Ńďîíńîđčđŕíî îň:        Dreyfus Health Foundation

DHF, 205 East 64 Street, Suite 404

New York, NY 10021

E-mail: Postmaster@thf.org


                                           Fax #  212-371-2776


News: April – August 2002




On May 17th, there was a meeting at the Bulgarian Red Cross Headquarters in Sofia. The Director,  Assoc. Prof. Gladilov and the Director of the International Department. Dr. Stoimenova presented the activities of the organization.

Dr. Jan Sobotka presented the programs of DHF in Europe and the Middle East.

Mrs. Yanka Tzvetanova presented the DHF programs in Bulgaria coordinated by the Association for Better Health, and collaboration with organizations in Bulgaria.

Dr. Daniel Levine, Director of Children’s Help Net Foundation (CHNF) talked about the programs of CHNF in Romania, Moldova and Bulgaria. CHNF has already donated computers for a children’s computer club in a school in Pleven, and is now starting a new program – computers for medical professionals. Possibilities were discussed for future collaboration.


On May 19th,  Dame Sheila Quinn, Shelagh Murphy, Dr. Jan Sobotka and Mrs. Yanka Tzvetanova attended a meeting of the Pleven Regional Branch of Association of Managers and Professionals in Nursing.

Dr. Sobotka presented the programs of DHF in the world, and what had been accomplished by the nursing PSBH program in Bulgaria and other countries in Eastern Europe.

Dame Sheila Quinn, DHF Consultant for nursing programs addressed the meeting, and Shelagh Murphy, acting board member of International Council of Nurses (ICN), presented ICN, and conditions for national unions to join ICN.


Site Visits


On May 17th, Dr. Daniel Levine, Dr. Jan Sobotka, Dr. Katarzyna Broczek and Mrs. Yanka Tzvetanova visited the computer club, equipped with computers donated by Children’s Help Net Foundation (CHNF). The computer club is a project, originally started as a PSBHI (Pleven Initiative – 1999) project in Ivan Vazov Comprehensive School in Pleven, to reduce stress in children who had lost a parent.

The now functioning computer club covers 60 underprivileged children (aged 7 -12), and the school provides computer training. 


On June 12th, international facilitators - Dame Sheila Quinn (UK), Pamela Hoyt (USA, Coordinator for Nursing Programs), Shelagh Murphy (UK), Fatmeh Atiyeh (Jordan), Paul Florea (Romania) and local facilitators visited projects in Gabrovo Regional Hospital.

 Projects from September 2001 PSBH workshop were seen, implemented by Kalina Parashkevova, Desislava Lazarova, Neila Maknin, Zdravka Kyuchukova, Raina Gencheva. Most projects were concerned with patient education, and Mrs. Raina Gencheva’s project aimed at improving the conditions in the pediatric ward by setting up a children’s playroom. The latter is one of the most successful projects in the hospital, especially so in attracting funds and collaboration with hospital staff and NGOs.



Follow-up Workshop


PSBH Follow-up Workshop (May 18, 2000)


The workshop in Pleven was attended by participants from 2001 August 30-September 1st PSBH workshop, and 22 participants attended. Five participants could not attend and sent their project status reports to the Association for Better Health.

In this issue, you will find more details on these projects.




PSBH Workshop for Nurses (May 20 -22, 2002)


Participants were addressed by Assoc. Prof. K. Ignatov, Rector of Medical University – Pleven, Dame Sheila Quinn – Nursing Program Consultant for DHF, and Dr. Jan Sobotka – Coordinator for DHF programs for Europe and the Middle East.

Prof. Faisal Ibrahim, Dean of Medical Faculty of Medicine of Upper Nile University, Sudan, Assoc. Prof. Boris Kornovski of Medical University –Varna, Deputy Mayor of Varna, Mrs. Marina Cholakova – Vice-president of Varna Anti-Drug Association attended part of the workshop.

The workshop was organized by the Association for Better Health and the University Hospital in Pleven.

The team of international facilitators (Dame Sheila Quinn, Jan Sobotka, Shelagh Murphy, Dr. Daniel Levine, Dr. Katarzyna Broczek) and the local facilitators (Assoc. Prof. Maria Alexandrova, Dr. Angelika Velkova, Dr. Kamen Kamenov, Mrs. Yanka Tzvetanova, Mrs. Makretta Draganova, Mrs. Polya Zhivkova) helped participants to prepare their projects. The following projects were prepared:


§         Setting up an emergency intensive care unit at the clinic of narcology for treatment of addicted persons (Alexander Alexandrov)

§         Organizing alternative forms of treatment (occupational therapy) for female patients with acute psychoses (Andriana Chakalova)

§         A program for patients undergoing radiotherapy on proper skin care, diet and leukocyte control (Anelia Zlateva)

§         A program for cancer patients and their relatives on pain control (Vilyana Stoeva)

§         A training program for diabetic patients on prevention of foot injuries (Galina Viteva)

