01 Sep Report/Notes 2012-2015
Introduction. In the history of DEMMA in the year of 2004 when DEMMA showed some anaemic symptoms a special get-together session was organized right in the heart of Drenthe province in the village Diever. Because the event was very similar to a conclave the name of this session was named: “DEMMA-claaf 2004”. Close prior to the 25th year jubilee it was decided, due to similar signals of anaemia, to organize a second “DEMMA-claaf 2015” with the expectation that it would work out as an effective refreshment course.
Attendants were: Jannes Janssens as moderator and host, CoR-member Ernst Lutgert, and as DEMMA-members Paul Mulkens, Jan Burggraaff, Edwin Poorts and Rutger Hissink. Unfortunately it turned out the DEMMA members Jur Niewold, Mark Tijink, Coen Holzhauer and Ben Knipscheer were not to be able to participate in the session.
The first presentation came from Paul Mulkens. He mentioned our own intrinsic motivation and the extrinsic influence of DEMMA-M. Our own motivation is of course represented in the statutes of DEMMA. To refresh our memories: improving our mutual healthcare-systems and benefit from our mutual medical knowledge. Some DEMMA members decided to appear more infrequently to the DEMMA meetings. It is likely that their motivation was strongly reduced due to their absence. As a result the working groups consist mainly of a small amount of the same members. During a proposed working visit of a small DEMMA delegation, probably due to be scheduled in January 2016, the mind set of DEMMA-M will be explored as one of the major objectives. An analysis of our powerful points was also put forward, which is of course our bond of friendship, our annual exchange Dwoyka’s and several additional projects. It is not to deny that DEMMA has been slightly mentally influenced by the tense political relation between Russia and the Western countries. However not in an obstructive way to our collaboration. The second speaker was Jan Burggraaff, who made a SWOT-analysis of DEMMA (SWOT = Strengths-Weaknesses-Opportunities-Threats). Our strong points to mention: our board, our website, our contacts and the exchanges. Our weaknesses: commitment, finance, external international development and our inability to fill vacant board places. Ernst Lutgert made a third contribution. He spoke about our board structure and possible changes.
After the presentations there was a lively discussion about the future of DEMMA resulting in the following conclusions:
The DEMMA board will be reduced to about 5 to 6 core members. The core board will consist of a chairman, a secretary and a treasurer.The board will meet on a regular basis. TESTEST
RUSSIAN DELEGATION WORKING (“spring”) VISIT 2014, 4th – 8th June
(Russian guests’ visit report still in process).
For the schedule of the program click here
DWOYKA 2013, 17 NOVEMBER – 1 DECEMBER 2013
A VISITING REPORT FROM THE RUSSIAN MEDICAL GUEST DOCTORS.
The history of DEMMA begins since 1991 and many doctors have the opportunity to see and learn something new about the organization of medicine in another country.
We, Natalia Kaira (ophthalmologist) and Galina Fokanova (paediatrician) would like to share now our impressions about what we saw and what we learn during our staying in the Netherlands.
Our familiarity with the country was started from the Amsterdam Schiphol airport, where we met Kirill Rykov – Durch medical student, who was visiting Russia one year ago. So our impressions were started from that moment. First of all, Kirill was able to speak Russian language, and the second – we were impressed how huge is the Schiphol airport!
About two hours by train and we were in Emmen. At the railway station we met Jan Burggraaff, he gave us DEMMAfoon mobile phone so we could contact at any time with all our colleagues. We stayed at Hampshire Hotel, not far from the hospital, in comfortable rooms, where we had everything we needed.
(Scheper Hospital Emmen. From left: Paul Mulkens MD PhD, Eric Janson MD, Jur Niewold MD, Jan Burggraaff, MD, Rutger Hissink MD; seated: Natasja Kaira MD and Galina Fokanova MD)
Beforehand, we know a lot about health care system of the Netherlands from our colleges who was on the exchange experiences before us. But to know and to see more, to understand how everything is organized in the hospitals and departments – it was our main purpose of this visiting.
All our program was planned beforehand by members of DEMMA and we liked a lot the fact that we had a great opportunity to visit and to see how is working this system in different types of hospitals and even in different cities!
Our schedule was very extensive and included visiting many hospitals. During first week Galina was in paediatrics department SZE hospital Emmen. In Russia ones doctors work in policlinics and other work in hospitals, but in Emmen we saw that doctors work in hospital and in policlinic. We met with organization of hospitals, Public Health system, Obstetrics department and family doctors system. In Russia we have not family doctors, our patients can get specialized assistance immediately. We had one day in Groningen University Hospital. This is very big and highly qualified Medical center with departments for children and adults.
During our first week we were visiting SZE hospital in Emmen, looking the organizations of the different departments (ophtalmology and paediatrician), meeting doctors, sitting with the colleges during the policlinic work, taking active part in a disscussion about diagnostic of the deseises. The whole department and the patients rooms were shown and we could see some of the treatments the patients received. We participated in a conference where a difficult patients were discussed. We also had the amazing opportunity to take part in a meeting with director of the hospital Eric Janson MD where we were speaking about the organization and the differences of the medical health care in Russia and in the Netherlands. The healthcare system itself also has its good and bad sides. The differences begin with the learning process (studying in the Netherlands requires much more years compared with Russian education system). In Russia doctors are not using special protocols in every case, of course we have some regimens for treatment but we done have strict rules for not using them. One of the problems of health care system in our country is a lots of bed-days at the clinic. To many. For example, in ophthalmology department in the Netherlands after all kind of operations patients leave the hospital in the same day (day care) and staying at home using a special treatment recommended by the doctor. One more difference we saw during our visiting hospitals, doctor almost no adding antibiotics to treatment, in Russia we use them quite often.
