Introduction of Combined Health and Social Services in Semey Brings New Meaning to Lives of Vulnerable Groups

by Vira Illiash

Editor's Note: The Demeu Family Medicine Center, which was opened in the capital of Kazakhstan in 2000 under the auspices of AIHA's Astana/Pittsburgh partnership, was the first healthcare institution in the country to integrate social programs into primary care. This approach not only led to better service and enhanced patient satisfaction, it also resulted in noticeable improvements in the health of the population served by the Center and, more importantly, people began to show greater concern and responsibility for their own health. These factors weighed heavily in the joint decision of the Kazakh Ministry of Health and Ministry of Labor and Social Welfare to initiate cooperation with AIHA to replicate the Demeu model in four more cities.

Semey, the Kazakh city once known as Semipalatinsk, was the first of these pilot sites to launch combined health and social services in its system of local outpatient clinics. Under the project, staff of the two family practice clinics (FPCs) in this northeastern city of almost 400,000 people received appropriate training. In June 2005, AIHA provided these institutions with furniture and office equipment necessary for creating an environment where community-oriented clinical and psychosocial programs could thrive. In the months since then, many significant changes have taken place in the lives of the people who need social services and human attention the most.

The destiny of 16-year-old Igor, who lives in Semey, seemed determined from the outset by the diagnosis he received as a newborn in the delivery ward: cerebral palsy. Despite his obvious native intelligence, Igor's illness has forced him to stay at home since he was a little child. As he grew up isolated from others, he became accustomed to his lonely existence to such an extent that he lost interest in what was happening outside his own tiny world.

Alarmed by their son's apathy, Igor's parents turned to Semey's Department of Social Protection for help. As a result, psychologist Gulnar Nikhambayeva came into Igor's life, becoming not only his counselor but also a reliable friend. In an attempt to develop Igor's interest in the outside world, for two long years Nikhambayeva called on her extensive arsenal of methods to engage the boy and spark his imagination. She read him stories and articles about the challenges various people have encountered in their lives, trying to get him to see that life is difficult in a different way for each person. She used a wide range of psychological techniques and role-play games, but all her efforts failed to produce the desired results. After these sessions, Igor would retreat back into himself. It seemed that all her work with the young man had been in vain.

But finally something Nikhambayeva suggested yielded the tiny flicker of interest she had long tried to spark and, from that moment forward, Igor began to gain a sense of hope for the future that knew no bounds.

A Chance for Self-realization Is As Close As a Keyboard
Two months ago, Nikhambayeva began working part-time at FPC No. 9 where staff are implementing AIHA's community-oriented primary care and social support program. One of the innovative services they have introduced is a computer class for children with special needs. Hoping against all odds, she asked Igor if he would be interested in attending and, "To my great surprise and pleasure, he agreed without hesitation. What's more, he even started calling me up to ask when we would start the lesson," Nikhambayeva recounts in inspired tones.

Igor and his young student smile at the camera while participating in a computer class. (Photo courtesy of Kairat Davletov.)

Working on the computer opened up a whole new world for Igor, who mastered this new technology quickly and also began volunteering at FPC No. 9, helping to teach other children to use the computer and to play his favorite game—chess—Nikhambayeva says, her joy in his success obvious in every word. Igor is already an acknowledged specialist in this area, she continues, explaining, "Now Igor comes to us almost every day. He not only helps us with the other children, but he also takes part in the preparations for various events and holiday celebrations we organize for disabled children."

Igor himself takes great pride in his work as a volunteer and his parents can't stop thanking Nikhambayeva and all the social support program participants at FPC No. 9 for giving their son the opportunity to live a full life. They also report, incidentally, that now that Igor has begun to feel needed by those around him his fears of the outside world have vanished. He rarely even thinks about his illness because it no longer seems to be an obstacle on his pathway through life.

Creating a Nurturing, Healing Environment
The story of Igor and his family is not the only tale demonstrating the success of the social programs at FPC No. 9. For more than two months now, the Victoria Club for mothers raising special-needs children has been meeting at the clinic, as have the Second Youth Club for lonely elderly people and a club for women who are preparing to become mothers.

