Currently the populations of Vladivostok and Primorski Krai have no immunizations whatsoever for hepatitis. The lack of measles, mumps, and rubella immunizations are exceedingly common for the children of Vladivostok. The vaccine for diphtheria, pertussis, and tetanus is usually given.

The incidence of hepatitis B (also see GAVI) worldwide is approximately three hundred million carriers actively. These patients are very disabled and often become a medical and financial burden to the society rather than being productive individuals in their mid-age life. The financial and economic impact is exceeded only by the personal suffering that these individuals have secondary to their chronic illness. These illnesses are exceedingly avoidable, and indeed, for an emerging economic society it is imperative that the immunizations be made available.

The local, state, or national government are not addressing these needs.

Project's conception

At his own expense Cameron Park Club Member Thomas Leavitt M.D. visited Vladivostok in Sept.1998. He went there as a guest of Dr. Anna Kolemagina, a member of the Vladivostok Rotary Club, to discuss and teach in his specialty, oncology. Interacting with numerous medical doctors there, he was able to gain a brief, firsthand experience in Russian medical procedures. One thing he noticed was the lack of records reflecting immunizations of children, because there are little or no inoculations given (only DPT and Polio).

It was obvious to him that this was a significant area where minimal expense would generate meaningful results. The economics of it were exciting. He also realized this was an opportunity for Rotary to provide service, which can promote goodwill and further understanding in Russia. Future illnesses could be prevented, general health conditions improved, daily output of healthy workers enhanced and contributions toward an improving economy would help Russians reach a higher quality of life.

When Dr. Leavitt returned from Vladivostok he developed a proposal for a 3-H Grant project which could progress into a comprehensive inoculation program for the children of Vladivostok, then spread through Primorski Krai, and later through the Russian Far East by the Rotary Clubs. The Cameron Park Rotary Club Board of Directors approved and supported his proposal in February,1999.

Later in February 1999 Cameron Park Rotary member Terry Wilson met with Rotarians Terekhova and Klokova, during the Tucson, Arizona Russian workshop, to discuss the proposal. The Russian Rotary Members thought it was a very needed project and agreed to work together on it. Both Vladivostok Rotary Clubs held a follow-on meeting in California between Cameron Park Rotarians Leavitt and Wilson and Vlad-Eco Rotarian Terekhova to confirm the desire of participation. There was a detailed discussion of the health information retrieval needed and how to set up communication to Russia. (We are using e-mail and it is timely and effective)

In April 99 The Cameron Park Rotary Club formed a Project CARE (Caring Alliance of Rotarian Efforts) committee and the first task was to pursue a 3-H Planning Grant in order to obtain the necessary planning, information, contacts, and confidence that the cooperating Rotary Clubs could conduct the project. It was also necessary to make contact with the Russian public officials to ensure they supported the project and were willing to carry it through.

The 3-H Planning Grant was approved and received at the end of June 99. Dr. Leavitt and Past-President Bob Dorr traveled to Vladivostok in July 99. The itinerary is attached (Attachment 2). As shown on the itinerary meetings were held with state (Krai) and local officials, Rotarians, and hospital administrators. Our visit received Russian TV (all 5 channels) and newspaper attention. And we accomplished our goals to develop the needed facts, make the right contacts, and get the necessary commitments for support of the project.

Attachment 3 is a copy of the agreement reached between the Cameron Park Rotary Club and the Russian Vladivostok and Vlad-Eco Rotary Clubs which defines responsibilities for proceeding with the 3-H Grant application.

Russia's involvement in the project Design process.

As Dr. Leavitt began to develop his idea for this project he had continuing discussions with members of the medical community in Vladivostok. Some were Rotarians, but others were not. The medical community was very helpful in obtaining information needed to design the project. Dr. Leavitt made many friends in this community who strongly support the project and will be helping to implement it.

Russia will be required to implement the following five basic steps.

The first step is customs clearance. This entails pre-arrangements with all necessary Russian agencies to expedite transfer of biological substances (vaccines) through customs. In meetings with Victor A. Logachev, deputy head of Primorski Health Department they accepted this responsibility. The vaccine must be declared for humanitarian use to avoid custom duty.

The second step is the storage of vaccines in appropriate safe and temperature controlled environments while awaiting distribution. This need has been discussed with Tataiana Burmistrova, Chief of Pediatrics Public Health Department and she will accomplish this task.

The third step is distribution of vaccines to immunization centers for inoculations. The Rotary Clubs of Valdivostok will monitor this process.

The fourth step is the inoculations. This will require cooperation from local hospital chiefs and staffs. We have personally met with personnel and reviewed the hospital sites including Dr. Irina Keldusheva, chief Children Hospital #1, Gennadiy Shergin, medical chief Primorski Center Regional Hospital, and Lyudmida Minkin, regional director Children?s Oncohematolgy Center. The Rotary Club members in Vladivostok will review all immunization records on a regular basis.

The fifth step is appropriate destruction of one-time-use syringes and needles. Dr. Leavitt has personally observed the incineration facilities and they meet the requirements.