We had not only working time, in the evenings we had dinners with our colleagues families. It was very interesting to know more about Dutch traditions and about life in Holland. We had good time during our walk in Groningen with Aleid and Kees. Then we had a wonderful trip to Friesland with Kees and Guus. We were at the famous Zoo in Emmen. And during our last day in Holland we saw Amsterdam with hundreds lights and Christmas trees.
(fare well dinner)
We would like to thank the DEMMA-organization for the opportunity and good time. All the people we met in Holland were very kind to us.
It was a great experience and we think DEMMA-Organization plays an important role in the exchange of experiences between our countries and helps us to understand what can we do more in our work.
Galina Fokanova MD (paediatrician) and Natasja Kaira MD (ophthalmologist)
For more photo’s go to Photo Gallery and for the schedule click here
Accommodation: Hampshire hotel Emmen click on logo link below
WORKING VISIT REPORT MYTISHCHY, 21-25 AUGUST 2013
Participants: Paul Mulkens and Rutger Hissink
21st August (Wednesday)
After a pleasant journey by train and KLM flight from Schiphol to Sheremetyevo Airport, we were picked up from the airport by Alexey Azarov (interventional cardiologist) in his new, all white Audi A6. Guided by a navigation app on his iPad (“a present from a satisfied patient” – Alexey dixit) we steered past a few of the Wednesday evening propka’s and were taken to Hotel Lecco. We enjoyed a Mytishchi-Italian style pizza outside on de the new veranda of the hotel watching the Mytishchi locals stroll by on Letnaya Street on this pleasant summer evening. 
22nd August (Thursday)
At 8:45 we were picked up from the hotel by Sacha, one of the drivers of the hospital director, to meet up with Valery Yanin at the Mytishchy Medical Centre in de director’s offic
e building: corpus nr. 1. We received a warm welcome from Valery and were later joined by Alexey Azarov and Elina Iglitsina (head nurse of the hospital). During the meeting we were told about the administrative changes in governance of the Hospitals and Poliklinika’s in the Mytishchi region, which have lead to the new position that Valery Yanin now holds as director of almost all these locations in the region. Life has not become more easy for Valery lately!
We discussed the attention points as set up beforehand by Paul Mulkens (see attachment below).
Attention points to discuss or to organize: 1. Introduction Rutger Hissink, vascular surgeon. 2. DEMMA-M suggestions & ideas. 3. Preparing Dwoyka 2013 (17/11-1/12) including meeting with the prospected participants: Galina Fokonova (paediatrician) and Natasja Kaira (ophthalmologist). DEMMA WG: Jan Burggraaff (chairman), Edwin Poorts, Kyrill Rykov and Paul Mulkens. 4. DEMMA-M organization (minutes, reports). Invitation to the WV participants to attend a DEMMA-M meeting? Erismani Institute participation within DEMMA-M has been instituted? Last DEMMA-M minutes 16-02-2007. 5. Communication: still a (major?) language barrier? 6. DEMMA-M focal points: still main focal point through the secretary. How can we enlarge. 7. DEMMA website: more input from DEMMA-M? 8. Evaluation DEMMA annual report 2012. 9. Meeting with e.g. Elena/ Ludmilla Sarancha, Alexander Lebedev, Alexey Azarov, Andrey Melentev, Ludmilla Saarkoppel and others. 10. Meeting with Elena Toshakova? 11. Idea to found a society for all the previous Dwoyka/Troyka participants to make it function as a brain centre in developing new views. An attachment with all the personal data will follow. 12. A visit to the Dutch embassy has been cancelled due to ambassador change. 13. Continuation: we will proceed in the same way or alternative suggestions? 14. Committee of Recommendation: idea the Mytishchy mayor Azarov will join?
The position of DEMMA-M was mentioned and it was suggested that participation the new generation of Mytishchi doctor’s would be welcome.
This would also help relieve the language barrier somewhat, as their knowledge of the English language is increasingly improving. The Dwoyka 2013 participants were also confirmed: Galina Fokonova (pediatrician) and Natasha Kaira (ophthalmologist) will be coming to visit Drenthe from 17th November until 1st December. Lastly, to approach Mr. Azarov, mayor of Mytishchy region, as a member of the Committee of Recommendation was found to be a good idea.
After the meeting we made a tour of a few of the hospital buildings with Alexey Azarov and Elina Iglitsina. They showed us where the new Neonatal ICU is situated. We were shown round the surgery building where we met up with Nadjezda Nozdrecheva on the ENT ward. Unfortunately Elena and Ludmilla Sarancha were not there because of illness of Ludmilla, for which she was admitted to another hospital in Moscow, whom Elena was visiting at this time. We were shown round the Vascular Surgery ward by the head of Vascular Surgery, Yurii Debelii. An impressive amount of patients with a diverse selection of vascular pathology was presented.
At lunch time we split up: Rutger went to the Cardiology department and Paul in company of Valery Yanin went to pay a surprise visit to the 46th birthday party lunch of Vladislav Mirzonov, head of the regional health care department, and DEMMA-M chairman (Dwoyka 2009).
At the Cardiology department Rutger met up with Alexander Lebedev, cardiologist (Dwoyka 2009).
A tour of the renovated building (corpus nr. 5) showed that a differentiation of acute and normal pathology was made on the wards, and the coronary care unit was being developed. Alexey Azarov showed the CAT-lab, which was equipped with all the standard modern equipment (such as an intra-aortic balloon pump), and standard catheters and angioplasty balloons. He also performed a coronary angiography procedure (via the radial artery). We understood that the Mytishchi CAT-lab might become a teaching centre for the area in cooperation with Medtronic. The second part of the afternoon we joined up with the girlfriend of Alexey, Anna Kanavina (studying architecture), to go to Abramtsevo.
