Why a Clinic Partnership?
Already since 2002 Berlin-trained diagnostics, therapy and HIV/AIDS care courses are conducted in Eastern Europe, and in particular in Ukraine. Responsible for organisation and conduct of most of those training modules is a group of individuals from the environment of the Clinic for Internal Medicine - Infectiology / Gastroenterology of the AVK and its Immunological Day Hospital.
After reviewing previous projects the group decided to establish additionally a long-term partnership project with one specific institution. The time limit of the training courses (approx. one week or weekend workshops) makes it difficult to understand to what extent the knowledge gained can be realised, i.e. in how far sustainable effects were achieved.
The Berlin-based journalist and documentary filmmaker Karsten Hein established the contact between the AVK and the Donetsk AIDS Centre in 2005, after he became acquainted with the AIDS Centre during his research.
Goals of the Clinic Partnershipt
In January 2006 PD Dr. Keikawus ArastÃ©h, Inge Banczyk and Susann Kowol from the AVK visited the Donetsk AIDS Centre for the first time and agreed with director Nikolai Grashdanow upon a cooperation to support the AIDS Centre collegially; basically with a constant transfer of knowledge about diagnostics and therapy as well as the care of people infected with HIV/AIDS. The following was agreed:
Training Courses in Diagnostics and Therapy
Based upon the resources available in Donetsk, physicians will receive training in diagnostics and the therapy of opportunistic diseases.
By this training the physicians should achieve a qualification of built on their resources and strengths.
Training in HIV/AIDS Care / HIV/AIDS Palliative Care
Another equally important goal is transferring knowledge to the health care workers of both centres about the special care and palliative care of people with HIV and AIDS.
Multiplication/Training-of-Trainers in Donetsk
The Donetsk colleagues, i.e. the target group of the clinic partnership, either work in the policlinic of the AIDS centre in the city of Donetsk or in the new AIDS ward. The knowledge acquired during observations is subsequently shared/multiplied in both locations.
A bilingual communication platform is planned to provide an exchange of information on a regular basis. Thus results and questions regarding treatment and care could be discussed online.
Realisation of the Clinic Partnership
The partnership's goals and project stages are above all aligned to the needs in Donetsk. In frequent team meetings the development of the clinic partnership is pondered and discussed, thus making the implementation subject to a constant process of improvement. Top priority is of course to incorporate the Ukrainian colleagues into the development and realisation of the partnership goals.
Advanced Training, Sonography
This training is realised in Berlin as an observation lasting several weeks. Depending on the focus, an employee of the AIDS Centre (physician or trained health care worker) aided by an interpreter sits in on the wards of the Clinic for Internal Medicine - Infectiology / Gastroenterology as well as on other AIDS care departments of the AVK. In addition to that, there are meetings with other Berlin care utilities. Subsequently the observants will impart their newly acquired knowledge in the Dontesk AIDS Centre. See also Photo gallery: Observations in Berlin.
Website and Telematics Platform
The Internet portal www.aids-ukraine.org provides background information on the situation of the HIV epidemic in Ukraine and guarantees transparency of the projects. An internal communication platform will facilitate prospectively a prompt exchange between centres. But that is neither meant nor capable of replacing regular personal contact.
Visit the Tuberculosis Hospital in Donetsk.
The Donetsk AIDS centre is visited in regular intervals (at least every six months and on demand). These visits provide the basis to specify the educational foci of the training courses under the conditions existing in Donetsk and to discuss developments so far, like e.g. to what extent the knowledge acquired in Berlin can be applied und multiplied under local conditions. Given that the German and the Ukrainian health systems have a rather different history of origin (the differences and similarities of which have to be considered in the project conceptualization), the assessments allow to get to know better both, the (sub-) national HIV care structures as well as the working conditions of the Ukrainian colleagues. See also the photo gallery "Visiting Donetsk in 2007 - 2008".
The training course are organised and conducted by a interdisciplinary group in Berlin. Communication takes place with the aid of Germanâ‡”Russian or Ukrainian interpreters in Berlin and Donetsk.
The Berlin Team co-operates with national and international organisations, like e.g. the Berlin Aidshilfe e.V., the Felix Pflegeteam gGmbH, with the hospice service Tauwerk e.V. as well as several Berlin surgeries specialised in HIV, with the Federal Ministry of Health (BMG), the German Technical Cooperation (gtz) and the WHO.
Another important factor is the participative involvement of the Ukrainian colleagues into the planning, the implementation and evaluation. There are specific contact persons for that in the Donetsk AIDS centre.
