- in the North Caucasus NEWSLETTER ON EMERGENCY PREPAREDNESS AND RESPONSE JANUARY-FEBRUARY 2004 Laboratory assessment mission to Grozny From 16 to 19 February a WHO laboratory spe- cialist carried out an assessment of selected laboratory facilities in Chechnya and Ingushetia. In Grozny, laboratories of city hospitals N2, N3 and N4, as well as the Republican clinical hospi- tal and the city polyclinic N3 were assessed and in Ingushetia, the Sunzha district hospital and the Republican central clinical hospital in Nazran. After the mission the WHO expert briefed inter- WHO expert assessing laboratory facilities in ested humanitarian organisations, including Grozny ICRC, Hammer Forum, MDM, MSF-B, IMC, IR, The laboratory assistants generally perform few, MSF-F and IHI in Nazran. simple and inexpensive manual techniques as direct bacteriological examination of urine, direct The main findings are that the physical condi- examination of faeces for parasites and a few tion of the visited laboratory facilities in Grozny haematological tests (Haemoglobin, white blood is precarious; with no access to central water count, etc). The specificity and quality of the and sewage and irregular electricity supply and results are questionable since neither Standard most buildings in dire need of rehabilitation. The Operating Procedures were noted nor quality equipment is often outdated and in some in- control measurements were in place. stances unsafe for handling. Insufficient provi- Also the safety of the working environment of sion of consumables and glassware leads to use the laboratory staff is questionable. broken materials and sometimes long expired test kits and reagents. The overwhelming majority of laboratory assis- tants have not received training in the last dec- ade. The assessment of the Grozny city policlinic N3 revealed even less equipment and supplies, than in the hospitals’ laboratories, though policlinics are the first line out-patient health care provider and need to be able to provide differential diag- nosis to refer appropriately. The situation in the clinical laboratories in the Sunzha district hospital and the Republican clini- cal hospital (Ingushetia) is notably better. Al- Repair works at the Republican clinical hospital in though most of the equipment remains out- Grozny dated, test kits are new and the amount of pos- sible laboratory tests is quite impressive. 1 2. Training, upgrading of skills on new equipment and frequent supervisory visits. 3. Standard operational procedure manuals should be made available from the reference laboratory to guarantee uniformity in testing protocols and methods. 4. Quality Control Measures and Quality Assess- ment Schemes have to be developed, imple- mented and maintained. 5. Equipment supplies, training of personnel, and the layout of laboratories should be coordi- nated by an experienced professional. (The full report, including lists of recommended equipment/consumables/reagents is available from WHO offices in Moscow and Nazran). Physical condition of laboratory facilities in Chechnya is precarious, the equipment being unsafe and outdated Standard Operating Procedures were not avail- able either. The WHO laboratory specialist made following recommendations: 1. Each clinical hospital laboratory should be equipped with basic equipment and reagents; linked with physical rehabilitation of the building, including regular provision of electricity ( gen- erator). The overwhelming majority of laboratory assistants need training INGUSHETIA AND CHECHNYA TB According to the chief doctor of the TB service opened TB dispensary in Grozny provides inpa- of Chechnya 5,766 active TB patients were reg- tient services to 60 patients but has a 200-bed istered in 2003 including 1,051 newly diagnosed capacity. The MoH of Chechnya has provided patients. One third of them are residents of sufficient stock of TB drugs and the main re- Grozny. quest for humanitarian assistance comes for Furthermore, 1,841 cluster locations with one laboratory and general physiotherapy equipment and more TB persons were reported. The newly as well as food items for patients. 