This is a state historical artistic and literary museum-reserve 50 km north of Mytishchi. Our guide was a nice, well English spoken girl, named Maria, who told us about the artistic commune that settled down here in the second part of the 19th century. We were shown round the estate with its typical and beautiful buildings, except the main building, which was closed for reconstruction (a good reason for visiting again in the future!). Afterwards we ate a typical Russian meal in the restaurant there.
23rd August (Friday)
In the morning we went to Sofrina (30 km to the north) to visit an Icon factory, again with Alexey Azarov and Anna Kanavina. We were guided through the showrooms, where all kinds of ornaments of the Orthodox Catholic church were on display, which were all manufactured there. Beautiful craftsmanship, with a lot of gold-plated works. Having to get back in time, Alexey showed us some real Russian driving skills on the way back.
12 o’clock sharp we were back in Mytishchi hospital. Paul went to join up with Elena Sarancha at the ENT department and Rutger went to join the vascular surgeons Yurii Debelii and Michael Pyrla (fellow vascular surgery) to do a carotid endarterectomie in the operating theatre. Although the operating facilities and monitoring are somewhat different from those in Emmen, a skilled and precise procedure was performed, using the eversion technique for removing the carotid plaque.
At 2:30 we joined up with Alexander Lebedev to drive to the Babushkinskaya metro station to take the undergound to the Maryina Roshcha station, where we were met by Elena Toshchakova, ENT specialist (Troyka 2005). She is now working in the Global Medical System private clinic in the centre of Moscow. She gave us a nice tour of the clinic, which offers GP and a wide scope of specialties in an out-patient clinic setting, and even a small clinic for short hospital stay.
The last part of the afternoon and evening we went to the centre of Moscow and saw the usual sights, such as the Red Square and Kremlin. After a sturdy walk we arrived at a riverside café by the Krasny Oktyabr Chocolate Factory, named Strelka. We enjoyed the trendy, modern-day culture displayed here (yuppies and iPhones!). Walking back from the café to the Metro station to go home, on the bridge by the Cathedral of Christ the Saviour we were caught in a sudden downpour of heavy rain, with nowhere to run for shelter. We got absolutely soaked to the bone! We were blown dry by the warm metro wind, and by the time we got back to the hotel we were reasonably dry.
24th August (Saturday)
At ten the next morning we met up with Natasha Kaira, the ophthalmologist coming to the Netherlands this year as a Dwoyka participant. Keeping the walking distances as short as possible in consideration with Paul’s injured knee, we went through a busy programme. Natasha drove us to the Moscow Medical Center, where she had studied herself, a large avenue – the Pirogovskaya Bol’shaya ulitsa – with a separate building for every specialty in Medicine. At the end of this avenue lies the Novodevichy monastry, which we visited. After a cup of coffee (with some ‘ENT style’ strawberry cake for Paul) we went off to the Pushkin Museum of Fine Arts, where we met up with a gynecologist friend of Natasha, Elena Bordakova, who had already bought tickets. No queue for us! A nice collection of arts and statues (for a large part plaster-cast replica’s) with exhibitions of Titian, the Italian renaissance artist, and the Pre-Raphaelites.
For dinner we went to a Georgian restaurant, Elarchi, with typical Georgian dishes, very nice. Rutger and the ladies went for a walk down the Arbat, although not so crowded because of the rain. There we bought the usual souvenirs. Satisfied and somewhat exhausted by all the day’s impressions we went back to the hotel for a cup of coffee to round off the day.
25th August (Sunday)
The last day of our stay we were collected by Valery Yanin to go the Mytishchi town hall. There is an exhibition centre joined to the town hall, where there were two exhibitions: Seri Kulmanoz, a Russian emigrant to the USA who, despite being almost blind, made beautiful engravings (ex libris) and pictures. The other was an exhibition of modern Contemporary Japanese Crafts.
After this we drove out to the home of Valery and his wife Xenia, and not forgetting their newborn boy Valery jr !
We ate a lovely meal (also prepared by the mother of Xenia, who was also there). We discussed some more on the topic of DEMMA. Valery suggested a possible delegation of the Mayor and the department of health commissioner of Mytishchi and Valery perhaps paying a visit to Emmen to meet with the mayor Bijl (who is a member of the Committee of Recommendation) and director of the Hospital.
We were driven to the airport and were well in time for the plane back. The journey back was uneventful, everything was on time, even early.
FAREWELL DINNER GUUS DE GROOT (SINCE 1993) AND KEES TUINMAN (SINCE 1994), 11th. JANUARY 2013
Initially, long time in advance, the venue of the cocktail party for the farewell occasion of Kees and Guus was intended in Assen, Grand Café Liff. But in due course the plan came up to make a change into a surprise party and therefore kept strictly secret to the both of them. So when they arrived at the café entrance they got collected by Paul (because of illness Irma was excused) and “abducted” in his car up to restaurant Wielens in Noord Sleen. And so a transition operation from a simple drinking party into a full farewell dinner was achieved. At Wielens all together the DEMMA members, partners included, with the exception of Jan, who was in Thailand, welcomed them with a loud “For they are jolly good fellows”*. After an aperitif drink around the bar, Rutger Hissink as our master of ceremonies guided the group to the special dining room. Here we had, first of all, a speech of Jur in which he reminded us of the first years of DEMMA. After the starters Edwin held a speech about the last visit to Mytishchi and the marvelous stay in Podlipki Sanatorium. Afterwards Kees and Guus received DEMMA presents, which contained of a gift coupon for a painting by the well known Tatyana Murova from Groningen . Mark presented a bouquet of flowers to Kees` and Guus` wives Janny and Barbara. After the main course Coen gave a hilarious Kees imitation show as John Cleese. In addition even Aleid Tensen, as special DEMMA guest, thanked Kees and Guus for their fine cooperation and teamwork in all those years. Finally Paul gave a presentation about the long history of DEMMA and the major role Kees and Guus played in it. After his words he handed over (surprise number two) a certificate of Honorary Membership. At dessert Kees, also on behalf of Guus, addressed himself to the audience in a full blow speech and in his final words he thanked everybody for the nice and interesting time he had in the DEMMA group and wished us all the good luck in the future. And finally he offered, of course as a good honorary member, to be stand by and helpful in local projects, if desired, all the time.
