attended a training in the use of the EKG machine, hematocrite centrifuge, and electric microscope.
• Health assessment tools were developed for hypertension screening.
• The nurses from Central Rayon Hospital began an asthma school for pediatric patients and a hypertension school in November 2002. Nurses run the school and conduct the classes; student nurses also work in the schools.

Nursing

• As a result of the nurse training the partners conducted the Central Rayon Hospital in Tomsk signed an agreement with the Tomsk Medical College to provide a clinical practice site for nursing students from Tomsk.
• A nursing association, with 23 members, was formed in the Tomsk Rayon and registered with the Oblast. Two nurses from the Svetly Polyclinic were assigned leadership roles.
• The chief nurse of Timiryazievo Rayon developed a survey on nursing reform, based on methods learned during AIHA’s community development workshop in 2001. The nurse collected 200 surveys from nurses in Timiryazievo and the results reflected that nurses do not feel they are being utilized appropriately and that the biggest barriers to advancement for nurses are financial, lack of initiative, oppression and lack of information.
• Approximately 40 participants, including faculty from the Medical College Nursing Department, attended a presentation by a US family nurse practitioner on oppression and challenges in nursing in the US, and US and Russian participants engaged in roundtable discussions.
• During their 2002 trip to Tomsk, US partners conducted a leadership workshop for Tomsk Rayon nurses. The nurses learned about quality improvement methods, communication, and facilitation of team development. They practiced brainstorming, how to write a mission statement and flowchart processes.
• The nurses from Tomsk Rayon conducted a seminar for nurses from the Tomsk Oblast in December 2003 to establish a Council of Head Nurses for the Oblast.

Emergency Care

• In 2001 the US and Russian partners conducted preliminary planning and assessments aimed at improving emergency care in Tomsk.
• The director of emergency services in Timiryazevo learned about the EMS model, including ambulance services, in Bemidji and received training in several EMS topics.
• Three Tomsk partners received training at the Vladivostok EMS Center and are responsible for training others.
• All 64 feldshers from the Tomsk Rayon were trained in first aid by the three instructors who received training at the Vladivostok EMS Training Center.

Hypertension

• After receiving training in Bemidji, a physician from the Tymiryazievo Clinic conducted a medical record audit on assessing cardiovascular risk factor prevalence and treatment. The prevalence of diagnosed hypertension was 44%, undiagnosed hypertension 7%, and 8% were not screened. The audit results and an overview of continuous quality improvement process were presented to the therapeutic medical staff and selected Rayon clinical staff in May 2002.
• US partners presented to a group of 20 physicians at the Timiryzevo Hospital on the benefits of treating mild hypertension and the use of aspirin therapy to prevent myocardial infarctions.
• As of March 2004, of an average of 90 patients with hypertension who had been monitoring their blood pressure every month, 52 are able to maintain the level of 140/90 mmHg (a 58% success rate).

Maternal and Child Health

• US partners conducted a training-of-trainers course on neonatal resuscitation. Three regional certified trainers taught six individuals in the Tomsk Rayon to become trainers for their community healthcare providers who attend deliveries. Courses continue to be provided to nurses at the Central Rayon Hospital.
• A complete set of neonatal resuscitation equipment was purchased by North Country Regional Hospital in Bemidji and sent to Tomsk.
• As a result of the partnership, all relevant medical personnel in the Tomsk Rayon Medical facilities are trained in neonatal resuscitation assuring that newborns and infants (144 born in October and November 2002) will receive proper care.
• Partners led a roundtable discussion with pediatricians and maternal child nurses from Tomsk and Bemidji on promoting breastfeeding, and breastfeeding supplies were distributed to healthcare professionals.
• According to the data from the community health education center in Svetli, 93% of mothers initiated breastfeeding in July and in August 2002 (74 out of 79 births in the Rayon in July and 64 out of 69 births in August).
• Of 71 women who delivered in the Tomsk Rayon in October 2001, 69 initiated breast-feeding. In November, of 57 who delivered, 56 initiated breast-feeding. Tomsk partners report that the percentage of women who breast-feed for at least six months is currently 32%.
• Breastfeeding posters and patient education fliers were developed, printed, and distributed.