• Increase the availability of evidence-based FP/RH practices and information at targeted primary care facilities in Volgograd and Volzhskiy to accurate and useful information on FP/RH
• Increase the availability of evidence-based FP/RH practices and information at targeted primary care facilities in Volgograd and Volzhskiy

Achievements

• The Little Rock and Volgograd partners conducted an initial two-day video conference in November 2004 to discuss the FP/ RH program and planning for FY05. Cultural attitudes and preferences for contraceptives were reviewed and the Volgograd partners provided an overview of the current status of reproductive health programs and services in Russia. A presentation by a UAMS ob/gyn professor outlined women’s health care and family planning practices in the US. The video conference was attended by 70 Volgograd faculty members, physicians, and regional leaders; in addition, approximately 100 VMU students were able to watch the conference via auxiliary screens in the lobby adjacent to the virtual conference site. Volgograd television and print media reported on the videoconference.
• Two nurses from VMU spent time at UAMS participating in educational workshops and clinic experiences to study family medicine practices in the US, with an emphasis on physician-nurse teams. Upon their return to Volgograd they presented information to their colleagues and began to re-evaluate how patient education on family planning is provided.
• The first “meeting” of an international student interest group in obstetrics and gynecology took place March 23, 2005, at UAMS College of Public Health and VMU in Russia. Using Internet video, UAMS third-year medical students and VMU medical students and residents discussed cultural attitudes to issues in women’s health and family planning, such as management of unwanted pregnancies and use of contraceptives. The also compared structures of clerkship, preceptorship, and residency programs; post-doctoral fellowships; tuition and training costs; and class diversity. VMU students discussed the Russian Student Scientific Society, which is hosting a conference to demonstrate student research in obstetrics and gynecology.

2004 Sustainability Grant

The Volgograd partners were awarded a sustainability grant in November 2004 to join the efforts of the oblast health administration to replicate the primary health care clinic at two additional sites. The clinics will be used for residency program training and physicians trained through the partnership program will be employed at the clinics. The partners were to also conduct a best practice conference.

The best practice conference was held in March 2004 and focused on family medicine programming, health management, smoking cessation, and poison control.

The two replication sites, Volzhsky and Mikhailovka, have been established. The primary clinic at Volzhsky is based at the medical center and VSMU graduates are staffing the clinic. The hospital in Mikhailovka retrained 18 practicing physicians to be family medicine practitioners at the clinic.

As part of the development of a community-based primary healthcare system in Volgograd, the partners focused on initiatives that would improve the quality of primary care, increase access to care, and address a significant concern of the Volgograd partners regarding poison treatment.

• Improve the quality of primary care by enhancing the skills of primary care providers, both current practitioners and those still in training
• Increase access to primary care services by opening a second primary care clinic
• Establish a poison control center

Quality of Care

• The practice of family medicine is a recent development in Russia (less than ten years). The family medicine department at Volgograd Medical University grew from three residents in 1995 to 25 residents in 2003. Seventeen of these residents participated in trainings offered by the US partners and 15 VMU family medicine residents participated in three-month residency training at various Arkansas hospitals. The partners also developed curriculum for the newly established Family Medicine Department at VMU. Demand for the trained residents was high because of a strong interest in replicating family medicine training programs throughout the oblast.
• An existing multi-specialty medical clinic, opened in Volgograd in 1993, was renamed the RussAm Clinic and hosted an “opening ceremony” in 2001 in honor of the contributions made by the US partners including providing medical education for many family physician residents; assistance with the reorganization of medical education to include family medicine; and over twelve years of partnership. Two residents who trained in Arkansas practice at the clinic and other family practice residents intern there. The RussAm Clinic director received advanced training in clinic practice management at an Arkansas primary care clinic. Using the skills and knowledge he gained through the partnership, the clinic director assists with the training of others and teaches courses on business practices at the VMU family medicine department.
• US partners worked with VMU family medicine faculty, practicing physicians, and residents to create standards for conducting patient examinations; the standards include health issues specific to women not included previously. The responsibilities of primary care nurses and procedures for recording patient histories were also developed. The Volgograd partners incorporated the specific patient exam skills, clinic management and interdisciplinary techniques into their practices.
• The US and Volgograd partners hosted a two-day conference in March 2002 on The Role of the Primary Care Provider in Tuberculosis Treatment and Prevention. Over 100 healthcare professionals from Volgograd and other AIHA Russian partnerships attended. An article in the Volgograd medical newspaper, Medicine, reported on the TB conference, and a local TV broadcast featured the US partners visiting with the mayor of Volgograd.
• During an exchange visit to Little Rock in 2002, a Volgograd partner reviewed the methods used by Arkansas medical establishments and professionals to communicate current medical information and physician standards. The Volgograd partner, a co-founder and editor of a new Russian professional health promotion publication for primary care, now incorporates what he learned on medical information communication in his own publishing.
• In April 2002, VMU residents who had trained in Arkansas conducted a workshop on the principles of management utilized in US family practice clinics. Twenty staff members, some from the RussAm clinic participated.
• Nurses in Volgograd expanded their responsibilities based on the medical model observed in Arkansas; specifically nurses in family practice clinics have taken on a greater role in patient education.
• The Volgograd partners reported that there is great demand for VMU residents to work at other primary care locations throughout the oblast. Residents will be assigned to these locations to increase the level of primary care services offered. Volgograd and Arkansas partners participated in discussions with city health directors, hospital medical directors, and physicians to explore opportunities for replicating the partnership's achievements in physician training at other clinics that are prepared to include family medicine as a service.
• The VMU family medicine department hosted four medical conferences between October and December 2003. Conference subjects included the diagnosis and treatment of hepatic diseases; treatment of depression at general practices; heartbeat disorders; and the usage of diuretics in hypertension treatment.