Good bye Guus de Groot (left) and Kees Tuinman.
For they are jolly good fellows, for they are jolly good fellows
For they are jolly good fellows, for DEMMA all the way
for DEMMA all the way, for DEMMA all the way
For they are jolly good fellows, for they are jolly good fellows
For they are jolly good fellows, for DEMMA all the way
for DEMMA all the way, for DEMMA all the way
VISITING REPORT MYTISHCHY DUTCH MEDICALSTUDENTS 18 NOVEMBER – 2 DECEMBER 2012.
For over 20 years DEMMA has been, and still is, an organization that stimulates and supports the exchange experiences and knowledge with the largest country in the world, Russia. Not only on a medical, but also on a cultural level and the success has been remarkable. For many years these exchanges have been between already established healthcare practitioners. This year, for the first time, there was an exchange of medical students. We, Michele Eisenga and Kyrill Rykov, were offered the opportunity to go to Russia and learn about this amazing country and its healthcare system and we would like to share our impressions. First we will give an account of the time we spent in the hospitals, our impressions and differences with The Netherlands and we will finish with our impression of the Russian culture.
Beforehand, we knew little to nothing about the Russian healthcare system and we did not really know what to expect. Fortunately, we brought into contact with Andrey Melentev, who visited The Netherlands in 2011, and with his help we were able to shape the program to some of our interests in medicine. We were able to see a lot of different departments in two different hospitals.
The first hospital we visited during our first week was the Erismani Institute, a hospital primarily focusing on occupational diseases and research. This was not a regular hospital, as we were told, and the patients had different diseases than you would see in a regular hospital. Also the diagnostics and treatments were somewhat different. In Erismani we visited the department of Neurology, Functional diagnostics, Rehabilitation and Dermatology. 
The whole department and the patients’ rooms were shown and we could see some of the treatments the patients received. We also participated in a conference where a difficult patient and her illness were discussed. Although everything was in Russian, one of the younger doctors translated everything for us.
The second week we spend at the Mytishchy Hospital. This was a regular hospital with more common illnesses and patients. We only spent two days there due to our very busy program, but we still had the chance to see a lot. We started with cardiology with dr. Lebedev who asked us a lot of questions about ECG’s, illnesses and treatments. We went to one of the departments of neurology where patients with strokes were treated and we had a short visit to the department of dermatology, which was comparable with that in the Erismani. The next day we went to the surgery department and had a look how things were organized there. Dr. Hvorov showed us the Urology department and the ICU. We went to the operating rooms where we had the chance to see the OR’s and how the operations were performed. Kyrill was even able to scrub in and assist with one of the operations.
In short this is how we spent our time in the two hospitals. As said before we did not know what we were to expect in the hospitals, we could only guess. Overall we think the medical protocols and knowledge is very comparable with that of The Netherlands. But the infrastructure is less sophisticated. For example, a regular patient room has 6 beds in it and the room itself is not as well equipped as here in The Netherlands. This is the case in both hospitals. When we look at the Erismani, we saw that some treatments there are very different to ours, some of the treatments we had not even heard of. Other treatments are almost never done in a hospital in The Netherlands, but by physiotherapists on an out-patient basis. We think the biggest difference we saw, was at the department of surgery and the OR’s at the Mytishchy hospital. The hygiene level was very low, when compared to The Netherlands. There were two operating theatres in every room and they were not separated by a door. One could freely walk from one into the other. Also the ‘sterile’ robes were sometimes stained as they were washed every time, instead of disposables robes we use. This was something that surprised us most. On the other hand, we did see a lot of improvements were being made. We saw a totally new cardiology angiosuite, both hospitals had their own CT-scanner and the Mytishchy Hospital also had a MRI-scanner, but unfortunately it was broken when we visited it. We were told that more improvements are being made, albeit slowly.
The healthcare system itself also has its good and bad sides. The healthcare is free, but patients have to pay for all the medication and medical tests themselves. Also, prescription drugs can be freely bought in a pharmacy, from painkillers to antibiotics, everything. Partly due to DEMMA there are some General Practitioners in the Moscow region, but most of the people go to a specialist directly, which is different from The Netherlands. We came to learn that the healthcare system is very badly funded by the government and it is not likely to change soon. Moreover, the insurance companies will probably become more powerful and will decide how the future of the healthcare will be.
On the upside we can say that some of the screening programs are better organized, although it is debatable whether this is a good thing or not. We think that it is better for some of the illnesses, mainly cancers. And also the national donor registration is better and the waiting list for transplantation is much shorter.
In conclusion, we can say that we learned a lot in these two weeks about the Russian healthcare system. We saw many departments and the way doctors worked, how the doctors are being educated and we even went to a nursing school to see the differences with nursing education and their function in the hospitals. We learned about the differences between the two countries, but also the resemblances and the many improvements that are being made.
