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WHO World Health Organization |
An International Conference on Humanitarian Assistance to the Population of the Far North and the Far East of the Russian Federation was arranged by the Central Committee of the Russian Red Cross Society in Petropavlovsk-Kamchatsky, Kamchatka, on August 28-30, 2000. National Russian Red Cross societies represented Arkhangelsk, Chukotka, Kamchatka, Karelia, Khabarovsk, Komi, Komi-Permiak, Koriak, Krasnoyarsk, Magadan, Nenets, St. Petersburg, Taimir, Tiumen, and Yakutia. Government officials from these regions included some ministers of health. The Conference was attended by representatives of the International Federation of the Red Cross of Russia and Geneva Headquarters, WHO Special Representative of the Director General, national Red Cross Societies from Canada, Iceland, Norway and the United Kingdom, and the Moscow-based embassies of Canada, United Kingdom and USA. The total attendance was over 100.
Dr. Mikko Vienonen, Special Representative of the Director General of WHO,
addressed the audience explaining WHO's health policies and strategies in Russia.
He highlighted what Director-General Dr. Gro Harlem Brundtland had said at the
International Consultation on the Health of Indigenous Peoples during the World
Health Assembly in May 2000 during the International Decade of the World's Indigenous
People. Socio-economic changes in the regions inhabited by small ethnic groups
are very visibly reflected in the state of health of the people and in the demographic
situation. Indigenous
people are turning for medical help and are being hospitalised for circulatory
and cancer diseases more often than the population in general. Diseases of the
ear, nose and throat are significantly more common among northern ethnic people
than among newcomers living in the same areas but in better living conditions.
The number of indigenous deaths from these diseases is higher. Infant mortality is also high. The mental health of indigenous northerners is also under threat. The growth of drunkenness and aggressiveness is an indicator of this problem. From 1970 to 1980, one in two deaths among the indigenous population was caused by injuries at home, accidents at work or murders and suicides, or approximately 70 to 90 cases per 100,000, which is three to four times as high as the national average.
The health of indigenous people is also threatened by damage to their habitat
and natural resources. Environmentalists' estimates show that certain Arctic
populations' exposure to environmental pollutants is among the highest in the
world. Some of these pollutants are carried
to the Arctic Ocean and accumulate in animals used for traditional foods.
Most worrisome, indigenous people are the worst off among Russia's poor. This does not only mean that they have low incomes; poverty is multi-dimensional. Like other people in poverty, indigenous people are less likely to live in safe and adequate housing, more likely to be malnourished, and less likely to have access to appropriate and affordable health care services.
Very practical solutions to existing problems were discussed at the Conference. For example, considerable experience has been gained from organising soup kitchens which provide direct support to the most vulnerable groups in society. Real community centers can be developed around them, with community nursing, psycho-social support, child care and protection, etc.
The Conference adopted the Kamchatka Declaration highlighting the need for humanitarian and development assistance to the people in the North and Far East. It underscored the important role of the government and society in general (including the business community), and emphasised the role of networks and partnerships. One of the main concerns is the challenge of linking relief assistance with longer-term community based action.
WHO plans to seek partners in at least one of these regions and, therefore, identification of suitable donors has started. As a long-term goal, a WHO satellite office would be established in central Siberia, and in the Far East region.
Dr. Mikko Vienonen, WHO Special Representative of the Director General in Russia receiving a warm welcome from the indigenous and Russian people of Kamchatka
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On September 21 and 22, the World Health Organisation and the Stop TB Initiative
hosted a Donors' Meeting on Tuberculosis Control in the Russian Federation
in the Marriott Grand Hotel in Moscow to expand the response to tuberculosis
control in the Russian Federation. Representatives of over 100 national and
international partners and agencies, including the Russian Ministry of Health
and Ministry of Justice, were present.
The international community joined Russia in adopting the Moscow Resolution to Stop TB in Russia, committing itself to work together in taking vigorous action to stop the spread of tuberculosis across the nation. The Resolution calls upon national and international partners to "actively participate in gaining support and momentum in the fight against tuberculosis for the improved health of the people of the Russian Federation." According to the WHO Global Tuberculosis Control Report 2000, Russia ranks eleventh among the 22 high-burden TB countries in the world, and in 1999, there were over 124,000 new cases of TB in Russia.
"There is no time for differences in the face of this epidemic," says Dr. Arata Kochi, Director of the Stop TB Initiative. "We have a strategy that works. We have seen it work in Russia. Today's commitment by all partners to adopt one unified TB strategy is a huge achievement. Russia can become a model of partnership for other countries."
International partners and governments pledged financial support to expand the WHO TB control strategy in Russia. Under the coordination of WHO, TB control strategies will be implemented in more regions over the next several years. Recognising the need for an accelerated response to the epidemic, donors, such as USAID, DFID, and the Finnish Government, reiterated their support for TB control programmes in Russia.
The Russian Ministry of Health and its Research Institute of Phthisiopulmonology (RIP), restated their commitment to revising the national TB programme in line with the WHO TB control strategy. The other leading Russian TB institute, the Central TB Research Institute (CTRI) of the Russian Academy of Medical Sciences, was officially designated a WHO Collaborating Center in 1998 and continues to be a major partner in WHO's TB control activities.
