Welcome to Russian Culture “Добро пожаловать в русской культуры”

Culture: How do we define the term?

We can use the traditional definition that culture is shared knowledge, beliefs, values, language, attitudes, and experiences among a population group, as well as learned and shared patterns of communication and information that have meaning for a group.  From those terms, any society from the Amish to the gangs of various cities has its own unique culture.  Russian culture has been shaped and molded over time with their beliefs, practices, and rituals that date back for centuries.

Russian is the predominant language spoken, but there are many dialects which include the most popular Tartar, Ukrainian, Chuvash, Bashir, Mordvin, and Chechen. (kwintessential.)

Certain customs have been passed down through the years and still remain in Russian culture today such as naming of individuals.  All Russians that cling to the traditional naming conventions have a first, middle and surname.  The middle name is where they differ from other cultures.  The middle (patronymic) name is the father’s first name with the suffix –vich or –ovich for males and –avna or –ovna for females.

Russians also share some of the same icons that the United States have been privileged to have for many years.  As seen here, they do have Coca-Cola ™ in Russia.  They also share some of the same food choices we do with the invasion of fast food in Moscow.

Opening day McDonalds, Russia

January 31, 1990 McDonalds opened its doors in Pushkin Square.  To this day this is the single busiest McDonalds in the entire restaurant chain.

Russian Art and Architecture

Russian art and architecture are very unique facets contributing to culture.  Some of the buildings seen in Russia have been duplicated in other parts of the world and have the distinction of worldwide recognition such as the Kremlin in Moscow (at the top) and the many different styles of churches of St. Petersburg.  Numerous paintings from Russia seem to focus on the troubles and the strife that define life there.

 

Traditions

One of the most popular traditions in Russia is drinking.  There can be a justifiable reason to drink, day or night.  New job? Drinking time! Moving day? Drinking time! Took a test (Med/Surg test)? Drinking time! All, of course, are in the proper time and place, but it’s a celebration of sorts.  New Year’s is the best time of all to drink.  The celebrating begins the day before and continues until the day after.  A person can go from one party, to the next, to the next all in the name of the holiday.

 The most important tradition in Russia is that men always pay for women when they go to out.  (Russian Travel).
 

Sense of Self/Space

Russian people have a much closer interpersonal space than that of Americans. While having a conversation a Russian person would be close enough to, at any point, wrap their arms around you.  When on public transportation or waiting in line it is common for a Russian to be very close, if not touching you. When using an elevator, they will squeeze as tight as they can often touching shoulder to shoulder.

 

 

Communication/ Language

It is important to pay close attention when speaking with a Russian. This is because the Russian style of nonverbal communication may be more difficult to comprehend than that of Americans.  Americans tend to think that if someone is leaning forward and seems agitated, then the person is aggressive; while on the other hand, Russians are just very adamant about their point.  If a person came across two Russians speaking to each other in their own language, their body language might show two people arguing; but in reality the two might be having a good discussion on something they agree upon.  A laugh in the middle can quickly change the foreigner’s perspective on the matter.

The “OK” sign is considered to be a positive gesture to some but to others is obscene and therefore should be avoided (Department of the Navy).

Food/Feeding Habits

In rural Russia, most people grow their own vegetables – primarily carrots, beets and potatoes as well as some berries. Many city-dwellers have small houses, called dachas, in the country in order to grow their own vegetables. Produce is also sold at open-air markets and small street side stands in both the city and the country, particularly during the summer months.

It is customary to bring a small gift if invited to a Russian home for a meal.  Flowers are the typical gift, are expected from males, and should not be yellow (Kwintessential), or in even numbers.

Russian women spend a lot of time in the kitchen making food from scratch. Microwave meals simply aren’t as readily available in Russia.
Soup is often an essential part of both lunch and dinner for Russians. They stress the importance of eating warm things; this can prevent the stomach problems caused by “dry foods” such as sandwiches and pizza. Many Russians also drink tea with each meal – from breakfast to dinner. Russians sometimes drink “mineral water” (carbonated water), but it is usually at room temperature and rarely with ice. Russians fear that cold beverages can contribute to illness.
Traditional Russian foods include blini (thin pancakes, like crepes), borsch (beet and cabbage soup), venigret (cold salads consisting of cooked veggies and mayo in many varieties), shashlik (all meat shish kabobs—mainly lamb, chicken or pork), pelmini (meat filled pasta comparable to tortellini).
Russians have a special affinity for dairy products. There is a much wider variety of dairy products in Russia, including kefir (sour milk) and smetana (sour cream). Mayonnaise is used in almost every salad. Russians think that dairy products are a crucial part of good nutrition.

 

Time Consciousness

Russian’s have an altered sense of time compared to American’s views except where meals are concerned, which are at specific times.  They rarely consider themselves late and even though there may be business at hand, traditionally they engage in casual conversation prior to completing necessary tasks.

Relationships/Social Organization

Russian family life is based on dependence.  Families live in apartments where there are three generations in a 700 square foot living space.  Family members take care of one another sharing expenses.  A parent cares for a child and then the roles switch.  Grandparents take care of grandkids during the day while mothers are away at work.  The limited amount of space makes for tolerance and patience.  Though couples get married young (between ages 18-22), infidelity and divorce rates are high, leaving the mothers and grandmothers to do most of the rearing of the children.  Russian people place emphasis on the elderly as wiser and more knowledgeable.  They do not eat until the oldest, “most honored” member of the family begins.

Work Habits

The mother or grandmother is the primary breadwinner due to divorce and single parent homes.  A Russian female typically wakes up anywhere between 6 and 8 am and prepares the morning meal before heading off to work, usually at a factory or small shop. Most workplaces are 60-90 minutes away by public transportation.  The usual work day is 8 hours, though working for a private company could mean longer hours.  A 30-60 minute lunch break is given.

