Health Action
− in the North Caucasus
NEWSLETTER ON EMERGENCY PREPAREDNESS AND RESPONSE OCTOBER-DECEMBER 2005
“Stop AIDS. Keep the Promise” local students and a fair was set up in the Naz- On World AIDS Day, WHO supported the Repub- ran “Palace of Culture”. lican AIDS centre in Chechnya to organise the- IMC distributed 4.000 booklets on prevention matic presentations on HIV/AIDS issues and a and contraception to nine ambulatories and FAPs concert with leading Chechen singers and dance in Ingushetia and 20 in Chechnya. groups. WHO also sponsored 10.500 condoms, 100 t-shirts with the World AIDS Day logo and two banners (3 x 6 m each) that were displayed Behavioural research on risk of HIV in- on the central street of Grozny for the period of fection among the population of the three months. Republic of Northern Ossetia - Alania and their knowledge level of HIV/AIDS issues
In September - October 2005 WHO conducted in
North –Ossetia Alania a KAP survey (knowledge,
attitude and practice) funded by the SDC.
The survey revealed a high degree of awareness in the population on the issue of HIV/AIDS and the recognition that it is a socially important dis- ease. It is likely that the HIV/AIDS prevention
campaigns of the previous years conducted
through a variety of international and national WHO World Aids Day poster on Grozny streets organisations in the republic have greatly con- tributed to this effect. Nevertheless, the results
also revealed lack of in-depth knowledge of UNICEF, in co-operation with the Republican sexually transmitted diseases in general, possi- AIDS centre, youth-information centre (YIC) of bly due to the reluctance in this community to the Chechen state youth committee and local discuss freely about sexual matters and the NGO “Youth against Drugs”, demonstration of stigma related to being infected. (Full report is the movies “Philadelphia” and “Nastia’s Diary” available from WHO). for young people and contributed to the joint WHO/UNICEF concert in Grozny. In co-operation with WVI, UNICEF held a performance for senior schoolchildren in Urus-Martan village. In In- gushetia, in-cooperation with the MoH of In- gushetia, YIC (local NGO “Genesis”), Republican AIDS centre, a special performance was pre- sented by the actors of the “Peace theatre” and
1 HEALTH AGENCIES IN ACTION
MSF Holland in the North Caucasus
A little history…
MSF-Holland (MSFH) has been operational in the
North Caucasus since 1999 when it began sup- plying medicines and medical materials to hospi- tals and clinics treating the large influx of IDPs in Ingushetia. Hospitals and clinics in Chechnya were included in the distributions from February
2000. MSFH began the rehabilitation of health facilities in Chechnya in April 2000. From August 2000 surgical facilities were also upgraded. An IDP settlement in Ingushetia From May 2000 to June 2005, MSFH organized © Simon C Roberts/NB Pictures regular distributions of drugs and medical mate- rials to over 22 health facilities in Chechnya. Distributions were also made to over eight health facilities in Ingushetia until September Chechnya 2005. The overall objective of MSFH operations in Chechnya is to contribute to improved health Current programmes… status of the population in Chechnya by increas- ing access to quality healthcare services.
Ingushetia Mental Health: Since 2002 The Mental Health (MH) activities in Chechnya have included 3 The overall objective for MSFH projects in In- components: emergency counselling, mental gushetia is to contribute to improved living stan- health in supported TB facilities and counselling dards and health status of IDPs in Ingushetia. in several Temporary Accommodation Centres Mental Health: the programme started in (TACs). 24-hour emergency counselling services 2002. Currently there is one stationary mental are provided by MSFH in Grozny hospital #9, as health centre in the Sunzha district, as well as 2 well as planned counselling services for patients mobile mental health teams providing mental and for the hospital staff. Since July 2005, MSFH health services in and around 25-30 spontane- mobile teams also provide counselling for inhabi- ous settlements. The main focus of the pro- tants of the Grozny (Rural) district of Chechnya. gramme is on individual and group counselling Mobile Teams: Since 2004 a mobile medical and psychosocial education in the community. team consisting of a therapist, gynaecologist, Medical Centre: in October 2005 MSFH opened paediatrician and psychosocial counsellor has a clinic in one of the IDPs' settlements in Naz- been serving six TACs in Grozny. From July 2005 ran. The medical team consists of a gynaecolo- an additional mobile team began to serve 5 set- gist, a therapist, a paediatrician and a psychoso- tlements in Grozny (Rural) district. In December cial counsellor who provide aid to IDPs as well as a third mobile team will start serving the popula- to the local population. ti on of 4 m o re settlements in Grozny (Rural) district. Emergency Response: MSF is always on stand-by to intervene in emergencies when needed and has stocks of surgical kits available
in Ingushetia and Chechnya.
