Treating Asthma In a Secret Russian City


Vol. 14 •Issue 9 • Page 10
Close Up

Treating Asthma In a Secret Russian City

No one would claim that asthma care in the U.S. is perfect. Too many people go to the emergency room for flare-ups, for instance, and patients too often confuse their medications.

But try delivering treatment in a country whose health care system has essentially imploded, in a city that’s so secretive that during the Cold War, it wasn’t found on any maps.

That was exactly the situation facing a group of American clinicians who traveled to Russia in the late ’90s and early 2000s. Their mission was to teach better asthma care in Sarov, a city dedicated to nuclear research, much like Los Alamos, N.M., though it took its security measures to suffocating extremes.

A big fence surrounded Sarov, which is located in a forest about 250 miles east of Moscow, and permits were required to enter.

The security was so tight that the first time he came to Sarov, Phillip Hertzman, MD, FACP, FAAFP, was told not to stray from a track where he went jogging. As he exercised, someone watched his every move. “They guarded us like crazy,” he said.

The asthma project, described in detail in a Chest article earlier this year, was an outgrowth of collaborations between scientists at Los Alamos and Sarov.1 With health care after the fall of communism in a state of disarray, in part because so many resources had been going to the military, a group of American doctors was invited to the secret city to help with various medical conditions, including asthma.

They found a nation in meltdown. Life expectancy had declined, and the country was losing population, as the death rate had surpassed the birth rate. “It was a disaster,” said Dr. Hertzman, a primary care physician at the Los Alamos Medical Center and medical director of the Los Alamos-Sarov medical partnership.

Infectious diseases such as tuberculosis got first priority, to the detriment of chronic conditions. The city of Sarov had only one spirometer, and when patients suffered asthma attacks, they were admitted into a hospital for prolonged periods. But because much of the government-provided housing is substandard, the patients often didn’t mind. “They stay until they don’t have a wheeze left in them,” said team member H. William Kelly, PharmD, professor emeritus of pediatrics at the University of New Mexico Health Science Center, Albuquerque.

Some Russian docs were stuck in their ways. Dr. Hertzman once held a brainstorming session with Russian clinicians, but a meeting where everyone is encouraged to call out ideas isn’t natural for a society where people basically were told what to do. A Russian leader spoke up, “This is not the way we do things.”

Despite the obstacles, the medical partnership had many successes. It convinced the city’s government, which controls fiscal resources for medications, to provide money for more potent corticosteroids that weren’t available. Also, accurate data were collected. During Soviet times, researchers suppressed anything negative.

The Americans shifted the Russian clinicians away from an acute approach to asthma, and they emboldened patients to take a more active role in their care. By the time the project ended in 2002, it was growing exponentially.

Unfortunately, communication out of Sarov has been limited since then, so it’s hard to say whether the asthma measures taught still remain in practice. Like many things in Sarov, that info remains closed off.

REFERENCE

1. Hertzman PA, Kelly HW, Coultas D. Chronic illness care in Russia: a pilot project to improve asthma care in a “closed city.” Chest. 2005;127(3):861-5.

John Crawford is associate editor of ADVANCE. He can be reached at jcrawford@merion.com.

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