Access to Primary Care

• The Volgograd partners identified a second site at which to establish a primary care clinic that would use the same model of care as the RussAm clinic. The building, not previously used for a medical practice, needed extensive repair and renovation. The partners purchased four family medicine kits—one each to be located in exam rooms; US partners trained staff on use of the medical instruments. The Volgograd partners worked to establish a relationship between the Volgograd City Health Administration and VMU in order to promote the services that would be provided by the renovated clinic. The clinic was not opened as of September 2004 and AIHA has not been able to determine its status to date.

Poison Control

• Volgograd health leaders held an official opening for the poison control center on Nov. 19, 2002 when the US partners were in Volgograd (the center had been operational since May 2002). During a press conference held immediately following the opening, the center director presented on the center's objectives and capacity to provide poison control services. The local television news broadcasts routinely run messages across the bottom of residents' television screens promoting the center and the number to call for poison emergencies.
• Computer equipment and software were purchased by the partnership and installed by the US partners. The poison control center staff was trained to use software specifically designed to help identify the poison that a patient has been exposed to and its effects.
• In October 2002, a Volgograd clinical pharmacologist attended a four-week course at UAMS on poison control and toxicology. The same partner was also trained to use MedCases.com, an interactive learning resource in which a user can access peer-reviewed, evidence-based family medicine cases. The partner demonstrated the resource's applications to approximately 65 faculty, students, and area health professionals at VMU.
• The poison control center's director studied the UAMS model of poison control centers, as well as the UAMS standards for treatment and prevention of poisonings involving various toxic substances. Approximately 60 VMU faculty members, residents, and students also received advanced technical training in toxicology, drug interactions, and overdoses from US partners.
• The Volgograd physicians trained to staff the poison control center and Little Rock partners visited a local Russian pharmaceutical production company, a substance abuse rehabilitation center, and another hospital to present the poison control center model. In addition, the partners hosted a gathering of representatives from local medical institutions, pharmaceutical companies, and VMU to present the center's goals and objectives.
• The Volgograd partners received inquiries from the Russian Ministry of Health asking how the center might be replicated throughout other parts of Russia. Healthcare professionals from surrounding areas expressed interest in using MedCases.com and exploring the poison control model.
• On average, the center receives approximately 100 inquiries a month from healthcare providers and approximately 20 inquiries a month from community members.

Other Accomplishments

• A delegation of American World War II veterans traveled to Volgograd in 2003 to celebrate the 60th anniversary of the Battle of Stalingrad and to participate in the civic ceremonies of Victory Day. The ceremonies were widely covered by the media and included interviews regarding partnership objectives and sponsors. American and Russian veterans attended the anniversary reception and met with the governor of Volgograd.
• VMU added a College of Nursing, dedicated to advanced degree nursing specialties, in the 2003 academic year. Its curriculum is modeled after Western nursing curricula and was reviewed with the US partners in September 2002.
• An employee health fair was held in March 2004 at the Volzhskiy Hydro Electric Plant, a significant employer in the region. In addition to health screenings, employees had the opportunity to participate in special programs on weight loss and smoking cessation.