§         Reorganizing the activities of paramedical staff to provide more time for proper nursing care (Darya Genova)

§         An educational program to reduce stress among patients referred for hemodialysis (Dechka Miteva)

§         An educational program for stroke patients and their families to prevent decubital ulcers after discharge from hospital (Dimirinka Mircheva)

§         Setting up daycare service for psychiatric female patients at the clinic of acute psychoses (Evlambia Racheva)

§         An educational program for farmers on proper handling of chemicals used in agriculture ( Iskra Velkova)

§         An educational program for early detection and timely treatment for tuberculosis ( Yordanka Valkova)

§         Building up a support group for nurses working in a hemodialysis center (

§         Yordanka Nikolova)

§         Prevention of postoperative infections in patients after laryngectomy (Katya Christova)

§         An educational program for diabetic patients to improve follow-up and control of blood sugar level (Katy Hinkova)

§         Improvement of rehabilitation in patients after hip joint replacement (Keti Georgieva)

§         Improvement of rehabilitation procedures in patients of the clinic of orthopedics (Krassimira Tzoneva)

§         Shortening the rehabilitation period for stroke patients (Kremena Mircheva)

§         A program for social reintegration of multiple sclerosis patients (Maria Stankova)

§         An educational program for patients undergoing chemotherapy for oncological conditions to improve life quality (Meliana Al Shargabi)

§         Health education for glaucoma patients of the eye clinic in Pleven and their relatives (Mitka Ilieva)

§         Training of nursing staff to improve cost effectiveness of treatment( Pavlina Zhekova)

§         Health education for patients to maintain proper hygiene of tracheostoma canule (Petya Angelova)

§         Training proper inhalation techniques to patients with chronic obstructive pulmonary disease and asthma (Petya Simeonova)

§         Training courses for nurses working at the lung disease clinic (Snezhana Petkova)

§         Prevention of alcohol intoxications in 400 children aged 1114 (Stefka Kancheva)

§         Health education for newly diagnosed diabetic patients (Tzvetelina Ivanova)



June 2002


PSBH Workshop for Nurses (June 1315, 2002)


The workshop was organized by the Association for Better Health, in close collaboration with Dr. Antoaneta Stoikova (deputy director) and Mrs. Nelly Todorova (head nurse) of Gabrovo regional hospital. Nurses, physio-therapists, lab technicians, midwives from Gabrovo Regional Hospital, and nurses from the Pulmonary Disease Hospital in Gabrovo participated. A couple of doctors also attended.

The 48 participants worked in five groups with the international facilitators Dame Sheila Quinn and Shelagh Murphy (UK), Pamela Hoyt, Nursing Programs Coordinator from DHF (USA), Fatmeh Atiyeh (Jordan), Paul Florea (Romania), and the local facilitators Assoc. Prof. Maria Alexandrova, Dr. Angelika Velkova, Mrs. Yanka Tzvetanova, Mrs. Polya Zhivkova, Mrs. Nelly Todorova.

Miss Mariana Glouhova, a representative of the Red Cross – Bulgaria participated as an observer,

Projects were mostly concerned with patient education, improvement of working conditions for the staff, improvement of quality of nursing care, health protection for hospital staff.  The following projects were prepared:


§         A program to reduce in-hospital infections in a surgical ward (Albena Boteva)

§         Introduction of local anesthesia in lumber puncture for patients at the neurological ward (Bisera Uzunova)

§         Increasing the levels of reliability of tests performed at the microbiology laboratory (Assia Peikova)

§         Shortening of recovery period for pediatric ward patients through improvement of dietary regimen (Daniela Simeonova)

§         Health education for 800 inhabitants of Gabrovo on proper actions in cases of exogenous poisoning (Dimitar Dimitrov)

§         Training asthma patients for proper use of inhalants (Donka Georgieva)

§         Health education on proper diet and regimen for hepatitis B patients (Donka Encheva)

§         Motivation of patients to undergo bronchoscopy (Ivo Stanchev)

§         Training for relatives of 20 stroke patients for proper care in the home (Emil Damyanov)

§         Health education for patients operated on for glaucoma and cataract to reduce postoperative complications (Galina Nedyalkova)

§         Stress reduction in patients planned for fibrocolonoscopy (Galya Christova)

§         Health education for parents of children with asthma (Ganka Nedelcheva)

§         A program to improve hygiene in a surgical ward (Genka Kamenova)

§         Training patients with chronic obstructive pulmonary disease to use a spirometer at home (Irina Tapova)

§         Health education program for acute myocardial infarction on proper exercise regimen in the acute stage (Kalina Parashkevova)

§         Training of relatives to prevent decubital ulcers in stroke patients (Kamelia Dragieva)

§         A program to promote health protection of personnel working in an X-ray department (Kremena Dimitrova)

§         Health information campaign on the hospice services offered to chronic and terminal patients from Gabrovo region (Lubka Dimitrova)