In summary, steps for development of an immunization program have been identified. Appropriate public health and government officials have accepted responsibility for administration of the program with proper oversight by local Rotarians. The Chief of Public health of Primorski Krai, Valery Prikhodko, has extended the full support of his office during our Vladivostok meeting and our recent Rotary Conference in Seattle.

A joint effort between the co-sponsors.

The design of this project has truly been a joint effort between the co-sponsoring Rotary clubs (the two Clubs in Vladivostok and the Cameron Park Rotary Club). Prior to June 1999, preliminary meetings were held between Rotarians Dr. Leavitt, Terry Wilson, Terekhova, and Klokova to determine if there was sufficient support, desire, and capability to conduct such a project. Then members of the Russian Clubs began to gather information and statistics in conjunction with the Krai (State) health director and his staff. Cameron Park members began to gather information about submitting 3-H Grant applications. The three Rotary clubs formed sponsoring committees to design the project and pursue funding. They applied for and received a 3-H planing Grant to fund the necessary travel for members of the Cameron Park Club to visit Vladivostok. The purpose of this visit was to establish a good working relationship with the Vladivostok Rotarians, to gather firsthand knowledge about the capabilities there to conduct the project, and to develop good working relationship with the public officials and the medical community. A side benefit was that our project received TV and other media attention. The trip was very successful. The design process continued with at least monthly e-mail contact between the club members.

Then a meeting was held in Seattle during the "Expanding Rotary in Russia" Conference January 28-30, 2000. Rotarians from the three Clubs and Dr. Prikhodko (Krai Public Health Director) were in attendance. Here the final details of the project were discussed and responsibilities were assigned. See CARE Outline, attachment 4 for the elements of the project that were discussed.

Russia's governmental agency's role in the Design process.

A health project of this nature would be impossible without the support and cooperation of the Krai (State) health department. Also it is important to have the Krai Governor's support. Dr. Valery Prikhodko is the head of the Krai health department, Galina Gorshunova is the deputy head of the department and Dr. Tatiana Burmistrova is the Krai chief of pediatrics and all three have helped us design the project. Dr. Prikhodko has participated in the preliminary meetings. During the 3-H Planing Grant trip to Vladivostok members of our three Rotary Clubs met with the Vice-Governor A. Gartman and he expressed the Krai Government's full support (recorded on all 5 TV channels). There have been several meetings with Dr. Prikhodko in Russia and in Seattle. He has offered his full support as well as taking a lead role in the design for transporting and storing the vaccines and administering the immunizations. Both Galina Gorshunova and Dr. Burmistrova attended the exit press conference in Vladivostok in July 1999, and again they gave their strong support to the project and left no doubt that they were able to make the project happen in Vladivostok.

Other agency which helped in the design .

We have also coordinated our project with the Center for Disease Control (CDC) and the World Health Organization (WHO) to make sure our effort is compatible with what they are doing. We have contacted UNICEF to arrange for purchase and delivery of vaccines.

The project is designed to be self-help projects.

A road to self-help.

Through this project there will be an increase in the population?s awareness of the great benefits of comprehensive immunization programs. The Rotary clubs of Vladivostok will be instrumental in educating the public about the need to get immunizations and about the administering of the hepatitis B (also see GAVI), and MMR vaccines in the project. The strong support of the Krai Government demonstrated during the project will also serve to develop an increased awareness for the need of an on going immunization program. As the public actually observes the improvement in their children's health because of the immunizations there will be greater support for continuing the program. The project will demonstrate that prevention through immunization is far less costly than treating hepatitis after the children have the illness.

We believe we can create the momentum for the community to strongly support a continuing program. In addition all co-sponsors will be working with the Krai health department to develop a source for affordable vaccines. This project can "bridge-the-gap" until an affordable (less expensive) source of vaccines is established.

The long-term benefits to Russia after the 3-H Grant funding is completed.

The obvious long-term benefits are improved health of the population, increased life span, a reduction in cost of health care, and a better productivity from people in mid-age life. Also, once the program is established, immunizations can be provided for adults. Beyond these benefits our goal is to demonstrate the feasibility and benefits of a comprehensive immunization program in Vladivostok and expand it through the Russian Far East. This will be possible by working through all the Rotary clubs there with support from clubs outside Russia. The network has been established demonstrated by the most recent "Expanding Rotary in Russia" conference Jan.28-30, 2000. A side benefit will be to give us a significant project, which allows clubs inside and outside Russia to work together. In addition Dr. Prikhodko is president of a medical association which includes most, if not all, of the Krai health directors in the Russian Far East. This is another network, which can help spread the program.

Project beneficiaries will participate in the project.

The project beneficiaries will be making a significant contribution in the following ways. The Krai government through the health department has agreed to provide transportation and storage facilities for the vaccines. They will lead in getting the vaccines through customs. Further they will use their facilities (clinics, hospitals, and personnel) to give the immunizations. And they will provide syringe disposal.

The local Rotary clubs will work with the government in publicizing the effort and assisting in conducting the project. In addition they will monitor the operation and provide the necessary information for the 3-H Grant reports.