CONTACT: C. LINDON LARSON
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Iowa City IA 52242
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UI project brings new family medicine clinic to Russia
IOWA CITY, Iowa -- More than a year after launching a collaborative project
with Russian physicians, University of Iowa faculty members have seen the
results of their work -- a new Russian clinic that they hope will be a model
for American-style family practice medicine.
Drs. Elizabeth Swanson and Gerald Jogerst, principal investigators for the
project, and Gayle Nelson, nurse manager, visited the clinic in October 1996.
In early 1995, they and colleagues from the UI and the St. Petersburg Medical
Academy of Post-Graduate Studies (MAPS) in Russia initiated an effort to teach
Russian physicians the principles of family practice and to establish a clinic
to serve patients and prepare new generations of family doctors. The project
is funded by the U.S. Agency for International Development.
"It is rewarding to see the people we've taught actually putting into
practice what they've been trained to do," says Jogerst, assistant professor
of family practice at the UI College of Medicine. "That includes seeing
patients in the clinic as well as teaching their first class of interns in
Five Russian doctors spent six months in the United States being trained by
counterparts at the UI and in community clinics across Iowa. They returned
home having learned a type of medicine much different than prevailing Russian
"The Russian polyclinic system has a large number of specialists, and
patients move from doctor to doctor within clinics that resemble mini-hospitals,"
explains Swanson, associate vice president for health professions education
at the UI. Family medicine can help provide a less expensive and more efficient
approach by training doctors to diagnose and treat a range of relatively common
"The family physician can fill in to provide 90 percent of the care needed
by the general patient population," Jogerst says. When necessary, family
physicians can refer patients to hospitals or polyclinics, much like in the
Establishing a model family practice clinic required educating staff and patients
about a new style of medicine. In training the clinic's nurses, Nelson helped
teach them to take a more active role in patient care.
"Some of these women left stable positions to take a shot at this new
idea," she says. "Russian nurses are truly the handmaidens of the
physicians and don't have much independent decision-making capabilities. We
worked with them and the physicians to promote a team concept."
Though the clinic had only been open 10 days when the UI visitors arrived,
it was already busy treating patients, many of whom seemed to realize that
they were receiving a different kind of care.
"One of the interns studying with the physicians we trained brought her
own child to the clinic because she wanted the child to receive that level
of care," Swanson says. Physicians who treat both children and adults
are rare in the specialized Russian system, so the idea of a clinic serving
whole families is another departure from the Russian norm.
Models of family medicine are spreading in Russia, although they often adopt
many of the practices and expectations common to their culture. For example,
clinic staff treat about half of their patients in "house calls"
to nearby apartment buildings. Standard Russian medicine also incorporates
many treatments considered alternative in the United States, including massage
and herbal therapies.
"We really encourage them not to abandon their whole way of practice,"
Nelson says. "We hope that they will take the best of both ways and come
up with a high-quality system accepted by patients and physicians."
The MAPS clinic and Russian family medicine in general could face a challenging
future in an changing environment with scarce resources. Health care financing
is a complex blend of state stipends and subsidies, private insurance, and
fee-for-service care. Success may depend as much on business acumen as quality
"I think the entrepreneurial spirit is going to help," Nelson says.
"Those who establish new types of clinics will have to learn how to do
business as well as practice good medicine." She adds that the Russian
physicians learned marketing strategies as part of their training.
Jogerst notes, however, that many of the dilemmas confronting Russian health
care are not unfamiliar. "Their problems may be larger in certain areas,
but we have the same problems. Maybe we can learn to apply some of their solutions,"
Indeed, the project has underscored similarities much more than differences
for its investigators. "All three of us grew up in the Sputnik era with
a distrust of Russia. Through this, we've learned that the Russian people
are very hard-working, gracious and committed," Swanson says.
Swanson, Jogerst and Nelson will return to Russia in March to conduct a family
medicine conference with MAPS faculty and complete the project. Through their
visits and regular e-mail communication with Russian colleagues, they have
found friends as well as business partners. "This has been a life-changing
experience in its depth of friendship and the chance to work in a different
cultural environment," Nelson says.