When I arrived in St. Petersburg, Russia for the IMF Clinical Conference, it was like stepping back in time. The immigration entry hall was a tall gray room with long lines of quietly anxious passengers. Having visited Russia many years ago, I realized that much of the uncertainty about potential bureaucratic malevolence remained. Was my visa correct? Did they have it listed in the computer that I recently supported the release of a sick American from a Russian jail? Did they have a computer? (They didn?t.)
The smiling faces of our host Prof. Eleonora Podoltseva and her colleague Dr. Vladimir Ryasnyansky were a great relief. Despite enormously busy clinics, they had taken time off to meet us, with a tiny car waiting in a parking lot which was a mixture of mud and partially frozen puddles of water. We took a road, which apparently continued straight to Moscow, past apartment complex after apartment complex to the center of town where our hotel was located.
The BMT Center where the conference was held and where Prof. Podoltseva runs the myeloma unit and transplant service, had been in the past the top hospital in St. Petersburg, used by the Communist elite. When we arrived to complete plans for the meetings, we needed a special pass to enter the gates into the grounds of the hospital center and permission to pass the guard into the hospital proper. The hospital was disconcertingly gloomy: the last visit by a maintenance crew had been many years ago.
But the meeting room was an excellent large auditorium with plans for the conference obviously well underway. We discussed microphones, projectors, translators and the like.
We were joined by Prof. Heinz Ludwig from Vienna and Prof. Mario Boccadoro from Torino. The physician seminar covered some biology but focused on management and new approaches to myeloma treatment. It was the first Russian myeloma meeting in living memory, probably ever. Yes, there had been individual lectures in the past, but not a coming together of physicians from all over Russia for a first day of guest lectures followed by a second day of Russian presentations for discussion of protocol results. Sequential translation carried the listeners through the details of diagnosis, transplantation and newer therapies such as thalidomide. One of the many ironies of past and present medical research was noted ? melphalan, then called sarcolysin, was first introduced in Russia. The Russian doctors knew about many aspects of the current myeloma research and treatments, but didn?t have the equipment or facilities to do much research nor the opportunity to use many of the treatments for their patients. Brilliant doctors; few resources. And how hard it is to know what is really going on in clinical practice from published reports of protocol results! This was the opportunity for the Russian physicians to learn how we really treat our myeloma patients.
During the second day of the conference, we heard results of research from several centers. In the face of limited resources, the role and benefits of stem cell transplant were controversial. The use of other expensive agents such as interferon also met with similar conflicting recommendations. But the clinical rounds, visiting patients hospitalized in the transplant unit of the Center, was a truly touching experience. The dedicated bright doctors, most of whom are women, receive salaries so low they struggle to survive financially but remain on call for their patients at all times. They have to work so hard in part because the available medical
technology dates from the 1960s. Bone marrow needles are sterilized, re-sharpened and re-used as needed. Stem cell harvesting is still done directly from the bone marrow with the patient under general anesthesia. The doctors do everything themselves ? there is no stem cell harvesting or sorting equipment. They collect and re-infuse marrow directly. They treat patients with the drugs available ? using not necessarily the best or recommended approaches. Nurses assisting them work in 24-hour shifts.
Amid all this, the expectant, anxious eyes of the patients. ?Will I be alright? Is there a better treatment? Is it available?? One patient hopes he can get by without the planned transplant ? he is so frightened by the prospect of intensive therapy and the constraints of care. Hallelujah! His myeloma is smoldering, his blood counts are fine and myeloma protein stable. The transplant can wait for now. Later, as we are squeezing into our car for the trip back to the hotel, we see the beaming patient literally skipping away out of the hospital. What a crazy world we live in! We wipe the tears from our eyes.
The next day, seeing the glory of the Hermitage; the paintings, the gold rooms ? the dichotomy which is Russia, past and present, overwhelmed all of us. We hope to return. The needs are clear. The answers will take time.
More than 100 Russian doctors in attendance were joined in the audience by medical students, nurses and several myeloma patients
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