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Pdf | 900.76 Kb Health in the North Caucasus NEWSLETTER ON EMERGENCY PREPAREDNESS AND RE SPONSE, APRIL 2001 Proposed Emergency TB Control Programme in Ingushetia to maintain the TB related services (a TB hospi- As reported in the March issue of Health in the tal, including an additional 50 beds, out-patient North Caucasus, the main objective of the dispensaries, laboratories, surveillance and joint WHO/Ministry of Health RF mission to monitoring services, etc.). the Republic of Ingushetia in March 2001 was to assess the TB infection burden in the re- MoH RF will provide the needed X-ray equipment public, including that among internally dis- and quantity of TB drugs of the first and second placed people (IDPs), and to devise relevant lines. measures to curb its uncontrolled spread. The If the necessary funds become available, the local health care infrastructure is not able to United Nations will be responsible ensuring: meet increasing demands. The estimated inci- dence of TB is 278 cases per 100 000 IDPs in · the purchase and setting up of prefabricated Ingushetia. modules for a 50-bed hospital; · the provision of laboratory equipment and appropriate diagnostic media; In order to control the spread of TB, an action plan based on WHO recommendations has been · the training of personnel; elaborated. In this plan, the responsibilities of · health education campaigns; the three main actors, MoH RI, MoH RF and UN organizations, were clearly outlined. The pro- · social support of TB patients; and posed plan encompasses all obligatory elements, · overall management including three local from active detection to curative treatment. staff members and a manager at central The Ingushetian government has pledged to in- level. crease the number of local personnel by 20 and Rehabilitation of the disabled By Zhanna Tsallagova, director The Vladikavkaz Centre for Rehabilitation of the Disabled with Muscular-skeletal Problems was established for both physical and social rehabilitation as well as to increase the social status of the disabled in society and with their family. The centre plans to set up classes for the voca- tional training of the handicapped at their cur- rent place of employment with an Ingushetian company and by creating at-home jobs. 1 Apart from suffering from their inability to serve reading room and deliver books to the disabled themselves fully in everyday life, the disabled at home. are also discontent with their inability to make a Last year, for the first time, a team from our living for themselves and their families, all of centre successfully participated in the Sports which fosters an inferiority complex. Games for the Disabled. This led to the idea of Given their varying intellectual and physical ca- establishing a professional sports team, which pabilities, it is planned to set up a computer would participate in competitions at various lev- class and rooms for learning jeweller’s, carpen- els. ter’s, knitting and sowing crafts. There will be Regional significance the possibility of some form of employment fol- The Vladikavkaz centre is of regional signifi- lowing completion. cance, because it is the only institution of its The centre is already trying to sign contracts type in the North Caucasus. In North Ossetia with some institutions of higher learning in the alone, there are about 2 000 handicapped in republic, stipulating enrolment quotas for the need of the services provided by our centre. And disabled in the daytime education and corre- there are even more unattended in the spondence learning d epartments. There will also neighbouring republics. Given the situation in be a library at the centre, which will have a the North Caucasus, we anticipate an increase in the number of disabled. By yearend, our centre will be radically restruc- tured in order to obtain additional beds and a catering unit, and become able to admit p atients from both remote villages of our republic and the North Caucasus region at large. This will e n- able us, if respective equipment and facilities are provided, to improve significantly the quality of the services. The issue of patient transportation to the centre and back home is also of critical significance. We will soon start using ambulances to provide transportation. However, following the recon- struction of the centre, the number of disabled undergoing rehabilitation will be increased to up to 40-50 persons at a time. We are already look- ing for the possibility of acquiring bigger ambu- lances from abroad, because no such vehicles are manufactured in Russia. Nevertheless, in spite of our ambitions, we still lack experience. To remedy this, in the near fu- ture we will contact similar centres in Russia and abroad in order to organize study tours for our In North Ossetia alone, there are about 2 000 employees. This will help make our centre more handicapped in need of the services provided by the Vladikavkaz centre. professional and more successful. 