Finally, a short word about the cultural program. Most of our cultural trips were in Moscow and because it is such a big and beautiful city, two weeks is just too short to see all the sites. What we did see was all amazing. We went to the Tretyakov museum and saw the magnificent art of Russian artists. We went to two concerts, visited the Kremlin and the Red Square, many churches and parks, new and old. We are probably forgetting half of the things we have seen, but fortunately we have many pictures to remember it by. And I think the most important thing is the people we have met. Although sometimes the English language was a minor problem, we were always guided everywhere by amazing people, many of them also doctors. If there was just a small problem (we actually had none!), everything could quickly be solved. Words cannot describe the hospitality we received!
All in all, it was a great experience and one we will never forget. We have learned a lot, did and saw even more. This experience will stay with us for the rest of our career. Nowadays it is becoming more and more crucial to work with other countries and cultures and this opportunity is one nobody should decline!!
Kyrill Rykov (left) and Michele-Freerk Eisenga, medical students Groningen University
FAREWELL VISIT REPORT, MYTISHCHY (MOSCOW REGION) 21 NOVEMBER – 2 DECEMBER 2012.
The purpose of this visit was to run a review with DEMMA-Mytishchy members, on past, ongoing and on future projects, in combination with a farewell visit for Guus de Groot and Kees Tuinman.
Both of them will retire from DEMMA as per 01.01.2013
Wednesday 21.11.2012 Aeroflot flight Amsterdaml-Moscow SVO. Collected by Valery Yanin, transfer to Podlipky Sanatorium near Mytishchy. Dinner: room service
Thursday 22.11.2012 Breakfast is served in Podlipki dining room. Driver Sacha, who will drive us on our visit, drops us off at the Mytishchy Hospital (MH). MH has undergone hughes changes over the years and is still in the process of renewal. Their new Director is Dr. Valery Yanin, who subsequently reports to Wladislav Mirzonov, now head of medical affairs in Mytishchy City Council. MH has 30 departments with a total of 950 beds, 1200 FTE’s increasing to 1500 in 2013. Total acreage of the site is 27 ha. MH annual budget is based on two sources; Mytishchy City Council and from a National Medical Insurance Company. As per 01.01.201 it will rely on the latter only. There are 5 additional policlinicas throughout Mytishchy town, and another three dedicated for children. Chief nurse Eilina Iglicyna, who is the guide on our MH tour, knows the organization well and is a potential candidate for a future DEMMA nurses exchange program, with a proviso for her limited knowledge of English. Cardiology Dept.: Fully refurbished and well equipped. We meet again with Dr. Alexander Lebedev, and at the ENT Department with Dr.Ludmilla Sarancha and Dr.Nadjezda Nozdracova, who both have visited the Occupational Health Department of Shell in Assen back in 1994-5, their first visit to The Netherlands. We enjoy their hospitality lunch. Daughter Dr.Elena Sarancha is at the moment in Groningen, Assen and Emmen for an extended ENT project. Pediatrics Dept. Again well equipped, a child-friendly environment and very dedicated staff and nurses. Dr.Galina Fokanova, who is fluent in English, proudly shows us around. Galina will be considered for a Pediatrics Project, possibly within a traditional 2-weeks Dwoika visit with another Russian colleague. On the premises of MH, a new Federal Pediatric-Neurological Centre is considered in the near future. Transfer to Erismani Institute. Here we meet with prof.Lyudmila Saarkoppel we’ve seen in Drenthe at the 2010 Dwoika and also professor Kyriakov at previous occasions in Mytishchy. Our visit coincides with the presence of two Dutch medical students on the first DEMMA Student Exchange in Mytishchy. Both are very positive about their program hosted by Erismani, with special attendance from Andrei Melenteyev (was in Drenthe in 2011) and Nikolay Polyansky. We meet another, well motivated and excellent English speaking Neurologist Dr Anna Novikova, again a candidate for a future Neurological Exchange program. Transfer to Mytishchy Medical School for Nurses. “Our” students Michele and Kyrill have been asked to prepare a presentation on the professional training of nurses in The Netherlands. The Audience here are trainee students of the last two years of the school and their Head Master Mrs Nina Anatolievna and English Teacher Mrs.Vera Hvatkova. The presentation was a great success; E-mail addresses and facebook details were also part of the exchanges afterwards. Note: there were a few student nurses present, who were fluent in English.To be born in mind when considering a Nurses Exchange program.
Friday 23.11.2012 In the evening we pay a visit to the Moscow Stanislavsky Theatre, for a modern ballet performance originated and directed by the Nederlands Dans Theater. On the after party we were invited to meet with the Dutch Ambassador in Moscow, Mr.Ron Keller, a member of DEMMA Committee of Recommendation. Mr Keller showed keen interests in DEMMA activities, and invited us with the students, now in Mytishchy, to the Dutch Embassy later this week.
Saturday 24.11.2012 Own program: Moscow Underground, Kremlin, Red Square. Meet with the students over a drink.
Sunday 25.11.2012 Social Program with Valery and Xenia. We visit the church of Alexander Nevski near Pavlovskaya Sloboda and a monastery further in Zvenigorod, west of Moscow. Later this afternoon back to Valery’s dacha. Good company and good dinner
Monday, 26.11.2012 Svetlana Basalevskaya, who was in Drenthe for a Medical Management programme only a fortnight ago, invited us for a trip to Losina-Petrovsky, to the (hidden in the forest) Airforce museum. With the first snow it was a refreshing and very interesting tour with a Korea Veteran guide. Andrey Sutugin, head of Losino-Petrovski Hospital joined us for lunch.
Return trip by train with more snow to come.
Tuesday, 27.11.2012 Sacha brings us safely over the snowy roads to Mytishchy Hospital Pediatric Policlinic, head Dr.Svetlana Stepanova. Svetlana gives us a full tour through the beautiful and well-organized clinic, additionally we visit a nearby periferal and smaller unit for children where fysiotherapists and logopedists have visiting hours. We’ve tried to ring Dr. Valentina Korshikova , but she is enjoying a holiday.
