27.01 – 30.01.2009 Ultrasound training for imagists and obstetricians took place.

The seminar was conducted by Cora Voekt and Olav Lapaire, Basel, Switzerland and Gheorghe Iliev, Iasi, Romania.

The agenda of the seminar included such subjects as: Ultrasound in early pregnancy; Nuchal translucency and first trimester test; Non – invasive prenatal diagnostic possibilities; Invasive diagnostic procedures; Doppler ultrasound – physical principles, indication and management; Intrauterine growth restriction; Twin / multiple pregnancy: diagnosis of and management in twin pathology; Cervix length and prediction of preterm delivery; Principles of fetal echocardiography; Neural tube defects; CNS-anomalies; Anterior wall defects (omphalocele, gastroschisis etc.); Fetal infections; Foetal systemic echography. Principles of prenatal diagnosis; Heart congenital malformations. Principles of prenatal diagnosis. Malformations of the four chambers; Heart congenital malformations. Principles of prenatal diagnosis. Malformations of the four chambers. Malformations of the big vessels.

The practical training sessions included such activities as: measurement of nuchal translucency, analysis of IUWR or multiple pregnancy cases, and discussions of posters on the following issues: Possibilities of prenatal diagnosis and obstetrical management of congenital heart defects; Multiple pregnancy with malformed foetus. Prenatal diagnosis and obstetrical management. Importance of echographic visualization of aorta and pulmonary arteries in prenatal diagnosis of heart congenital malformations; Prenatal diagnosis of heart malformations with normal cardiac architecture.

The seminar was attended by 22 specialists from IIIrd and IInd level Perinatal Centers.

21.01.2009 Workshop Telemedicine in clinical practice: organisation, roles and responsibilities

Marc Blunier, Health Technology & ICT Specialist from SCIH, STI carried out a workshop with the heads of the OBS/GYN and Neonatology departments of level II and III maternities to plan and prepare the implementation of Telemedicine in clinical practice enabling efficient communication and exchange of expertise among health professionals in order to enhance practical skills and knowledge. The event covered the following topics:

Introduction to the Programme (activities and objectives); Introduction into Telemedicine (definitions/ key concepts); Presentations of i-Path application;   Introduction into Telemedicine Model of the Mother & Child Health Program in Ukraine (how/ when/ why/ benefits/ problems);

Possibility of collaboration between second and third level Maternity Hospitals; Presentation of the planned regional network in Volyn oblast; Organisation of Telemedicine in the clinical practice / Expectations and responsibilities; Preparation of the Telemedicine working place and next steps.

9-13th of February, 2009 A seminar on Neonatal Follow-up and Neurodevelopment assessment by the Bayley test was organized at the MCHCRI. About 30 specialists, including neonatologists and neuro-pediatricians, attended the course held by Prof. Robert Cicco (pediatrician & neonatogist) and Diane Shaffer (Manager - Training & Organizational Development at United Disabilities Services) from PA, USA.  The first two days focused on the theoretical aspects, including overviews of such subjects as: Normal development of the infant in the first year of life, Impact of prematurity on infant’s development, Follow-up evaluation components, Organization and set up of the standardized Bayley evaluation. In the following days the participants had the opportunity to observe several evaluations carried out by the trainers, and subsequently take part in evaluations themselves.
To assure the quality of the evaluations and involve all the participants in each of them, a team of cameramen and a light specialist has been invited; in this way each evaluation session was simultaneously projected on a screen from the conference room and videotaped for future reference.

On the last day of the training, Alice Visan (kinetotherapist) Iasi, Romania has carried out a presentation on the Romanian experience in Neonatal Follow up and Neurological Rehabilitation. A separate practice session on kinetotherapy manipulations was carried out for the nurses from NICU.

The seminar ended with a post-course evaluation and certificate awarding.

10-11th of March, 2009 A workshop for the Elaboration of the National Program for Monitoring Congenital Malformations was organized, with the participation of two invited speakers from the UK – Patricia Boyd, President of EUROCAT and Ann Tonks, Anomaly Specialist at the Perinatal Institute, West Midlands Congenital Anomaly Register.
The session started with an overview of the current situation in Moldova, through several presentations offered by the Moldovan specialists, including: Prenatal cytogenetic diagnostic in Republic of Moldova,  Ala Halabudenco; Prenatal molecular genetic diagnostic in RM, V. Secara; Postnatal screening in RM, N. Usurelu; Evidence of congenital malformations through the National Malformations Registry in RM, V. Secara.

The UK specialists presented the Experience of Congenital Anomaly registers in the UK and the links to other programs, Ann Tonks; Surveillance of congenital anomalies in Europe and use of the data held by EUROCAT and the EDMP method of surveillance used by EUROCAT, Patricia Boyd.
In addition, during the first day the draft of the National Program for Monitoring of Malformations in RM was presented.

During the second day, the participants worked in several groups on elaborating and improving different compartments of the National Program, including promotional materials for the population, statistical forms for the registration (tracking) of congenital malformations, educational materials for doctors, etc.  At the end workshop, the UK specialists offered their opinion and recommendations in regards to the further development of the Program.

