Pioneering Model Primary Healthcare Programs, Astana Family Medicine Center Combines Medical and Social Services

By Evangeline Coleman-Crawford

Hoping to change age-old healthcare practices in Kazakhstan where nurses would simply followed physicians' orders, staff at the Astana Family Medicine Center "Demeu" have implemented several programs that involve a high level of participation from nurses and social workers. "In the past, nurses did not use any form of their own creativity; they basically worked with doctors on patient issues," says Saule Shataeva, a nurse at the Center.

Gul Ospanova, (third from right) a staff physician, meets with members of the Golden Age Club.

"Now, nurses are involved in all aspect of patient care at the Center. They evaluate patients' health concerns and living environments, they provide patient training, resources, and advice on healthier lifestyles, and they have a huge commitment to personal growth," she adds. Social workers at the Center are actively involved in providing additional assistance particularly for senior citizens, single mothers, and disabled children.

Supported by local government officials, the Astana Family Medicine Center "Demeu" was established last November under AIHA's Astana/Pittsburgh partnership and has served more than 5,000 patients since its inception. The Center, which has a staff of nine physicians, 13 nurses, and two social workers, was created to provide prevention-oriented, family-based primary care programs that offer an integrated delivery of medical, ambulatory, and social services to some 20,000 adults and children living in a selected catchment area of Astana.

Roza Abzalova (standing, center), head physician at Family Medicine Center "Demeu," teaches cardiac patients in the "Zhansaya" Club to check blood pressure.

Under the leadership of Roza Abzalova, head physician, the Center offers the services of social workers as part of its healthcare delivery team. Social workers work closely with nurses as they tend to single mothers, parents of infants and toddlers, disabled children, and the elderly. A significant aspect of the social workers' job is the home visits they make to see patients. Abzalova says staff at the Center often participate in training exercises, workshops, and educational sessions that focus on health promotion, patient education, and disease prevention to increase their skills and technical expertise, as well as to improve their relationships with patients. "Their commitment to personal growth and professional development encourage their participation in continuous training opportunities," adds Shataeva. Some of the Center's staff have participated in nursing management training at the Kazakh School of Public Health and attended primary healthcare infection control, medical waste disposal, and early childhood development workshops in Almaty.

Adolescents from School #22 gather for a Trust Club meeting.

While conducting community assessments and gathering public health data during the initial process of establishing the Family Medicine Center, the partners performed several door-to-door interviews to determine healthcare needs within the community. Armed with statistics published by the Astana City Health Administration, they also surveyed approximately 890 teenage girls at Secondary School #22. It was during this time that the partners realized the urgency for educational community outreach programs. The results showed that none of the teens participating in the study had ever received information about sexually transmitted infections (STIs); however, all of them were very eager to learn about HIV/AIDS. Another disturbing fact was that 80 percent admitted to having experienced emotional violence and 30 percent stated that they had been in contact with TB patients.

Madina Musakulova (seated, foreground) information coordinator at the LRC at the Family Medicine Center "Demeu," teaches the staff about Internet resources.

Recognizing these factors, a Community Advisory Board (CAB) and a smaller governing board for the Family Medicine Center were organized by the partners to identify and assist with developing programs to solve healthcare problems in Astana. Having received training during various partnership exchanges, the members—physicians and other healthcare providers, educators, local government and media representatives—identified and developed activities to target several risk groups: low-income families, orphans, diabetics, TB and mental health patients, drug addicts, and alcoholics. CAB and the partners then developed several community-based education and intervention programs, as well as health promotion and community outreach activities, including an injury prevention education program for parents and children, sexual and reproductive health training sessions, STD intervention programs, and alcohol prevention education for adolescents.

Dr. Valentina Pitsik, an instructor for the Safe Childhood Club, teaches young members about violence prevention and safety.

CAB also met with local senior citizens and young mothers to gather detailed health information for targeted clinical services. Board members later created a breastfeeding promotion group and sponsored a two-day seminar last spring for women leaders on women's rights and domestic violence.

After learning about the unique needs of citizens within the catchment area, Abzalova says that five "common-interest clubs" were created at the Center to actively engage in community outreach and preventive medicine education as a way to respond to some of the prevalent problems in the community. "These clubs focus on specific health needs, especially at schools and polyclinics, and allows the Center to carry out significant health education programs."

The five clubs—Healthy Parent/Healthy Children, Golden Age, "Zhansaya," Trust, and Safe Children—offer valuable services to members of the community, and, according to Shataeva, bring medical personnel together with local citizens.

• The Healthy Parent/Healthy Children Club trains parents in the personal hygiene of children and interacts with several local and international organizations for the training of practitioners. The club also teaches methods of preventing STIs.
  
• The Golden Age Club was designed for retirees and the elderly, and established with assistance from Linda Powell, a volunteer social worker from England. Local social workers offer outpatient services and study problems to help the elderly and retirees grow old with dignity.
• The "Zhansaya" or Heart Club was organized for cardiovascular disease patients to help to control the disease, and to prolong the lives of patients. Nurses teach patients to measure heartbeats, check blood pressure, take medication, and follow nutritious diets. The club provides free medication to cardiac patients living in the Center's catchment area. "Zhansaya," which means the wellbeing of the soul, signifies the club's purpose.
• The Trust Club is designed for adolescents and is run exclusively by volunteers. The club also caters to single adolescents mothers and disabled children.
• The Safe Childhood Club teaches trauma and violence prevention. Parents are also taught to prevent injuries and control manageable diseases.

Dinara Baiserkina, a staff gynecologist, reviews materials with a couple in the Healthy Parents/Healthy Children Club.

Abzalova, who has also conducted a training session on handling hypertension crises for cardiac patients, says that the "Zhansaya" Club also teaches family and community members to perform medical massage techniques to aid cardiac patients before the arrival of an EMS team.

Overall, the response from members of the community has been very positive, says Shataeva. Since January, the Center has had 3,368 patient visits, including 454 for primary healthcare services and 1,024 home visits.

Hoping to replicate the Astana Family Medicine Center in other regions of Kazakhstan, Abzalova says that family medicine is an ideal platform to combine private and public healthcare services. Although concerned that the frequent changes of administration and low funding will continue to challenge the progress of the country's healthcare system, both Abzalova and Shataeva are pleased with improvements that have come about through the hard work of the Astana/Pittsburgh partners.

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