Partnership Community Education and Outreach Programs Spark a Healthcare Revolution in Russia’s Tomsk Oblast

By Kathryn Utan

In an era when poor lifestyle choices are resulting in swiftly increasing rates of chronic disease, disability, and behavioral health concerns the world over, the age-old adage "An ounce of prevention is worth a pound of cure" is more relevant that ever before.

This is especially true in Russia, a nation with one of the lowest life expectancy rates in all of Europe, and a country where cardiovascular diseases, cancer, and accidental injuries or poisoning--all largely preventable causes--account for the vast majority of deaths. The average Russian citizen, however, especially the older generation, has little or no experience with prevention because the Soviet medical model focused more on curing, rather than avoiding, disease in the first place. And, although patient education did exist, it was conducted on a relatively small scale through dull, formal lectures.

Tomsk/Bemidji partners share information on the benefits of breastfeeding with members of the Svetly community during the health fair. (Photo: Mary Thompson.)

Yuri Sukhikh, chief physician of Tomsk Central Rayon Hospital, is quick to point out that the past 11 years of economic transition in Russia and the subsequent decentralization of healthcare financing have led to greater burdens being placed on local health authorities. "In the past, patient education was handled only by state-run institutions, but this model is untenable under our current circumstances. The government does not have the funds to take care of educating patients on healthy lifestyle choices and we cannot afford to stand idly by waiting for their help," says the Russian coordinator of AIHA's Tomsk/Bemidji partnership.

"Before becoming involved with our AIHA partnership, patient education and outreach in the region left much to be desired. Through our collaboration, though, we learned new approaches to this almost forgotten art," Sukhikh says, explaining how he and his colleagues from Tomsk witnessed many of these approaches first-hand during exchanges in the northern Minnesota town of Bemidji. There, US partners at the North Country Coalition--an alliance that includes North Country Health Services, Bemidji State University, Beltrami Area Service Collaborative, Cass Lake Health Service Indian Hospital, Bemidji MeritCare, Beltrami County Nursing Service, the Headwaters Regional Development Commission, and the Rural Physician Associate Program--encouraged their Russian counterparts to look for ways to use communication programs to promote healthier lifestyle choices back home in Russia.

Mary Auger, a certified lactation consultant who works with the Beltrami Area Service Collaborative, conducts a breast feeding focus group in Tomsk. (Photo: Mary Thompson.)

"When our Tomsk partners came to Bemidji, we introduced them to a number of community groups as a way to expose them to the education and outreach process. The Beltrami County Nursing Service and the Area Service Collaborative have very effective community-based programming and, by speaking with staff at these agencies and interacting with some of the support groups, we hoped our partners would begin to realize that these types of programs could also work in their own towns," explains US partnership coordinator Mary Thompson, a professional nurse and director of clinical safety, infection control, and risk management at North Country Regional Hospital.

While their interest may have been piqued by what they saw in Bemidji, many of the Russian partners remained skeptical that such an approach would work in Tomsk. "When we first started working with our American partners, we didn't think that what we saw in the United States would work well in our own community," admits Olga Kayalova, deputy chief physician at Svetly Rayon Polyclinic in Tomsk Oblast. "As a doctor myself, I can tell you that physicians are not always easy to deal with," she says with a laugh, explaining that change can be a bitter pill to swallow.

Concurring that many of his colleagues in the Tomsk region were unconvinced that the education and outreach programs would be effective in their communities, Sukhikh says, "With the image of a Soviet-style lecturer mumbling boring phrases from a rostrum fresh in everyone's minds, our healthcare professionals unanimously agreed that preaching healthy lifestyles in this manner would fail miserably." But, this method of patient education was not at all what the US partners had in mind.

Getting Started by Making the Community Part of the Equation
"Our Tomsk partners expressed initial concern that the public wouldn't be interested in these types of programs," Thompson acknowledges, noting that she and her colleagues in Bemidji arranged meetings for their Russian partners with people in Minnesota who had benefited from their involvement with support groups and other patient education methods. Two of these groups--a breastfeeding support network and a cancer group made up entirely of concerned patients and family members--were particularly effective examples of how a community can embrace outreach programs. "The visits with these people seemed to have the most significant impact on the clinicians from Tomsk," Thompson recalls, explaining that the meetings helped set the course for the partners' future endeavors.

