| Cleveland-Volgograd
Meeting |
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Two doctors from MetroHealth, one a neonatalogist and
one an obstetrician, spent 10 days in Volzhsky, Russia,
a city of about 400,000 persons directly across from Volgograd
on the lower Volga River. Their host was the Volgograd
Regional Perinatal Clinical Center; an operation supported
the regional government, but located in the City of Volzhsky.
The writer accompanied the two doctors, made some brief
remarks at the opening of the conference, and oversaw
the translation support the doctors received.
The two doctors, each gave four lectures to an audience
of some 140 obstetricians and neonatalogists throughout
the region. The regional authorities had called for each
hospital in the region to send two representatives from
each of the region's hospitals, whether regional or city,
and eleven doctors from neighboring Kalmykia also attended.
They stayed in local hotels near the city conference center,
so that they could attend each lectures at the four-day
conference. |
Drs. John Moore and Graham Ashmead
with Ms. Nancy Cronin |
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Besides the two American doctors,
various regional health officials, including the vice chairman
of the regional health committee, and the region's head obstetrician,
along with academics from the Volgograd Medical Academy, also
spoke at the conference. Dr. Graham Ashmead, an obstetrician
at Metro, and head of the fetal center there, presented lectures
on Prenatal Care, Prevention of Smoking During Pregnancy, Induction
of Labor and Delivery, and Obstetric Hemorrhaging; Dr. John
Moore, head of neonatalogy at Metro, presented lectures on the
latest Resuscitation techniques, Respiratory Distress Syndrome,
Intraventricular Hemorrhaging, and Fluids and Electrolytes.
All but the last of these lectures were projected in Russian
onto a large screen from a computer using Power Point. Dr. Moore
presented his lecture on Fluids and Electrolytes as a black
board talk, posing problem situations and asking the audience
members for treatment procedures.
In addition, two video lectures by Metro's Chief obstetrician,
Dr. Leroy Dierker, on External Cephalic Versions and use of
Steroids to Accelerate Fetal Lung maturity, and one on Anesthesia
and analgesia by Metro's obstetrical anesthesiologist, Dr. John
Fisgus, were played and projected onto the screen during the
conference. All three of these had built in Russian translations.
Drs. Moore and Ashmead also made rounds with the staff of he
Perinatal Center and had extensive conversations with members
of the staff from the director on down. They also met with the
chairman and vice-chairman of the Regional health Committee,
Dr. Evgenny Anishshenko and Dr. Vladimir Lomovsky, with the
Chief Regional Obstetrician, Dr. Alexander Raevsky, and with
the Vice Chancellor for International Affairs at the Volgograd
Medical University, Dr. Alexander Spasov. In the meeting with
the Chairman of the regional medical committee Dr. Moore made
three recommendations:
- a) institute a program to educate sexually active women
to quit smoking because of potential harm to their infants;
- b) Use of progesterone suppositories weekly from 20 weeks
to 34 weeks for mothers at risk of premature delivery;
- c) for second-time mothers where there has a previous
history of Rh incompatiblity with the infant, use of RhoGham,
not only within 72 hours of delivery, but also at 26 weeks
of pregnancy.
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Mr. Ken Kovach |
A follow up
letter along with medical articles on issues b) and c)
is planned for sending to the regional medical representatives.
Dr. Ashmead's translated lecture on Prevention of Smoking
and excerpts of the WHO Framework convention on Tobacco
are also planned for sending along with Dr. Ashmead's
lecture on Prenatal Care.
Below is a summary of the observations and impressions
these doctors made from these rounds and conversations.
In one area Russia is considerably ahead of the US. This
is the encouragement of mothers to breast feed their babies.
In the Volgograd region, the rate of mothers who breast
fee is more than 99%. At Metro the rate of beast feeding
is about 50% although it may be somewhat higher at hospitals
that serve more affluent patients. The Perinatal Center,
designated by the World Health Organization, as a baby
friendly facility, has undertaken along with regional
officials a very successful program to encourage local
mothers to breast-feed. |
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The attitude of the physicians, especially at the Perinatal
Center was also open and positive. Most of the physicians
were open to learning new approaches and techniques, were
candid about their problems and the shortcomings in Russian
medicine and eager to correct matters where they could. As
an example, Elena Zhavaronkova, one of the young obstetricians
who spent a several months at Metro two years ago, learned
from Dr. Leroy Dierker how to perform an external cephalic
version. Since returning to Russia, she has performed 39 of
these procedures and 31 have been successful, a very successful
record.
In another instance, a young physician at the Center confided
to me that the head of the NICU was not open to new ideas
and new approaches. At the end of our visit, the second in
command at the center mentioned that the NICU unit needed
some changes and he was working to persuade Dr. Kirichenko,
the center's head, of this.
But major deficiencies do exist, some resulting from economic
circumstances, some resulting from structural and organizational
circumstances, and some perhaps from lack of understanding.
A major problem is the salary for physicians working in public
health centers and hospitals in the region where the vast
majority of Russians are treated. Doctors' salaries range
from $75 per month to $175 per month, hardly enough to live
on even with a spouse who contributes to family expenses.
This compares with a salary of more than $700 per month for
lower court judges, now appointed by the president. As a consequence,
many doctors hold second jobs: the Center's second in command,
Alexander Bukhtin, operates a private bus/taxi service, our
most capable translator, Timur Azhibekov, works as a sales
representative for the largest Russian pharmaceutical company,
Nizhpharm. Obviously, holding a second job detracts from enhancing
professional skill and knowledge, and for those who do not
hold second jobs, many are very discouraged in any event and
lack initiative in their work.
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