aiha success stories · ed orenburg were struck by the sight of nurses performing menial...

ed Orenburg were struck by the sight ofnurses performing menial labor. “What awaste to have them scrubbing downwalls,” Stith says, still riled by thethought. The Elmhurst team immediatelydrew a connection between this under-utilization of human resources and thepatient retention problem.

Elena Gutareva is a nurse in the vol-untary testing and counseling unitof the Orenburg AIDS Center. Sheprovides pre- and post-test coun-

seling to those getting tested for HIV in theRussian town of Orenburg. “Every personhas his own personality, so counseling hasto be done on a case-by-case basis,” sheexplains. As she describes it, her job is asmuch about listening as it is aboutexplaining the mechanics of how HIVreproduces in the body. “We try to findways to explain HIV that are appropriateto each person.”

Gutareva is a natural fit for the job, easilyestablishing a rapport with her patients andtaking her cues from them. Despite almosttwo decades as a nurse, however, this kind ofpatient contact is new, even novel, to her.Russian nurses have traditionally been rele-gated to administrative and even janitorialroles. They have performed very little of thepatient support services—intake, counseling,and health education—that are consideredcore duties of the nursing profession inmuch of the world. In most cases, that hasmeant that patients haven’t had access tothese crucial services.

But as the staff at the Orenburg AIDSCenter has learned, these support servicescan go a long way in determining thehealth outcomes of their patients. Throughan institutional partnership with theElmhurst Hospital Center in New YorkCity, the AIDS Center has committed itselfto improving the care and treatment itoffers to people living with HIV/AIDS. Thepartnership is supported by the AmericanInternational Health Alliance (AIHA)through funding from the US Agency forInternational Development (USAID).

When the partnership began in late 2004,the AIDS Center had trouble even keepingits patients in care, recalls Jacqueline Stith,a nursing supervisor at Elmhurst who isactive in the partnership. In the face ofthis, Stith and other US partners who visit-

AIHA Success Stories

Nursing a Russian AIDS Center to HealthBy Empowering Nurses, an AIHA Partnership Improves Patient Care in Orenburg

Physician Naylya Mikhaylova (left) and nurse Natalia Kargopoltseva (right), both of the OrenburgAIDS Center, share a patient history with Elmhurst Hospital's Dr. Marilyn Fabbri. The partnership hasled to greater collaboration between nurses and doctors at the AIDS Center.

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“We try to find waysto explain HIV thatare appropriate toeach person.”

When the American partners suggestedthat the partnership workplan shouldinclude an expanded role for nurses, theirRussian counterparts were skeptical butagreed to try it.

Recognizing that seeing is believing, theElmhurst team countered their Russiancolleagues’ initial doubts by bringing themto New York to see how nurses thereworked. Elmira Vagapova, chief nurse atthe AIDS Center, came and shadowed herAmerican counterparts as they went abouttheir daily duties. Equally important wasthe fact that doctors and administratorsfrom Orenburg also had first-hand oppor-tunities to see the way nurses and doctorsat Elmhurst interact with patients andwith each other.

Less than two years later, the transformation in Orenburg is remarkable. “We havepatients who come to us and say, ‘HIV is not curable, so why am I taking this medi-cine?’” says Vagapova. “And the nurses can explain, we can counsel that patient. That’ssomething we credit our partnership with.” The nurses educate patients about howantiretroviral drugs work to keep HIV at extremely low levels in the body, therebyimproving the health and quality of life of those living with the illness.

Such positive changes prove that it was not a lack of training or ability that kept thenurses from playing a crucial part in improving the quality of patient care. It wasreliance on the traditional roles of an ineffective system. “The key has been getting theothers on board with the plan—the infectious disease specialists, the director,” Stithobserves.

Nurses at the Orenburg AIDS Center now work closely with doctors in two-personteams, providing counseling and education to help patients manage their disease, asthey’ve learned from their US partners. For example, nurses use pillboxes and samplemedications to reinforce the importance of taking antiretrovirals according to the

AIHA Success Stories

2006/No.23

indicated schedule and to encouragepatients to set up their own systems toremind themselves. They follow up withpatients who fail to show up for appoint-ments, even making house calls at times.They try to establish a connection withtheir patients, so that each one will feelcomfortable asking questions or talkingabout the struggles of managingHIV/AIDS.

By all accounts, these efforts have been suc-cessful. Laura Vishniakova, another nurseat the AIDS Center, tells the story of ayoung woman who nodded stoically as thedoctor told her she was HIV-positive. “Themoment the doctor left, the girl looked atme and she said, ‘Talk to me,’” Vishniakovarecounts. “Every nurse has a story like that,”she says, stressing that until recently, nurseshad not been empowered to provide thistype of patient support. “Before, only thephysicians did counseling, but now we’reconsidered specialists too.”

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Russian nurse Elena Gutareva has eagerly andadeptly taken on her new role in the voluntary testing and counseling unit at the Orenburg AIDS Center.

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US and Russian nurses have worked together to elevate nursing as a professionat the Orenburg AIDS Center. Shown here are American nurses Jacqueline Stith(front right) and Judith Garcia (front left) with the head nurse of the OrenburgAIDS Center, Elmira Vagapova, and her staff.

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“We have patients who come to us and say,‘HIV is not curable, so why am I taking thismedicine?’ And the nurses can explain, we cancounsel that patient. That’s something we creditour partnership with.”