2 Surgical Support: MSFH supports the neuro- terechnaya, Gudermez and Shali which serves surgery, trauma surgery departments and inten- the population of 4 districts. DOTS corners have sive care unit of the Grozny city hospital #9. The been set up and TB educators also work in the program includes (but is not limited to) improv- TB teams. In the coming months MSFH plans to ing the quality of surgical, nursing and longer- expand its TB work to Karagalinka hospital in term physical and mental health rehabilitation Shelkovskoi district. services for the patients in these departments. (MSF-H) Tuberculosis: This program was initiated in 2002. Now MSFH supports the implementation of a DOTS programme in 3 TB hospitals in Nad-
INGUSHETIA AND CHECHNYA
Health situation concluded that it was caused by psycho emo- tional stress.
Health assistance
As of December 2005 there were 16 humanitar- ian organizations engaged in the health sector in
Chechnya, 14 of them also implementing psy- chosocial projects. In Ingushetia were 13 or- ganisations, six with psychosocial projects. In
North Ossetia 12 are mainly operating psychoso- cial assistance projects and one organization works in Dagestan. Children, hospitalized with psychological disorder in Chechnya The Moscow based Fund “Guarantee” visited
Photo ITAR-TASS Chechnya on 24-31 November, to address the issue of anaemia: 1) haemoglobin screening; 2) results analysis; 3) detection of women and chil- In early December mass poisoning was reported dren who require additional tests and consulta- in Shelkovskoy district of Chechnya. By the end tions; 4) free treatment for three months; 5) of the month nearly 90 people, mainly children follow up tests in three months; 6) statistical and teenagers were registered with similar analysis; 7) detection of helminths; 8) treatment symptoms (eye and nose burning, suffocation, of helminths; 9) consultation-diagnostic services weakness and hysterical condition behaviour to local population. The fund carried out blood disturbance, convulsions). The majority of pa- analysis of 1200 people, mainly children of five tients were hospitalized to the Shelkovskoi cen- schools in Kurchaloi, Chechen-Aul, Starie Atagi tral district hospital and the republican children village, orphanage and hospital in Kurchaloi vil- hospital in Grozny. The diagnosis could not be lage. Each participant received a kit of vitamins set immediately; however, food poisoning was and syrups for three months intake with further excluded. Later on, a medical commission arriv- follow up testing. ing from Moscow to investigate the situation and including, inter alia, the Deputy Chief of the The preliminary results indicated that Kurchaloi Moscow Serbsky Institute of Forensic Psychiatry, people had the worst anaemia rates; Chechen- named the condition psychological disorder and Aul – average and better situation was in Novyi
3 Atagi village. The best haemoglobin rate was FAPs in Voznesenovskaya and Nesterovskaya. among children of Kurchaloi based orphanage. Commemorating the International Day of Dis- The fund specialists also lectured parents and abled IMC donated hygienic kits to the residents medical students on prevention of anaemia. of the internat for disabled and children rehabili- tation centre in Troitskaya village, Ingushetia.
IMC carried out two training courses on first aid
for 27 primary health level staff and nine medi- cal college representatives in Ingushetia in No- vember.
Hammer Forum conducted three days work- shop on treatment of helminths, anaemia and
issues of general health facility management for 24 health workers from Chechnya and In- gushetia in late September, and a training on prevention and treatment of childhood diseases Doctors from the Fund “Guarantee” taking blood for the staff of its assisted facilities in Chechnya samples from children in Chechnya in December.
