Health and human security - Environmental and Human Security in the Arctic - page 179

health-care delivery. All these factors represent hurdles for any attempt to
cope with new and re-emerging infectious diseases. 22
Therefore, the Task Force approach to communicable disease control was
not solely aimed at combating the diseases as such, but also on promoting
structural change to facilitate greater empowerment of GPs at the local
level and expanded cooperation between GPs and specialists. The effort to
rectify the structural shortcomings of the post-Soviet health-care systems
was directed at strengthening primary health-care delivery (Task Force
2000:33). For people with infectious diseases, early treatment is essential.
It requires that the first medical worker met by a patient, a front-line doc-
tor or nurse, be sufficiently trained to make the correct diagnosis, prescribe
the proper medication and follow up the patient over time. The Soviet-style
system was not designed for this. For instance, TB patients could not see a
tuberculosis specialist without a referral from their local doctor, and a refer-
ral depended on the local medical worker's ability to identify tuberculosis
as a possible cause for the patient's grievances. Often, local personnel had
not received sufficient training and failed to comprehend the symptoms and
provide proper treatment. Much time was therefore often lost before the
patient commenced treatment, and many therefore remained unaware of
the risk they posed to people around them. HIV/AIDS infection carries the
same risks, of course.
Many projects were therefore designed for primary health-care worker train-
ing, for doctors as well as nurses, in the diagnosis and treatment of infectious
diseases. A substantial effort was put into producing information material in
Russian and Baltic languages on tuberculosis control, HIV and other sexually
transmitted diseases, vaccination and vaccination coverage, and prudent use
of antibiotics. Exchange visits of primary health-care workers from munici-
palities in Western and Eastern countries have taken place. Most interviewees
give a favourable impression of these efforts. Again, the situation is more
difficult in Russia than the Baltic countries, as Soviet traditions remain more
firmly entrenched in Russia than in other former Soviet republics.
The clarity of the Task Force's strategy for primary health care was high-
lighted by many officials. A Latvian interviewee said that, although Latvia had
a primary health-care service already, the Task Force had generated new ideas
and helped bridge the divide between different specialities in the health-care
system. But as one Russian interviewee pointed out, 'they [specialists] tend
to mistrust GPs and are very protective of their particular field of work'. The
Task Force therefore encouraged specialists to dampen their 'protectionism'
and open up for wider, cross-discipline communication. To take an example
of the difficulties that can arise when coordination is poor, it is obviously vital
for doctors to know if a tuberculosis patient has tested positive for HIV, but
this information has not been readily available. We found an improvement in
Arkhangelsk, where they had established a database for epidemiological infor-
mation in the region that was open to all types of specialists. It was considered