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To Russia with love


* UPDATE: Cuba cares for Keeba

Whitethorn youth baseball team traveled to Cuba; player injured

IN THE COURSE DESCRIPTION, IT IS DESCRIBED AS "an immersion experience into the culture and health care system of a nation of ethnic diversity, poverty and acutely diminished resources in the health care sector." But hiding behind that academic language was a life-changing journey, one which took 10 nursing students from Humboldt State University and thrust them into the society and hospitals of the town of Nakhodka, located on the eastern fringe of Siberia. Working in a pediatric hospital, a maternity hospital and the general city hospital, they did more than visit the health care system -- they lived in it.

[photo of group]At top: Lacy Jackson in scrubs.
Left: Nursing students (left to right) Elizabeth Perpetua, Laura Mojica,
Katie Allen Cheryl Thompson, Jana Martin, Erica Foss and
an unidentified Russian interpreter.

It is called "transcultural nursing." Students volunteer to leave the shelter of home and to go to another country, learning its values, methods and culture -- and how those affect the country's health care system. Participants worked five days a week at one of Nakhodka's three hospitals, watching and helping their Russian counterparts. It was an experience sometimes uplifting, sometimes depressing, sometimes frightening -- but always enlightening.

"Now that I know and have seen Russia, I would not want to go to the Russian hospital," said Katie Allen, a second-year nursing student who took part in the trip. "That was actually my fear; I would pray every day for all of us not to get hurt. You might never leave the hospital."

Why not?

"Infection," Allen said. The risk was everywhere in the Russian hospitals -- and it was often ignored. U.S. hospitals are equipped with special hand-washing sinks that can be operated with foot pedals, eliminating the need to touch handles. Not in Russia.

"They didn't even have hot running water in the city hospital," said Cheryl Thompson, a program participant who graduated from HSU's nursing program in the spring. Among the basic items the hospital was often not able to provide were toilet paper, sheets, medications, IV needles and sometimes even soap. Such necessities were often available at a local drug store, but only if you had the money to buy them. Cotton balls were unavailable, so nurses roll wads of gauze during their down time.

[photo of hospital] The city hospital, where serious injuries were taken care of.

"The same pair of gloves would be used to go from patient to patient," said Mary Anne Levine, who has been leading transcultural nursing expeditions since 1985. This practice could easily facilitate transmission of infections from one patient in the hospital to another. Levine said the lapse in sanitation is partially due to lack of funds -- gloves are scarce -- but that's not the only cause.

"It's not necessarily always related to finances," Levine said. "It's their cultural interpretation of infection control. They don't have the consciousness that they can transmit infections." Some of their fellow nurses even refused to wear gloves at all.

 [photo of Erica Foss] Erica Foss feed babies at the children's hospital.

 [photo of Katie Allen] Katie Allen, in surgical scrubs, holds a newborn.

"One day there was a big discussion in the pediatric ward. The doctors insisted that the nurses wear gloves and the nurses refused. They said that they didn't have enough time. That is incredible."

Not wearing and reusing gloves are practices that could have dire consequences. Until recently, the main danger is that a bacterial infection could be transferred from one wound to another, which is serious but not likely fatal. With the recent introduction of HIV into Russia, however, that will change.

"We were very worried that this area is going to have a huge epidemic because they don't quite understand all the precautions they need to take," Thompson said.

An awareness of infection wasn't the only difference between their health system and in the United States. A scarcity of pain medication coupled with a culture of stoicism where patients are expected -- required, really -- to grin and bear it during pain-intensive procedures.

"There was a guy who came in and they said it was going to be minor surgery. Then they operated on his lymph glands," Thompson said. She said that operating on those glands involved "basically slitting his throat. And this was all done with local anesthetic."

"The patients were often obviously in pain, but they're very stoic about it," Allen said. "They don't scream, they don't even ask for pain medication. I couldn't do it -- I felt like a big baby."

And Russian nurses often share that stoic attitude, Allen said. Enduring pain was "just what you gotta do."

Russian nurses occupy a different place in the hospital hierarchy than their American counterparts. U.S. nurses receive a more comprehensive education, allowing them to make many informed decisions about the care that a patient is receiving. They can voice concerns when they believe a patient isn't getting appropriate care from his or her doctor, acting as "patient advocates" even if that it means disagreeing with a doctor.

[photo of nurses] Nurses fold surgical gauze in place of cotton balls.

"They don't have that, which is pretty sad to me," Allen said. Not only do nurses lack the education required to make decisions, their input is also not welcomed.

"They don't question the doctor," Thompson said. She pointed out that the Russian word for nurse, Medsestre, means "little sister to medicine." Thompson said, "You're seen as the doctor's little sister when you're a nurse."

Levine said she would sometimes ask the Russian nurses why they were giving a medication to a patient, "and they wouldn't even know." It is that way in much of the world, she said, but not in the United States.

"American nurses aren't trained, we're educated," Levine said. "Here we teach critical thinking skills and principles" along with technical knowledge.

One would expect a newly graduated American nurse like Thompson to bridle under the Russian system. But one of the things that the group had to learn was to respect differences in culture and realize that as different as their Russian colleagues were, they were still trying to save lives and heal wounds. For example, their ambulances lack car seats for children; the Siberian solution is to have nurses carry the babies.

[photo of Katie Allen] Katie Allen as a human carseat.