Wednesday 28.11.2012 Departure from Podlipki, to the medical school for nurses to collect the students and then to Medvedkowo Metrostation. Exit at Biblitheka Imini Lenina and on foot to the Dutch Embassy. Mr.Keller is a good host and very interested in the activities of the students. He offers us to write a letter of recommendation to Groningen Teaching Hospital to emphasis the importance of a regular student exchange between Russia and The Netherlands. Demma in a liaising role. We receive a exclusive tour through the Embassy, a building with a rich history. Mr.Keller is offered a copy of our DEMMA annual report 2011, he wants to be kept updated on DEMMA activities. At our return trip to Podlipki, snowfall becomes more intensive and we hit Moscow heavy traffic propka’s. The two GPs, Coen and Edwin, who have both arrived at SVO this evening, have spend more time to travel from SVO to Podlipki than getting from Amsterdam to Moscow. We are now with four DEMMA–ers at Podlipki Sanatorium.
Thursday 29.11.2012 Because of the severe snowfall both the program for the GP’s and our program had to be reviewed. The four of us will travel to Moscow, Moniki. Dr.Nadjezda Chirokova (also a DEMMA veteran) and GP Ekaterina Suslova, guide us via the Sputnik fast train to Moscow and the Metro Network to the surface to Moscow in white. At Moniki we are welcomed by Georgy Maltzin, our Russian founder of DEMMA and by professors Agafonov and his deputy Natalia Shevtsova both from Stupina. The latter two are very interested in aspects of management of GP practices in The Netherlands; Edwin and Coen provide the answers, Guus translates. A very informative meeting facilitated by Georgy Maltzin. There are considerations to move the GP training centre from Stupina to the more centrally locallaized Mytishchy. All will meet again tomorrow at the GP conference organized in Mytishchy. We enjoy an informal dinner with Nadjezda and Ekaterina.
Friday 30.11 2012 Due to the weather conditions the GP meeting at Policlinica building no.V in Mytischchy was slightly delayed. Host of the meeting is Nadjezda Chirokova, invited speakers are Professor Agafonov, Wladislav Mirzonov, Natalia Shvetsova, Coen Holzhauer and Edwin Poorts and a GP from the region. With great respect for the interpretors, a passionate discussion followed between speakers and audience i.e. Valery Yanin, Georgy Maltzin and Elena Bikova. The plea was to make the audience aware of the need to improve the quality of GP training in Russia in view of the expected rise in costs of medical specialist help, as is seen presently in Western Europe. Professor Agafonov was very keen in establishing a liaison between Groningen University and Mytishchy on the issue of GP training. Dr. Bikova closed off the morning and hosted a tour around the facilities of the clinic.
Saturday 01.12.2012 Wladislav Mirzonov is taking the four of us on a “surprise” tour through Moscow. Most of the snow on the roads have been cleared now, and we are heading to Panorama Museum in Moscow where a display painting of 50 feet high and 360 degrees around, can be seen on the Battle of Borodino against Napoleon in August 1812. Although almost 200 years in the past now, our guide Wladislav explains every detail to us of the siege and battle by the hour. Very interesting piece of history, not known to us. A” light” lunch is taken in an Azerbeidzjan restaurant, after which we head for Podlipki, where a farewell dinner is prepared.
Sunday 02.12.2012 Students arrive at Podlipki. Transfer of 6 DEMMA guests to SVO Airport.
By KLM to Schiphol Airport and further by rail back to Drenthe.
We are grateful and say farewell to so many good friends after 20 years in DEMMA and thank them for the warm and sincere contacts we have had over the various projects and visits.
Kees Tuinman, secretary (1994-2012) Guus de Groot, corresponding member (1993-2012)
VISITREPORT (28TH OF NOVEMBER – 2ND OF DECEMBER 2012)
28 November: 11.40 leaving Schiphol and 18.00 arrival Sheremetyevo International Airport. Valerii Anatol’evich Yanin met us at the airport. Due to the weather (snow storm) late arrival at Podlipki Sanatorium. Here we met Kees Tuinman en Guus de Groot.
29 November: After hearty breakfast we (Kees, Guus, Coen, and Edwin) were picked up by driver at 10.00 a.m. We traveled, with some delay by snow, to Mytischi Hospital. Here we picked up Nadezhda Shirokova and Ekaterina Suslova. With them we traveled by train and metro to Moniki in English officially: Moscow Regional Research and Clinical Institute).
In Moniki we met with Georgii Khatskelevich Mal’tsyn, founder of DEMMA-M and deputy-director of Moniki. Kees handed him a Demma-poloshirt as a present. Afterwards we met Professor and dean of the faculty B.V. Agafonov and Associate professor Natalia Shevtsova. Coen Holzhauer explained the Dutch GP-system. Professor Agafonov explained the plan of Moniki to start a GP-education in Mytischi. Moniki wants the help from the GP-educational institute of the UMCG to set up this education.
After this meeting we went back to Mitischi with Nadezhda Shirokova and Ekaterina Suslova. Here we had a lovely diner at a local restaurant.
30 November.: After another hearty breakfast we were brought by our driver to the place of the seminar, poliklinika No. 5. Here we met Stanislav Mirzonov and Valerii Yanin. A little after 10.30 a.m. the seminar was opened by Mirzonov. After him professor Agafonov held a little speech. Associate-professor Shevtsova held a lecture about the structure of the GP-institute in Moniki. Then Coen Holzhauer held a lecture about the Dutch GP-system and presented some facts and figures about his own practice. Nadezhda Shirokova held a lecture about COPD treatment in Russia. Nadezhda Shmeleva, a local GP, explained the role of the GP in the treatment of COPD. Finally Edwin Poorts held a lecture about the treatment of COPD in Holland, which is for a large part done by GP’s.