§         Prevention of infections among medical staff in a pulmonary hospital (Lubka Haralambieva )

§         A program to increase number of blood donors in Gabrovo (Margarita Tzanova)

§         Shortening the hospital stay of maternity ward patients (Maria Petkova)

§         Reduction of stress levels in children admitted for treatment at the ENT ward (Maya Petkova)

§         Reduction of risk in oxygen therapy given to newborns (Maya Dyukendjieva)

§         Prevention and control of nosocomial infections in the pulmonary hospital in Gabrovo (Michaela Dimitrova)

§         Providing information for oncololical patients   to ensure timely admission for radiotherapy (Milena Nedelcheva)

§         A training program to reduce low-back pain among personnel in the neurology ward (Milena Pencheva)

§         An educational program on hormone replacement therapy for hysterectomized women aged 35-45(Natalia Milkova)

§         Patient education to prevent complications in diabetic patients (Neila Maknin)

§         Antismoking program for children aged 1114 attending a middle school in Gabrovo (Nelvena Christova)

§         Training paramedical staff to prevent nosocomial infections (Nikolina Christova)

§         A training program to improve communication skills of nurses in a tuberculosis ward (Petya Hadjinukiforova)

§         Education of disabled people to inform them on the social services provided for them (Petya Vitanova)

§         Health education for hypertensive patients aged 25-50 (Petya Stancheva)

§         Reduction of stress among patients referred for fibrocolonoscopy (Radka Milcheva)

§         Building up data base on newly diagnosed patients with lung diseases (Radostina Petrova)

§         Organizing activities for children treated at the pediatric ward to reduce stress levels (Raina Gencheva)

§         Health education for patients with increased serum lipid levels (Reneta Ilisanova)

§         An educational program for timely detection and treatment of osteoporosis in 100 women (Roumyana Ivanova)

§         Improvement of accuracy of diagnostic procedures in the clinical laboratory (Snezhinka Tomova)

§         Reduction of nosocomial infections in a neurological ward (Stella Koleva)

§         Health education for patients of the intensive care unit in Gabrovo to reduce rehospitalization rates (Svetla Grancharova)

§         Health education for families of tuberculosis patients (Tatiana Dimitrova)

§         Improving registration process and follow-up of patients in the surgical ward (Temenuzhka Stancheva)

§         Health education for hypertensive patients (Yulia Popova)

§         Health education for hepatitis B patients (Dimitrinka Ivanova)



Varna PSBH Workshop for Nurses (June 17 – 19th)


The participants (52) were mostly school nurses. There were six nurses from St. Marina University Hospital, including the head nurse, Mrs. Angelina Zhelyazkova.  The workshop was organized by the Association for Better Health, in close collaboration with Dr. Dilyan Droumev, Director of the Health Department of Varna municipality, and the Municipal Center for Drug Abuse Prevention. 

International facilitators - Dame Sheila Quinn, Pamela Hoyt, Shelagh Murphy, Fatmeh Atiyeh, Paul Florea and local facilitators - Assoc. Prof. Maria Alexandrova, Dr. Angelika Velkova, Mrs. Yanka Tzvetanova, Mrs. Polya Zhivkova, and Mrs. Gergana Momova helped the participants prepare their plans of action. As might be expected, most projects were oriented to school health, and all the hospital nurses presented finalized plans of action. The projects prepared were:


§         Health education for teenagers on STIs and the risks of early pregnancy (Albena Christova)

§         A training program for paramedical staff to reduce in-hospital infections in a surgical ward of the Varna regional hospital (Angelina Zhelyazkova)

§         Health education for teenagers on the risks of alcohol abuse (Anelia Parousheva)

§         A program to reduce stress in children attending an art school in Varna (Blagoika Petkova)

§         Antismoking program for children aged 15 (Dimitrichka Ovcharova)

§         Organizing continuous postgraduate training for nurses (Dora Vasileva)

§         An antismoking program for children aged 15 (Elenka Peikova)

§         An educational program for mothers accompanying children at the pediatric ward to reduce in-hospital infections (Galina Ganeva)

§         Health education on reduction of body weight in patients after acute myocardial infarction (Greta Demerdjieva)

§         Health education for Rroma children to reduce the number of carriers of head lice (Ivanka Georgieva)

§         Training basic hygiene skills to Rroma children (Ivanka Panayotova)

§         Anti-drug education for 60 children aged 15-18 (Katya Stankova)

§         Prevention of spinal deformities in 70 children aged 7-8 (Koharik Kouyuomjiyan)

§         A program to improve on the skills of 8 theatre nurses of the regional hospital in Varna (Krassimira Dimitrova)

§         A physical education program for children with mild spinal deformities and incorrect posture (Margarita Mihova)

§         Antismoking program for children aged 14-16 (Maria Vlaikova)

§         A training program for parents of disabled children (Mariika Angelova)

§         Increasing the knowledge on the dangers of early pregnancy among girls aged 14-15 (Milena Yovcheva)

