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United Nations Development Programme |
The Cardiovascular Disease Educational Programme begun in Moscow in 1998 is confidently moving beyond its original limits. Four new components have recently been added to the project, which is being run by the UN Development Programme (UNDP) in 10 Russian regions: Infection Control in Russia, Disinfection and Sterilization, Children Without Pain, and Surgical Treatment for Incontinence in Women. Professor David Josseliani, Director of the Scientific and Practical Center for Interventional Cardioangiology and Head Cardiologist of the Moscow Health Care Committee, is the project Director.
The current high morbidity and mortality rates in Russia demand
immediate and urgent measures to improve the 
health
of the population. One of the tasks of the health care establishment is to promote
among specialists, and the public at large, modern diagnostic and treatment
methods – which, when properly used, yield favorable results.
Cardiovascular disease has long been the number-one cause of death and disability among the population. The UNDP project is aimed at educating the public about the means for preventing and treating these diseases, which should allow to reduce the disability and death they cause. The prevention of massive heart attacks and other serious complications from atherosclerosis depends largely on starting treatment promptly. It is therefore important that people be informed as to the first symptoms of the disease as it emerges; and to identify patients who are in its initial stages, or who have latent forms of the disease. In recent decades, there has been a great deal of success in treating atherosclerosis. Thanks to this, the interrupted flow of blood can be permanently restored to its full measure, and the patient restored to a fully productive life.
The growing incidence of infectious diseases – AIDS, hepatitis, tuberculosis – gives the Infection Control in Russia programme a special social relevance. Its aim is to improve the training of health care workers (especially senior and head nurses, government sanitary and epidemiological inspectors, and hospital epidemiologists) in matters of preventing intra-hospital infections and infection control, via seminars and educational conferences; and through the printing of scientific articles and academic materials in professional publications. The most important result of this (from the perspective of potential effect) has been the preparation and printing of the informational and methodological posters on the problems of infection control that were issued as an appendix to Nurse magazine. In addition, there are now a number of courses for raising the professional qualifications of senior and head nurses on the problems of infection control and intra-hospital infections.
At
the same time, the introduction of modern medical technologies and the use of
new medical instruments demand that completely new methods of disinfection and
sterilization be learned. Thus, the main task of the Disinfection and Sterilization
part of the project is lowering the risk of spreading disease, via medical instruments
and equipment in the course of treatment and diagnostic procedures, by developing
and emphasizing the use of standard procedures for handling various categories
of medical equipment and instruments, and the proper training of medical workers.
The aim of the Children Without Pain programme is raising the professional qualifications of doctors on the timely problems of children’s anesthesiology; and improving the quality of medical help for children during operations, recovery, and intensive therapy, via pediatricians and children’s anesthesiologists taking part in international conferences, and the development of training materials on anesthetic methods. Most important (from the perspective of potential effect) are the preparation and publication of methodological materials on the catheterization of peripheral veins and the use of peripheral vein catheters, which allows the quality of not only the physician’s care, but that of the nurse to be improved as well.
The problem of incontinence has gone from being a purely medical problem to becoming a social problem as well. Around 40% of all women suffer from incontinence under tension. In the majority of cases, treatment of this affliction is done by urologists, although this is often done in conjunction with gynecological pathology. In such cases, the broadening of surgical intervention is needed for the patients. The informational materials developed as part of the project offer a comparative analysis of contemporary methods and the gynecological aspects of surgically treating stress-induced incontinence in women. Evidence, both in favour of and against such procedures, and their possible complications and the means of preventing them, are also examined. The educational programme is presented in such a way as to answer difficult questions from novice and experienced specialists alike.
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International Labor Organisation |
On February 1, a press conference was held at the Moscow Bureau of the ILO to announce the release of the report The Situation of Working Street Children in Moscow. The conference was opened and conducted by the Director of the International Labour Organization’s Moscow Bureau, Pauline Barrett-Reid. She introduced the authors of the report, whose core was made up of researchers and instructors from the Department of Sociology of St. Petersburg State University, to the Russian and foreign journalists present. The report, like previous research on the same topic, was prepared with support from the ILO, as part of its International Programme on the Elimination of Child Labour (IPEC).
The
fact that street children are more and more becoming a noticeable social problem
for Russia testifies to the timeliness of the report. The problem stems from
the country’s economic crisis, which has been accompanied by the social degradation
of the population. In many families, parents sometimes cannot even feed their
children enough to keep them from being hungry. Those children seeking their
own sources of sustenance are forced to go out onto the street. Separated from
their families, lost to their parents and other relatives, they become not just
a cheap labour force but easy prey for criminals as well.
Serving as the basis for this analysis were the results from a survey of 1,500 street children. Among them were three target groups. The first was children up to the age of 14, earning their living on the street through non-criminal activity. The second was children up to the age of 18, involved in prostitution. The third was children up to the age of 14, engaged in illegal types of activity. Also surveyed were 81 employers and 96 experts from government and non-governmental organizations working to help these children, plus representatives from government organs and law enforcement agencies.