As a critical first step, the Bemidji partners traveled to Tomsk in February 2001 to conduct three focus groups comprised of women of varying ages in Svetly, a town of approximately 17,500 people. The goal of these sessions was to gain insight about community opinions concerning their health-related needs and if available clinical services were effective at meeting those needs. These meetings also allowed partners to demonstrate the focus group model to local government and health authorities.

"The first focus groups were immensely successful. The women of Svetly were delighted to have the opportunity to express themselves and the medical community was amazed that they had so much to say," Thompson explains, noting that this experience was a clear indication that people in Tomsk Oblast could be receptive to education and outreach programs.

People attending the Svetly health fair were able to obtain information on more than 20 different ailments and discuss their health concerns with medical professionals. (Photo: Mary Thompson.)

Another important step in convincing the Tomsk partners that members of their community were interested in learning more about health and wellness issues also helped the Russian physicians better appreciate the untapped potential of nurses, midwives, and other mid-level healthcare professionals.

"During an exchange in Bemidji, we worked together with the US partners to plan our very first health fair, to be held in Svetly in June 2002," Kayalova says. "A decision was made there that struck many of the doctors as quite unusual: the nurses and midwives were put in charge of conducting the event," she continues, explaining that--historically--nurses in Russia were given little if any autonomy. "Our nurses and mid-level professionals embraced the idea from the very beginning and they showed us that they have enormous potential. For me, this was an eye-opening discovery. They did a wonderful job!"

Sukhikh wholeheartedly agrees that the health fair was a huge success, although he acknowledges that the partners were more than a little nervous on the day of the event. "In the morning, the only people there were a flock of curious school children who always like being in the thick of things no matter what is going on," he says with a laugh. "By the afternoon, though, their fathers and mothers started approaching us with various health-related concerns and requests and, by the end of the day, we had seen almost 400 people and distributed some 6,000 pamphlets and brochures on topics ranging from depression, smoking cessation, and alcohol abuse to hypertension, osteoporosis, and contraception."

But answering questions and handing out educational brochures played only a small part in the event, Sukhikh notes. "Even though we ran out of materials people kept coming because we offered them real help in the form of consultations, blood pressure screening, and practical advice on matters that were important to them. The next day we were inundated with requests for us to hold similar events in the future. After that, any lingering doubts we had about community interest and involvement disappeared completely."

Creating Educational Programs That Meet the Public's Needs
Once the Tomsk partners were convinced that people in the region were eager to learn more about health-related issues and wanted to play a more active role in preserving their own wellbeing, a strategy to get positive health messages out to various segments of the community was developed.

First, nurses and other mid-level personnel conducted a series of surveys designed to identify the population's most prevalent health-related concerns. Then healthcare workers were trained in a variety of patient education techniques and gathered up-to-date information on key issues that emerged from survey data-drug and alcohol abuse, HIV/AIDS, sexual and reproductive health, cancer, proper nutrition, dental hygiene, and the impact of pollution on health, for example. Next, the partners prepared educational materials and acquired didactic tools such as videos and mannequins. Finally, they were ready to begin. Using traditional health communication methods such as posters, brochures, and fliers, as well as a more comprehensive approach that combines community mobilization, school-based health education, focus groups, and mass media campaigns, the Tomsk/Bemidji partners launched an oblast-wide health promotion and disease prevention program.

Russian nurses provide blood pressure screening and offer advice on hypertension and cardiovascular disease to two women at the health fair. (Photo: Mary Thompson.)

According to Sukhikh, their education and outreach efforts fall into one of two categories: programs for the community at large or programs for children and young adults. "Our community-based education focuses on a number of issues such as prenatal care, depression, breastfeeding, obesity, and general first aid," Sukhikh says. All together, the partners have established almost 100 different community focus groups, attracting some 1,600 participants, he adds, noting, "People now turn to us for help in making healthier lifestyle choices and for accurate information about health-related concerns instead of relying on potentially inaccurate sources such as their neighbors, friends, or television shows."

