Samenvatting. De kwaliteit van de eerste lijn (de huisartsengeneeskunde) als onderdeel van de Nederlandse gezondheidszorg verslechtert zienderogen. Het lijkt dat de oorzaak is gelegen in een verstarde infrastructuur waarbij een moeizame afstemming op de tweede lijn (medisch specialistische ziekenhuisgeneeskunde). Het systeem van Primary Health Care, zoals dat in Rusland/Oekraïne wordt toegepast, zou een mogelijke oplossing (in ieder geval als inspiratie) kunnen bieden. In deze presentatie zullen de resultaten van dertig jaar analyserend onderzoek door DEMMA naar de upgradende elementen van dit systeem worden besproken.
Klik hier voor de werknotitie.
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Samengevat verslag van een werkoverleg in Drachten op 8 februari 2023. Deelnemers aan deze bijeenkomst waren enerzijds Paul Mulkens (secretaris stichting DEMMA) en anderzijds de collegae Bert Brouwer en Wim Brunninkhuis (gepensioneerde huisartsen, bestuurlijk verbonden aan Sûnenz).
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Aanleiding voor deze informatieve bijeenkomst was: de interactieve presentie van collega Bert Brouwer bij de medische presentatie (“Help de dokter verzuipt”) van Paul Mulkens in Groningen op 28 november 2022. In die presentatie werd toen uit de doeken gedaan hoe in Rusland/Oekraïne de anderhalvelijnszorg (1.5-zorg) al heel lang robuust en systematisch is georganiseerd. Dit systeem kon ter plaatse door de stichting DEMMA jarenlang uitgebreid worden bestudeerd. In de daaropvolgende discussie bracht Bert Brouwer naar voren hoe succesvol in Drachten een vorm van 1.5-zorg was ontwikkeld. Om die reden nam Paul Mulkens namens DEMMA het initiatief voor dit werkoverleg waarin een en ander met elkaar kon worden vergeleken.
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Klik hier voor volledige verslag.
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Klik hier voor de volledige notitie and click here for the English version
At November 2th. the annual Antonius Deusingdag was organized by the Medical Alumnus Society Groningen. The venue was the Department of Education at the University Medical Center Groningen. The work title: “Health Care in the Future. Our nowadays concern”. The focus was put on “Innovation”. A workshop was achieved, two times, by DEMMA board members Paul Mulkens and Jan Burggraaff. Present were in the first shift 11, in the second 16 participants.
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To see the program: Click here
Click here for the hand-out of the workshop presentation.
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During his impressive European car trip from remote Moscow, crossing through Tsjech Republic, Germany, France and Belgium, Vladimir Chvorov MD (urologist, Dwoyka 2015) planned to stay for a couple of days in Drenthe. He did this together with his wife Tatiana. At the 20th. of June he passed by the city of Assen. Scheduled were a meeting with the DEMMA secretary Paul Mulkens, a visit tot he Drents Museum and a home dinner. In conclusion it was a cheerful flash visit confirming the warm ties between Mytischi and Drenthe in the framework of DEMMA.
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Click here for the report (pdf).
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For some more pictures go to page “Photo Gallery”.
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Not only is mentioned in the article “Anderhalvelijnszorg in poliklinika” the DEMMA history of 28 years exchanges in which nearly twohundred people were involved. Also the focus has been put on the Russian Poliklinikasystem as well. It provides in addition the Russian health care organisation (not in the country side) with effective and well functioning centers on a 1.5 level.
This means central organised medical services on a quality level between the GP (family doctor) and hospital specialists. This system might be an interesting model for the organisation of Dutch health care. Of course further research on this topic must be done. So as an idea it certainly is not a blueprint but for sure might be a subject for inspiration.
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Click here for the article in pdf
Click here for the online link
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A three people DEMMA delegation of medical doctors paid a five day visit working visit to Mytischi with two main objectives. First, a further orientation and exploration on the interesting issue of the 1.5-care (poliklinika) system which is working so well in Russia. Secondly to be present during the official visit of the Dutch ambassador in the Mytischi hospital at December 11th. Not only with the presence but also with representation of DEMMA by a lecture in which the fulle DEMMA history of 27 years was outlined. For the details of this event we do refer to the other topics along the working visit. Of course, a professional meeting with the head of the hospital was included in this visit as well. It was impressive to note the big changement in organisation of all the medical institutions in Mytischi region. From the local administration, it was prescribed to realise a huge merging of all the independent institutions with the hospital organisation. So, to the hospital head a tremendous job magnification. Another remarkable fact is the rapid growth of Mytischi city up to an inhabitation number of 250.000. The prognosis has been set on further grow to the figure of 300.000 in five years!
