Report of Dr. Timur Azhibekov to Trustees of GCVOA on 11/16/01

Dr. Azhibekov is one of several physicians in the transport Department of the Regional Perinatal Center. Along with the other physicians, Dr. Azhibekov rides in the Centerís ambulance to hospitals in the nine districts for which the Center is responsible and to the nine additional districts for which the Center and its Mikhailovka affiliate are responsible. Dr. Azhibekov observes and treats neonatal intensive care infants and decides whether they should be transported to the Center in Volzhsky, while monitoring and treating the infant in the ambulance.

Dr. Azhibekov has been in the residency training program at MetroHealth Medical Centerís NICU since October, 9, 2001 and will remain in this program until his departure on December 15. The second phase of the current training program will begin next March when an obstetrician from the Perinatal Center will start a two month course at MetroHealthís obstetrical unit after language training.

At MetroHealth I am training as a resident in the NICU (Neonatal Intensive Care Unit). My work starts at 8 AM. I take part in rounds as I have a few patients. I treat these patients along with other residents, because I have no license to give orders or to recommend procedures in the US. However, close observation and discussing of individual treatment plans are very useful while training and provide me with a wide experience.

Most of my patients are premature babies with different kinds of perinatal pathology such as respiratory insufficiency, neurological problems,congenital heart discease, infectious diseases, and problems requiring surgery. In addition, this group of patients demands special care just because they were born premature with physiologically and sometimes anatomically immature organs and systems. They are unlikely to survive without competent support.

During my training I am learning new methods of respiratory care in neonates, modern approaches to neonatal nutrition, parenteral and enteral feeding. Also I am getting experience in the management of critically ill newborn infants, in

  1. using special diagnostic and medical procedures: radiological studies, blood sampling, transillumination and catheterization of the central and peripheral vessels, and
  2. applying new medicines, indomethacin in PDA cases*, surfactant in RDS cases**.

I am learning the indications and contraindications of the use of these medicines and how to be alert to possible complications resulting from their use. I have read about these medications in special books we have in Russia, but I have never seen them actually used and have no practical experience with them.

Of course, some of these medicines are not available in our hospital, such as surfactant, IV phenobarbital and Vitamin K1; and some types of modern equipment are not available either, such as SIMV ventilators, and respiratory and other vital signs monitors. But my experience here with these shows me the direction which we should follow.

Besides this work in the NICU I attend lectures and conferences, devoted to topical aspects of perinatal care, take part in discussions and division meetings, and meet with specialists in adjacent fields of medicine, obstetricians, nutritionists, pediatric surgeons.

Sometimes I stay in the unit for the whole night to take part in emergency cases, observe the management of patients with the most complicated diseases and discuss some problems with other residents. I have access to the hospital library which is very helpful as there is a huge number of current journals in all fields of medicine. I also have access to the Internet and for research on the Internet. I spend most of my leisure time in the library.

Upon my return to Russia I want to share my knowledge with my colleagues and to use what I have learned. I want to make some changes in respiratory care using modern modes of mechanical ventilation and respiratory support; nutrition and maintenance of fluid and electrolyte balance. I want to establish closer relations with our microbiological lab and with specialists in adjacent fields of medicine who are involved in perinatal care. I want to reconsider some existing procedures at our center respecting control of infections and treatment of infectious diseases with antibacterial therapy. That is when the appropriate medicines become available to us.

  • patient ductus arteriosus- failure of ehe channlel between the pulmonary artery and the aorta to close at birth;
  • **Respiratory Distress Syndrome

 


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