After the seminar there was a lively discussion by Valerii Yanin, Vladislav Mirzonov, Georgii Maltsyn, Agafonov and Elena Anatol’evna Bykova (leading physician of Poliklinika No. 5) about the change of finance of the Russian medical system and the effects on the change of the education system.
Associate Professor Shevtsova afterwards asked Coen and Edwin for a article about the GP-education in Groningen).
Elena Anatol’evna Bykova gave us a tour around Poliklinika No. 5.
1 December: We were collected by Stanislav Mirzonov at Podlipki at 9.45 a.m. and he took us to a museum about the Napoleonic war. Here there was an impressive exhibition about the battle of Borodino. After lunch at a Azerbaidjani Restaurant we went to a bookshop.
The day ended with a great farewell-diner in Podlipki.
2 December: At about 13.30 p.m. we met with the students and later with Valerii Yanin. We went to Sheremetyevo International Airport together and our plane left on 19.00 p.m. and arrived on 19.40 at Schiphol.
TROYKA 2012 DRENTHE PROGRAM 11-24 NOVEMBER 2012
from L to R:
Mrs. Svetlana Bazalevskaya, Mytishchy City Council
Dr.Elena Sarancha, ENT Specialist Mytishchy Hospital
Dr.Alexey Azarov, Angiosurgeon, Mytishchy Hospital
This year, DEMMA have invited three health care officers from Moscow Region. Two medical doctors; Elena Sarancha (ENT specialist) and Alexey Azarov (vascular intervention cardiologist) both from Mytishchy Central Hospital and one Financial Manager, Svetlana Bazalevskaya, from Losino-Petrovski Municipal Council Medical Finance Dept. and formally employed by Mytishchi Municipal Council Medical Finance Dept.
Svetlana, who stayed only for a week, (so Troyka turned into a Dwoyka) was offered an introductory tour to get familiarized with the health care system in The Netherlands with special emphasis on finance.
She visited the Administration of Scheper Ziekenhuis in Emmen (SZE), a GP group practice in Emmen, a private Psychology Practice in Amersfoort and a large Revalidation Centre” het Roessingh” in Enschede. Host and CEO of Het Roessingh, Pieter Windt was a former CEO of Scheper Ziekehuis in Emmen.
The two Medical Doctors had a tight two weeks programme.
Alexey Azaraov, a vascular intervention cardiological surgeon was housed in Emmen and participated in Cardiological and X-Ray activities at Scheper Ziekenhuis .
For Elena Sarancha, an ENT specialist, this was her second turn (DEMMA also hosted her visit in 2007). The purpose of her visit was to increase her experience in
Functional Endoscopical Sinus Surgery (FESS) an area of Rhinology. She shuttled between SZE-Emmen, Wilhelmina Ziekenhuis Assen and UMCG Groningen teaching hospital. Unfortunately due to delays in MRSA screening and the TBC prevention procedures, her activities for the first week were to be adapted.
In conclusion, the clinical professional items and visits of this DEMMA Exchange Programme were met with great enthusiasm, not only by our guests but also by the host teaching colleagues in the different hospitals and in the institutes visited.
DEMMA are expressing their gratitude towards all (both inside and outside the DEMMA Organisation) who have participated and contributed in this success.
As a final note: it is good to see how our visitors have improved on their acuity of English in such a short period.
VISIT REPORT EAR NOSE THROAT MEDICINE PROJECT MYTISHCHY HOSPITAL 16-22 MAY 2012
16 May (Wednesday)
ENT working group (Paul Mulkens, guest ENT surgeon and Irma Stoetman, guest surgery nurse) was collected at 19 hours from airport by Alena Sarancha (ENT doctor) with the company car of the hospital droven by Sacha, the driver of the hospital ‘s director Valery Yanin. This car with driver was reserved the whole week for the DEMMA guests transportation.
Check in Lecco hotel Letnaja Street 32 in Mytischy.
Dinner at 21 hours in the hotel and late meeting with Valery Yanin who had a lot to explain how the process had runned up to his new position as the head of the Central Mytischy hospital. Very interesting story. The previous director Vladislav Mirzonov got a new position as administration head of all the medical institutions in the whole Mytischy region.
17 May (Thursday)
Actually Ascension day, in NL an official holiday but locally here a normal working day. At 9.30 when we entered the hospital we did meet by chance the gynecologist Wladimir Davidyuk (Dwoyka 2007) just in advance of the warmly welcome at the ENT department staffed by:
* Ludmilla Sarancha, still head of the dept. At her age of 70 and mother of
* Elena Sarancha (Dwoyka 2007), most experienced in the rhino logical endoscopical procedures and professionally leading
* Nadjezda Nozdrecheva, member of the ENT medical staff since many years.
Three patients were scheduled for operation: two endoscopical rhino-sinus surgery in order to remove polyposis nasi (general anesthesia) to perform by the guest surgeon together with Elena S. The third patient had to underwent a conchectomy (local anesthesia) operated by Ludmilla S. Anesthesiology time is spare quality time, so the waiting delay between two operations normally is quite long. The anesthesiologist Konstantin Veresov (Dwoyka 2010) welcomed us first but referred the patients to the anesthesiologist Christina Markajan, 6 months pregnant but perfect speaking the English language. She might be a proper Dwoyka candidate in due course.
Some remarks around the surgery procedures:
• Elena does not have a sitting position during the operation resulting in reduced stability from her arms. So she was advised to try to change this.
• Irma gave a lot of instructions around hygienic conditions and she assisted during the procedures
• The equipment made in Russia (Kazan) was well enough and the Shaver was quite effective however missing automatically rinsing for continuous cleaning.
