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As a child growing up during the Cold War, Joan Warren, RN, never thought she’d interact on a positive basis with the Russian people. "We were raised to fear the Russians, because they had the bomb," she said. But as a nurse at the turn of the century, she counts several Russians as her friends. Since 1998, she’s traveled to Russia on four different occasions–– three times as a volunteer with Heart to Heart, an Oakland, Calif.-based nonprofit organization that provides free medical services, extensive training, education and medical supplies to sponsored hospitals in St. Petersburg. In July, she went just for fun, to visit friends she made during her humanitarian excursions. "I fell in love with the people in St. Petersburg and their need. Their need is tremendous," Warren said. Russian nurses, she said, make about $20 a month––if they’re paid. But lack of funding wasn’t the only need when Heart to Heart was founded 11 years ago, said Josie Barry-Everett, executive director of the organization. "The medicine and surgery that the Russians were performing was equivalent to about 1950 in the U.S.," Barry-Everett explained. That left many unmet needs in 1989, particularly for cardiac care. At that time, a Russian interpreter implored the American businesswoman for whom she was translating, to somehow help her 7-year-old daughter with a congenital heart defect considered untreatable and terminal in Russia. Her daughter was brought to Children’s Hospital Oakland pro bono for the life-saving surgery. That success prompted more requests from Russian families whose children needed cardiac treatment. Heart to Heart evolved to help them out, not by flying more children to the United States, but by training Russian health professionals to provide the care themselves. "We don’t go and show off" by performing surgeries with techniques and equipment that are inaccessible to the Russians, Barry-Everett said. Instead, physicians, nurses and other clinicians bring supplies and teach techniques on their missions that their Russian counterparts can replicate after the Americans return home. Recently, the surgical team taught its colleagues how to do off-pump coronary bypass surgery––surgery on a beating heart that circumvents the need for a heart-lung machine. Since its inception, Heart to Heart has sent more than 20 medical teams and more than $15 million worth of medical supplies and equipment to Children’s Hospital No.1 and Adult Hospital No.2 in St. Petersburg. Volunteers use their vacation time and usually pay for their airfare for the trips, which are about two weeks long. Most volunteers have been from the Oakland area, but teams from the Boston area and other parts of the country have participated as well. In large part due to training and donations from Heart to Heart, the cardiac program has improved significantly. "By 1999, they had almost caught up to us," said Barry-Everett. But supplies remain scarce and help is needed. Critical to the missions have been the nurses involved, she said. "We couldn’t do it without them. American nurses are incredibly well received there. American nurses do so much more work in terms of their depth of knowledge, the level of care they provide." So, early training by Heart to Heart volunteers focused on the role of nurses as part of the cardiac team. The nurses’ involvement extends well beyond the operating rooms in the Russian city. About six to eight months before a trip, the nurses and others start to scrounge for supplies. "I was in charge of everything that we needed to do open-heart surgery in St. Petersburg. We had to bring everything," said Owenita Escalada, RN, specialty coordinator for neurosurgery and vascular surgery at Alta Bates Summit Medical Center in Berkeley, Calif. Escalada has been on two missions with Heart to Heart. She and Warren, service coordinator for cardiac and thoracic surgery at Alta Bates, were chosen to participate by Nilas Young, MD, a cardiac surgeon and one of the founders of Heart to Heart. But even before they were asked, both women wanted to be part of the operation because of the enthusiastic stories they heard from other volunteers. Escalada’s pre-trip role involved cajoling medical supply representatives to donate necessary equipment. Warren also hit the phones to ask for donations and began saving usable, uncontaminated supplies that otherwise would have been thrown out. The clinicians from the two countries share information like colleagues because the Russian nurses have learned so much since the missions started, she said. "You don’t go there to boss them around. You go there to teach and to learn." Escalada, for example, has learned to be a lot more resourceful. "We’re so spoiled. We need specific things to do a case," she said. "Over there, they can do the same case without using the same things we do." Escalada surprised herself by working with some of the Russians to jerry-rig a new electrical connection to fix a faulty headlight on a piece of the surgeon’s equipment. Had she been in the States, she would have just reached for a new one. Warren said she’s benefited from working on cases she would never see here. "It’s been a real learning experience," she said. "It expands your horizons." Her international expeditions also have energized her practice at Alta Bates, renewing her interest in her chosen field. "We’re all part of a special mission," she said. Both women are ready to contribute their energy, their efforts and their vacation time again. Escalada said, "If I get asked to go again, I wouldn’t think twice because of the friends I have made."
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