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November 2002, Vol 92, No. 11 | American Journal of Public Health 1740-1742
© 2002 American Public Health Association

FIELD ACTION REPORT

Pursuing Community-Oriented Primary Care in a Russian Closed Nuclear City: The Sarov–Los Alamos Community Health Partnership

Robert L. Rhyne, MD and Philip A. Hertzman, MD

Robert L. Rhyne is with the University of New Mexico School of Medicine, Albuquerque. Philip A. Hertzman is with the Los Alamos Medical Center, Los Alamos, NM.

Correspondence: Requests for reprints should be sent to Robert L. Rhyne, MD, University of New Mexico School of Medicine, 2400 Tucker Ave NE, Albuquerque, NM 87131 (e-mail: rrhyne{at}salud.unm.edu).

The Russian health care system historically has not relied on medical evidence to guide practice, uses centralized management, and is burdened by overspecialization. In 1999, a community health partnership was established between Sarov, Russia, and Los Alamos, NM, 2 cities linked by their nuclear weapons histories. Health problems addressed include asthma and diabetes, pediatric dental caries, low prevalence of breastfeeding, and adolescent drug abuse and sexually transmitted diseases.

A community-oriented primary care approach was adopted that includes (1) implementing a "train the trainers" strategy to educate health professionals and lay people, (2) adapting established clinical practice guidelines based on local resources, (3) restricting use of expensive or limited resources, and (4) securing commitments from local government for expendable supplies and medications.






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