The following was taken from Nursing without Borders…values, wisdom and success markers and was written by Christine Newman, Neonatal Nurse Practitioner Program Coordinator at Henry Ford Hospital

“With the fall of the iron curtain in the early 1990s, doors were opened for humanitarian missions in the former Soviet Union. The American International Health Alliance (AIHA), a consortium of major health care provider associations and professional medical education organizations, was formed to help the nations of the former Soviet Union structure a much-needed healthcare system. Funded initially by the United States Agency for International Development (USAID) through a series of cooperative agreements, partnerships linking U.S. hospitals with their counterparts in Georgia, Kyrgyzstan, Russia, Ukraine, and Uzbekistan were formed. Hospitals and organizations in the United States donated time and expertise of staff, and AIHA funded travel and expenses.

The Assessment
An in-depth assessment made onsite in L’viv revealed that infants who survived in the district maternity hospitals were brought to this unit in L’viv for care that was impossible for them to receive in their birthplace. The facility at LOCH was a large 48-bed unit, which in 1993 had little capacity to provide much more than basic care to infants, and the mortality was high. Morbidities at this time were not quantified, but case reports depicted significant issues resulting from asphyxia, hypothermia, and other neonatal complications.

Transport of Sick Newborns
A major focus of outreach education was the early transfer of sick infants from the region in an effort to decrease mortality and morbidity. Prior to our efforts, most infants arrived after 7 days of life, very sick and in almost every case hypothermic. Some who were kept warm with hot water bottles arrived severely burned. Transport was done by automobile when gasoline and a physician were available, and only if the infant survived the first few days. Ford Motor Company International (FMCI) donated a transit vehicle, and the UVC seniors raised money for an infant trans- port incubator. These two significant donations allowed us to put a program in place. The staff from LOCH could now go into the region and transport sick infants safely. Infants now mostly arrive on the first day of life, cared for during transport by trained intensive care staff.

Lessons Learned
In the US, as leaders of a NICU, we were constantly striving to improve care by adopting new strategies based on research and literature. Our assumption was that we would do the same in L’viv. It took quite some time to understand that guidelines and standards of care in this country were established by the Ministry of Health (MOH), a local health administration, and accepted research did not always serve as a basis for practice standards. Proposed changes did not always coincide with the agenda of local officials, and we developed strategies to gain their support. Education without resources was a source of frustration for our colleagues and was often a barrier to improving patient outcomes in the unit.

Communication is critical to the life and growth of a partnership. In the beginning, little access to the Internet was available, and the only means of communication was by phone. Our personal investment early on in a computer and Internet connection was one of the best strategies we employed. This means of communication between the partners gave us not only a constant connection for continued dialogues regarding issues but also provided a connection for clinical consultation.

Commitment is essential and not without personal sacrifice. This partnership was a lifeline for our professional colleagues as well as the infants entrusted to their care. They often shared their concern that many people came to visit and promised to help, but few followed through. This made it clear to us that our commitment needed to be without wavering and was one of the most important things to enhance their growth and independence. Our continued commitment eliminated their constant explaining of issues to every changing group of people and created a seamless approach to the project.

Words of Wisdom
• Understanding of the local culture is critical to success. This understanding often takes time. People rarely reveal all details, especially those problems that might be looked upon as unfavorable, until a trusting relationship is established. Most people want to improve their situation, but an outsider must understand the local climate, obstacles, and realities to help effectively. Basic concepts may be the same, but how you implement and make any change is different in different environments.
• Develop a detailed plan with the partners—do not develop a plan for them. They must be equal partners and understand and determine what is needed in their environment.

• Consistency is essential—of a core group of people committed to the project builds trust and prevents rework and allows you to focus on the plan developed and improves efficiency. If you make a commitment, make sure you follow through.

• Empower the People. It is important to provide support to the people in their environment in which work and change are being made. With support most people will strive to improve, knowing that they can fall back on others if needed. Partners that grow together can establish long-lasting partnerships.

Special thanks to my colleagues in L’viv Ukraine, Henry Ford Hospital Newborn Intensive Care Unit, and my mentor, Sudhakar Ezhuthachan, MD, for giving me this opportunity and allowing me such professional and personal growth.”