[photo of ambulance] Lacy Jackson and ambulance.

Thompson said her might sound grim, but "I don't want to paint the picture that people there are getting terrible care. [The medical staff is] really doing the best they can with what they have."

Allen said the people they met outside of the hospital have also had to make do with what they can get. She describes visiting apartment houses and thinking that from the outside, "Everything kind of looks the same -- just rectangles." Once inside, though, the apartments were full of personality. "The kitchens were very small, and they reuse everything, but there were always lots of plants and books."

Compared to Americans, Russians are certainly very poor, Allen said, but rent is inexpensive and the local diet is supplemented with food grown in backyard gardens.

"People have enough to survive."

Even more amazing than the resiliency and resourcefulness of the people of Nakhodka is their willingness to share what they have. Allen, Thompson and Levine all said that people are very open and giving.

"I'd recommend that anyone travel there. You'll meet people who will take you into their homes and make you part of their family. When you travel in other countries people are more closed," Thompson said. At work or on the street, Russian people were often gruff and rarely smiled. But once they were at home in a family setting, they became extremely welcoming.

"They were so open and very hospitable," said Levine. "They just took us in."

Thompson tells the story of her friend Zoya, who invited her to her house for dinner -- "a feast" -- and then let everyone use her sauna, or Banya.

"I'm so floored by that, because if a group of Russian nurses came to America I don't know that they would get that. I don't know that people would take them in and make them part of their families."

[photo of family] Zoya and the family at the Banya.


It wasn't just good hospitality.

"They are very family oriented," Thompson said. "They actually give women up to three years to stay at home with their children -- paid -- and men can take a long time off of work after the birth as well. Actions like that really show commitment to family values instead of the lip service we do in this country."

But with poverty high and economic prospects uncertain, there is also a darker side to Nakhodka. Levine said that many people she saw were very depressed because "They don't feel that they have a future." Just last year, she said, a group of six high school students killed themselves in a suicide pact.

Allen said while she grew to love the children she worked and lived with, it was often heartbreaking. Many of the children had been abandoned and face an uncertain future.

"It made me so sad that they have no parents. I just wonder what life's going to be like for them," Allen said. Many are adopted by couples from other countries, but some, with HIV or fetal alcohol syndrome, "are outcasts," Allen said.

Unemployment is high, Levine said, in part because a plodding and inefficient government inhibits potential enterprises.

"There is a huge port there and Americans have come in and tried to get things going." But faced with a regulatory system nearly impossible to navigate, they eventually gave up.

[photo of feast] "They just took us in," said Levine, third from the left.

Bureaucracy and unemployment are more reflections of deeper cultural differences. Having lived in a controlled economy for so long, Levine said, "They just don't understand about paying bills or waiting for orders to come in."

They may have to learn. Levine, Thompson and Allen agreed that people had enough to eat, but both water and electricity are spotty at best. There was a demonstration against failing services while the group was there -- the first protest in memory for Nakhodka.

Levine said that her students didn't have any trouble adjusting to the cold showers and randomly timed spurts of electricity.

"I worked with a fantastic group of innovative, flexible and creative students," who readily discovered "the common strand among all nurses -- caring," Levine said.

"It was a life-changing experience for them."

Cuba cares for Keeba


[photo of Keeba]HSU'S TRANSCULTURAL NURSES AREN'T the only Humboldters to get a taste of another culture's health care system. While the nurses were working in the remnants of a state-run health care system, one Southern Humboldt youngster was on the receiving end of some socialized medicine in Cuba.

Keeba Drake was playing third base with the Lost Coast Pirates, a youth baseball team from Whitethorn that traveled to Cuba in July on a "baseball diplomacy" tour with the Garberville chapter of Veterans for Peace. The team and the veterans were both part of a US-Cuba Friendshipment Caravan organized by Pastors for Peace.

While trying to tag a runner out during the second of three games the team played against young Cuban ball players, Drake was hit in the leg and twisted his knee. It soon became apparent that there was a problem.

"Keeba seemed to be in more pain than this particular sort of blow would produce," said Rob Then, president of the Southern Humboldt Little League and witness to the event. The Cuban team's medic -- yes, Little League teams in Cuba have their own medics -- checked Keeba out and sent him to Havana's general hospital.

"After their initial assessment at the general hospital, they took him across town to the orthopedic hospital and had him seen by the top orthopedist."

What they found surprised everyone: x-rays showed that Keeba had a bone spur in his knee. It made sense, Then said, because "Keeba had sustained leg injuries before and his always bothered him more or for a longer period than the other kids if they got whacked in the leg."

Then said he was impressed. "My point is that that the Cuban health care system, which is free to all of their citizens, responded wonderfully to the team. They were just given great care."

The team did not have any other major medical problems on the trip, although they did have trouble adapting to Havana's heat and humidity. Several boys passed out from the heat towards the end of the first game they played.

An obvious suspicion would be that Keeba was given better than average care because he was a guest, but Then said that what he saw didn't support that idea. "I'm sure that the fact these kids were guests played some role in how they were taken care of, but we were in two hospitals looking at all the regular people, and they were getting taken care of.

"I think a kid on the Cuban team would have gotten the same care," Then said. Keeba did receive one piece of special treatment, however. When part of the Pirates team paid a visit on Cuba's president, Fidel Castro signed his cast.


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