by Maggie Somerset
In terms of territory, the republic of Kazakhstan is the largest of the former Soviet republics, excluding Russia. The country, part of the USSR since 1938, gained independence in 1991. With a population of about 16 million, Kazakhstan possesses large fossil fuel reserves as well as plentiful supplies of other minerals and metals. However there are radioactive and toxic chemical sites associated with former defence industries throughout the country, these, and severe industrial pollution pose serious health risks to the population.
Since 1995 the UK Department for International Development has funded a number of projects, including health projects to facilitate Kazakhstans transition to a market economy. One of these involved the development of family practice. My colleagues Professor Debbie Sharp, Dr Terry Patterson and Dr Kim Hearn together with a number of other Bristol GPs organised and implemented the training of general practitioners in Almaty, which is the largest Kazakh city and at that time was the capital. It was from this initial project that my involvement with Kazakhstan developed.
Dr Talapkali Izmukhambetov, a surgeon, once Minster of Health for Kazakhstan, and now Director of the main college for professions allied to medicine in Almaty visited Bristol University during 1997. We were introduced. When he learnt that although now a lecturer in primary health care research, I had once been a nurse, Talapkali asked if I would be interested in examining the situation for primary health care nurses in Kazakhstan. Our initial discussions resulted in a fact-finding visit followed by a successful application for a Regional Academic Partnership (funded by the British Councils Know-How Fund). The main aim of the work was to assist development of the educational curriculum for nurses in Kazakhstan and to further recognition of their contribution to primary health care.
Over the next few years I travelled to Almaty on several occasions. I was always treated with the most extraordinary kindness and hospitality. I visited polyclinics on the lower reaches of mountains, urban housing, hospitals and hospice developments. I met nurses and doctors who were eager to learn, some who were disenchanted, others who were fearful about proposed changes- many of their problems seemed very familiar and others were outside my experience.
The project has resulted in many benefits. The Republican Medical College now has excellent teaching facilities some of which were financed by the project. For instance it has access to information technology and many medical texts have been translated and are now available to students. The project has included a large English language-teaching element, which has been lead by Ian Badger. Students and teachers have been able to access English language medical teaching materials provided by the project. English teaching has been supplement by the presence of University of Bristol Russian language students who have spent several months at the College as part of their studies.
Nurse teachers from the University of the West of England assisted with teaching and advised on aspects of the curriculum in 1999. Members of the Bristol Russian Department have visited Almaty to provide support for the Russian students. A friendship has built up between many visitors from Bristol and Almaty health care professionals. The Director of the Republican Medical College and members of his staff visited Bristol University and Primary Healthcare facilities on several occasions.
The final visit relating to this project was in May 2002. This visit, hosted by Dr Izmukhambetov centred on a conference attended by Directors and Deputy Directors of the main nursing colleges in Kazakhstan. Professor Tim Peters and I represented the University of Bristol. The conference concluded that the model of education that had been devised as part of the project was applicable for all Kazakh colleges. It was hoped that ultimately all the colleges could work on a shared national framework of education and aspire to maintain shared standards.
At the beginning of the conference I was granted an enormous privilege when I was presented with an award for services to medical education in Kazakhstan. It was the first time that a non-national had ever received the honour. In thanking the ministry of health for the award I responded that projects of this nature are very much a two way process. I, and my colleagues have learnt as much from our contact with this extraordinary country as they have from us. My advice to potential visitors to Kazakhstan is build friendships above all and arrive by daylight, so that as you step out of the plane you catch the sun on the snow-capped mountains