Russian Synthesis Moscow January 7, 2009 - January 12, 2009 Moscow is a big city with many people bustling through the subway system and walking along the streets seemingly ignoring the cold temperature. A highlight of our stay in Moscow was our visit to the U.S. embassy and speaking with Dr. Tongs former student Peter Chordas, who is a nurse practitioner that lives on the embassy compound with his family and cares for the employees of the embassy. He shared information about the health care available to Russian citizens and he described much about the culture. One subject that makes Russia such an interesting place of study is the ongoing government transformation and how this change is affecting the health care system. The negative aspects include: outdated medical equipment, inavailability of modern diagnostic equipment in smaller hospitals, massive shortages of nurses with a ratio of one nurse to up to thirty patients, and the role of the nurse having less influence in the medical community. On a more positive note, health care is available to everyone. This means access to medications that are expensive and unaffordable to some people in the U.S.; the care for children is outstanding; the government provides free access to polyclinics that make physician house calls if needed; children are provided with exercise, massage, and water therapy three times per week and have speech and physical therapy available. The family members are very active in the care of patients. Russia is a community-based culture, unlike the U.S, which is an individual-based culture. In the hospitals the family is usually more willing to take on nursing tasks to help with care, such as bathing, feeding, and ambulating the patient. This helps balance the high ratio of nurses to patients. Yaroslavl January 12, 2009 - January 17, 2009 Yaroslavl is a charming older city founded in 1010. During our stay here we visited a medical academy and interviewed professors and students, a regional hospital where we toured their ICU, The Savior Monastery, a retirees clinic that treated many veterans, a pre-birthing and baby polyclinic that offered services as mentioned above, an orphanage, and a mental health clinic that focuses strongly on art therapy. Interestingly, the psychologist who is heavily promoting art therapy as a focus to treat patients with schizophrenia and other mental disorders has entered the pieces of art produced by patients into galleries around the city of Yaroslavl, distributed and sold pieces of art work by patients in street fairs, and stated he has the goal of starting an art museum by collecting art produced by patients from mental institutions around the world. He appeared very motivated in his drive to go the next step of expansion. His goal is helping patients function more in society while discovering themselves and learning more about their mental illness through art therapy. Pskov January 18, 2009 - January 23, 2009 In 1991, when communism was ending in Russia, the statues of Lenin, Marx, Trotsky, and other communist leaders were taken down and placed in the Park of Fallen Idols. Pskov still keeps a statue of Lenin erected because Lenin lived in Pskov for a short time and it is still a part of Russian history. During our stay we visited: a hospice that was very clean, comfortable, and similar to what one might find in the U.S.; the Mirozhsky Monastery, which was in the process of uncovering a beautiful fresco mural because it was covered up by plaster and survived bombing by the Germans during WWII; a Secondary Medical School that taught nursing, EMT, dentistry, cosmetology, psychology, pharmacology, and medical doctors; a school for disabled children that was also very similar to American facilities except that they also offered water therapy and massage therapy to students on a regular basis at the school, an HIV/AIDS prevention clinic, and a Russian Red Cross facility. St. Petersburg January 23, 2009 - January 29, 2009 St. Petersburg is a beautiful city that has the feel of a typical European city because of the old ornate buildings that line the canals that intertwine through the city. From September 1941 to January 1944 the Germans besieged St. Petersburg, devastating the people and property. Catherine the Greats palace and Pauls palace were pillaged and burned, among many other historical sites; Russians suffered famine, and many died during this ominous act of war. Fortunately, the Russians were able to fend off the Germans and retrieve their city; as we were in St. Petersburg on this January 27, we observed the celebration of the 65th anniversary marking this victory. During our stay here we visited Catherines palace and Pauls palace" both palaces were reestablished as exact replicas of what existed during the pre-WWII siege of St. Petersburg. We also saw a medical school where we spoke with students, a hospital that had a CAT scan, and a birthing center. Dr. Tongs friend Yuri, who is a Russian anesthesiologist, came to our hotel and talked to our group for a couple of hours. He was a wealth of information and helpful on addressing our questions that sometimes would get misinterpreted during translation with the interpreter. I asked Yuri if he believed there was a trend in the Russian health care system of improving technology and advancing with the rest of the medical world. He said he did not think so; and it was related to the economy and how the money is filtered through during the transition to a free market with private enterprise. He also believes this is because the Russian government has slowed down development since the 1950s, when the government invested heavily into the military only, and that in the 1970's medical development stopped completely. My experience traveling to Russia during Jan Term was educational; it broadened my perspective on the Russian culture, history, and health care system. While visiting Russia our tour guides would teach us about art and the countrys rich history as we walked through historical sites, palaces, and museums. Our visits to the health care institutions was an experience of a lifetime"-at some sites we were the first nursing students from the United States to sit down with the head of these facilities to answer and ask questions. We were warmly welcomed and received with respect and humble curiosity. I feel our trip connected many people, resolved unfair biases and misconceptions, and united healthcare providers from different countries that share the common goal of caring for individuals with the desire to aid and improve humanity.