'A revolution in out hearts'

AAACN Viewpoint, Mar/Apr 2002 by Pyle, Rebecca Linn

Special Report

Viewpoint Editor Becky Pyle describes her visit td Ukraine where she spoke with nurses and physicians about ambulatory care nursing practice in America. One of the nurses told her "You woke us up" nurses' potential in their country.

Last August, I traveled to Ukraine to learn more about nursing in that country and to educate nurses, physicians, and government officials about ambulatory care nursing practice in America.

As it turned out, I was able to share valuable information about ambulatory care nursing in the United States with our Ukrainian nurse colleagues while at the same time have a life-changing learning and living experience of my own.

My discussions about the trip to Ukraine began early in 2001 after I received an e-mail from Amy Hecht, a nurse currently living in Denver who is Dean Emerita, College of Allied Health Professions at Temple University in Pennsylvania. I had been recommended to Amy as someone who may be interested in learning more about nursing in Ukraine. She was also aware of my association with AAACN and my years of professional work in ambulatory care nursing. I gladly accepted Amy's invitation to lunch.

On August 24, I found myself boarding a plane to Kiev with Amy. We had bonded as friends and colleagues almost instantly. As the plane ascended, I thought back to the e-mail that marked the beginning of our journey.

Background

In 1998 I had the honor of hosting a group of medical and government officials from Ukraine who were visiting the Westminster Kaiser Medical Office where I worked as the Medical Office Administrator.

The visit had been arranged by John T. Reeves, MD, Professor Emeritus at the University of Colorado School of Medicine. What was to be a 2-hour visit turned into an entire day of discussion about health care at Kaiser Permanente and in Ukraine.

The visitors were in America at the invitation of NADIYA, which means "Hope" in Ukraine. NADIYA is a Denver group founded in 1992 to provide assistance in health care, especially family medicine, to people in Ukraine.

NADIYA represents the Department of Family Medicine at the University of Colorado School of Medicine (Dr. Reeve's department), Montview Boulevard Presbyterian Church in Denver, the Ukrainian-- American Association in Denver, and some interested individuals.

Dr. Reeve's department provided the initial impetus for the group's visit here. NADIYA!s work has had a noticeable effect in strengthening family medicine in several Ukrainian cities, primarily Kiev, L'viv, and Komsomol'sk. Efforts by the group have included but are not limited to: making recommendations for organization of ambulatories, evaluating the success of family medicine assistance in developing curriculum for education of family doctors, providing clinical and educational materials, and offering side-by-side teaching.

Collaborative clinical research has been published in Ukraine on patient health education, emotional health, and alcoholism. NADIYA has also provided exchanges of personnel, clinical instruments, physicians' bags, and facilitation of a USAID-funded study tour for 23 Ukrainian physicians at the University of Colorado in 1998.

In 2000, NADIYA initiated a novel program of integrating physical and emotional health in L'viv. Early this year NADIYA received a request from the Department of Family Medicine in Kiev for assistance in the training of family practice nurses. Our visit from August 24 to September 7 was in response to that request.

Ukraine

Ukraine is slightly smaller than Texas and is the second-largest country in Europe. Belarus, Hungary, Moldova, Poland, Romania, Russia, Slovakia, and the Black Sea border this country, which is rich in natural resources including iron, coal, natural gas, oil, salt, sulfur, timber, and arable land. Strategically positioned at the crossroads between Europe and Asia, it has been fought over and subjugated for centuries.

The country enjoyed a short-lived independence from Russia in 1917-1920. Those years were followed by Soviet rule in 1921-1922 during which two artificial famines took over 8 million lives.

During World War II, Nazi forces occupied Ukraine and German and Soviet armies were responsible for some 7 million more deaths.

Environmental, Social, Economic Hurdles

In 1991, with the dissolution of the USSR, Ukraine voted for independence. True freedom remains elusive, though, as many of the former Soviet elite remain entrenched. Efforts at economic reform, privatization, and civic liberties are stalled.

There is a negative population growth rate in Ukraine. Life expectancy at birth for the total population is 65.98 years. Half of the population lives below the poverty line. For employment, 32% of the people work in industry and construction and 24% work in agriculture and forestry. Major industries include coal and iron mining, electric power, and food processing, especially sugar.

As we prepared for our trip Amy and I read about some of the current environmental issues: inadequate supplies of potable water; air and water pollution; deforestation, and radiation contamination in the northeast from the 1986 accident at the Chernobyl Nuclear Power Plant. I began to wonder what I was getting into. As if that wasn't enough we read that travelers must register with Ukrainian authorities upon arrival and may be asked by the local police to present their passport and visa. Crime is a serious and growing problem in Ukraine. Tourist facilities are not highly developed and many of the goods and services taken for granted in other countries are not yet available. Now that got my attention.