Classes for children are conducted twice a week during the school year on a wide range of topics, including reproductive health, sexually transmitted infections (STIs), substance abuse, smoking cessation, and dental health, explains Olga Rozhkova, deputy headmaster of Svetly area schools. "In the past, healthcare providers rarely conducted educational programs for children, but now we work directly with Dr. Kayalova and other local clinicians as a team. Together we are developing a special five-year plan to give our children the information they need to keep themselves healthy."

Partners, such as this local surgeon dressed like a clown, work hard to make learning about exercise and healthy lifestyle choices fun for children. (Photo: Mary Thompson.)

Dentist Elena Petrova also believes that arming young people with the knowledge they need to live a long, healthy life is a priority for the Tomsk partners. She teaches dental hygiene to children of all ages and, after the interactive lessons, provides free examinations and treatment. Since the dental program began in October 2002, nearly 200 children have attended her classes--and almost half required additional treatment for caries.

"We've managed to make these kids aware of how important it is for them to take good care of their teeth while at the same time easing their fears about going to the dentist, but we also must make their parents understand the importance of oral hygiene so they can reinforce these lessons at home," Petrova explains. "Russia differs significantly from many other countries because there is no real tradition of prevention and taking care of one's own health. We are doing everything we can to raise a new generation of Russians who accept responsibility for their wellbeing and are capable of changing this old and destructive mindset."

Another Svetly practitioner who is helping to build a healthier future for the young people of her community is midwife Nadezhda Malyukova. She teaches reproductive health classes for girls at six area schools. Explaining that while many young women have a broad range of knowledge about their own bodies and sexual health, much of the information they glean from television, movies, magazines, and their friends is superficial, distorted, or even downright inaccurate.

"Parents, as a rule, do not discuss sexual matters with their children, so my goal is to teach the young women in my classes to preserve their health by loving and respecting themselves enough to take proper care of their bodies," Maylyukova says. "Before we became involved in our AIHA partnership, reproductive health classes for girls didn't exist because local educators lacked the medical knowledge necessary to conduct such courses effectively and healthcare providers lacked the pedagogical skills. As a result of the training we've received, however, a new breed of health education specialists has emerged here in Tomsk Oblast."

Whether the people they are targeting are young or old, Sukikh contends, it is important for healthcare providers to educate the public about health issues and get them to take greater responsibility for their own wellbeing. "It is a well known fact that prevention is easier and more cost-effective than waiting until a disease has taken hold of a person to start treatment. Watching a patient waste away and die from a disease in its advanced stages is a very painful thing for a physician. Healthcare providers who waste the opportunity to educate their patients and the public in general, in effect, facilitate this process, he says, noting that economic circumstances alone should preclude squandering precious funds by ignoring the benefits of prevention.

Primary Care Serves as a Vehicle for Education and Outreach
Patient education and outreach is just one aspect of the work being done by the Tomsk/Bemidji partners. In March 2002, their efforts resulted in the opening of the Kislovka Family Medicine Center, a primary care clinic that serves a village of some 4,000 people, and of the Svetly Community Health Center, a health education and outreach facility located at Svetly Rayon Polyclinic, staffed entirely by hospital employees and other members of the local community who volunteer their time, energy, and expertise.

In July 2002, the Tomsk Oblast government adopted legislation calling for the introduction of similar primary care centers in every district throughout the region. This replication process will begin later this year when a Family Medicine Center opens in the village of Zonalnaya Stantsiya. Another Center is slated to open in early 2004 in Kornilovo.

Some 400 Svetly citizens braved temperatures in excess of 100 degrees Fahrenheit to attend the health fair. (Photo: Mary Thompson.)

"Given the current budgetary constraints that we are all feeling at local, national, and international levels, it is even more imperative to focus on primary care and prevention programs. The bridges and relationships we have built through our AIHA partnership with Tomsk are invaluable tools for creating a safer, more caring, global community," Thompson contends.

"If our common goal is for societies to prosper and thrive side by side, these programs will lead to the fulfillment of that goal with the wisest utilization of resources," she continues, concluding, "While I feel that I am realistic about what we are accomplishing and am not overly sentimental about 'saving the world,' I can honestly say that the work we've done with AIHA and this partnership is possibly the most meaningful thing I have done in a professional nursing career that has spanned 30 years. I am very grateful to have had this opportunity to help expose our Russian partners to information that can dramatically improve the quality of their lives."

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