While parents in the Victoria Club come together to share their experiences and talk among themselves to solve common problems, the children who come to the FPC with their mothers also find something to do in the game room or at computer class. "Our shared pain brought our children together just as it brought us as parents together," acknowledges one of the mothers, remarking that because of an earlier lack of government programs to integrate disabled children into public institutions these young people were totally isolated. Now they have someplace to go, she says, noting in a voice ripe with gratitude, "Here they joyfully rush to see each other; they reach out for one another."

The senior citizens who have joined the Second Youth Club are satisfied with the comfort they have found at the FPC, too. They meet every Wednesday at the clinic to share their problems and joys, as well as to do therapeutic physical and respiratory exercises. They also learn how to monitor—and regulate—their blood pressure and study the wisdom of nutritional science and plant healing. Gulnar Nikhambayeva conducts their lessons, never tiring of enriching the lives of those she cares for with spiritual warmth and healing knowledge.

Zhanar Kuanysheva briefs local journalists about the community-oriented programs implemented at FPC No. 9. (Photo: Kairat Davletov.)

Nikhambayeva and the other specialists at FPC No. 9 are not the only ones who offer consolation and advice to the Semey residents who flock to the center. Seven volunteers from the Semey Medical Academy and Shakarim State University also work with club members, as does a legal authority who provides advice if needed, according to clinic director Zhanar Kuanysheva. And, Marina Tabamo—a professional social worker from the Philippines who was placed at the center by the British developmental organization Voluntary Service Overseas (VSO)—assists all these specialists, helping them fulfill their many duties. Tabamo was recruited by AIHA to help develop the social support project in Semey and ensure its success.

Explaining that the clinic's social support program had been under development for approximately two years before AIHA began working with staff there in February 2005, Kuanysheva notes that the project really took off once the collaboration started, rapidly becoming more meaningful, popular, and stable. Last winter, two nurses, a doctor, and a social worker traveled to Astana to train at Demeu, and Kuanysheva herself had the opportunity to witness first-hand the kinds of social programs that are commonly integrated into healthcare systems in the United States when she visited Astana's American partners in Pittsburgh, Pennsylvania. Impressed with what she learned there, she says she brought home a number of new ideas about how to improve the quality of life for the most vulnerable segments of the population, including disabled children and the elderly.

"World experience confirms that every person regardless of age, health, or social status can lead an active life and we are trying to transplant this experience to our soil as well," Kuanysheva admits. For this purpose, the healthcare professionals and volunteers taking part in the AIHA program have begun to hold joint workshops on social support issues for primary care workers with the Kazakhstan Association of Family Physicians. Noting that the first workshop took place in August, Kuanysheva says that it introduced a clear understanding of the essence of social support and its positive impact on a community. "Historically, social support in the countries of the former Soviet Union is associated with things like picking up pension money or cleaning the house for somebody who is gravely ill. But what we want to do is reshape the mind set of the healthcare community, making them aware of the fact that social programs should not only make life easier, but also enrich life for the people they serve."

In this connection, Kuanysheva notes that the equipment supplied by AIHA plays a substantial role in the success of social programs at the clinic. Each item was carefully selected and is earmarked for a particular use. For example, comfortable furniture and household appliances make things cozy, so that club meetings take place in a warm, homey atmosphere. Computers capture the interest and develop the minds of the younger generation while table games help brighten the leisure time for children and adults alike. The clinic also has a library that was established with support from AIHA, along with audiovisual equipment and videos, which are used to educate patients about health issues and disease prevention.

Second Clinic in Semey Launches Its Own Social Programs to Better Serve Those in Need
Specialists at another clinic in Semey—FPC No. 11—also participate in AIHA's community-oriented primary care project, receiving training and material assistance. When staff first began exploring options for implementing social support programs at their center, they enlisted Tabamo's help with creating questionnaires and conducting a community survey to determine precisely which services would benefit their patients the most.