2 Obstetric and gynaecological services of the Chechen Republic in 2000 (based on the MoH Chechnya performance review for the year 2000) Due to the fighting in the Chechen Republic, many of the health institutions (primarily in Grozny), except for the central district hospi- tals in Goudermes, Shelkovskaya, Naour- skaya and Nadterechnaya, reduced their a c- tivities and provided only certain outpatient care at some polyclinics. As of the beginning of the year 2000, only 229 obstet- ric/gynaecological beds were in use in the republic, including 106 for the pregnant and for women in labour (versus 1 410 and 607, respectively, for the same period in 1998). Maternity Ward No. 2 in Grozny, April 2001 women was 4.1 (compared to 5.0 per 10 000 in Facilities and equipment the Russian Federation) versus 4.8/10 000 in As the situation in the republic stabilized, the 1998. In the districts, this indicator is much obstetric/gynaecological service bed capacity lower, a maximum of 2.9 per 10 000, although was expanded. By 1 January 2001, the number the majority of women live in rural areas. of obstetric/gynaecological beds totalled 804, The 70 OB-GYNs in Grozny (per 50 017 women with 435 for the pregnant and women in labour. population) and 14 in Argun (10 605 women) All inpatient care departments were in dire need are almost triple the republic’s average. The ru- of repair, though with relatively fair sanitary and ral districts (Vedensky, Shatoevsky, Nozha Yur- hygienic conditions. They are without central tovsky, Atchoy Martanovsky, Naursky, Grozny heating, water and a sustainable electricity sup- Region, and Nadterechny), on the other hand, ply. The sewerage system is in need of repair have only one third of the required number of and there is a lack of disinfectants, detergents, OB-GYNs, which is reflected in all service per- furniture, linen and medical instruments. formance indicators. In 2000, almost no diagnostic or rehabilitation equipment was supplied to the gynaecology o f- fices at polyclinics, women’s counselling offices and inpatient care facilities. Today, there are no appropriate conditions for pre-term baby care (though in the hospitals in Goudermessky, Kourchaloevsky, Urus Martanovsky and Argoun four incubators have been retained). Similarly, there are no services for blood han- dling, cytological, serologic, histologic and intra- uterine infection testing, determination of hor- monal quantification in women and hys- The main building of Maternity Ward No. 2 in teroscopies. X-ray facilities are not available in Grozny is still functioning. all districts. Medical professionals Preventive care As of 1 January 2001, the Chechen Republic For disease prevention, medical and diagnostic (455 320 women in total, of whom 164 675 are service provision to women, including those of of reproductive age) had 191 OB-GYNs (vs. 244 reproductive age, as of 1 January 2001 there in 1998). The number of OB-GYNs per 10 000 were 26 women’s counselling offices (13 in rural 3 areas and 13 in Grozny). The total number of The number of abortions per 1 000 women of gynaecological offices was 69, with 15 in Grozny reproductive age averaged 9.2, compared to 53 and 54 in rural areas. per 1 000 for the Russian Federation as a whole. Out of the total number of 191 OB-GYNs work- The quality of counselling and medical services ing in the republic, 69 (36%) worked for ambu- provided to pregnant women was considered to latory care/polyclinics, of them 19 in Grozny. be of extremely low quality, because of testing limitations and the medical personnel’s low level Reproductive health of training (many professionals are not special- More that 90% of pregnant women had ex- ized or have not taken refresher courses in o b- tragenital pathologies over the year 2000. stetrics/gynaecology). Anaemia was registered in 78% of the cases, kidney failures in 11.5% and circulatory diseases Drug supply in 3.4%. There was no targeted funding for drug pro- curement for gynaecologic patients, the preg- The total number of babies born in the republic nant and women in labour. The drugs and dress- in 2000 was 10 205. Early neonatal mortality ings were supplied mostly as humanitarian aid equalled 17.5%. The number of Caesarean sec- and, partly, by MoH RF. They were primarily tions per 1 000 deliveries was 68. Perinatal mor- pain-killers, antibiotics, spasmolytics, vitamins, tality in the republic was 35/1 000 (compared to injected medications and dressings. No drugs 29/1 000 in 1998). were provided on a regular basis. Only 30% of BCG was administered to 82% of immunised the needs were met. babies and polio to 69%. Lab service Approximately 39% (3 914) of all babies were The existing lab facilities of the republic tested delivered at home (without a follow-up hospital the pregnant and women with gynaecologic p a- visit).
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