In addition to regular supply of medicines and MDM arranged for 20 Chechen health care medical consumables to the hospitals in Chech- workers a training course in Nalchik on first aid nya, Ingushetia and Dagestan, and provision of in emergencies and on diagnosis and treatment several hospitals in Chechnya with Insulin, ICRC of the most common diseases. has effected a donation of laboratory equipment to the Grozny city paediatric hospital no 2, provided ad hoc medical assistance to Shelk- MSF-France funded participation of two doc- ovskoy regional hospital, funded participation of tors, one - from the Republican maternity hospi- one neonatologist of the Republican children tal in Grozny and one – from CDH in clinical hospital in two months training in Ufa Sleptsovskaya village, Ingushetia, in the state and facilitated training of the ENT expert of the required certified course on gynaecology in Oc- Nadterechny Central district hospital in St. Pe- tober. tersburg. MSF-Holland carried out a one-week training IRC distributed multivitamins to school-aged for 15 nurses of neurosurgery, surgery and children in 10 schools in Ingushetia and eight trauma departments of assisted hospitals in schools in Grozny as part of its public health Chechnya in Stavropol in December. program and carried out a dental hygiene train- ing for school aged children in Sunzha, In- WHO held a training course on TB/HIV monitor- gushetia. ing and registration for 25 state TB specialists from Chechnya and Ingushetia in Nazran in De- In addition to continuous support of settlements cember. in Ingushetia through operation of “family medi- cine” mobile teams and operation of mobile teams in Gudermes, Achkhoi-Martan and Grozny-Selsky districts in Chechnya, IMC has repaired and provided basic equipment to the “reproductive health” rooms in five women con- sultations in Ingushetia and rehabilitated two
4 HIV/AIDS Mother and child health
In November-December, within the framework In November, WHO donated within its Norway of the SDC funded WHO IMCI/MPS/PEPC pro- funded HIV/AIDS project, during the mission of gramme a training course on IMCI for 28 health the Norwegian Ambassador Mr Oyvind Nordslet- workers from MoH, city and district polyclinics, ten to the Republican AIDS centre in Chechnya and local medical academy was held in Vladi- 1200 booklets on HIV awareness and HIV test- kavkaz/North Ossetia-Alania; two ten days systems. courses on IMCI for 40 health workers (paedia- tricians, feldshers, and nurses) were held in Nadterechny district of Chechnya; a training course on breastfeeding and HIV consultation for
20 Chechen neonatologists took place in Grozny;
and a training course on obstetric and gynaeco- logical care for 25 Ingush state health workers was arranged in Nazran.
The Norwegian Ambassador in RF wit- nessing WHO donation to the Republi- can AIDS center in Grozny
WHO IMCI training in Znamenskoye, Chechnya WHO also sponsored participation of five spe- cialists from AIDS centres from Chechnya and Ingushetia in the training course “HIV/AIDS: In continuation of its Mother Empowerment Pro- Epidemiology, clinic and treatment”, organized gramme (MEP) UNICEF’ implementing partner by the Federal AIDS centre in Moscow; and or- Hammer Forum targeted in October - November ganized a training course on prevention of over 800 pregnant women, lactating mothers mother-to-child transmission of HIV for 30 Che- and mothers with under-5 children living in chen and Ingush health workers in Nazran. Temporary Accommodation Centres (TACs) in Grozny. In Ingushetia, up to 290 women resid- UNICEF organized a study tour to Saint- ing in IDP temporary settlements in Malgobek Petersburg’s Youth Centre ‘Yuventa’ for 12 districts were covered monthly. In Achkhoi- health care providers working in YFSs in Chech- Martan district, around 1000 women attended nya and Ingushetia, within its programme on MEP training sessions on a monthly basis. The raising awareness on HIV/AIDS and healthier life Ingush Republican Centre for Disease Prevention styles among young people and teenagers in the conducted training sessions in Sleptsovskaya two republics. and Troitskaya. In October UNICEF supported the participation of two health care professionals from the Ingush WVI conducted an internal training course on and Chechen MoHs in a training course held in HIV for its staff in Nazran, Ingushetia and in Lviv (Ukraine), devoted to issues of Young Child Urus-Martan, Chechnya. Survival, Growth and Development.