23-25th of March, 2009

The seminar “Management of complicated deliveries” moderated by Prof. Irene Hosli, Basel University Hospital, Switzerland took place at the MCHCRI. The event was attended by obstetricians from all the maternities from the republic (about 50 participants) and lasted for 3 consecutive days, covering such important topics from obstetrics filed as: IUGR and the usage of Doppler in its diagnosing; management of the breech presentation; multiple delivery; management of postpartum hemorrhage; tocolysis; preeclampsia; induction of labor; vaginal operative delivery.
The course involved the review of basic theoretical knowledge, supported by a large number of illustrative materials and also a complex presentation of the most recent studies and trials performed worldwide on the presented subjects.
The assessment performed at the end of the course showed that the participants have greatly appreciated the excellent work and were interested in participating in similar events in the future.

In the period of 31st of March – 01st of April, 2009, in the context of the HTM component a 4th session of the HTM WG was organized and special focus have been put on the review and continuation of the newly equipped services cost study initiated last December, through a separate  work session dedicated to the review of activities with HTM WG members in charge and continued on the next steps of the study; the mission also reviewed the work of the HTM WG (working group) in the various identified directions, including the update of the delivery of the tools to the 3 pilot maintenance workshops and their installation, the monitoring of the use of the Moldova telemedicine platform, the introduction of a software to manage medical equipment at hospital level, the planning of the future study tour to Romania and monitored the work of the local consultant (current HTMWG coordinator) recruited to follow activities up. The SCIH expert was supported along the two meetings by Nicu Fota, consultant from CRED Foundation (Romania).

The 10th of May, 2008 marked the official start date of the MMPS IInd phase.

Between the 30-31st of May, the 1st Regional Moldo-Romanian Conference “Neonatal Days” has been organized by the local team at Vadul lui Voda, with the participation of 69 local neonatology specialists and 35 Romanian specialists form various clinics of Romania.

At the end, a bilateral agreement of organizing a similar event in Romania in 2009 year has been achieved. In addition, a set of recommendations for strengthening the collaboration between the two parts has been generated.

In the frame of the mutual collaboration between AMP and the Swiss Partner, with the aid of Prof. Michel Berner (Geneva University Hospital), several Moldovan neonatologists and one X-ray imaging specialist have visited Geneva and Basel University Hospitals for clinical training and exchange of experience.

Moldo -Romanian collaboration was continued through the visit of 2 selected nurses from NICUs (MCHCRI) to analogous units at “Cuza-Voda” Maternity, Iasi, Romania for a training on kinetotherapy and neonatal care performed in these departments.
On the 18th of September, in the frame of the FIGO Saving Mothers and Newborns Project Activities and AMP collaboration, a seminar on “Facility based audit” moderated by Prof. J. Gardosi, Director of Perinatology Institute, Birmingham, UK with the participation of 40 specialists from the IInd and IIIrd level institutions was organized.

In the period of 1-30th of September, AMP has hosted 3 groups of specialists from the University of Louisville, Kentucky, USA and has been involved in all the trainings and clinical work carried out by them in the 2 NICUs from the MCHCRI, along with other 44 participants. The courses were oriented on providing specialized medical care to the newborns, using available modern equipment provided by MMPS phase I. 

The visit of the US specialist was supported by the International Department of Pediatrics, Pediatrics Foundation and University of Louisville and has been made possible due to the collaboration with Prof. Dan Stewart, director of the Neonatal Departments at the Kosair Children's Hospital, Louisville. Each team of specialists included neonatologists, nurses with completed higher education and a respiratory therapist. 

The US specialists have mentioned that the neonatal service in the Republic of Moldova has deeply progressed during the last few years, as a result of the endowment with medical equipment of the institutions that provide perinatal care, from the Grant offered by the Swiss Government in the frame of the implementation of the MMPS (2006-2007 year).
In their opinion, the continuation of this support during the second phase of the project will allow the newborns from Moldova to receive higher quality medical care in the future years. These activities have been carried out in support of the Component 1 of the MMPS II.

Throughout 17-21st of November, an international theoretical-practical course on Nosocomial Infection and Hygiene of the Hospital Environment has been organized. The course was moderated by two foreign lectors: Dr. Lucas Opitz (France) and Prof. Johanes Huebner (Germany), and was attended by approximately 50 participants, including neonatologist from IInd and IIIrd level institutions and epidemiologists from several Centers of Preventive Medicine.

The new HTM component has been integrated into ongoing project activities through the organization of three HTM workshops, during which an HTM work group has been identified and formed, a group coordinator has been nominated; a list of individual tasks has been elaborated and responsible persons selected. In addition, in the frame of the same component, 3 medical facilities (MCHCRI, Hospital No.1 (Chisinau) and the Perinatal Center from Balti) have been selected to host the first pilot maintenance centers for the medical equipment used within these institutions. A list of basic tools for the endowment of these centers has been discussed and agreed on; these are to be procured from Switzerland and delivered to Moldova during the first quarter of 2009.