§         A program to reduce violence among and to schoolchildren aged 17 (Minka Christova)

§         An educational program on the dangers of drug use and abuse for children aged 15 (Nanka Dimitrova)

§         A program to improve on social integration and follow-up of 14 psychiatric patients (Nadya Kostadinova)

§         Reduction of traumatism in children aged 15 attending a vocational school (Nedka Gospodinova)

§         Organizing exercise sessions and diet education for overweight children aged 9-14 (Nedyalka Mitkova)

§         An educational program on the dangers of alcohol abuse (Nelly Markovitch)

§         A program to reduce weight in obese children aged 7-14 in an elementary school in Varna (Nikolinka Miteva)

§         A health education program to improve knowledge on the dangers of drug use for children aged 15 (Radka Mileva)

§         An educational program to promote save sex and preservation of reproductive health of girls aged 16-18 (Rositza Filipova)

§         Antismoking program for primary school teachers (Roumyana Eftimova)

§         An educational program on the dangers of alcohol use and abuse for children aged 13-15(Roumyana Andonova)

§         Education on proper diet and physical exercise to reduce weight in obese children (Rousinka Todorova)

§         A program to reduce aggression-related traumatism in children aged 12-14 (Sabka Arabova)

§         Antismoking program for middle school children (11-14) (Sasha Ilieva)

§         A program to increase immunization rates in 360 children aged 7-14 (Sminka Koleva)

§         Reduction of traumatism due to aggressive behavior in children aged 11-12 (Stanka Manolova)

§         Remedial gymnastics for children with neuroses and high blood pressure (Todorka Popova)

§         An educational program on sexual health for children aged 12 (Tzanka Ivanova)

§         Health education on basic hygiene for Roma children aged 7-8 years (Velichka Georgieva)

§         Health education for 100 teenage girls to prevent bulimia and anorexia (Violĺta Borisova)

§         An educational program for children aged 12 on the physiological changes in puberty (Yanka Andreeva)

§         Education on proper diet for girls aged 17-19 to reduce somatic incidents due to improper slimming diets (Yordanka Gacheva)

§         A program to reduce the number of children aged 8-9 with spinal deformities and incorrect posture (Zlatka Ivanova)




Follow-up workshops for projects from Sofia PSBH 2001 and Stara Zagora PSBHI 2001 workshops will take place in the autumn. Participants will be notified about the exact date, time and venue.

Those interested to get more detailed information on Dreyfus Heath Foundation programs worldwide may look at www.dhfglobal.org

To see photos from workshops and projects, please check the web-site of the digest: www.livebg.net/psbh-digest. You may have a look at previous issues of the digest as well. More about the program may be found at www.dhf-bg.org.

Write to us at: abh-psbh-bg@el-soft.com, or to the address of the Association for Better Health: 1, St. Kl. Ochridski Str., 5800 Pleven, Bulgaria, for Yanka Tzvetanova, PSBH/CBH coordinator



Management of Nipple Discharge


Dr. Georgi Baichev, I. Daskalova

Oncology Centre, Medical University – Pleven


Summary  Nipple discharge in non-lactating breast is an important complaint  in patients. It indicates pathologic changes based on endocrinological or local abnormalities. Although most common discharges have a benign etiology, 10-15% of cases are associated with cancer.

A combination of diagnostic tests, including breast examination, exfoliative cytology and galactography, can help the clinician to establish the diagnosis and plan proper management. Depending on the underlying breast pathology, a central or single lactiferous duct excision is the procedure of choice.


Key words: nipple discharge, galactorrhea, breast cancer.



Summaries on Implemented/Completed Projects from the August’2001 PSBH Workshop


Health education on proper diet for diabetic patients


Mrs. Kalina Parashkevova (Gabrovo)


   The project was implemented in September 2001, and is to be completed in September 2002.

   Two nurses were trained to work on it.

Brochures were prepared with information on the principles of diet recommended to diabetics, and given to patients treated at the ward.



Reduction of stress levels among patients scheduled for surgery in the Loukovit hospital


Mrs. Pavlinka Petrova (Loukovit)


   A team was built to work on the project.

A program for working with the patients was made, and each patient was acquainted with the daily regime at the ward and the facilities.

All patients were given brochures containing basic information about the intervention, and the nurses had talks with them and answered questions

All patients filled in a simple test for assessment of the level of stress. 

   The project was completed in March 2002. The test showed reduction of stress levels in 80% of the patients treated in the ward.



Health education for insulin-dependent diabetic patients: diet and exercise regimen, prevention of complications


Mrs. Neila Maknin (Gabrovo)


   The project covered 19 patients. All of them got a booklet, specially adapted and containing information on diabetes control, and prevention and/or postponing the complications of the disease.

   The project continues, and more patients will be included.



Teaching self examination of the breast to women in Belene


Mrs. Rositza Ivanova (Belene)


   A brochure was printed and distributed among the women.