Club members speak to family physician Tatiana Krutova during a meeting at FPC No. 11. (Photo: Kairat Davletov.)

The study showed that 46 percent of the 17,000 residents of the community served by this clinic are retirees who, in many cases, live alone and are in need of combined healthcare and social support. With this significant population in mind, staff decided to establish a special program that would help these people live a fuller life. Thus the Golden Age Club was created along with similar clubs for other special-needs groups, such as young mothers, adolescents, and disabled children.

According to the pensioners, the club meetings give them something to look forward to—something that helps fill their often monotonous days with joy and camaraderie. Center staff are happy to report that club members always tell them how grateful they are to learn how to overcome stressful situations, monitor and regulate their blood pressure, and have the opportunity to speak with the doctors on various health-related topics and concerns. They also enjoy having the chance to get out of the house and chat with their contemporaries in a cozy atmosphere. For many, these meetings are one of the few chances they get to socialize all week long.

No less satisfied are the mothers and children with whom the clinic's trained staff members are working. The doctors see the success of their work in the satisfaction of those under their care and the certainty they receive from the knowledge acquired in their study sessions.

"The health education work these clubs do has resulted in a decrease in the number of appointments patients make for medical attention because the members have become better informed about health issues. Now, they themselves are teaching their neighbors, relatives, and friends about what we discuss with them during our meetings," reports Tatiana Svitich, director of FPC No. 11. In particular, teenagers have been very active in disseminating the knowledge they receive, she says, noting that the young people conduct polls in their schools to determine how informed people their age are about the harmful effects of drug dependency and the prevention of sexually transmitted infections. In addition, they have used their club as the venue for organizing their own resource and consultation center, which creates educational materials on disease prevention and high-risk behavior using the computers and copy machine supplied by AIHA.

Marina Tabamo, Tatiana Svitich, and a journalist from Semey TV station "K-6" during a press conference about the equipment hand-over to FPC No. 11 in June, 2005. (Photo: Kairat Davletov.)

One of the main strengths of these clubs is the fact that they give patients the chance to talk about their troubles and concerns in an open, nurturing environment, Svitich explains, noting that only a few short months ago when the program was just starting up, most people—particularly the young mothers and pensioners—came exclusively to hear talks about ailments or complications. "This was due to their lack of confidence in themselves, which stemmed from lack of knowledge. Now that our patients have the information they need, however, they try to communicate and to help each other," she says. And, the interaction among peers is another valuable aspect of the club model, according to Svitich. "For young people, the club gives them the opportunity to openly discuss personal issues and problems they cannot always talk about with their parents and, for the older generation, full-fledged contact with others is therapeutic because it provides moral satisfaction and a feeling of being needed. The meetings also take their minds off their illnesses," she acknowledges.

"As a family doctor myself, I consider combined healthcare and social support programs tremendously useful. A family's health and its social problems are always interconnected," Svitich stresses, noting that such programs need to be developed everywhere. "Based on our experience at FPC No. 11, we have been able to see quite clearly how much the population needs such programs."

Discussing plans for the future, Svitich explains that clinic staff want to start a club for young fathers, as well as to draw in the fathers of disabled children to take part in study sessions. As a first step, a survey of men is now under way. Based on the results, an educational program will be designed to help them develop a greater interest and sense of responsibility for bringing up the younger generation. According to Svitich, this idea took shape because many women complain that their husbands take too much of a passive role in rearing their offspring.

The clinic staff is also working to organize a club for volunteers that will target activists from the already existing clubs as well as other people interested in becoming involved in the center's innovative social support programs. "Informing the population about our social programs and getting them to join in is a very important area of experience that our foreign colleagues have shared with us. Our collaboration has helped us see that it is only possible to improve people's quality of life if they want this to happen and play an active role in the process. Now we have a good resource base for our social programs, which provides comfortable work conditions and the opportunity to realize creative ideas for those who participate in our programs," Svitich concludes.

— Vira Illiash is AIHA's Staff Writer based in Kiev, Ukraine.

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