On the surface, West Jordan and its Russian sister city, Votkinsk, have many things in common — from Votkinsk's size to the initial bond it formed because of the missile base there and the link to this Utah city.

But when it comes to medicine, there are both similarities and striking differences. Two Jordan Valley Hospital physicians and an emergency room nurse learned that during a recent "sister city health care exchange" to Votkinsk, which is 900 miles southeast of Moscow. And both communities could benefit from closer ties between the two, they say.

The trio — Dr. Barbara Dahl, an emergency room physician, Dr. Arlen K. Jarrett, an obstetrician and gynecologist, and nurse Lisa Price — were among a contingent that also included a physician from Tooele (and a tour of facilities in Tooele's sister city Kambarka), among others. They didn't go to provide care or show Votkinsk how to practice medicine, but rather to learn how they manage with fewer resources and what each city's medical teams can offer the other.

Doctors there are well-trained and very skilled, but they have extremely limited access to modern equipment and technology. They have become geniuses at fixing appliances and simple devices, but can't fake technology. And they have a hard time keeping up with worldwide medical breakthroughs because most medical literature has not been translated into Russian and the lack of computers limits instant access to the Internet. It's not uncommon for a doctor to go to an Internet cafe to do research, the Utah team notes.

As many as 95 percent of the doctors are women. It is the doctors who provide most of the care, partly because equipment is so scarce. Price was startled to see how underutilized the nursing staff is. They don't do a lot of patient monitoring.

In Votkinsk, everyone receives care because medicine is socialized. But it is stretched thin and there are limits to how much care one receives, part of it dependent on where you live. In the region, for instance, there is one cath lab. There would be two, but a motherboard blew out a couple of years ago and hasn't been replaced. A dozen ambulances share a single glucometer. There are only two or three oxygen saturation measurers in the area. Such limitations affect both longevity and quality of life, Jarrett says.

Not all of the differences favor patients in America, says Jarrett. At a time when the on-site school nurse is a rarity in Utah, each school in Votkinsk has a pediatrician responsible for the students' health.