   The team includes a nurse, a surgeon and a gynecologist.

   The project is to be completed in December 2002.



Reduction of stress in children admitted for treatment at the pediatric ward in Gabrovo


Mrs. Raina Gencheva (Gabrovo)


   A team was built, and the activities planned were discussed and coordinated with the hospital managers. Fund raising was organized, and firms in Gabrovo approached. A psychometric test to assess the children while at the ward was prepared by a psychologist.

   With the support of sponsors from Gabrovo-based firms - Shell – Bulgaria, Proekt-Stroi Ltd, Lion Ltd, Simat Ltd. Emona Ltd, and many volunteers, the team managed to set up a children’s corner in a sunny room in the ward. Toys, books, a TV, materials for drawing were purchased. Children from primary schools in Gabrovo provided many of the toys. 

   For four months, the children have been busy drawing, coloring, arranging puzzles, preparing postcards, watching cartoons, listening to fairy tales and playing various games.

With each child a psychometric test was done, and the parents filled in a questionnaire.

The results from trying to give the children an opportunity to spend their time at the hospital playing very much like at home will be assessed for the first six months – January-June 2002.

The goals and the activities of the project team were made known to the public through the local media: Gabrovo Cable TV, and Gabrovo Today Newspaper.



Early diagnosis of cervix carcinoma in one general practice


Dr. Emanuil Manoilov


   A list was made of women (18- 75), registered with the practice and supposed to undergo an examination and a PAP-smear test. 

   A brochure was prepared and distributed, explaining the necessity for such check-ups, and the importance of early diagnosis.

   Consultations with a cytologist were made, and the personnel were trained.

Results: 25% of the women were examined. No pathological changes were found.

   Comments: it is difficult to motivate the women to undergo the examinations.



Organizing training for nurses newly appointed at 2nd Clinic of Neurology


Mrs. Diana Arsova (Pleven|)


   In collaboration with the head of the clinic, the doctors and the senior nurse, the following was accomplished:

   - lectures were prepared on the diseases treated at the clinic;

   - registration cards and standard  procedure protocols were prepared;

   - a nursing procedure protocol for prevention of decubital ulcers was prepared;

   - a standard procedure protocol for catheterization was prepared;

- instructions for preparation for lumbar puncture were prepared;                      

- a program for the nurses who will train the newly appointed ones was prepared.

   Criteria were set for evaluation of the results from the training at the end of the first and the sixth month.



Organizing a screening program for early detection of breast and cervix cancer


Mrs. Valentina Besheva (Pleven)


   Oncologists from the University Center of Oncology in Pleven examined 250 employees of the Academy of Economy in Svishtov.

   Comments: the numbers of patients diagnosed with ovary cancer are increasing, and the age of those diagnosed with malignant tumors is decreasing. This necessitates the promotion of prophylactic check-ups.

   The project team plans to include more patients in the program.



Prevention of in-hospital infections in the intensive care unit


Mrs. Erka Andreeva (Pleven)


   A program to realize the project was made and a team was built, lectures and materials prepared. Training sessions for nurses and orderlies were started.

Results are checked every three months, and measures are taken if necessary.

The hospital authorities, the hospital epidemiologist and the staff of the intensive care unit supported the project team.



An educational program on the risks in alchemic heart disease


Dr. Lidia Tzoneva (Belene)


The program activities are addressed to 100 patients with ischemic heart disease, aged 40-65, and 73 have been selected so far. These have been hospitalized and treated in hospital. Brochures have also been given to them, containing information on risk factors.

Follow-up to evaluate the project ill be carried out in collaboration with the hospital and the general practitioners.



Promotion of early diagnosis of breast and cervix cancer among female employees of “Yana” Ltd – Pleven


Mrs. Pavlina Angelova (Pleven)


   The aims of the project team (a doctor and a nurse) were:

   - to teach the women self-examination of the breast for early detection of pathological changes

   - to establish co-operation with the Oncology Center in Pleven for performing PAP-smear tests

   The project was presented to the management of the firm; leaflets with information on breast and cervical cancer were prepared and distributed. Talks with a specialist were organized, and a video was seen.

   The questionnaire filled at the beginning and the end of the program showed there was an increase of the level of knowledge of the role of early detection for the treatment and outcome of both conditions.



A program on pain control for the families of terminal cancer patients


Mrs. Penka Manolova (Pleven)


   The program is to cover 36 patients and their families. So far, ten have been included.

Talks were organized with the relatives, and additional information on opiates used in pain control was given to the relatives of each patient. The relatives also signed an agreement to return the medicines they had not used back to the consulting room for chronic pain control.

   Evaluation will be made on the basis of questionnaires.

   The head of the clinic Assoc. Prof. Deliiski and the head nurse Mrs. Besheva were very supportive. The pain-control consulting room is now bigger, and procedures can be made there. A nurse was appointed, and now the patients from Pleven can be visited in their homes.