The Russian Ministry of Justice also actively participated in the meeting. "The TB problem in the Russian prisons is very serious," said Alexander Kononets, Chief of the Medical Department and Deputy Chief of Correctional Facilities at the Ministry of Justice. Pledging the support of the Ministry of Justice, he called on others to join the fight against TB. "There is an urgent need to forge partnerships to stop TB in Russia prisons."
While WHO coordinates much of the TB control activity in Russia with the technical
assistance of the Centers for Disease Control and Prevention (CDC, United States)
and the Royal Tuberculosis Association (KNCV, Netherlands), several NGOs and
other agencies play key roles in this fight to stop the TB epidemic. The Finnish
Lung Health Association (FILHA), German Technical Cooperation
(GTZ), the International Federation of the Red Cross and Red Crescent Societies
(IFRC)/ Russian Red Cross Society (RRC), Medecins sans Frontieres (MSF), Medical
Emergency Relief International (MERLIN), the Norwegian Lung and Heart Association
(LHL) and the Public Health Research Institute of New York (PHRI) are all partners
in the massive effort to stop TB.
Under the coordination of the WHO, these NGOs and agencies will maintain and expand their TB control efforts in Russia. The Russian Government has also requested WHO to supervise and monitor the TB component of the proposed World Bank Project. The proposed World Bank loan includes approximately $100 million for reinforcing TB control in Russia by improving TB control services and the management of drug resistance, both in civilian and prison populations.
In 1999, there were over 124,000 new cases of TB and over 29,000 deaths nationwide, which is 2.5 times more than the number of cases and deaths in 1990. In the nation's prison system the situation is much worse. The incidence of TB in prisons is 40-50 times as high as among the civilian population, which means that an estimated 4,000 per 100,000 prisoners have TB. The situation is further worsened by the increase in the number of TB cases that are resistant to available anti-tuberculosis drugs. Multi-drug resistant TB is especially widespread in the prison system.
In 1994, the WHO began assisting the Russian Federation by introducing a TB control strategy in the Tomsk Region. Since then, WHO-recommended TB control strategies have been implemented in 13 other regions. Still, only 6 per cent of the total Russian population has access to TB services under the WHO strategy. The Moscow Resolution to Stop TB and the commitment of national and international partners can reverse the epidemic. Even with the collaboration and support from the international community, though, the ultimate success of TB control in Russia will depend upon the Russian people themselves. Together, all are determined to stop the spread of this curable disease.
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Prevention of HIV/AIDS is very timely, thinks Dr. Nickolai Mashkilleyson, newly appointed coordinator of the WHO programme for sexually transmitted infection control in Russia.
Together with other UN agencies WHO actively participated in preparing the donors' meeting in Moscow on November 16-17, 2000, on prevention of HIV. WHO's task was to work out effective measures to prevent sexual transmission of HIV infection. The meeting to discuss problem was very timely and important.
During the last few years, the HIV epidemic driven by the sexual transmission of the virus has entered a new stage in the Russian regions where the outbreak of the epidemic started among drug injection users. Since almost all the infected people are in the sexually active age group and the practice of safe sex has not yet become commonplace in Russia, the HIV-infection will easily spread to the general population via sexual contacts.
The danger of contracting HIV is considerably greater if a patient also has a sexually transmitted disease. Accordingly, as was demonstrated by international experience, a considerable part of HIV infections could be averted through preventing and controlling sexually transmitted infections, particularly if effective intervention is carried out early in the HIV epidemic, before a widespread dissemination of infection takes place.
The rates of sexually transmitted diseases in Russia have remained at epidemic levels for the last decade, even taking into account considerable under-reporting and self-treatment. In 1999 the average rates of new syphilis and gonorrhea cases in Russia were 188 and 176 per 100,000 population, respectively, which is 128 and 24 times as high as the corresponding figures in the EU countries.
Besides being a substantial risk factor for contracting HIV, non-treated sexually transmitted infections are an important cause of impaired fertility in both men and women. In the present situation of decreasing life expectancy and high rate of chronic diseases in Russia a decrease in birth rates further affects the health of the nation.
Another factor contributing to the rapid spread of the infection is the growing number of HIV-positive sex industry workers, mainly drug injection users going into prostitution to sustain their addiction. Sexually transmitted diseases in this group are not uncommon due to the constant exposure to the infection, lack of protection, neglect of own health and frequently absence of apparent symptoms of sexually transmitted infections in women.
Dr. Nickolai Mashkilleyson newly appointed coordinator of WHO propramme
on sexually transmitted infections countrol in Russia
In order to reduce the spread of HIV through sexual transmission WHO developed
a comprehensive approach to the prevention and control of sexually transmitted
infections. This project is designed for implementation at a regional level.
It will cover such important aspects as improvement of epidemiological surveillance of sexually transmitted infections, rapid diagnosis and effective treatment, counselling of patients and their partners in order to prevent future infections, raising awareness about sexually transmitted diseases and active promotion of safe sex in both the general population and groups at risk, creation of user-friendly diagnosis and treatment facilities for sex industry workers.
There are still substantial problems and gaps in the management of sexually transmitted diseases of legislative, economic, administrative and psychological nature, which will be addressed by the project. The window of opportunity is not yet closed, but the start of the WHO involvement and implementation of its plans will fully depend on the support and funding from donor governments. An appeal has been sent out to such partners.
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