Dr. Joseph Merrill speaks at the Ukrainian National Conference.

Dr. Joseph Merrill (left) speaks through an interpreter at the Ukrainian National Conference.

On Sept. 25-26, Ukraine hosted “The Principles for the Management of Drugs, Psychotropic Substances and Its Precursors in General Practice Settings,” the first national conference of its kind. Initiated and organized by the International Renaissance Foundation (IRF) and other international and national stakeholders, including the International Training and Education Center for Health (I-TECH), the event brought together more than 300 experts, including general practitioners and family physicians, state officials, policy makers, infectious disease doctors, narcologists, psychiatrists, and palliative care providers.

The key goal of the conference was to educate primary health care providers on the application of controlled substances in key areas of their practice – such as medication assisted treatment (MAT), often referred to as opioid substitution therapy (OST); palliative care; and mental health – as well as initiate a dialogue about decentralization of these services through primary health centers (PHC) and coordination with specialized facilities and medical specialists.

Joseph Merrill, MD, MPH, an internal medicine physician and associate professor in the University of Washington’s Department of Medicine, delivered a keynote speech on OST in the practice of the family doctor. He also facilitated a day-long section on OST in partnership with local OST expert Vadim Klorfain, MD, from Poltava.

“Dr. Merrill’s contribution was greatly appreciated by the IRF and other conference organizers,” said Anna Shapoval, I-TECH Ukraine Project Director. “His successful participation in the conference seems to indicate a promising start to expanding I-TECH’s activities in this area in the future.”

Topics discussed included the basics of addiction and measuring success in addiction treatment; OST with methadone and buprenorphine; co-occurring medical and psychiatric conditions such as HIV infection, depression, tuberculosis, and viral hepatitis; and the advantages of integrating OST into the practice of family doctors.

Dr. Merrill says the last topic is particularly important to ensure increased access to care. “With the current siloed system, specialties have narrowly defined roles, which often has a negative impact on people with co-existing problems, such as HIV, mental health, and addiction,” says Dr. Merrill. “These individuals currently have to access multiple systems to get reasonable care.”

He also cites efforts to integrate HIV specialists into OST sites as a step in the right direction, as the HIV epidemic in Ukraine is driven in large part by injecting drug users and their sexual partners.

Dr. Merrill had the opportunity to visit an overburdened OST site at the City Clinical Hospital #5, next to the Kyiv City AIDS Center. “There were too many patients for the amount of staff, and there wasn’t any onsite counseling or psychosocial treatment when I was there,” he says. “We continue to have the same issues here in the U.S., where it is easier to implement medication than the treatment around the medication.”

To inform efforts to bring this care into family practice, Ukraine hopes to learn from the experiences we’ve had in the U.S., he says.

Recent health care reform, still under way in Ukraine, brought significant changes in legislation and regulations that now enable access to narcotic, psychotropic, and precursor substances at PHC facilities. The 2013-2020 National Drug Strategy of Ukraine envisions development of a humanistic model of drug policy, moving away from law-enforcement approaches to prevention and treatment, including broadening access to controlled substances – such as OST – to those patients in need.

“Ukraine is in a crisis situation, and that is both an obstacle to change and an opportunity for change,” says Dr. Merrill. “They are making a really strong effort to change their health care systems for the better, and they seem to really rally around each other and try to move forward in spite of the challenges they face.”

Collaborative Creates ‘Culture of Quality Improvement’ in Jamaica

October 14, 2014

A JaQIC team’s storyboard illustrates inspiration points and accomplishments on the journey toward quality improvement. Storyboards are a creative way for teams to learn from one another. Despite strong clinical capacity, systemic barriers may prevent local care teams from executing CD4 count and HIV viral load tests. These tests are critical for monitoring the health […]

Read more …

I-TECH Supports More Than a Quarter of a Million Trainings

September 30, 2014

SEATTLE, Sept. 30, 2014 — The International Training and Education Center for Health (I-TECH) is pleased to announce an incredible milestone: to date, more than a quarter of a million people have been trained with the support of I-TECH and its partners. This total includes: more than 100,000 nurses; nearly 29,000 physicians; and approximately 11,500 […]

Read more …

VMMC Community Mobilizers Now More Mobile in Malawi

September 15, 2014

Community Mobilizer Adyasi Bamusi (left) receives advice on bicycle care from Lilongwe District Environmental Health Officer Mavuto Thomas. A group of eight Voluntary Medical Male Circumcision (VMMC) Community Mobilizers can breathe a sigh of relief after receiving bicycles to ease mobility in their clusters. The beneficiaries were selected based on the remote areas and long […]

Read more …

Stories of Success from Ethiopia: The Tsadkane Holy Water Well

September 8, 2014

Samuel Tadesse found consolation at the Tsadkane monastery, but he saw that more needed to be done. The following is the first in a three-part series of I-TECH success stories from Ethiopia. Samuel Tadesse discovered he was infected with HIV in 2004, after undergoing a routine test as part of a U.S. visa application. He […]

Read more …

PLOS ONE Publishes IDCAP Facility Performance Results

August 26, 2014

The International Training and Education Center for Health (I-TECH) is proud to have been a partner on the first randomized trial of educational outreach and continuous quality improvement (CQI) in Africa. The evidence in a new IDCAP Overview article published in PLOS ONE — “Improving Facility Performance in Infectious Disease Care in Uganda: a Mixed […]

Read more …

I-TECH and DGH Leadership Visit I-TECH Ethiopia, Speak at Outpatient Clinic Launch

July 28, 2014

Dancers prepare to perform at the University of Gondar’s Diamond Jubilee. Earlier this month, a distinguished group from the University of Washington’s International Training and Education Center for Health (I-TECH) and Department of Global Health (DGH) visited Addis Ababa and Gondar, Ethiopia, for several days of discussion, workshops, events, and celebration — including the University […]

Read more …

I-TECH Presents at AIDS 2014 in Melbourne

July 17, 2014

On July 20-25, the biennial International AIDS Conference, AIDS 2014, will be held in Melbourne, Australia. Dr. Gabrielle O’Malley, I-TECH’s Director of Implementation Science, is heading down under to present two posters: Evaluating the Effectiveness of Patient Education and Empowerment to Improve Patient-Provider Interactions at ART Clinics in Namibia, lead authored by Dr. Ellen MacLachlan, […]

Read more …

Ukrainian Medical University Delegation Visits I-TECH HQ

July 8, 2014

From L to R: Dr. King Holmes, Dr. Olga Vystoska, and Dr. Ann Downer present the signed MOU. On June 12 and 13, representatives from Ukraine’s Bogomolets National Medical University (NMU) visited I-TECH HQ offices at Harborview Medical Center and the University of Washington (UW) Department of Family Medicine. NMU is the leading medical school […]

Read more …

I-TECH Presents at CUGH 2014

May 5, 2014

I-TECH staff will head to Washington, D.C., this week to the Fifth Annual Consortium of Universities for Global Health (CUGH) Conference, which will take place at the Washington Hilton from May 10-12. More than 1,300 participants from 50 countries are expected to attend the conference, co-hosted by the George Washington University and Stanford University. This […]

Read more …