How many street children are there? Most experts estimate the number of street children in Moscow to be from 30 to 50 thousand. Fifty to sixty percent of these are children under the age of 13. From 10% to 30% of this age category is engaged in illegal types of activity: theft, dealing in stolen goods, and narcotics. The proportion of street children engaged in prostitution and the making of pornographic movies is from 20% to 30%.
Who are they? In the opinion of experts, from
60% to 80% of the children working on the street are boys. The 
percentage
of boys among those involved in illegal activities is much higher. Girls predominate
among those children engaged in prostitution. Most working street children are
either migrants from Belarus, Ukraine, or Tajikistan; or come from the areas
surrounding Moscow. The percentage of actual Muscovites is not great – from
10% to 35%. As a rule, they come from socially disadvantaged families, and families
belonging high risk groups.
What do they do? A large percentage of the children work as salespeople, guards, cleaners, loaders and porters, and car washers. Among those surveyed, 109 were involved in theft and the selling of stolen goods; while 113 of the girls aged 13 to 18 were engaged in prostitution and, simultaneously, theft and the distribution of narcotics.
Two-thirds of those surveyed were native Muscovites, while around a quarter came from quite far away; every ninth one was a resident of Moscow Region. Among the children involved in prostitution, the number of migrants was far higher – 77%.
Of those surveyed, 61.6% regularly attended school, while the remainder either attended only sometimes or had left school altogether. More than 80% of those drawn into prostitution had not attended school in more than a year.
What pushes children onto the streets? According to the surveys’ results, the primary cause is family problems. Just over half of those surveyed had a complete family (both father and mother) at home. Around one-third came from incomplete families. Every tenth child had either a stepfather or stepmother in place of their biological father or mother. Of the children involved in prostitution, only 29.2% had a complete family at home; for those engaged in illegal activities, this figure was 33.9%. Only among 36.4% of the children forced to work on the street did both parents have a source of income. A mere 13.4% of those engaged in prostitution had a working father and mother; for those involved in illegal types of activity, this figure was 13.9%.
What dangers do they face? Living outside the family, without parental support, has a negative effect on children’s health. Only two of every five children surveyed were able to say they were completely healthy. Among those involved in illegal activities, only every fourth child said he/she was healthy. Of the girls engaged in prostitution, the share of those completely healthy was just 14.3%. According to expert estimates, around 70% of the children did work that was dangerous to their health. Almost every second child working on the streets encounters real threats to his or her health – and even life. Among the children involved in illegal activities, two-thirds face such a threat; almost every fifth such child has been the target of an adult’s sexual attentions. Of the children involved in illegal activities, almost half of those surveyed mentioned such an incident.
What makes them work on the street? More than half simply want to make some money “on the side”. For one-third of the children, however, this was the most important (if not the only) means of existence. For 27.2% of the children, the money they made was the only way they had of staying alive. Fully 56.9% of those involved in illegal activities, and 77.9% of those engaged in prostitution, began doing so in order to survive.
How much do they work? According to the children’s survey data, the average was around five hours a day; their employers say it was about 5.3. However, more than a fourth of the employers admit that the children they hire sometimes had to work 6–8 hours at a time. Every fifth employer sometimes had his children work 8–12 hours at a time, and occasionally at night.
How much are they paid? The daily average was from 100 to 150 rubles. The lowest income (79 rubles) was that of those who collected scrap metal and bottles. Those who cleaned offices, stores, etc., made 92 rubles a day; those who kept watch over personal items or trade goods got 97 rubles a day. Car washers made 122 rubles a day; loaders and porters, 150 rubles a day; vendors in stalls or at markets, 154 rubles a day. The largest income was that of children engaged in prostitution – 735 rubles a day.
Who are their bosses? Most of the children organize
their work independently, without having an adult “supervisor” 
looking
over their shoulder. Exceptions to this are the children engaged in prostitution:
two-thirds of them said that they had an adult “boss”, while more than half
said that they had to hand over a part of the money they made to their so-called
sponsors. Of all the children surveyed, 17.5% (and 28% of those involved in
illegal activities) mentioned that they had been extorted at one time or another.
Will they ever leave the streets? Fully 72% of the children surveyed were not about to leave their street work, even if they were offered other, decent, living conditions. At the same time, 40% of those engaged in prostitution want to change their lives, along with 70% of those involved in illegal activities. As one kind of outside help, 8.3% of the children surveyed would like a permanent place to spend the night (22% of those involved in illegal activities). It seems as though it is now much easier to allow a child to remain on the streets than it is to get him off them.
How can we help them? The authors believe that work aimed at eradicating child labour must be stepped up at the state level. This calls for coordinating the activities of government, social, and religious organizations in order to improve their efficiency. This might be done through the development of a special comprehensive programme, oriented along the following lines:
– Effective strategies for resolution of family problems, strengthening the foundation of family as a social institution;
– Creation of jobs and provision of job placement to children and adolescents aged 16 years and up;
– High-quality situational analysis of the problem, continuous monitoring of the number and social backgrounds of families and children, identification of risk groups, provision of a data bank of case studies, etc.;
– Introduction of a system of juvenile justice;
– Provision of recreational activities for children, the revival of children’s organizations;
- Sensitising the public to the problem of street children and elaboration of effective intervention strategies.