5 In November, UNICEF distributed MEP brochures shops on ‘nature therapy’ were conducted for to health professionals, breast-feeding brochures 57 primary school teachers. 150 children have to MEP training participants and medical regis- been involved in the programme through the tration forms to the Chechen Ministry of Health. preparation of materials for the ‘Thank You’ (UNICEF) postcards, book and a mobile exhibition. 31 IRC provided 8-hour educational sessions about traumatized children, 10 parents and teachers key maternal and child health messages to from Beslan took part in the three-day autumn pregnant women in schools in Grozny and com- camp held in November in the local mountains. pleted a round of safe motherhood trainings in In November, UNICEF provided medical equip- the communities of Alkhazurolvo and Surkhahi in ment to the therapeutic department of the mu- Chechnya. nicipal district hospital, and furniture to 8 schools of Beslan. UNICEF, through the Russian Charity Foundation Mental health NAN, completed a Psychosocial Baseline Study (Stage 1) to assess the psychological state of UNICEF continued to support the psychosocial Chechen children, as well as the availability and rehabilitation of children and adults affected by quality of the available governmental and non- the school siege of school n.1. in Beslan. In No- governmental psychosocial programmes. NAN vember, 48 children completed the rehabilitation recommended focusing on the urgent need for course at the UNICEF-supported centre. The the establishment of a comprehensive system of treatment techniques included relaxation, thera- psychosocial assistance for children in Chechnya, peutic games, physiotherapy, oxygen cocktails, jointly coordinated by the government, the UN stress relief sessions and massage. A total of and the NGOs, and the development of specific 256 children have been diagnosed by the local rehabilitation techniques. psychologists, with support from student- The first follow-up step to the study was a train- volunteers from the local university. A specialist ing for 38 school psychologists from Chechnya, from the Raul Wallenberg’s International Univer- facilitated by ‘Harmony’, the Russian Institute of sity of the Family and Child (St.Petersburg) paid Psychotherapy and Counselling (St. Petersburg). a monitoring/supervision visit to the Centre. He (UNICEF) provided professional advice to families of crisis- affected children, conducted individual psycho- Apart from its regular programmes UNICEF pro- emotional relief sessions and delivered trainings vided six sets of children furniture, bed linens for psychologists involved in the project. Three and conditioner to the Republican psycho- specialists from the Centre have been trained in neurological children dispensary in Grozny. working with the UNICEF-provided BOS (biologi- cal feedback) cabinets.
In the context of its emotional rehabilitation While continuing its psychosocial programs in programme, implemented through the Centre of Grozny and in Ingushetia, IRC carried out an Ecological Education ‘Obninsk’, UNICEF contin- inter-sectoral assessment in the Maiskoe village ued the implementation of the ‘Thank You All in Prigorodni district of North Ossetia in order to Who Helped Beslan’ project, aiming at fostering briefly assess the psychosocial health of popula- the emotional healing of traumatised children. tion. The results of the assessment revealed se- The specialists of the Centre developed over 50 vere emotional distress of unspecified diagnosis thematic sessions taking into account the re- and signs of incidents of major depression with gional and traditional peculiarities and the psy- many of the village population. The Hopkins chological state of the children, parents and Symptoms Checklist (HSCL), a cross-cultural teachers in Beslan. In November 2005, IT and screening instrument, measuring symptoms of audio-visual equipment were provided to the anxiety and depression was applied for this as- Centre of Emotional Rehabilitation created in one sessment. of the two new schools of Beslan. Three work-
6 DRC continues operations of psychosocial cen- Handicap International funded participation of tres in three schools and a TAC in Grozny. In eight specialists of rehabilitation facilities from November, DRC organised a retreat for 16 Che- Chechnya in the certified course in Kislovodsk chen children in one of sanatoriums in Kislo- technical college and provided 16 people with vodsk, where they also were able to undergo prosthesis in Grozny based prosthetic workshop. neurological treatment. In Ossetia, DRC contin- Alongside with this, HI is distributing wheel- ues working with women groups and local com- chairs, crutches, mattresses etc. for disabled in munity on the basis of schools in Chermen, Chechnya through the regional centres of the Maiskoe and Beslan. Regular group work takes Ministry of Labour and Social Protection. place with pre-selected 15 girls, teenagers and local mothers on various subjects. Other news
