By Darcy Tashlein-Van Heuveln
Cold War images of Russia in movies and the country’s dramatically different culture have always enthralled me. So, when as a rising senior in the School of Nursing, I was given the opportunity to choose an externship in a foreign country, choosing the location was simple.
But, getting to Russia proved to be tricky. I tried working with several institutions on campus – the FedEx Global Education Center, Slavic Studies and Study Abroad programs – and found no assistance. Even the Russian Nurses Association said my desire to experience the Russian healthcare system was “unrealistic” and “not possible.” Fortunately, I discovered Connie Vance, former dean of the College of New Rochelle School of Nursing. Vance put me in touch with Sean McGivern, an American residing mostly in Russia, who has organized exchanges between Russian and American nurses for 20 years.
With his help, I secured an externship with several healthcare facilities in the ancient town of Velicky Novgorod. I lived with Natalia, a Russian doctor who teaches nursing skills to nurses at the public hospital. She spoke no English, so I had a true immersion experience linguistically. (I also had the opportunity to teach English to three doctors and a nurse three times a week at an HIV Center.)
I was astonished by Natalia’s poverty – her towels were thread-bare and she washed her clothes in the rust-stained bath tub. Nursing is not a highly-respected profession in Russia. Doctors and nurses earn an equivalent to $200 American dollars per month. Since the Russian Nurses Association formed in 1992, that perception is slowly changing, but it is difficult because nurses have little time for professional development.
While in Russia, I observed how the healthcare system functions by visiting a public hospital, an orphanage, and HIV clinic, a hospice, a polyclinic (a clinic that provides services in many specialty areas), a rehabilitation clinic for disabled children, a dermatology clinic and a birthing center.
During my observation, I witnessed incredible understaffing. One surgical unit had three nurses for 40 patients. Scarcity was evident everywhere. Nurses completed only essential tasks, and almost all supplies were reused, including suture needles, surgical gloves, patients’ surgical drapes, emesis basins, urinals, bed pans, jars and glass IV bottles.
Russian healthcare is far different from the American system. Far more women get abortions to avoid having children born into an unstable financial or social environment. Consequently, the Russian population is declining. There is also a high rate of HIV infection either from sexual activity or intravenous drug use, and society stigmatizes these individuals.
The hospice I visited had 100 beds – 60 for children and 40 for adults. Ten of the 40 adults had contracted HIV. The remaining patients were suffering from sepsis, flu, pneumonia and mosquito-born encephalitis. Three doctors and nine nurses cared for the adults. Each room had up to four beds, and there were no privacy curtains or amenities, such as televisions. While doctors did provide grief counseling upon request, one of the nurses told me that they have no formal training in it.
Whether the setting was a public hospital (which provides free care) or a polyclinic (which accepts the federal government insurance and serves mostly the middle class), conditions are still dismal by American standards. Patients in public hospitals often share rooms with multiple other patients, and they must all bring their own hygiene supplies, while sharing a hallway bathroom. Polyclinics, though more modern, still do not have all the supplies available in American healthcare settings. For example, I witnessed a dentist performing a root canal without using any water for the drill because water is contaminated. Consequently, the clinic smelled strongly of burning bone.
I also observed the situation with Russian orphanages. Since the population is declining in number, there are a fewer number of orphans. This situation has led the country to consolidate the homes for these children. One orphanage that currently has 95 children expects to expand to 135 soon with no extra funding to support the additional youths. Many of these children come to the orphanages with physical or psychological maladies that stem from congenital or substance abuse problems, and they require a great deal of care.
But the situation is not hopeless. Despite the current dark picture, most Russian nurses I interviewed reported that even with the country’s poor and struggling healthcare system, life in Russia is better than it was 10 years ago. There is hope that modern advances and assistance will push Russian healthcare to continue to move forward.
**Darcy Tashlein-Van Heuveln graduated from the School of Nursing in spring 2009. To view all of the photos from her Russian externship, click here: http://www.flickr.com/unc_ch_son.
as the first nursing student and only undergraduate ever to work on the UNC-Malawi Project that focuses on HIV research. She will be in-country from July 27-Aug. 20, and she will be blogging about her experiences and posting pictures as she is able.
