Kate Steenberg (left) and Beth Megerth, MS, NP, enjoy hands-on pediatric interaction at a clinic in Bishkek.

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Kyrgyzstan Online

To learn more or to get involved with the Montana National Guard partnership with Kyrgyzstan, contact Sami Butler, Montana Nurses Association at (406) 442-6710 or e-mail sbutler@mtnurses.org.

Health care challenges

Until the collapse of the Soviet Union and the declaration of Kyrgz independence in August 1991, Kyrgyzstan’s health care system depended on the former Soviet Union’s Ministry of Health for financial support. Without the support of a major country’s economy, Kyrgyzstan’s health care system has suffered in the past 10 years and the health of the Kyrgyz people has measurably declined, according to a report released last August by the Business Information Service for the Newly Independent States of the U.S. Department of Commerce.

Cardiovascular disease is the major cause of death, and accounts for more than 40 percent of the total mortality rate in Kyrgyzstan today, while respiratory infections in children and a decline in access to pre- and postnatal care are the major causes of infant mortality. The incidence of sexually transmitted diseases has rapidly increased, and tuberculosis, intestinal infections, dysentery and brucellosis (a systemic infection also know as undulant fever or Bangs disease) also are on the rise, according to the report.

~ Michelle Paolucci

A devoted people
In one sense, that was easy. The Kyrgyz people were welcoming and eager to learn from their American visitors, Butler said. On the other hand, Butler and her colleagues were shocked by the shortage of supplies in clinics and hospitals. Protective gloves, ECG machines, wound dressings and antibiotics were hard to come by. IV needles were re-used, to the point of becoming dull.

"There’s really just a dire need," Butler said.

Still, the Kyrgyz impressed their guests with their efforts to make do. Besides turning scraps of paper into patient gowns, medical staffs also kept their hospitals clean and managed to follow sterile practices in a rural clinic without running water. Steenberg recalls that the clinic had a three-basin system, which required nurses and doctors to dip their hands in a bleach solution.

"That’s effective," Steenberg said, "But it’s tough on your skin."

Another demonstration of the Kyrgyzstan nurses’ devotion was that they may have to go months without getting paid – one of several signs the Kyrgyz economy is in trouble.

Steenberg, Megerth, and Butler were careful not to be "ugly Americans" during their visit, but they nonetheless saw aspects of the Kyrgyzstan health care system that left them concerned.

A step back in time
For one thing, some Kyrgyz health officials seemed to lack awareness of sound aseptic principles. During one tour, the hosts "just waltzed right into the first part of the OR," Steenberg recalled. "No masks, no shoe covers."

Steenberg also observed that nurses maintained a disturbingly low status compared to doctors. This was apparent during a training session given to Kyrgyz doctors and nurses.

"As long as the doctors were there, the nurses wouldn’t speak at all," she said. "It didn’t matter what I asked the nurses, the doctors would answer."

The Kyrgyz also could improve their treatment of mental health patients and developmentally disabled people, Megerth said.

"It’s like our mental health system was in the 1950s, when mental health patients were hidden in asylums," she said. "They’re kind of the untouchables of society."

Dire need
The Montana National Guard program isn’t the only attempt to bring U.S. health care expertise to the former Soviet republics in Central Asia. For example, a partnership exists between the medical community in Tucson, Ariz., and the city of Almaty in Kazakhstan.

Arlington, Va., nurse Betty Bristol, meanwhile, is a one-woman aid program. Bristol, a 54-year-old RN with a master’s degree in community health nursing, lives in the rural Kyrgyzstan city of Naryn and has taught basic preventive health and hygiene courses there. She also coordinates medical volunteer trips and is involved in a project to assess the health of children in two rural villages.

Bristol has had to combat a lack of awareness about preventive care – especially dental care – and even the belief that people can use the "Evil Eye" on one another. She first arrived in Kyrgyzstan eight years ago with her husband, an official with the U.S. Justice Department who was helping set up a court system. She visited again two years ago and has stuck around.

"My heart was moved by the health care needs of the Kyrgyz people," Bristol wrote in an e-mail from Kyrgyzstan. "[My work here] has reinforced my view that education and prevention as taught by health care providers such as nurses are essential."

Montana nurses also have been moved by the needs of the Kyrgyz. For the recent cargo container of supplies, nurses contributed enough materials to fill 25 boxes. Steenberg’s colleagues also have given their time, agreeing to work her shifts so she could go to Kyrgyzstan last summer.

None of this generosity of spirit surprises Steenberg.

"Although most nurses are overstressed and underpaid and underappreciated by physicians, they have that instinct to help," she said.