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Release: June 8, 2000

UI to play key role in family medicine clinic in Moscow

IOWA CITY, Iowa -- The University of Iowa will play a key role in the development of a first-of-its-kind, American-style family medicine clinic in Moscow, a clinic that will serve as a model for transforming health care delivery in Russia.

The Russian-American Family Medicine Center will open this month, occupying a portion of the first two floors of the 11-story Medicina Clinic in Moscow. Although the Medicina Clinic owns the center, the effort is a collaboration between the Medicina Clinic, the Russian State Medical University (RSMU) and the UI. The center will serve Russian citizens, as well as Americans and other foreigners living in Russia.

"The Russian-American Family Medicine Center is an entrepreneurial effort, but it has a strong educational component," said Cynda Johnson, M.D., UI professor and head of family medicine. "The ultimate goal is to deliver high-quality health care to people and families living in Moscow. However, this center also will provide clinical experience in international medicine for Iowa family medicine physicians, residents and students, and establish an academic base for additional collaborative work between the UI, the Russian State Medical University and the Medicina Clinic. There's really nothing quite like this center in Russia right now."

Beginning this month and throughout the next three years, as many as 10 UI-associated family physicians will travel to Moscow annually for three-week stays to serve as consultants and provide training in family medicine to Russian doctors and medical residents. The RSMU and the Medicina Clinic have already begun a family medicine training program; UI physicians will help train those residents at the new Russian-American Family Medicine Center.

Richard Dobyns, M.D., UI associate professor (clinical) of family medicine will be the first UI physician to take part in the project. Johnson will join Dobyns the last week in June for the first assembly of Russian doctors interested in family medicine. Both have been involved in the development of this consortium since the first American/Russian Family Medicine Conference held in Moscow last October.

Plans are to develop a course on Russian and international medicine and provide opportunities for UI medical students and residents to travel to Moscow and receive training in international medicine at the Russian-American Family Medicine Center.

Russian medicine currently values specialization and referrals over general practice and doctor-patient teamwork. The clinics where most Russians turn for basic treatment typically shuffle patients through a series of specialists for even minor health complaints.

"In the days of the Soviet Union, the government oversaw the health care system," Dobyns said. "The old system centered around a triage doctor who was often poorly trained and typically did very little diagnosis and treatment. The triage doctors referred patients to the specialists. They were true gatekeepers, and they always opened the gate."

Russian health care has become more decentralized and privatized, Dobyns noted. However, there are few, if any, non-governmental organizations -- like the American Medical Association, for example -- to work with the Russian government to ensure standards of patient care and physician training, represent patients concerns, or shape public health policy.

"Overall, it will take the building of a whole infrastructure for family medicine as we know it to take hold in Russia," Dobyns said. "Family physicians can provide much of the care needed by the general population in Russia, saving time and money while giving patients the opportunity to develop relationships with their doctors, which is something most Russians are not used to."

The UI's involvement in the Moscow project is partly a result of several years' experience in Russian medicine. UI faculty and staff began working with colleagues at the Medical Academy of Postgraduate Studies in St. Petersburg, Russia in 1995 to forge family medicine as a viable alternative to standard Russian outpatient care. The UI College of Medicine's reputation as a top school for training generalists also has enhanced the collaboration. Since last fall, Gregorii Roitberg, president of the Medicina Clinic, and several of his Russian colleagues have toured the UI Family Care Center, as well as the UI Family Care Centers in Belle Plaine and North Liberty, to see firsthand how an American-style family medicine clinic operates.

Other strong "Iowa ties" to Russia have enhanced the project, as well. These include the Office of International Programs (under the leadership of Assistant Vice President Tim O'Connor) at the University of Northern Iowa, the UI department of Russian, the UI Center for Russian, East European and Eurasian Studies, and the Iowa Academy of Family Physicians.

"Iowa actually has a long tradition of Russian studies and cultural experts, and we've been able to gather input from a number of colleagues and institutions across the state," said Robin Paetzold, coordinator of international program development in the UI department of family medicine. "We've been able to work closely and effectively with our Russian colleagues."

Funding for the initiative has come from a variety of sources. The UI, the Medicina Clinic, the Russian State Medical University, UNI, members of the Iowa Academy of Family Physicians and individual faculty and staff members involved in this project have actively shared costs of initial stages of this exchange. Support for planned curriculum development is currently being sought through private foundations.

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.