Creating a Healthier World:
The Institute for Global Health has formed a new partnership with Novgorod State University (NovSU) in Russia to exchange ideas about effective healthcare policies and programs to improve public health. As part of a three-year grant from the U.S. Department of Education, the partnership promotes student and faculty exchanges between NovSU and UMass Amherst.
The partnership comes at a critical time in Russian history. Since the breakup of the former Soviet Union, deaths have exceeded births by approximately one million people each year due to an unprecedented increase in mortality rates, especially for men, and a declining fertility rate.
The rising mortality rate among the Russian population is primarily due to chronic diseases such as heart disease, stroke and diabetes, which has decreased the life expectancy for Russian men. Currently, Russian men live an average of 59 years, compared to American men, who on average live to age 76. The demographic crisis in Russia is exacerbated by a high abortion rate. Given these rates, the Russian government has cited the critical need for developing innovative public health interventions. These health challenges are the impetus for the partnership between UMass Amherst, SPHHS and NovSU.
The initial exchange began in the fall of 2009 with a visit to UMass Amherst by a group of Russian medical students who participated in public health coursework and met with graduate students and professors here. Further building on this partnership, four UMass Amherst graduate students conducted 10-week internship practica in Russia last summer. SPHHS graduate students Megan Griffin and Jessica Vickery (Community Health Education), along with Lori Crawford and Sima Blank (Epidemiology), lived and worked in the ancient city of Novgorod. The students worked primarily in an HIV clinic and an alcohol and substance abuse center.
Prior to leaving for Russia, the students spent three months learning Russian. Once there, each student was paired with a NovSU medical student to enhance their language training and foster cross-cultural relationships. Despite the language training and assistance of translators, the language barrier was still significant and perhaps the greatest obstacle the students had to overcome. Fortunately, Blank speaks Russian fluently and was able to ease the transition.
Even with Blank’s language skills, however, the students underestimated how challenging the language barrier would be.
“There was a difference in health terminology,” Griffin explains. “One of our goals was to explain the mission of public health and the theories behind our approaches. This was a daunting process, because there wasn’t a direct translation for many public health terms. It was also interesting to watch Sima try to explain health and wellness through a holistic model, because they tend to view health through a very medical model.”
“The Russians don’t view public health like we do through a spectrum from wellness to sickness,” Vickery adds. “They see it as either you’re sick or you’re not.”
In addition to the language barrier, the students faced cultural and bureaucratic hurdles. Despite high mortality and low fertility rates, many Russians fail to acknowledge a public health problem exists. As Crawford notes, they tend to view the issue as a “personal or moral failing of the individuals who have the problem rather than any kind of larger public health crisis.”
Thus, learning the ins and outs of the Russian public health system played a major role in the students’ experiences. Blank, who interned in a government-run HIV clinic, notes that she conducted numerous onsite interviews in order to get a better grasp of the problem. “We interviewed physicians primarily, but we also met with patients. We learned a great deal about their HIV problem and how they deal with it.”
Griffin adds that a large part of their learning experience was simply trying to identify the scope of the HIV problem in the Novgorod region. “We sought to understand the social, bureaucratic, and political barriers affecting HIV healthcare promotion, and to understand how they collect and apply data to HIV prevention programs.”
One student gained a first-hand – though unwanted and unintentional – experience with the Russian health care system. Crawford’s seven-year-old son, who accompanied Crawford to Novgorod along with the rest of her family, fell ill.
“He was hospitalized twice, once for one day and later for five days,” she says. [Editor's note: Her son has fully recovered.] “It was very educational to experience the health care system and see how different it was. They obviously have so few resources and yet they provided good care for my son at a total fraction of our cost. He had ultrasounds, he had 2 sets of IV medicine every day, they ran all kinds of tests on him, and then I was told to come back the next day and pay the bill. I went with my translator to this little room way off in the periphery. There were two people, two computers, a pencil, paper, and a calculator. And that was their whole billing department. The entire cost of the five days of hospitalization was less than $200.”
The experience was a revelation for Crawford. “It gave me a new perspective on our system here. It really made me realize how much my experience with health care in America is accompanied by this constant anxiety over cost.”
Though their experiences were sometimes fraught with stress, the students were grateful for the opportunity to intern in Novgorod. “It was great to get a different perspective on the world,” Vickery remarks. “It was very eye-opening. We got to travel the world. It was an incredible experience to get to go to St. Petersburg and Moscow.”
“We had a really great experience with the people we worked with,” Blank notes fondly. “They were really warm and they gave us a wealth of knowledge to work with.”
“I really appreciated the cultural experience,” Griffin adds. “I also learned much that I can use in my future career. I got to see many of the social, cultural, political and bureaucratic factors that affect public health problems. You cannot create a program without being aware of all of those factors. You need to examine them in any setting, but especially in an international one because there are so many more barriers.”
Griffin sums up her experience thusly: “This practicum completely changed my perspective on public health. I now realize that the public health field is not as widely recognized in other parts of the world, yet there is such a critical need for public health programs.”
In addition to helping address the public health crises in Russia, the program aims to continue to provide UMass Amherst and NovSU students with dynamic learning experiences to enhance their understanding of public health practices and each other.
“There are a lot of opportunities for collaboration because there are people in Russia who are very open to working with us,” Vickery says. “Overall there was a lot of enthusiasm and excitement to bring these American public health prevention programs to Russia and help them with a lot of their issues, especially drug use and HIV and alcohol.”
Griffin, Vickery, Crawford and Blank are proud to have paved the way for the SPHHS in Novgorod. Vickery notes, “We helped set up a plan for the next two years for interns to go in there.”
This summer, the Institute for Global Health will send the next cohort of graduate students to conduct their practica. Vickery will continue her partnership with the substance abuse center and return to implement a group intervention program she is designing as part of her final MPH project. Griffin and Vickery are also helping to develop a media campaign and evaluation plan for reducing rates of unplanned pregnancies, abortions, STIs and HIV among youth in Pskov, Russia.