Health education for patients with acute myocardial infarction


Mrs. Vessela Yotova (Pleven)


   The project team includes a cardiologist and four nurses. Brochures were prepared and given to the patients, and patients are approached individually while at the ward. individual talks. The general practitioners were informed about the project.

   A questionnaire will be filled by the patients, and re-hospitalizations related to the condition will be used to evaluate the results, comparing the data before, and one year after the implementation of the project.



Organizing prophylactic check ups in one general practice for women aged 18-75, and men aged 45-75 for timely diagnosis of breast, cervix and prostate cancer


Mrs. Marineta Petkova (Pavlikeni)


The patients were invited to undergo the check ups using the local media – radio, TV, and by sending them individual letters.

   Questionnaires, brochures and an information table were prepared for the waiting room.

Results so far: 504 (80%) of the women, and 372 (80%) of the men have turned up. By August, the rest 20% of the patients will be examined.

   The annual check-ups are to be introduced as a routine practice.



A program to motivate female patients registered in one general practice (age range 18-75) to turn up for cervix and breast cancer check-ups


Dr. Evgeni Petkov (Pavlikeni)


   Health talks were given to the patients, an inquiry was made and brochures prepared and distributed. Gynaecologists were invited as consultants to the project.

   Of the 302 women examined, four were diagnosed with cervix cancer, and breast cancer was found in two.

   The rest 20% of the women are to be examined by the end of August 2002.



Health education for diabetics to reduce rehospitalization rates


Mrs. Vessela Kancheva (Loukovit)


   A lecture course was organized for five nurses from the internal disease ward. A brochure was prepared, an information corner set up, and additional blood sugar measuring instruments provided.

   The project was presented to the general practitioners, and brochures were put in the waiting rooms.

   Lectures prepared by an endocrinologist were broadcasted twice a week for two months by the local “Delta” radio.

While the patients are in the ward, nurses talk to them and their relatives, and brochures with instructions on blood sugar control are given to them on discharge.



Early diagnosis of carcinoma colli uteri among patients (aged 20-65) in one general practice in the second consulting and diagnostic center in Pleven


Dr. Julia Ivanova (Pleven)


   The project team includes a GP, a midwife, a gynecologist, a cytologist and an oncologist.  

   A brochure entitled “Cervical cancer: early symptoms, risk factors and modern treatment“ was prepared and distributed, and talks were given to the patients registered in the practice.

   The following check-ups were performed:

   - 1000 women underwent a PAP-smear test and mammography;

   - 2 women with PAPIII were consulted by an oncogynecologist.

   The project is coordinated within the programs of the national health insurance fund.



Reduction of stress in cancer patients planned for chemotherapy


Mrs. Zdravka Kichoukova (Gabrovo)


   A brochure was prepared, and the patients filled in questionnaires.

The project has covered 25 patients by April 2002, and will be completed in December 2002.

   The inquiry has shown that the patients find the information program helpful.



Health education on the necessity for regular gynecological check-ups for women aged 19-75


Dr. Blaga Lyubenova (Belene)


   A brochure was prepared and distributed.

   By April 30, 2002, 417 (14%) of the 3164 women included in the project have undergone a gynecological examination and a PAP-smear test. In two of them, precancer changes were diagnosed.

   The general practitioners have collaborated actively, referring the women for a check-up.



Reduction of anxiety in patients planned for endoscopy


Mrs. Desislava Lazarova (Gabrovo)


   The project was presented to the team of the ward, and materials to be included in the brochure were found, approved by the staff, and adapted for the purposes of the project. 

   Illustrations were made, and caricatures were added.

   The brochures were given to the patients, and copies were left in the ward, so that more people had a chance to see them. Brochures have helped some of the patients to feel less stressed.

   The project continues, and will cover more patients.



Teaching safety precautions to student lab technicians at the Nursing College in Pleven


Mrs. Ivanka Stoikova, trainer (Medical College Pleven)


   The project was presented to the director, and a team was built of three trainers and a doctor. The target group of 46 students was formed after studying the attitudes of the students and their expectations.

   The teaching program prepared was on five basic topics:

   - safety precautions in investigations of blood samples;

   - safety precautions for working with gases, acids and bases;

   - safety precautions in investigations of urine samples;

   - safety precautions in centrifuging in the lab;

   - preparation of lab utensils and materials – cleansing, disinfecting, and use of individual protection devices.

   Five brochures with instructions for work in the clinical laboratory were prepared and printed. All these were placed on an information board in the lecture halls.

   The practical training was conducted in April and May 2001.

   At the end of the training course, the students’ theoretical knowledge and practical skills were tested.



Projects from Varna Antidrug PSBH Workshop – May 2000



Education for youth community non-formal leaders to help peers cope with drug addictions


Mr. Ilyan Rizov


The project goal was to organize education on the dangers of drug addiction for 15 children (13-14 years old) from the „Dobri Chintulov“ Primary School, preparing them for peer-educators. The first step was to select the target group (6 girls and 9 boys).

