At times by air in a helicopter, other times on foot flanked by armed bodyguards, Linda Spencer, Ph.D., R.N. has traveled through some of the poorest, most unstable and dangerous countries in the world. With an overall mission of strengthening the capacity of the direst health care systems, Dr. Spencer concentrated her efforts by working one-on-one with local nurses and their patients. Although each patient encountered in her journeys has left an indelible impression, perhaps none have touched her so deeply as the sick and the elderly suffering in Russia's Northern Caucasus region.
In a collaborative effort between the Russian Red Cross and the American Red Cross, Dr. Spencer was first sent to Russia in 1995, where she spent two years traveling throughout the country directing a training program for Russian Red Cross home health nurses, called the Visiting Nurses Program. Using a training manual developed by the American Red Cross called "Foundations of Caregiving," Dr. Spencer's goal was to improve the level of home health care and the resources available to the nurses.
The program was an overwhelming success, and four training centers were established for the 70-hour course. The manual revolutionized training for visiting nurses and was subsequently accredited and adopted by the Russian Federation to be included into the standard nursing curriculum.
In August, 2002, Dr. Spencer returned to Russia, this time as an American Red Cross delegate working with the International Committee of the Red Cross (ICRC). Her mission was to assess the Visiting Nurses Program in the Northern Caucasus region - a volatile area in southern Russia bordering Georgia and Azerbaijan, and including the war-torn Republic of Chechnya.
Funds for the program came from a $1 million grant from the U.S. State Department to the American Red Cross, allocated to improve organizational effectiveness of Russian Red Cross branches in the Northern Caucasus region and to support the Visiting Nurses Program.
Although her history with international health services goes back 20 years and includes work in several third world countries, nothing prepared Dr. Spencer for what she found in Russia's Northern Caucasus.
"Many of the visiting nurses' patients are men who are veterans of World War II. They have dedicated their lives to their country, but now have been forgotten by their governments and treated as a burden," said Dr. Spencer. "For many of them, the visits from the Red Cross nurses are the only contact with the outside world that they have. It was heartbreaking."
Living conditions in the Northern Caucasus are some of the harshest in the country. An area at one time dependent upon the coal mining industry, the economy plummeted as coal mines closed over recent years. Meanwhile, the effects of years of civil war in Chechnya have spread throughout the Northern Caucasus region, as thousands of displaced persons have sought safety.
The situation was further aggravated during the second half of June, when heavy rains inundated southern Russia, destroying more than 13,500 homes and displacing at least 300,000 residents.
The financial instability has left the Northern Caucasus' vulnerable population with little medical support other than that offered by the Russian Red Cross' visiting nurses.
"There is no health care system to take care of the patients, and many have been left alone by their families, so the program is the only thing sustaining them," Dr. Spencer explained. "The nurses serve the elderly and disabled who are frequently trapped in their apartments because they can't use the stairs and there are no elevators. The patients are receiving food parcels from the ICRC as well, but when that service is discontinued, I don't know how they will survive."
The American Red Cross and ICRC grant from the State Department is scheduled to end in December, 2002. With only a few months of financial assistance remaining, Dr. Spencer stressed the need for support from the international relief community.
"The visiting nurses do what they can, but they have almost nothing to work with. They begged me for thermometers, gloves, hot water bottles, bed linens, First Aid supplies, syringes, disinfectant - financial donations for any of these basic supplies are critical and urgently needed," she said.
Support Needed for all Visiting Nurses Programs
The struggles of the Visiting Nurses Programs throughout Russia and all former Soviet republics date back to the collapse of the Soviet Union in 1991.
"Under the government of the Soviet Union, all citizens were obligated to make donations to the Red Cross. When the government collapsed, so did the financial support for the relief organization," explained Jacqueline Greene, Senior Associate of International Services with the American Red Cross. "Since that time, the Russian Red Cross and the Red Cross societies in all former Soviet republics have struggled to maintain their vital operations, such as the visiting nurses program."
Over the past decade, assistance for the beleaguered operations has come from international relief agencies, including the American Red Cross.
One program the American Red Cross has supported is the expansion of services provided by the visiting nurses program. In 2001, American Red Cross pledged $100,000 to support the Russian Red Cross Visiting Nurses program to pilot a project to prevent and control the spread of tuberculosis, which that year alone infected an estimated 111,000 Russians.
Through this ongoing program, nurses monitor patients' progress in combating the disease, ensure that they follow a healthy diet and remind them to take medications properly and regularly.
The Russian Red Cross has been piloting a new approach to TB control for Russia, based on the Directly Observed Treatment - Short Course (DOTS) approach recommended by the World Health Organization. In this approach non-infectious patients are allowed to go home, and are followed up by the Visiting Nurses to ensure their treatment compliance. The close support and monitoring of the nurses helps to ensure that patients do not fail to take their medications and relapse, or, even worse, develop multi-drug resistant tuberculosis.
However, with funds drying up, like Dr. Spencer, Greene, too, emphasized the crucial need for donations.
"The tuberculosis program is a great example of what the visiting nurses program can achieve," said Greene. "To lose the program would be devastating for the Russian health care system and the patients who depend on home treatment."
Dr. Linda Spencer is currently serving as the Director of the Public Health Nursing Program at Emory University School of Nursing in Atlanta, Ga.
- American Red Cross
- All American Red Cross disaster assistance is provided at no cost, made possible by voluntary donations of time and money from the American people. The Red Cross also supplies nearly half of the nation's lifesaving blood. This, too, is made possible by generous voluntary donations. To help the victims of disaster, you may make a secure online credit card donation or call 1-800-HELP NOW (1-800-435-7669) or 1-800-257-7575 (Spanish). Or you may send your donation to your local Red Cross or to the American Red Cross, P.O. Box 37243, Washington, D.C. 20013. To donate blood, please call 1-800-GIVE-LIFE (1-800-448-3543), or contact your local Red Cross to find out about upcoming blood drives. © Copyright, The American National Red Cross. All Rights Reserved.