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Click here visit report (in Dutch) DEMMA delegation 2018
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See the lecture slides (pdf) here
Thanking her host, after the working visit to the Mytischi hospital, the Dutch ambassador she sent a letter to Dr. Valery Yanin, head of the hospital and chairman of the DEMMA-M group as well. In an article in the Dutch newspaper the NRC-Handelsblad (29 December 2018) this specific letter was mentioned.
Click here for the article and letter in one (pdf)
During the working visit of the Dutch ambassador Mrs. Renée Jones-Bos the local press was present. A video reporting was made of the welcome, the presentation of Dr. Paul Mulkens, the round table conference with the presence of Russian and Dutch medical doctors. The visit was concluded by a swift round tour through the CAT-lab as part of the department vascular surgery.
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Click here for the video
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Dwoyka 2018 (November 4-17) exchange program inside Drenthe has been concluded in a nice way. From the department vascular surgery (head: Dr. Alexei Azarov) Mytischi Central/Regional hospital (head: Dr. Valery Yanin) two intervention cardiologists (Dr. Ruslan Akhramovich and Dr. Ilia Melnichenko) were DEMMA guests. Read more on page: PHOTOGALLERY.
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Click here to open program
In order to evaluate the year 2017 and to make new plans for the coming year a one man’s delegation (Dr. Paul Mulkens) paid a flash visit to Mytischi. In the program were scheduled visits to several poliklinika’s, a visit to Stentex which is part of the Skolkovo Innovation Center and a meeting with the new Dutch ambassador. In close communication with the DEMMA-M secretary Dr. Valery Yanin an interesting framework for continuated collaboration, showing mutual understanding, was designed.
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For the visit report click here
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The special year 2016 meant a 25th anniversary, and in January, in consultation with the Mytischi partners (DEMMA-M), it was decided to celebrate this in November. It was determined that it would be a double exchange this month. So a simultaneous program in Drenthe and in Mytischi was organised. In Drenthe four guests were welcomed: the pediatricians (neonatologists) Victoria Pertseva and Sergei Shchepin, Ludmilla Saarkoppel Professor of Neurology at the Erismani Institute and Valery Yanin, the head of the Regional Mytischi Hospital. In Mytischi, the internationally renowned Emmen urologist Ben Knipscheer was invited to participate in a special prostate-pathology project hosted by urologist Vladimir Chvorov, head of urology laparoscopic project in Mytischi. The jubilee program in Drenthe consisted of two main components. The first week, for all four guests, the center of gravity was the three-day Drenthe provincial program. A special evening open for public (see the flyer), , was held on November 3rd with a presentation program titled “Meet the Russians. A dialogue in friendship “. After the leave of Yanin and Saarkoppel week two was reserved for the two remaining guests only, with a purely professional program covering the theme of “intensive care neonatology” in Isala-Zwolle and UMCG-Groningen. This week was closed on November 11thwith a festive Russian cultural afternoon followed by the traditional “farewell dinner” in Assen.
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To read more, click here
The program for this DEMMA delegation (Paul Mulkens and Ernst Lutgert) working visit was shaped in an excellent way and was organized by the colleagues from Mytischi, especially by Dr. Valery Yanin. Scheduling all the elements and performing the logistics, everything was completed in a perfect way. This visit had the main objective to test and prove the mutual motivation. In addition, fine tuning of all the options was necessary. Despite the cold political surroundings, it turned out the mutual understanding was warm and with vitality. On this solid basis of trust both foundations were able to raise nicely designed building plans and projects for 2016. In particular the first fine tuning was done in order to make an outline of the DEMMA-25 jubilee celebration, projected in the month of November. The main topic would be neonatology. So the intention was to host two neonatologists from Mytischi (paediatricians Dr. Victoria Pertseva and Dr. Galina Fokanova). They were to be offered a professional program in intensive care neonatology. During the same period a general management program was organized for Prof. Dr. Ludmilla Saarkoppel, neurologist (from the Erismani Institute) and Dr. Valery Yanin, head of the Mytischi hospital, whom were invited to NL. Here they will present guest lectures for a Dutch audience. In return Mytischi Dr. Ben Knipscheer,urologist from Emmen was to be invited to set up a urological (prostate pathology) project in collaboration with Dr. Vladimir Chvorov, urologist. Also, amongst others a very interesting visit was paid to the poliklinikano. 5. The in NL unknown poliklinika system, a method of organization, shows an option to provide medical care in between the first (GP) and the second (hospital) level of care. This ‘1.5-care level” seems to be a worthy subject to explore deeper for a profound study reported by DEMMA.