The education program included teaching basic communication skills, conflict management, assertivity etc., and training them how to refuse when offered to experiment or take drugs and improving their skills for peer-consultation on problems related to drug abuse .

   Additional topics were included in the program, such as interaction skills for work with boys and girls from different ethnic groups.

   During the school year, these peer educators took part in anti-drug programs, and were assisted by the Center for Drug Abuse Prevention in Varna.



Harm-reduction (hepatitis B/C and HIV) program for heroin addicts


Dr. Borislav Stanchev (Varna)


   The need for such a program was estimated by key interviews, taken from 67 heroin addicts, who were also hepatitis B/C carriers. The key interviews were conducted using a semi-structured questionnaire and a card on the European Council  „MULTY CITY NETWORK project.

   The aim of the program was to motivate drug users to undergo treatment for hepatitis C if necessary, be vaccinated for hepatitis B, and to train them to avoid risks of infections when taking psychoactive substances.

   Of the 67 heroin addicts interviewed, 50% were admitted for treatment of hepatitis C, and about 60% got hepatitis B vaccine.

The program has its own rules, such as conditions for joining or leaving, ways of establishing and maintaining contacts, rules to collect, store and dispose of needles and syringes

   Future plans:

   - to equip a room for a needle exchange program, provide consumables, prepare brochures on harm-reduction techniques;

   - to recruit and train volunteers;

   - to provide monitoring and assessment;

   - to make the program sustainable;

   - to coordinate the activities with other institutions and NGOs.



Prevention of tobacco smoking among students from the Nursing College in Varna


Dr. Nikolai Temnyalov


   Meetings, discussions and interviews with 45 third-year student nurses were organized, and in April 2001, nine of them volunteered to be included in the program. 

   Functional assessment of breathing of all nine participants was made free of charge by the specialists at the lung disease clinics of the University Hospital and the regional hospitals in Varna.

   The participants then took anti-nicotine tablets - 3 to 8 tablets a day (the doses recommended depended on the needs of each participant).

   All of them got brochures with instructions how to take the medicine, and copies of articles on the harmful effects of smoking. 

   The results: all nine girls quit smoking. In December 2001, spirography showed improvement of breathing in all of them.

   Plans: to keep in contact with the participants after the leave the college.

   Participants will be followed up after leaving the college.



Health educational program on the harms of drug use for children in three schools in Varna


Dr. Elena Geneva


   Workshops and discussions were organized with three groups of children aged 12-14, attending health-promotion schools in Varna (“Yordan Yovkov” and “Nicola Vaptzarov” middle schools).

   The meetings took place at the Hygiene and Epidemiology Station, the Museum of Natural History and the “Human Health” video club.

   The program included:

1. Health education workshops on

- definition, nature and types of psychoactive substances;

- effects of psychoactive substances on the human organism;

- attitudes to drug use and types of behavior in young people;

- discussions.

2. A meeting with a specialist from the Department of Psychiatry of Varna Medical University.

3. Watching a video (“The vicious Circle”) with stories of young people related to their experiences and problems.

4. Small group discussions of cases and problem-solving sessions. Presentations of ideas and solutions suggested in each group.

   All the children got folders with health-education materials on psychoactive substances, their effect on the human body, a brochure on marijuana and a poster.

   The project was implemented by the health promotion department in Varna. Special thanks to Mrs. Snezhana Ilieva and Mrs. Maria Stefanova  (pedagogical advisors), and to Mrs. Toni Mileva (medical University – Varna).



Increasing the sensitivity of parents’ to their children’s experimentation with psychoactive substances


Mrs. Gergana Momova


   We interviewed over 400 subscribers of MSAT Cable TV, parents, of children aged 13-18. Three groups of questions were included in the questionnaire. Leaflets were prepared and distributed.

   The analysis of the inquiry showed that the sensitivity of parents varied, and in some it was as low as 44%, ad though 90% are worried, parents still remained passive, because they do not know how to behave or act.

   The media people, on their part, do not realize what role the media could play in solving the drug use problem.  There is “gap” between school and parents, and this gap could be filled with prevention programs.

   Meetings were organized to give basic information on psychoactive substances, discussions and possibilities for treatment.

   Video materials are to be prepared and broadcasted by MASAT TV.



Educational program for journalists on drug use and abuse problems


Mrs. Svetlana Koeva


   The Varna Drug Use Prevention Center organized training for journalists from four TV stations, two radios and six newspapers on the following topics:

- current problems of drug use and abuse;

- tendencies in drug use;

- social and demographic characteristics of drug use and abuse in Varna region;

- major anti-drug projects of the Drug Use Prevention Center in Varna.

   Future plans: to prepare and distribute educational and information materials on drugs and the harmful effects of use and abuse, and advertising institutions and organizations where consultations and treatment can be obtained.



