A Multiyear Medical Mission in Moldova Adapts to a Pandemic — and a War

By Geoffrey Johnson

In December 1999, Stephen Mackler was on a medical mission to Bucharest, the capital of Romania. As he completed his work there, a colleague pulled him aside.

“Steve,” he said, “I need you to go with me to Moldova.”

“Great,” replied Mackler. “Where is Moldova?”

Moldova, of course, is the Eastern European country and former Soviet republic situated between Romania and Ukraine. Mackler’s visit there would lead to a series of Rotary Foundation global grants and significant improvements to Moldova’s outmoded nursing program — and this endeavor would continue despite the global pandemic and the outbreak of war.

But first, back to 1999. While in Moldova, Mackler visited several hospitals, and he returned to his home in the U.S. distressed at what he’d seen, especially the number of people suffering from illness related to the Chernobyl nuclear disaster. Fortunately, Mackler, a periodontist and adjunct professor at the University of North Carolina’s school of dentistry, was also a member of Rotary. He had joined the Rotary Club of Guilford (Greensboro) in 1995 after an earlier medical mission — this one to the jungles of Brazil — where he’d seen Rotary in action. So he knew exactly where to turn.

Mackler reached out to a fellow Rotarian who told him about a recently formed partnership between Moldova and the state of North Carolina. The partnership was the outgrowth of a program, originally military in nature, promoted by the U.S. Department of Defense to encourage cooperation among U.S. states and the former Soviet republics. Mackler met with Elaine Marshall, North Carolina’s secretary of state (Marshall continues to hold that office today and remains a champion of the Moldova-N.C. partnership), and in 2000 he traveled to Moldova to provide dental care. “We’ve been coming back year after year,” he says, “and we’ve been doing the things [Moldova’s health care leaders] wanted us to do. So we were building a lot of trust, which is the first thing that we had to do.”

As the years passed, Mackler recruited other dental professionals, as well as some of his students, to accompany him on those trips, which were supported in part by contributions from his Rotary club. Often those recruitments took place at his North Carolina practice, and in 2006, a nurse landed in his dental chair. Before long she too became a member of Mackler’s traveling team and began enlisting other nurses who might help modernize another aspect of Moldova’s medical system.

“Moldova had nursing colleges that young women and some men attended right out of high school,” explains Mackler. “But they were more like nurse assistants, doing things like changing bedpans.” What’s more, Moldova lacked the regulatory standards applied to nurses in most developed countries.

Mackler and his volunteer team of medical professionals set out to rectify that. Once again, he got help from his Guilford (Greensboro) club, as well as from District 7690 (North Carolina), which provided district grant funding. Working with the Nursing Association of the Republic of Moldova, the team sought to develop a core curriculum in professional nursing for the Nicolae Testemițanu State University of Medicine and Pharmacy in Moldova’s capital, Chișinău. The Rotary Foundation provided the project its first global grant in 2015, with the Rotary Club of Chișinău Cosmopolitan serving as the host club and the Guilford (Greensboro) club as the international partner; in the three global grants that followed, the Rotary Club of Chișinău Centru served as host.

As the project expanded and evolved, Mackler concentrated on fundraising and assembling the right personnel. Eventually he ceded the lead role on medical matters to a 15-member vocational training team known today as the North Carolina-Moldova Nursing Collaborative. As Mackler recalls: “I told my wife, ‘You know, I’m not used to working with nurses.’ She said, ‘Steve, keep your mouth shut, and they’ll take charge, which is what nurses do.’ And that’s exactly what they have done.”

The training team includes medical professionals and educators from several schools in North Carolina. Among them are three key players with ties to the University of North Carolina at Greensboro: team leader Deborah Lekan, a recently retired assistant professor of nursing; Audrey Snyder, a professor and the associate dean for experiential learning and innovation; and Nancy Hoffart, the recently retired Forsyth Medical Center distinguished professor who is the project director on the collaborative’s latest global grant. “In describing these women, I use the words ‘committed’ and ‘dynamic,’” says Mackler. “They’re doing this on their free time, and it’s unbelievable the amount of time that they’re spending on this.”

“Thanks to the partnership, we were able to have higher studies for the training of nurses at the university level and obtaining licensed nurses,” says Elena Stempovskaia, the president of the Moldova nursing association. “Nurses can also continue their studies toward masters and doctoral degrees. All these activities contributed to the development of the nursing profession and the improvement of the quality of care provided by nurses.”

Two years ago, after reevaluating its strategies and goals, the nursing collaborative began laying the groundwork for what would become its fourth and largest global grant: a $197,400 bequest made possible in part by $150,000 in gifts to The Rotary Foundation presented by Guilford (Greensboro) club member Eugene Parker, and his wife, Margaret.

At the same time, the collaborative planned to continue the exchange of visits between the two countries that, beginning in 2014, had provided delegations of nurses and other medical professionals the opportunity to teach and learn together in person. The last exchange occurred three years ago when the North Carolina team traveled to Moldova, followed by a visit in which Moldovan doctors saw U.S. nurses at work. After that session, the doctors “were bubbling,” says Hoffart. “They began to see that having better-educated nurses with more autonomy and a broader scope of practice could help them as physicians and improve the services they were offering patients. So that was a really cool visit.”

It was also the last visit, as COVID-19 halted the in-person exchanges. The educational outreach, however, continued. In North Carolina, nursing collaborative members produced digital slide presentations and webinars that provided their Eastern European counterparts with information about dealing with the pandemic — and, when translated into Romanian (Moldova’s official language) and Russian, the slides and videos could be distributed to a wider audience than the personal exchanges had allowed.

“The webinars organized during the pandemic gave us the best lessons on how to [respond to COVID],” says Stempovskaia. “We had six webinars at the national level, in which up to 600 nurses participated each time. But since the webinars were recorded, we transmitted them to every medical institution in the country, where every nurse had the opportunity to participate.”

The webinar approach also proved effective when war broke out in Ukraine and refugees began flooding into Moldova. “We were able to turn on a dime and redirect our [efforts] to something that met the immediate need for education,” says Hoffart.

“The war in Ukraine led to a large number of complicated situations that nurses in Moldova had not encountered before,” says Stempovskaia. “Together with our colleagues from North Carolina, we picked the important topics and organized 10 webinars that were also recorded and placed on YouTube, web pages, and Facebook,” further extending their reach.

“The global grants had had a great impact, especially during the pandemic and now during the war in Ukraine,” adds Irina Rusanovschi, a member of the Rotary Club of Chișinău Centru. “The war also affects us because the Ukrainians are our neighbors, and we are trying to support them in this difficult time. We have many refugee centers, and any help is welcome.”

“We want to give sincere thanks to all our partners in North Carolina,” says Stempovskaia. “They have big and kind hearts and have done so many beautiful things for our republic, for our people, and for our nurses.”

In June, with help from the Rotary-sponsored nursing collaborative, the State University of Medicine and Pharmacy in Chișinău graduated its first class of students who earned a bachelor’s degree in nursing; the graduates dispersed to hospitals across the country to share their expertise. Meanwhile, members of the nursing collaborative are looking forward to resuming the exchanges between the two countries. At the end of a recent webinar, having concluded her 45-minute lecture, Lekan — who joined the Guilford (Greensboro) club in 2017 — smiles and addresses her virtual audience. “I wish you good health and much success in your work,” she says. “I look forward to a visit to Moldova in the future, and I hope that our paths will cross.” Undoubtedly.

This story originally appeared in the December 2022 issue of Rotary magazine.