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Russian doctors, nurses practice health-care diplomacy in La Crosse

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Health care diplomacy trumps political tension between the United States and Russia for a delegation of doctors and nurses visiting La Crosse to glean ideas to improve care back home.

The two doctors and three nurses are rubbing elbows with their counterparts and others at Gundersen Health System this week as part of World Services of La Crosse’s Bridging Cancer Care project.

“Our main goal is to improve the health of our patients, their quality of life,” Dr. Mikhail Frolov said through an interpreter in answer to a question about strained U.S.-Russian relations. “The politics between our countries doesn’t make a difference.”

On the other hand, their concerns mirror those of their U.S. colleagues not only in health care but also in costs.

Nurse Margarita Vakulina said delegation members learned valuable lessons from the start Monday, as they observed the role of Gundersen’s nurse coordinators in streamlining care. The position, which does not exist in Russian health care, involves working with patients and dovetailing care with providers and hospital services.

“We saw how much money can be saved with just a small number of nurses coordinating care,” Vakulina said. “If you are talking about costs, this is very important. We are always looking for better practices.”

Russia’s health care system has major differences, Frolov said, adding, “Health care in Russia is a government system, with a different structure, different financing and different insurance.”

Nurse Irina Azrapkina said, “What we can see now is that we can’t say one is better than the other — all are good, but in different ways.”

“But we already know that small steps in practice can create big changes in care,” Frolov said.

One such change involves patient education, particularly regarding cancer — the second-leading cause of death in Russia, delegation members said.

“Smoking is one of the leading causes,” Azrapkina said, but an aggressive anti-smoking campaign aims to stomp out butts.

A no-smoking law that went into effect July 1 forbids lighting up in hospitals, public buildings, schools “and even bus stops,” Azrapkina said.

“There is a very aggressive anti-smoking campaign,” she said, adding that stores are not allowed to post cigarette signs, so patrons have to ask whether they sell smokes, concealed behind counters.

Cancer diagnoses often occur in late stages, when treatment is less successful, Azrapkina said.

Statistics from 2010 show that 13 to 16 percent of the patients in the high-cancer region of the Saratov Oblast of Russia were diagnosed at stage three, and 16 to 21 percent at stage four, according to World Services of La Crosse.

The fact that cancer surfaces in so many disguises presents the same problem in Russia as it does in the U.S., delegation members said. In addition to lung cancer, colon, rectal and breast cancers are major problems, Frolov said.

“We have heard that patient education here is good, and we hope to identify tumors in earlier stages,” Azrapkina said. “Now we have more screening to identify earlier.”

In addition, one of the project’s goals is to increase patient awareness about the need for breast and colon cancer screening by 25 percent by the end of 2015.

Employers require annual physicals that must include mammograms for women, Azrapkina said. Women who do not work outside the home are referred for mammograms when they go to hospitals or doctors, she said.

“People also live longer, so they get sicker, and there are more patients with cancer,” said Frolov, who said he has three patients who have contracted three types of the disease.

“They survive one, and then get another,” he said. “In our system, we are trying to monitor recurrences more closely.”

World Services’ cancer-fighting partnership with Gundersen is funded in part with a $150,000 grant from the Bristol-Myers Squibb Foundation in 2011 and another $350,000 grant last year under its Bridging Cancer Care Initiative.

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