Hilfswerk Austria opened a new psychosocial rehabilitation centre in Vladikavkaz to provide The Ministry of Health and Social Development care to Beslan crisis victims and the general of the Russian Federation published a Decree population. regulating the referral of patients for out-of- town treatment in November. UNESCO funded the training course on psycho- Official site of the Ministry of Health of Russian logical assistance to 70 children and adults, in- Federation is http://www.mzsrrf.ru/ cluding school psychologists, students and teachers at the Chechen State University in Grozny. The course was facilitated by local Che- A delegation of the Council of Europe visited chen specialists from the Republican narcology Chechnya, Ingushetia and North Ossetia in early dispensary and psychology department of the November to meet the leaders of these republics Chechen state university. and to discuss a variety of issues, including ren- dering financial assistance for the restoration
and development of public health and educa- Assistance to the disabled tional institutions, economic development and prospects for foreign investment. The delegation included the official representative of the Euro- In November, UNICEF supported within its pean Commission in Russia, the Austrian ambas- physical rehabilitation programme for children sador and British ambassadors to Russia. Mem- with disabilities, a one-month orthopaedic train- ber of the delegation voiced the decision of the ing for a doctor from Grozny’s Republican Clini- EU to allocate 20 million euros next year for so- cal Hospital in St. Petersburg (Russian Scientific cial programs in these three republics. Research Institute of Traumatology and Ortho- paedics); a 10-day training has been organized for two doctors from the same hospital at the Medical Institute in Moscow; Grozny’s Prosthetic Workshop supported the production of prosthetic devices and orthopaedic footwear for 12 mine survivors; the Psychosocial Rehabilitation Cen- tre in Grozny assisted some 27 children and their primary caregivers for individual and group counselling. (UNICEF)
ICRC conducted a workshop on prosthetic assis- tance for three Chechen specialists from Grozny based Orthopaedic Centre in Vladikavkaz in De- cember.
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List of abbreviations: Health Action in the North Caucasus is a news- letter on the Disaster Preparedness and Response DRC: Danish Refugee Council programme (DPR) of the World Health Organiza- EPI: Expanded Programme on Immunization tion Regional Office for Europe. The information is FAP: Feldsher/obstetric post compiled by the WHO Humanitarian Assistance GP: General practitioner Programme in the North Caucasus, the Russian HI: Handicap International Federation. ICRC: International Committee of the Red Cross All rights are reserved by the organization. The IDPs: Internally displaced persons document may, however, be freely reviewed ab- IMC: International Medical Corps stracted, reproduced or translated in part or whole, IMSMA: International Management System for but not for sale or for use in conjunction with com- Mine Action mercial purposes. This newsletter is not an official IR: Islamic Relief necessary represent the stated policy of WHO. IRC: International Rescue Committee LSG: Lets Save the Generation Correspondence should be addressed to: MDM: Médecins du Monde Russia Office of the WHO Special Representative MoH I: Ministry of Health of the Republic of In- of the Director General in the Russian Federation gushetia WHO publication. The views expressed in it do not MoH RF: Ministry of Health of the Russian Fed- 28, Ostozhenka, eration 119034 Moscow MoH Ch: Ministry of Health of Chechnya The Russian Federation MSF−B: Médecins sans Frontières-Belgium Attn: Irina Tarakanova [[email protected]] MSF−F: Médecins sans Frontières-France Tel.: (+7) 095 787 21 52/12 MSF−H: Médecins sans Frontières-Holland Fax: (+7) 095 787 21 19 PHO: Polish Humanitarian Organization Editors: Dr Corinna Reinicke PTSD: Post-traumatic stress disorder [[email protected]], Irina Tarakanova OCHA: United Nations Office for the Coordination [[email protected]] of Humanitarian Affairs For more information about WHO Disaster Prepar- SARC: Saudi Red Crescent Society edness and Response programmes, please con- SES: Sanitary Epidemiological Surveillance tact: STI: Sexually Transmitted Infections TAC: Temporary accommodation centre Dr Gerald Rockenschaub [[email protected]] UNICEF: United Nations Children's Fund UXO: Unexploded ordnance The "Health Action in the North Caucasus" news- VOM: Voice of the Mountains letter of the Disaster Preparedness and Response WHO: World Health Organization programme (DPR) can be found at http://www.who.int/hac/crises/rus/sitreps/en/in dex.html
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