Publishing a specialized magazine „The freedom to choose“ for teachers and social workers in the city of Varna in order to carry out preventive work with young people who take drugs


Mrs. Petromila Atanassova


   The members of the „Intellect“ club gathered information, materials, research results in order to facilitate and promote the educational process in the „The freedom to choose“ magazine for 2001.

   We presented the issue at a press conference in the Youth Center in Varna. The first issue was advertised in national and local newspapers. The magazine is distributed free of charge to schools, NGOs, government and municipal organizations.

   We managed to organize exchange of information among school-teachers, sociologists, social workers, school directors and the Department of the Ministry of Education and Science in Varna.

As a result of our work we prepared an alternative project on the subject: „Achieving adaptive behavior in situations of violence among high grade students” which projects was approved by the Varna Directorate of Youth activities and Sports.

   Future plans: to continue collecting and analyzing statistical data on drug use and other problems, scientific articles and opinions. We hope to be able to continue with producing and distributing the magazine.



Giving basic knowledge on psychoactive substances and their harmful effects to elementary school children


Mrs. Evgenia Koleva


   The project included 308 children from „Vasil Levski“ Elementary School and 300 children from „Christo Botev“ Elementary School. There are no drug-dependent children in these schools.

   Once a week, the class teachers organized discussions on the healthy life styles.

   During the whole school year, various competitions and activities were organized: drawing competitions – „The Earth is My Home“, essay writing: „My School“, „My Town“, „My Street“, „My Friends“.

   School newspapers were prepared: „Time break“ and „Young Mathematician“.

   A concert with 100 % participation of the pupils from all ethnic groups was organized.

   Future plans: to provide for printing guidebooks for teachers and individual student‘s books on problems of drug use. The level of knowledge of children on the problem will be measured before and after the anti-drug education.



„Free youth territory“ Club


Mrs. Roumyana Ivanova


   The target group includes 108 children (age: 12-13 years).

Premises were provided for carrying out group work with parents, teachers, representatives from the police and social workers who work in the „Mladost“ housing estate in Varna („Geo Milev“ Comprehensive School and „Dobri Chintulov“ and „Ivan Rilski“ Elementary Schools). The local stadium is also used for our activities.

Three social workers, a journalist, a poet, a teacher in folk music, a psychologist and a sports teacher work on the project as volunteers

In their free time, the children were engaged with the preparation of the various social events: celebrating the National Liberation Day, presentation of collections of poems, skateboard competition in July.


- to provide for one more room so that there will be enough possibilities for communication between the different generations;

- to organize sports and tourist activities more often;

- to carry out an inquiry among the target group participants and assess the levels of addiction and proneness to drugs;

- to discuss the activities and the future steps on the project with parents, teachers, social workers and representatives from the police.



Increasing the level of knowledge on the harms of drugs among children from different minority groups in Odessos municipality


Mr. Fidan Assenov


   We started working on the project in May 2000.

The inquiry we carried out among 150 children (aged 8-18) showed that:

- only 11 children did not take drugs;

- 65 children aged 15-19 were intravenous heroin users;

- there was one child aged 8 who took heroin intravenously.

   The project team included two parents, a social worker, a pedagogue, and a psychologist.

   In August we distributed leaflets and brochures, advertising the project activities, and invited the drug users to join the training groups. The activities in the training groups were conducted by a teacher and a social worker, and the main goal was to get the children learn about the harms caused by drug use.

   Two training groups were formed: one for children aged 12-15, and another – for children aged 15-18. The training sessions took 5 months.


- the number of users has decreased by 60%;

- 20% of the users were sent for treatment abroad ( Spain, Italy);

- unfortunately, 5% died of overdose

- 10% of the target group emigrated;-      the eight-year –old user is now healthy.

   Although our project did not get support from the local government institutions, we achieved a lot with our project. We plan to continue working with the children.



Psychological work on drug abuse prevention among the stuff of the Bulgarian Marine


Mrs. Meglena Deresheva


   We created and began the implementation of a complex program called „Prevention of alcohol and drug abuse in the Bulgarian Marine“. We selected our target groups and began psychological work with the participants.

   The group work consisted of talks and seminars aiming to change the attitude to the problem and the formation of responsibility for one’s own health. On the basis of this work we managed to identify the participants to work with individually.

   With the senior staff, we conducted training aimed at building skills for early detection of drug seeking behavior and individual approach to such soldiers.

   Plans for the future:

- to carry out inquiries with the target groups;

- to provide and distribute different informational materials - books, videos, brochures, leaflets;

- to analyze the results and identify priorities for future activities.



Decreasing the numbers of drug users among high school students (15-18) in attending „Constantine Preslavski“ Arts School in Varna


Mrs. Albena Valcheva


   We started with an inquiry to assess the attitudes and level of knowledge of parents and students on psychoactive drugs. Training sessions were organized for teachers and class teachers: these sessions were to help them acquire skills at recognizing drugs and identifying drug-users.

Plans: to prepare brochures on the effects of psychoactive substances, and implement peer-education.