Transformative Education
for Health Professionals

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Feldshers in the Ukraine

Nina Multak, PhD (c), PA, DFAAPA , Nadia Cobb MS, PA-C

The Ukraine has a reported population of 45 million, with 32 per 10,000 physicians (2009 data available WHO). Because of the large rural population and challenging socioeconomic conditions health care access is in crisis. 

Feldshers were introduced in 1650 in Russia, and during WWII in the Ukraine to increase access to care in the rural areas. They are an accelerated medically trained clinicians providing primary care in the communities.

Full project description: 

During a recent visit to a feldsher training program in Kiev, Ukraine, the lead author had an opportunity to meet with the dean of Kiev Medical College #2 and director of its feldsher training program. The meeting was held in Kiev and conducted in Russian with the assistance of an interpreter.

 Kiev Medical College #2 opened its doors for feldsher training during World War II. At that time, the focus of training was combat-oriented and feldsher students received training on the battlefield.  Feldsher training programs use government-approved curricula and training standards. Each student is eligible to practice after receiving a certificate of successful completion. Most provide primary care in rural areas.

A student attending feldsher training is a high school graduate who provides evidence of high scores in the following areas: competency exam (SATequivalent), biology, and Ukrainian language and literature. Applicants are interviewed by the faculty and are evaluated for maturity and suitability for providing medical care. Upon matriculation, each student receives a monthly stipend from the government. The student uses the stipend for living expenses and a dormitory room.

As is typical of all feldsher programs in the Ukraine, the curriculum is composed of three cycles. Two cycles in the curriculum are theoretical, and the third cycle is clinically based. The first cycle includes courses in liberal arts and basic sciences. Medically related courses are presented in the second cycle and include anatomy, physiology, pharmacology, genetics, and clinical skills. Following successful completion of the first two cycles, students are eligible to participate in the third, which is the clinical phase of their training. Clinical training for students occurs in local hospitals. Each student rotates through the following clinical specialties: internal medicine, pediatrics, surgery, gynecology, orthopedics, physical therapy, dermatology, otolaryngology, and ophthalmology. Training in each specialty area lasts from three to eight weeks, with internal medicine, pediatrics, and surgery lasting for the longer durations.

Rural clinics are typically staffed with a feldsher and an obstetrical nurse. Both have office hours in addition to making house calls. Feldshers in rural clinics perform history and physical exams, prescribe medications, and perform follow-up evaluations. They also work in ambulances as they are staffed with a physician, a feldsher, and an ambulance driver. The ambulance team who responds is determined by the initial needs of the patient. New opportunities for feldshers are also developing in hospital emergency departments.

References:

 Lekhan, Valery, Volodymyr Rudiy, and Erica Richardson. "Ukraine Health System Review." Health Systems in Transition 12. (2012): 1-183.

WHO country summary: http://apps.who.int/gho/data/node.country.country-UKR

Physician Assistant History Society” http://www.pahx.org/period01.html

Photo courtesy John Allwood: Feldsher ambulance

 

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Case study addresses:

Quality: 
Yes
Quantity: 
No
Relevance: 
Yes
Sustainability: 
Yes