How the College is helping Russian health care
From the December ACP-ASIM Observer, copyright © 2001 by the American College of Physicians-American Society of Internal Medicine.
By Richard G. Farmer, MACP
It's 8:30 a.m., and Polyclinic 3 is buzzing with activity. Workers, pensioners and other residents of the city of Khabarovsk, located in Russia's far eastern corner, start arriving at the clinic to be treated for a wide range of problems and diseases.
Valentina Kohan, MD, and other physicians will treat about 1,300 patients today in this outpatient clinic, mostly women over age 45. Most of the polyclinic's physicians are also women, who work without much professional recognition or reward.
This is the type of environment I first encountered in 1998 when I began working with the College's Eurasian Medical Education Program (EMEP). In the three years since the program was launched, we have worked with more than 3,000 Russian physicians in more than 30 programs.
The EMEP's goal is to help Russian physicians do a better job of managing serious and often fatal diseases. We have focused our efforts on hypertension and cardiovascular disease, diabetes, and tuberculosis and other infectious diseases. Combined, these diseases account for about 60% of all deaths in Russia.
The EMEP is sponsored by ACP- ASIM and was developed by the Washington-based Institute for Health Policy Analysis. The project is fully funded by grants from organizations including the U.S. Agency for International Development and the Gates Foundation. (More background on the program is available in the September 1998 ACP-ASIM Observer online at www.acponline.org/journals/news/sept98/russian.htm.)
Visiting professors
In the last three years, 21 American physicians have traveled to Russia to work as visiting professors. Using a "train-the-trainer" model, the EMEP gives lectures and leaves slides for Russian faculty, who will later give CME lectures to their colleagues. By our estimates, every Russian physician who attends a lecture by a visiting professor teaches four more physicians in his or her community.
The program works closely with governmental health authorities, academic medical leaders and those responsible for clinical activities. We have held programs in lecture halls, hospitals and polyclinics.
Interpreters translate lectures and questions from the audience. Because many Russian physicians had never seen—let alone listened to—an American physician, they were initially reluctant to ask too many questions. When discussing Russian medicine, analysts often point out that isolation from the West was a major problem prior to the end of the Cold War. While we have seen plenty of evidence of this, enthusiasm for our visiting professors has been great.
The program, however, has experienced its share of challenges. It has been difficult, for example, to provide CME in a country where medical practice is organized very differently than in America.
Take diabetes, for example. All diabetics in Russia are "registered" by the government, given free medications and cared for by diabetes specialists. As a result, we have focused our diabetes CME efforts on about 50 physicians in each of three locations.
Tuberculosis, on the other hand, is managed by specialized physicians in separate hospitals and polyclinics. Because of the contagiousness of the infection, the frequency of transmission in prisons and a lack of medication upon release, as well as the incidence of multi-drug-resistant strains, tuberculosis represents a serious health threat in Russia. The complexities of tuberculosis compelled us to bring Russian tuberculosis specialists to the United States on five occasions to visit centers specializing in this disease.
Because cardiovascular disease causes more than half of all deaths in Russia, most physicians are involved in diagnosing or treating the condition in some way. (Russia currently has the highest prevalence of cardiovascular disease in the world.) Our cardiovascular disease programs cover the spectrum, from academic roundtables to lectures with audiences of 100 to 150 physicians to small group sessions in polyclinics.
Success stories
Despite these challenges, the EMEP has enjoyed success. In Khabarovsk, for example, Faith T. Fitzgerald, MACP, a former College Regent and Governor, lectured on the early recognition and management of hypertension. She emphasized the importance of patient compliance with medications, lifestyle modification and continuity of care.
When Dr. Fitzgerald met with Dr. Kohan and five of her colleagues, they confessed that blood pressure control and compliance occurred in fewer than 10% of their patients. Dr. Fitzgerald suggested that the physicians organize an effort to educate patients to improve compliance and blood pressure control. Dr. Kohan agreed, and she and her colleagues began enrolling patients in a "hypertension school."
The school conducted five three-hour sessions in which physicians talk to five or six patients about blood pressure management and diet, smoking, exercise and alcohol use. (More than half of all Russian men smoke, including many physicians.) As the program expanded, four more physicians joined the program faculty.
Last April, Dr. Kohan told me that Dr. Fitzgerald's lectures have led to almost 400 patients attending the hypertension school. She also reported that patient compliance with medication had increased from 37% to 83%, that blood pressure control had gone from 13% to 52%, and that more than 25% of the patients had quit smoking and/or lost weight!
Does this program sound like something that might interest you? As the primary "procurer" of visiting professors, I am always seeking physicians interested in a challenging and rewarding medical, academic and cultural experience—not to mention the opportunity to travel to Siberia in the winter! If you're interested, contact me at rgfarmer@emep-online.org.
Dr. Farmer is medical director of the ACP-ASIM Eurasian Medical Education Program.
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