Click here for the full report
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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.
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Click here for the full report
The annual Dwoyka exchange was held earlier than usual this year. Instead of in autumn, it took place in spring. Two enthusiastic Russian colleagues from Mytischi stayed here as a guest in Drenthe during two weeks in June. Iurii Debeliy MD, vascular surgeon and Vladimir Chvorov MD, urologist. Their hosts and coordinators in the Scheper Hospital Emmen were Rutger Hissink MD, vascular surgeon and Ben Knipscheer MD, urologist. Both guests were provided with an effective professional program along some social and cultural events. Professional visits to the University Medical Centers in Utrecht and Groningen were included. Their stay was concluded by a visit report presentation followed by the traditional DEMMA certification.
For the program click here
Participants DEMMA delegation: Paul Mulkens and Mark Tijink
This year was unfortunately marked by the tense political relationship between Russia on the one side and the USA and the European Union on the other side. This situation had to do with the Ukraine as a conflict zone. On top of that we were confronted with the tragic MH17 airplane crash in de eastern Ukraine in which 196 Dutch people lost their lives. So for DEMMA as a non political organization it was of paramount importance to keep a safe distance from all the feelings around this and to try to cherishthe ties of the warm friendship. In line with this for DEMMA it was good to see the relationship confirmed to be strong enough to continue with our activities. So it was good to notice that the working visit in November of a DEMMA delegation worked out very well. The continuation of the exchange programs was confirmed again.
On top of that it turned out good to meet and talk with so many previous Dwoyka guests in the hospital (see the pictures) giving a tremendous feeling of familiarization. Also, it was good to notice again the progress in the process of closing the language gap. On both visits we happily noticed how Valery Yanin MD PhD has completely settled in as the head of the Mytischy hospitals showing growing experience. Because of the timing of the second visit so late in the year and some funding matters as well it had to be decided to postpone the Dwoyka 2014 to the following year June 2015. For the details one is referred to the mentioned reports.
For the report click here
This visit had the objective to combine the municipal administration and the healthcare organisation related to our united Russian-Netherlands exchange in a single visit. So it was scheduled to invite a Russian delegation consisting out of the mayor of the Mytishchy Region (also a member of the DEMMA Committee of Recommendation) Mr. Victor Azarov together with the head of the assembled Mytishchi Region hospitals and policlinics Dr. Valery Yanin (since 1994 the DEMMA-M secretary).
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For the schedule of the program click here
Participants: Galina Fokanova,paediatrician and Natasja Kaira,ophthalmologist.
In this traditional annual autumn event two young Russian medical doctors from different disciplines were invited to be full time guests of the DEMMA foundation in Drenthe. The objective of this project was to make them familiar with the organization in the hospitals and to inform them about the Dutch health care system especially in the Northern regions of the Netherlands. Our guests in 2013 were the pediatrician Galina Fokanova and the ophthalmologist Natasja Kaira. In the playing field many hospitals (ziekenhuizen) were involved such as the Scheper Ziekenhuis Emmen (SZE), the Refaja Ziekenhuis Stadskanaal, the Bethesda Ziekenhuis Hoogeveen and the University Medical Centre Groningen. On top of that the Eyescan clinic in Utrecht participated and the GP practice in Erica acted as hosts. The base hospital was the SZE and for Galina more than 80% of her program was scheduled in there. This was quite different for Natasja as her program was spread out way over all the above mentioned hospitals and clinic. Along the professional programs several social events were organized, not only in Drenthe but in Groningen, Friesland and Amsterdam as well. The visit was concluded with well presented visit report presentations and a visit report abstract which was mailed afterwards and is to be posted on the DEMMA website.
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Click here for the full report
Participants: Paul Mulkens and Rutger Hissink
First objective in this visit was the introduction of Rutger Hissink (as a new DEMMA member), vascular surgeon in Emmen and at the Cardiology department he met up with Alexander Lebedev, cardiologist . A tour of the renovated building showed that a differentiation of acute and normal pathology was made on the wards, and the coronary care unit was being developed. Alexey Azarov, intervention cardiologist (guest in Emmen in 2012) 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. In addition we were shown round the Vascular Surgery ward by the head of Vascular Surgery, Yurii Debelii. An impressive number of patients with a diverse selection of vascular pathology was presented. In the end Rutger went to join the vascular surgeons Yurii Debelii and Michael Pyrla (fellow vascular surgery) to do a carotid end arterectomie 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.
