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WHO World Health Organization |
In August 27-29, 2001 a WHO team visited Saratov at the invitation
of the regional Minister of Health Dr Valentin Zavalev. The WHO team included
Dr Mikko Vienonen, Special Representative of the WHO Director General in Russia,
Dr Wieslaw Jakubowiak, Coordinator on TB Control, and Dr Nikolai Mashkilleyson,
Coordinator on HIV/AIDS and STI Control.
The purpose of the trip was to get an idea on the health situation in this important Russian heartland, particularly concerning TB, HIV and STIs, on the local resources for the prevention and control of these infections as well as on the needs for international assistance.
The region, which has a population of 2,7 million, traditionally has been an agricultural bread-basket of Russia. It has been suffering seriously from the transition caused by the fall of the Soviet Union, as it had been a base for military industry, which has now shrinked to a minimum. Currently, the region is facing a problem of a growing drug-abuse and hence HIV, particularly among youth, and raise in TB and STI rates.
Despite of the time shortages we had an opportunity to visit a number of medical institutions and organizations, including two TB hospitals in Saratov and Engels, hospital of the penitentiary institutional system (UIN), Regional AIDS-Centre, and rehabilitation Centre for drug-abusers, the latter being situated more than 100 km out of Saratov.
At present, there are 3,800 registered HIV-positive people in the region, and new HIV cases are rapidly growing. The majority of cases are diagnosed among injecting drug users. One small-scale needle exchange project, which has been running in the city of Engels, is far from covering the actual real needs of the region in harm reduction activities.
With approximately 2,500 new TB cases in the region, the proportion of TB in HIV-positive individuals has been increasing. Also the syphilis rate, which was decreasing a year ago, showed 15% growth during the first six months of 2001 compared with the corresponding period of 2000.
The mission was extremely warmly received and we were surrounded by an atmosphere of a genuine Russian hospitality throughout our stay in Saratov. We had many interesting meetings and discussions with regional authorities, including Deputy Head of the Regional Administration Dr Sergei Maron (by the way, anaesthesiologist by education), as well as with medical authorities and practicing doctors. Our special thanks to Dr Natalia Syrysheva, the First Deputy Minister of Health of the Saratov region, who accompanied us nearly all the time.
We departed from Saratov with a feeling of a strong local commitment towards international co-operation, which we want to convey to a donor community. We hope to come back soon for starting the joint activities.
Dr. Nikolai Mashkilleyson,
Coordinator on HIV/AIDS and STI Control
WHO/Russia
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A working meeting of CIS countries to discuss the WHO Framework
Convention on Tobacco Control (FCTC) took place in Moscow on September 28–29,
2001.
The meeting was held on the initiative of the RF Ministry of Health, and with
the support of the World Health Organization.
At the invitation of Academician Yuri Shevchenko, Minister of Health of the RF, representatives from the following 11 countries took part in the meeting: Azerbaijan, Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Ukraine, Uzbekistan, and the Russian Federation.
The delegations included deputy ministers of health, principal state sanitary doctors, heads of various health ministry departments, representatives from ministries of agriculture, taxation services, national coordinators for anti-tobacco and anti-smoking activities, scientists, and representatives from public service organizations.
The meeting was opened by Gennady Onishchenko, First Deputy Minister of Health of the Russian Federation and Head of Interagency Working Group under the Ministry of Health for elaboration of the FCTC. He determined the agenda of the meeting, emphasizing the similarities of the situations and health problems in CIS countries. In this connection, Mr Onishchenko noted the importance of reviewing the FCTC jointly, and the timeliness of an agreed-upon program being drawn up by the countries present.
Dr Mikko Vienonen, Special Representative of the WHO Director General in Russia, spoke on the poor health situation among Russia's population, and on the enormous damage to their health caused by the tobacco smoking.
The importance of tobacco smoking control in order to reduce
morbidity and premature death was noted in the speeches of WHO Headquarters`
Representative Dr 
Allyn
Taylor and WHO European Regional Bureau Representative Dr Haik Nikogosian, along
with the significance of the FCTC project in achieving this goal.
Intense preparatory work preceded the meeting. A working group of six specialists, formed at WHO's suggestion, prepared a draft of the FCTC text. It was refined further on the basis of a text proposed by the Chairman of the Intergovernmental Body for Negotiations; most of the WHO member-countries have taken part in these since 1999. Materials from the three working groups of the second session of the Intergovernmental Negotiations on the FCTC, held in Geneva in April–May 2001, were also used. In preparing this document, all the proposals and points made by the CIS states during the consultations in Geneva were also analyzed.
In two days, the meeting participants came up with common positions on all sections of the draft FCTC. The resulting version of the text will be sent to the CIS countries for their consideration and approval.
Galina Tkachenko,
Head of Coordination Center
on Overcoming Smoking,
Ministry of Health
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WHO Headquarters’ International Programme on Chemical Safety
organized a workshop on clinical toxicology for approximately 30 participants
from Russia and the Commonwealth of Independent States in Moscow 22–25 August.
With funding of approximately $34,000 from the German government, this workshop
was 
designed
to improve the quality, efficiency and functions of the national intoxication
centres and information centres. The meeting was hosted on the Russian side
by the Toxicology Information and Advisory Centre of the Ministry of Health
headed by Dr Yuri Ostapenko. The Headquarters’ counterpart was Dr Jenny Pronczuk
de Garbino.
Practically all the representatives gave a similar picture. Intoxication is becoming more common, with alcohol poisonings as the most usual (30–40% of the caseload). In the most common form of poisoning, alcohol particularly among Russians, the role of alcohol surrogates was emphasized. Actually, surrogate alcohol poisonings (methanol, ethylene glycol, etc) also exist but against the popular belief it is usually just normal ethanol (vodka) which causes most of the deaths. In second place is intoxication from pharmaceutical substances (often suicidal). Third common form is intoxication caused by narcotics, pesticides, occupational accidental poisonings and mushroom poisonings. Interestingly, snake bites and spider bites (black widow) are increasing rapidly. Another interesting finding was the probable underestimate of narcotic cases because the use of narcotics is criminal. If the clinics reported all cases this would have severe legal consequences for the patients. This is of course quite unacceptable as such legislation is an obstacle to access of medical care.
The workshop went through different latest treatment methods for intoxication. In Russia and CIS the clinicians use much more haemodialysis and other interventions than in the west. More conservative observation and life-sustaining therapy during the intoxication process is largely overlooked. This issue was widely discussed in the workshop, which hopefully gets continuation next year.
Dr Mikko Vienonen,
Special Representative of the WHO
Director General in Russia
28, Ostozhenka, Moscow
119034 Russia
Tel: (7-095) 787 21 66
Fax: (7-095) 787 21 01
Email: m.vienonen@who.org.ru