20 – 21 November, 2007. Seminar on improving skills in pediatric and neonatal mechanical ventilation. The seminar was held by Prof. Peter Rimensberger from Geneva University Hospital, Switzerland. 50 neonatologists from the Ist and IInd level maternity hospitals from the republic and 2 neonatologist from Romania attended the seminar.
The main discussed topics were: Physiological and pathophysiological basis for optimal ventilator settings, Lung recruitment and the open lung concept, Basic and advanced respiratory monitoring at bedside, Newer modes and strategies for mechanical ventilation, Practical illustrations and training on simple lung models

16 – 17 October 2007. Seminar on Neurological development issues of the neonate. The seminar was held by Prof. Michel Berner, Prof. Petra Huppi, associate Prof. S. Sizonenko and associate Prof. C. Korff, from Geneva University Hospital, Switzerland. 50 participants from the Republic of Moldova and 3 participants from Romania (Iasi and Cluj-Napoca) were invited to the seminar.
The main topics discussed were: Fetal and neonatal brain, Neurological examination of the neonate, Clinical practices for special care nurseries, Pathogenesis of the brain lesions, Clinical approach of hypoxic-ischemic encephalopathy, EEG and seizures, Cerebral USG examination in neonates, Monitoring the neonatal brain by aEEG and MRI, Brain development from NICU to home, Follow-up of preterm neonates, Neonatal brain injury and later outcome, Outcome issues, ethical considerations and  practical attitudes in NICU’s.

Between May 22 -25, 2007 - an initial seminar on new ventilation techniques conducted by Lucas Opitz, Nice, France was organized in Chisinau . Theoretical lectures were combined with practical instructions on the medical devices procured. Doctors from the second level hospitals, residents, the department of neonatology from the medical university, and doctors from the 3rd level participated in the seminar. Participant appreciated the high quality of teaching material presented, and the high value of practical exercises. The training was right in time considering the completion of the procurement process in May 2007. 

1 January, 2008. Medical equipment has been delivered, installed and is currently functioning. According to the contract between the Ministry of Health and SDC, in May 2007, medical equipment for 26 maternities of the Ist and IIIrd level, with a total cost of 2,5 millions CHF has been delivered, installed and is currently functioning.

After an evaluation of the medical programs dedicated to the mother and child health and the equipment management, sustained by SDC, performed by two external experts (Franziska Freiburghaus, Switzerland and Alin Stanescu, Romania), which determined the functionality of the equipment, SDC offered additional sources for the procurement of supplementary equipment: 4 ventilators for the maternities that have more than 700 deliveries per year (Ialoveni, Floresti, Stefan-Voda, and Comrat), medical devices for the two NICUs from MCHCRI: 2 mobile X-ray devices, infusion pumps, phototherapy lamps, brain  monitor, analyzer of the blood gases and medical equipment for the Perinatological Centers of the 2nd level (Chisinau, Balti, Cahul): phototherapy lamps, infusion pumps and cardio-monitors.

This equipment will contribute to the strengthening of the care of the children with low birth weight (LBW) and very low birth weight (VLBW), especially since beginning with the 1st of January, 2008, Moldova will pass on to new standards of medical care for the hospitalized children with the birth weight from 500g and 22 g.w.
The donation represents the first step for the increase of the survival of the newborns in the Republic of Moldova.

07 of November, 2007.  The official handover of the Neonatal Ambulance with equipment and devices took place. The event was unfolded at the MCHCRI, in the presence of the Minister of Health Mr. Ion Ababii and the Country Director from the local SDC office – Mr. Thomas Kugler. The cost of the ambulance constituted 170.460,5 CHF.

Donation of the Swiss Confederation
As part of the project agreement “Modernizing the Moldovan Perinatology System” dated July 1^st 2006 and the Memorandum of

Understanding signed on October 26^th 2006 between the Swiss Agency for Development and Cooperation and the Ministry of Health and Social Protection in the Republic of Moldova: medical goods, spare parts and consumables for maternity units of first level and partially for the third (Mother and Child Research Institute in Moldova) and second levels with a total value 2,5 mln CHF were procured and donated.

The project “Modernizing the Moldovan Perinatology System” is funded by the Swiss Confederation through the Swiss Agency for Development and Cooperation and implemented by Association of Perinatal Medicine in collaboration with Swiss Tropical Institute.

The medical equipment presented: surgical aspirators, vacuum extractors, adult physiologic monitors, sets of surgical instruments for caesarean section, sterilizing units, delivery beds, CTG, EEG, fetal heart detectors, sphygmomanometers, USG obstetric/gynecologic &neonatal, phototherapy lamps, infusion pumps, emergency kits, stethoscopes, glucose meters, pulsoximeters, ventilators for intensive care with high-frequency ventilation, nasal CPAP for neonates, infant incubators, audiometers, otoscopes & ophthalmoscopes.