Second objective was a fine tuning and evaluation on the topic of DEMMA organizational business during a meeting with dr. Valery Yanin, head of the Mytishchy hospital. Information was provided 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. In continuation list of attention points as set up beforehand discussed . The position of DEMMA-Myt. 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. In another issue the Dwoyka 2013 participants were also confirmed: Galina Fokanova (pediatrician) and Natasha Kaira (ophthalmologist) will be coming to visit Drenthe from 17thNovember until 1stDecember. Last topic, to approach Mr. Azarov, mayor of Mytishchy region, as a member of the Committee of Recommendation was found to be a good idea. In order to enlarge the DEMMA scope a tour to Moscow city was scheduled to meet dr. Elena Toshchakova (Dwoyka 2005), ENT specialist She is now working in the Global Medical System private clinic in the centre of Moscow. She provided with a nice tour through 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.
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Click here for the full report
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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.
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Click here for the full report
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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.
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Click here to see the full report
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
Kees Tuinman, secretary (1994-2012) Guus de Groot, corresponding member (1993-2012)
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See the full report here
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The GP subject was served very well by the intensive participation of our house doctors Edwin Poorts and Coen Holzhauer in a GP seminar organised by the Mytishchy hospital. In the same time a two-week exchange programme for two Dutch medical students from the University of Groningen was organised by the Erismani Institute. The objective of the visit was to explain the details of the GP educational system in the Netherlands, the management of a GP practice and to attend a GP conference about COPD-treatment. After their arrival Coen and Edwin joined up with Kees Tuinman and Guus de Groot at Podlipki Sanatorium. At 29thNovember the start was at the Mytischi Hospital, collected Nadezhda Shirokova (pulmonologist)and Ekaterina Suslova (a local GP) and traveled to the big MONIKI (Moscow Regional Research and Clinical Institute) hospital down town Moscow city. In MONIKI there was a meeting with Georgy Khatskelevich Maltsin, (founder of DEMMA-M and deputy-director of Moniki), Professor and Dean of the faculty B.V. Agafonov and Associate professor Natalia Shevtsova. Coen Holzhauer explained how the Dutch organization for General Practitioners (GP-system) is organized. Professor Agafonov explained the intention of Moniki to start a GP-education program in Mytischi. Moniki wants the help from the GP-educational institute of the UMCG (University Hospital Groningen) to set up this education. On 30thNovember they went to the GP conference at poliklinika No. 5. Here they met Vladislav Mirzonov and Valery Yanin. Professor Agafonov had a short speech and associate professor Shevtsova lectured 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 presented a lecture about the treatment of COPD in Holland, which is for a large part done by GP’s. Afterwards a lively discussion raised up followed by a small tour through the medical center of the (1.5-level) Poliklinika No. V.
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Click here for the visit report
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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.
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Read the full report here
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An ENT working group (Dr.Paul Mulkens, guest ENT surgeon and Irma Stoetman, guest surgery nurse) paid a one-week working visit to the Mytishchy hospital ENT department. The medical staff of this well organised department consists of three ENT specialists: Ludmilla Sarancha (as senior still in charge), her daughter Elena Sarancha and Nadzjezda Nozdrecheva. The main objective of the working visit was to get more familiarized with the Russian methods in the field of ENT medicine. In addition to this some consultancy, including participation in surgical procedures was offered. Special attention was given to endoscopic rhinosinus surgery in particular. As a result of this a number of suggestions were made upon the instruments used, the equipment and the way of performing the procedures. Another interesting topic was a regional seminar. Venue was the municipal hospital in Koroliev, a town (well known as the astronauts center for space science) adjacent to Mytishchy. Many ENT colleagues from the region came together to participate in this meeting. The organisation was supervised by MONIKI, an institute with the qualification of a top referral hospital in Moscow city. The sponsoring was provided by MSD (Merck Sharp and Dome). Another meeting was arranged with the medical staff of the federal Erismani Institute (Prof. Ludmilla Saarkoppel) in order to explore the possibility of inviting Dutch medical students to stay at the Institute for a couple of weeks in November. Finally the WG had a formal meeting with the new head of the hospital Dr. Valery Yanin, very well known within the DEMMA group. Informally the group was invited by him, together with his wife, to visit the Monastery of Svenigorod on Sunday. This day was concluded with a traditional Russian diner at his datcha. In summary the basis was laid for a professional counter visit for Dr. Elena Sarancha and for the visit to Mytischy of the two Dutch medical students, both scheduled in the month of November.
Click here to see the visit report 16-22 May 2012
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