The Vivantes Auguste-Viktoria Clinical Centre
Most of the team members come from the environment of the Vivantes Auguste-Viktoria Clinical Centre (AVK). Since 1985 people with HIV und AIDS are treated in the Clinic for Internal Medicine - Infectiology / Gastroenterology of the AVK and since 1992 in the Immunological Day Hospital attached to the Clinical Centre. Based on their long-standing experiences in the treatment and care of people living with HIV/AIDS (PLWHA) the AVK physicians developed their own therapy guidelines and set up a big pool with graphic material on opportunistic diseases. This knowledge and material is made available to the Ukrainian colleagues.
The Donetsk AIDS Centre, 2006
The Donetsk AIDS Centre
The Donetsk AIDS Centre was opened in the mid-1990s. Even at that time the oblast (district) Donetsk was one of the hardest hit Ukrainian regions by the HIV epidemic: 4.8 million people are living in the district, about 250.000 of them are HIV positive. It is one of the oldest public AIDS centres in Ukraine, which consisted right from the start in policlinic, a epidemiologic ward and a central lab. In 2007 the AIDS Centre extended its care utilities with a separate AIDS ward.
More information about the AIDS Centre Donetsk.
The AIDS Ward of the Donetsk AIDS Centre
The AIDS Ward of the Donetsk AIDS Centre
The AIDS ward is located about 20 - 30 km out of town, on the location of a former psychiatric ward. Up to 60 patients can be taken care of on two floors.
The extension was primarily funded by the Global Fund to fight AIDS, Tuberculosis and Malaria and to some extent by the Ukrainian Ministry of Health. It is the first AIDS ward in that East Ukrainian district. Hence the local health care workers lack experience in inpatient care [of PLWHA]. Likewise the technical options to diagnose opportunistic infections are still quite limited.
More information about the AIDS Ward.
These procedures will be documented and evaluated as a back up. The (partial) results will be discussed in the team and included into the planning.
The collection of data is made by partially standardised protocols and partially structured expert interviews in Berlin and Donetsk. Participant observation is used for methodological triangulation, too.
Plus, a questionnaire was elaborated for the AIDS centre with the objective to obtain information about the epidemiological development of the HIV epidemic, personnel resources, examination methods and spectrum of diseases in regular intervals.
At the end of every year an expert discussion will take place besides the evaluation of the protocols. The central questions are aligned to the internationally acknowledged evaluation criteria of the OECD Development Assistance Committee (DAC): effectiveness, efficiency, relevance, sustainability, impact, influence on general conditions, capacity development, and participation.
Thus during the stage of project implementation the focus is on qualitative evaluation. Shortly quantitative surveys will be included too, so as to be able to assess the impact, i.e. the extent to which the development measures contribute to accomplishing the desired (superior) goals, and other indirect effects that occur.
Perspectively it seems to be important to support the networking of the different HIV care structures in the city and the district of Donetsk. The German team can enhance this dialogue with its long-standing good experiences with the Â»SchÃ¶neberger ModelÂ«, a model concept of integrated care of people living with HIV and AIDS; which was developed during the 1980s in Berlin.
Certainly some co-operations do exist already between medical and social institutions in Donetsk and the AIDS centre. For instance, due to the limited technical equipment of the AIDS Centre one co-operates with other (district) clinics. Another co-operation exists in the fields of TB and HIV care, representing separate sectors in the Ukrainian health system. A - in most cases multi-resistant recurrent - tuberculosis [disease] is one of the most frequent opportunistic HIV infections in Ukraine. Here in particular it seems to be imperative to extend the network.
The AIDS centre co-operates with the harm-reduction project in Donetsk (a narcological health centre licensed for substitution therapy). At the moment substitution therapy can only be implemented as a pilot project with rather limited capacities in Ukraine.
The AIDS centre offers social support for people living with HIV and AIDS with a proper self-help group as well as in co-operation with other self-help projects in Donetsk and greater area (e.g. Svitanok). In Ukraine self-help means above all financial and legal, instead of psychological or psychiatric support. There is no professional training to become a social worker (so far), thus making training modules necessary in this field.
But not only these already existing networks can be used when questions arise. New care options can be revealed that provided good results in Western Europe: outpatient and hospice care. Both of them represent new options in the Ukrainian HIV/AIDS care. The pioneer in this field has been CARITAS Ukraine, which already co-operates successfully with the care programme Â»NadeshdaÂ«.
More information about the care programme.
Last but not least the cooperation with the Students Health Dialogue (SHD) will be extended further. The SHD supports the prevention of the general population necessary to curb the HIV epidemic.
More information about the SHD.