2 From 10 to 12 February WHO held a training plies (mattresses, blankets, buckets, water course on TB reporting, registration and moni- tanks and basic drugs and medical materials) to toring for 12 specialists in Nazran. The deputy people suffered as a result of a landslide in the head doctor from the central TB dispensary of village of Zandak in Nozhai-Yurt district of Orel region facilitated the course; he had been Chechnya in late December 2003. The landslide previously trained within the framework of the inflicted damage on 50 houses, out of which 14 WHO TB control programme in Russia. were completely destroyed. In addition, a gas- pipe, a power line, and a road were damaged. The Chechen authorities evacuated 250 people and distributed food to the victims. WHO donated medical consumables to the cen- tral district hospital in Sunzha district of In- gushetia and health literature, posters and booklets to the Republican infectious clinical hospital in Grozny. ICRC supported training of four doctors from Grozny in the training courses in Moscow. Two specialists from hospital N9 were trained at Bur- denko Neurosurgery Institute on neurosurgery and resuscitation, two others (from policlinic N9 Primary health care and Republican blood transfusion centre were trained at the Russian Medical academy of Post- From 14 to 29 January the IMC educational graduate education and at the haematological teams addressed a training course to 83 partici- centre of the Russian Academy of Medical Sci- pants on skin infectious and parasitic diseases ence. The organization has as well funded the for the personnel of their 24 assisted district participation of the cardiologist from Urus- hospitals and FAPs in Ingushetia and Chechnya. Martan district hospital at the All-Russian Cardi- IMC also carried out between 6 to 27 January ology Congress in Moscow. seven training courses for 65 Chechen IDPs with non-medical background in seven settlements in ICRC delivered medical equipment, including Ingushetia. One training session lasted for three lung ventilation devices, surgical tables, sterili- days and included special presentation and sation drums, autoclaves, etc. to the maternity practical classes on first aid in cases of cardio- department of city hospital N1 in Argun. pulmonary insufficiency, trauma and haemor- rhage, burns, drowning and birth assistance. The new programme of the local NGO “Memo- rial” arranges referral of individuals in serious WHO published 1000 copies of the 2004 table condition for medical treatment to other regions calendar with health awareness messages of the Russian Federation, covering all expenses. “Health for Chechnya”. The calendar was dis- tributed to health care facilities in Chechnya and Ingushetia and among humanitarian organisa- The NGO “Hammer Forum” finalized the physi- tions. cal rehabilitation of children polyclinics N1 and N4 in Grozny. The facilities also received electro- cardiographs. Health assistance MSF (Medecines Sans Frontiers) – France and MSF – Holland provided emergency relief sup- 3 Rational use of medicines 3000 MEP booklets with practical advice were distributed. On 10-11 February the NGO “Hammer Forum” On 24 February WHO/UNICEF held a joint conducted a workshop with head doctors of as- conference on breastfeeding in Nazran. Sixty- sisted hospitals and polyclinics in Grozny to dis- four participants from Ingushetia and Chech- cuss the promotion and active implementation of nya, amongst whom chief specialists from the rational drug use at all levels of health care. Ministries of health, representatives from medi- cal colleges and university, doctors from the primary health care level Epidemiology and Immunisation and heads of hospitals were briefed on WHO/UNICEF Mother and child health strat- The 2003 annual state report of the SES of In- egy and discussed the current situation in this gushetia enumerates respiratory infections, area in the two republics. The advantage of acute intestinal diseases, TB, measles and viral breastfeeding was accentuated along with tech- hepatitis as the five leading infectious diseases. nical aspects and problems of breastfeeding in different situations. UNICEF launched the next round of procure- ment of cold-chain equipment to primary health care facilities in Chechnya. Eighty-two health care facilities will receive refrigerators, cold boxes and vaccine carriers. Slogan of the WHO/UNICEF breastfeeding Chechen health authorities report the aver- Conference: “Healthy life start for every child” age vaccination coverage among children in Chechnya to be 96.2%. But they also report a decrease in coverage from previous years: for measles from 81.7% to 71.7%, for rubella from 20,000 copies of the WHO brochure “Infant 98.4% to 33.9% and for Hepatitis B from feeding in emergencies, a guide for mothers” 105.3% to 33.9%. were re-printed and distributed by UNICEF. UNICEF’s health inspectors visited selected health facilities in Chechnya and Ingushetia to Mental health and psychosocial re- verify the accuracy of records on vaccines ad- habilitation ministration, the adequacy of storage tempera- tures and expiry dates of vaccines. The mission UNICEF/PINF conducted in Nalchik a special revealed that in the National Cold Centre in training for 11 psychologists from 10 schools in Grozny and in the polyclinics N1 and N3 all vac- Grozny, providing them with specific knowledge cines are kept in compliance