• Elena is very much interested in advanced and delicate sinus surgery but prior to step up she needs more practice in handling with the Shaver.
• The assistance of Tanja around the surgery and the polyclinic as well was quite sufficient.
After the work we had a traditional but late lunch at Ludmilla’s office room. Afterwards a short meeting again with Valery Yanin. The idea was 
launched to subscribe Elena to a endoscopical sinus surgery course, may be within the frame of Dwoyka 2012. The possibility came forward to request for a special arrangement with University hospital Groningen (Prof. Bernard van der Laan). The home basis for Elena might be Assen as guest of the family. Another matter of discussion was an instrumental issue concerning the headlights which are so fundamental important in the ENT practice. It turned out the quality of the headlight of Elena was absolutely not acceptable according professional standards. As a preferred headlight it was advised to purchase BFW Vista View II Portable Headlight System ( ww.bfwinc.com). in the Netherlands available by the ATOS company (around € 2000,=) but may be less expensive in Russia or in Germany. This headlight system might be supposed as a top of the bill. Absolutely a must to have.
In the evening we were social guests in the family of Alexander Lebedev, cardiologist (Dwoyka 2009) with his wife Svetlana and children Margarita (5) and Fjodor (10 months). Their place was in Moscow in the Northern district Lianozovo, not so remote from Mytishchy. We were the first guests in their new flat. Prior to this they had to share a flat with their parents during more then 8 years. Before the dinner we had a walk through the Lianozovo park. A beautiful place including the Contemporary Art museum which we did visit with an exhibition of Konstantin Vasiliev who lived in the same building until his death in 1976. We spent a wonderful evening together with this happy family.
18 May (Friday)
At 10.00 one rhinoplasty procedure together with extraction of nasal polyps (with Shaver but not endoscopical) was scheduled.
Remarks on the procedure:
• Russian instruments again did work well especially a specific rigid suction tube (Guillain like but with the suction mouth not completely at the tip)
• Missing: collumella clamp, proper Blakesley forceps
• The surgery head light, too heavy including the heavy cable was terrible.
At 11.30 coffe break and short meeting with Valery Yanin in Ludmilla’s office. A short briefing on the tomorrow program in Moscow was held.
At 14.00 the next venue was in the Koroliev (previously named Kaliningrad) hospital. By MSD (Merck Sharp and Dome) a clinical conference was organized to an audience of medical doctors of different specialism (ENT, paediatry and pulmonology) coming from Koroliev and Mytishchy as well . The program issue was OSAS. The first speaker came from a snoring center which was specialized in the CPAP therapy. The second speaker came up with a presentation about the surgical options in treating snoring. His name was professor Wladimir Swistoechkin (he was the former teacher of Elena S. until 2004) and he came from the well known MONIKI hospital in Moscow .
At 16.30 the whole audience was invited by MSD for a small dinner to socialize. Afterwards the plan was to drive to Moscow but that was skipped due to the heavy traffic jams (propka’s).
19 May (Saturday)
At 10.00 hrs. departure from Lecco hotel direction Moscow, together with Elena S., to visit the new ENT policlinic of Elena Toshakova (Troyka 2005). The name of the clinic is GMS (Global Medical Systems, www.gmsclinic.ru ) . Only for consultations, no surgery. Elena S. was very much 
interested in this modern commercial clinic. May be there will be in the future an option to link this GMS with the Mytishchy hospital in providing surgery services? After this visit at 15.30 the professional program was ended for today. Strolling around the Kremlin, sitting and dining at the Red Square Bosco restaurant terrace was a very nice option especially together with the fine weather conditions with 25 degrees. The way back very simple by metro to terminal station Medvedkovo and transit direction Mytishchy by shuttle bus 169, bus stop right in front of the hotel. Total time elapsed from Red Square to the hotel: 48 minutes only.
20 May (Sunday)
Touristic travel day together with Valery Yanin and his girlfriend Xenia Chebitova. The destination was a monastery in the place Svenigorod, west of Moscow, 60 kms from Mytishchy. It was a nice and sunny day, most relaxed. Afterwards outside dinner at Valery’s place. In the mean time also some conversation concerning the planned 2012 projects.
21 May (Monday)
In the morning some ENT consultations including an extensive demonstration on the new Zeiss (up to date!) surgical microscope. Also a brief visit to the department of Valery.
After lunch meeting at the Erisman institute with Ludmilla Saarkoppel (Dwoyka 2010) together with Alexander Aliev (Dwoyka 2009) and Andrey Melentev (Dwoyka 2011). Also present the senior head neurologist prof. Afanawitch. These Erisman doctors confirmed the invitation for two young NL doctors for two weeks next autumn. DEMMA have to select two candidates (focal point Jur Niewold). Additionally a brief meeting with the Mytishchy hospital anesthesiologists Konstantin (Dwoyka 2010) and Christina. Christina would be a perfect Dwoyka candidate in 2013 and she would accept an invitation as she said.
After the meeting we were the private guests of Alexander (Sasja) Aliev for a short trip to the South of Moscow to visit a very beautiful park including a fully (by the former mayor Loeskov) restaurated palace named Tsaritsino. Good atmosphere together with impeccable summer weather. Sasja explained us he was busy in a new specialization (radiology) in order to get a new job elsewhere.
22 May (Tuesday)
Flight back departure scheduled at 10.45 was missed due to too many propka’s, taking 70 additional minutes, impossible to manage sufficiently by our driver Sasja. Next flight eventually that we could catch was at 18:00 hours. The seven Sjeremetjevo airport waiting hours turned out to be useful in composing this visit report.
Moscow, 22 May 2012
Paul Mulkens