What Bulgakov tells us about advanced roles for nurses in the former Soviet Union

I have now reached an age when I can go back to novels I read twenty years ago, reread them with fresh eyes and experience the joy of new discoveries.  Most recently, this has involved revisiting ‘A Country Doctor’s Notebook’ by Mikhail Bulgakov, a collection of short stories based on his experience as a newly qualified doctor sent to a remote region for his first job practicing medicine.  I sincerely believe it is essential reading for all new doctors and cannot recommend it highly enough.  In the 1990s, I was struck by how little had changed in the rural Russian landscape despite the electrification and mechanisation drives under Stalin.  In 2012, I was struck by the way in which different members of the clinical team were presented.  Maybe this is because I’ve recently returned from Minsk, Belarus where I was representing the Observatory  at a sub-regional policy dialogue on human resources in countries of the former Soviet Union.  As an aside to discussions about skill-mix and task shifting, a fascinating discussion developed around the concept of a ‘nurse’ and in the post-Soviet context, and where ‘feldshers’ fit into the picture. Nurses have their distinct heritage and philosophy which is focused on ‘care’, while the doctors are more focused on providing ‘treatment’.  So what’s a feldsher? Continue reading

Vaccination woes in Ukraine

Erica Richardson
European Observatory on Health Systems and Policies
5 April 2012

I’m recently back from a fruitful international meeting on crisis communication and pandemic preparedness in Kyiv, Ukraine.  One of the tools to be employed during an influenza pandemic is vaccination and while much emphasis is placed on obtaining vaccines of sufficient quality, stockpiling them and identifying the groups most at risk, less emphasis is often placed on ensuring those most at risk are willing to have the jab.  Consequently, in the meeting many of the discussions focused on ‘trust’ – who has it, who has lost it and how can public trust in state health interventions be rebuilt.  In the 2009 H1N1 pandemic, many at-risk Ukrainians resisted getting vaccinated despite a widespread ‘flu panic fuelled by alarmist media portrayals.  Vaccination coverage is something that we only touched upon in the recent HiT update for Ukraine (see page 12), but the immunization coverage data for 2010 are now available and warrant further explanation… Continue reading

“Four Russias”

Wednesday, 21 March 2012
Erica Richardson
European Observatory on Health Systems and Policies
6 March 2012
Four Russias
I’ve been pondering an intriguing opinion piece by Nataliya Zubarevich of the Independent Social Policy Institute in Vedemosti (30 December 2011, No. 248: 3014), which might be of interest to an ECOHOST audience.  NZ sought to explain the differing political landscapes in Russia in the aftermath of the Duma elections and the run up to the Presidential elections this year by conceptualising the country as four different Russias with different populations who were looking for different things from their political leaders – I paraphrase here for the non-Russian speakers: Continue reading