Contra Costa Times (San Francisco, CA)
Posted on March 6, 2003
By Andrea Widener
The Russians saw technologies that save premature babies and educational campaigns that wean people from addictions.
The Americans saw doctors and nurses who overcome technological shortcomings using intelligence and hands-on attention to treat the sickest patients. And both groups saw different ways to approach health care at home.
All this came during a three-year collaboration between Livermore health professionals and colleagues in their Russian sister city, Snezhinsk, which ended this year.
"Compared with what we have, they have very little," said Jessica Jordan, a nurse who runs infection control and staff development at ValleyCare Health Systems in Pleasanton and made five trips to the formerly secret and still-closed city in the Ural mountains. "But that didn't stop them from continually wanting to do more for their patients."
The Livermore-Snezhinsk Medical Project began in 1999, when the Department of Energy started funding cooperative work between the home cities of U.S. weapons labs and their Russian counterparts; Livermore is home to Lawrence Livermore Laboratory, and Snezhinsk was created around the Russian nuclear weapons lab there. The federal funders hoped improving conditions in Russia would keep scientists from taking their nuclear knowledge to countries such as Iran or North Korea.
In Snezhinsk, the city's residents wanted to improve their health care system, which had begun to crumble after the Soviet Union fell apart. So began the collaboration between Livermore and Snezhinsk.
Initial exchanges between doctors and nurses in the two cities involved just the basics, learning how each other's health care system works. Russian health officials came to the Bay Area, where they visited local hospitals including ValleyCare and John Muir, the Alameda County Public Health Department and high-tech research centers such as Stanford University's Lucile Packard Children's Hospital. They also saw that patients take an active role in their own health care, unlike in Russia, where the doctors hold the ultimate authority.
Then Livermore nurses and doctors visited Snezhinsk, where they saw how care was different because of lack of modern medicines or equipment. Russian care also was different, they said, because everyone there, rich or poor, gets treatment.
"They were eager, and they worked really hard, and they accomplished a lot with very little still in the way of resources," said Dr. Robin Gilleland, a pediatrician in Livermore and Pleasanton, who also traveled to Russia five times. "It was truly an eye opener."
Take one clear-cut example of the difference between the two systems: giving birth.
When women in Snezhinsk have babies, they spend 12 to 14 days after a vaginal birth in a maternity house, where visitors -- including fathers, children and other family members -- are not allowed. To communicate, the families put huge, colorful posters in the trees surrounding the house and wave to the new mother through the windows.
The Russian doctors were shocked when they learned American fathers often stay with mothers during the birth, and that new mothers often stay in the hospital for just 24 to 48 hours afterward.
"They frankly wouldn't believe it until they saw it," said David Mertes, who coordinated the exchanges.
Soon the groups jointly settled on several focus areas, including preventive medicine and children's and women's health care.
In the past, patient care in Snezhinsk focused on fixing problems rather than preventing them in the first place, said Dr. Jim Seward, Livermore lab's medical director, who taught classes on how to work with patients to reduce their cholesterol.
"They are certainly less aware of diet and health education," Seward said. But it is not as easy to fix there because "food is expensive, and there is an availability issue of fresh fruit and vegetables."
After seeing the effectiveness of U.S. programs, the Russians wanted to learn how to use the media to educate patients about their health.
The Alameda County Public Health Department provided pamphlets and posters on issues like tobacco control, translated into Russian. Marla Blagg, director of the county's tobacco control program, even conducted a press conference where a Russian journalist challenged her to write a press release on the spot. "He was really surprised" when I did it, she said.
The Russians have some advantages in spreading the public health message, Blagg said. Their population is largely confined inside the city, and they have a largely uniform population without the language barriers that are a major public health challenge in the United States.
"It was interesting to see the capacity and the dynamics and the willingness of the community to empower themselves," Blagg said. "It is something that we try to do here in the U.S., and it is very difficult to do."
The public health challenges often manifest themselves most among Snezhinsk's teenagers. The team addressed that by creating a peer mentor program to allow the children to talk about problems they can't address at school, like alcohol and drug abuse, sex, pregnancy and violence.
The team also worked on a dental program for schoolchildren and on enhancing the city's ability to deal with ill or premature newborns minus the high-tech devices available in the United States.
Gilleland remembers how proud the Snezhinsk doctors were when they saved a premature baby born after just 27 weeks.
"They kept her alive. ... Some doctors sat by her bedside 24 hours a day," she said. "They were willing to do that."
With women's health issues, the team trained doctors on breast self-exams and brought in a mammography machine for the first time. They also talked more about preventing sexually transmitted diseases and unwanted pregnancies, as birth control is very expensive in Russia. At their last trip, the U.S. visitors were guests of honor at the opening of a women's health center in Snezhinsk.
The group members say the Russians were able to take the lessons learned in the United States and adapt them to the needs of Snezhinsk. While their money for trips has run out, the group hopes to keep in touch through video conferences and e-mails while they write grants to fund more trips.
"The people touched us. We became very committed to the project," Blagg said. "I only see the whole program as being a win-win for the residents of Snezhinsk."
Reach Andrea Widener at 925-847-2158 or firstname.lastname@example.org">email@example.com
[Reprinted with Permission]