After work, ending from 5-7 pm, there is the public transport home.  Normally this is the time to stop by a small market shop and get the groceries for the day.  Dinner takes longer because readymade meals are not available like they are in America.

“Russians respect age, rank and position” (Kwintessential).

Religion

The picture is the Church of the Spilled Blood – a well-known Russian Orthodox Cathedral in St. Petersburg, Russia. The brightly colored onion-shaped domes depicted here are uniquely Russian – and Russian Orthodox.
In Russia, more than 60 percent of the population is Russian Orthodox, but there is a good portion of Muslims. However, during communist rule, the activities of many religious communities were severely restricted while other communities were completely destroyed. Most Russians consider themselves as Christian and belong to the Orthodox faith, but many are not ‘true believers.’ For example, they appreciate having the freedom to choose religion and appreciate the moral values of religion, but do not follow those values.  Many, however, were happy to have religion back in their lives after the fall of communism allowing them to practice openly again.

Percentage of state residents speaking Russian at home [Map]. (2003). Washington D.C.: U.S. English Foundation.

Demographics

As of the 2000 U.S. Census 2.7 million Russians live in the United States.  Although foreign-born Russians only make up 1% of the population in the United States, this percentage is rapidly growing.  Washington State, in particular, has one of the largest populations of Russians with 63,136 people living in communities throughout the state.  Large Russian communities in the U.S. include Brighton Beach, New York; Staten Island, New York; Los Angeles, California; Miami, Florida; Boston, Massachusetts; Philadelphia, Pennsylvania; Portland, Oregon; and Seattle, Washington.

Of the 322 languages spoken in the United States Russian is the 10th most common household language.  Interestingly enough Russian is the 8th most common language in Washington State.  As seen in the map above Washington State is one of the top five states where Russian is spoken within the household.  Of those individuals that speak Russian within the home 82.1% speak English as well.

The Russian population in the United States has a strong belief in education.  Over 94% of the Russian population has at least a high school degree, which is significantly greater than the national average of 80%.  Another interesting statistic revealing the emphasis of education within this community is that 55% of Russian-Americans have received a bachelor’s degree while the national statistic is only 25%.

Is there a perceived discrimination problem?

Many Russian immigrants have experienced at least one life-changing event that has the potential to leave a long-term, negative effect on one’s personality and outlook on life. A majority of the elderly observed the social chaos caused by the fall of the Soviet Union. Many immigrants to America experience the feeling of “loss of country, work and status.” They then constantly have to adjust their lives to fit in with the American culture and way of life. They feel isolated and alone, being in a country that they aren’t accustomed to and having to leave their friends and family in their homeland. These numerous changes result in depression among many Russian immigrants. However, most Russians don’t express their depression or the sadness and poor mental state they are experiencing due to their perceived fear that they will be discriminated against by the American healthcare system as well as American society. In Russia, people diagnosed with a mental illness suffer severe social consequences, such as first being classified as insane, then being put into a psychiatric hospital, and lastly being punished with psychiatric drugs. Consequently, this lasting fear of discrimination prevents them from making known their depression or even providing information to health care providers regarding any family or a personal history of psychiatric illness or treatments. Along these same lines, the number of Russians with HIV or AIDS may be almost three times the number officially reported. The Russians have many stereotypes and misconceptions concerning the virus, causing it to be a topic that’s tabooed, creating a major potential for discrimination to occur against those with the disease or causing HIV/AIDS positive Russians to perceive that same risk of being discriminated against by Americans. As a result, many of these Russians either ignore their illness or are unwilling to find essential treatment (Shpilko, 2006).

Discrimination against certain groups of Russians also has the possibility to exist due to the perception of some health care workers that older Russian immigrants use health services too much and in a disproportionate amount compared to their objective health needs. However, health care workers need to bear in mind that studies have found that many older Russian immigrants are in notably poorer health as a result of living in the former Soviet Union with its shortages and environmental hazards and are, therefore, in need of health services. Some perceive their frequent utilization of health services as an act of not wanting to take responsibility for their own health. Healthcare workers may draw this conclusion based on the fact that many older Russians were once part of a “paternalistic” and “authoritarian” healthcare system that caused people to become very dependent on professional care whenever they weren’t feeling well. However, studies among older Russian immigrants don’t support this idea, but rather Russians recognize themselves as being the ones responsible for their own health and for seeking out professional care when they feel in poor health (Aroian & Vander, 2007).

The United States and Russia have had a long story of an adversarial relationship.  Currently, there is a cautious cooperative effort in international relations between the two countries.  There are basic differences in the two cultures.  Russia has a long history of single rule with a centralized government where information and power flows downward.  Change is imposed on the society from above. The United States is relatively new on the world scene with an opposite view point, one where power flows upward and is diffused from the people. Change is an upward movement initiated by the individual.  Although the new Russian Federation has adopted a democratic form of government, the issue of rights continues to be subordinated for communal good where the rights in America are proposed to be celebrated and protected.  The Russian Federation is also attempting to move to a private free market as in the United States as opposed to the government centered economy.  Since the dissolution of the USSR, 30 billionaires are enjoying luxurious lifestyles in Russia.  The concept of private ownership for just about anything was foreign to Soviets as the land, buildings, businesses were all government owned.  Private ownership is central to the values of Americans.  These beliefs lead to a profound difference in the way social problems are dealt with and the perception of these issues.  Russians view the economic difficulties and social problems of poverty, homelessness and hunger as a government centered issue to be solved by the government.  Americans, on the other hand, evolving from our puritan beginnings see poverty, hunger and homelessness as a moral flaw that the individual has control over.  In reality, there is little difference in the manner in which both populations exist in 2010.  The difference lies in the action and the solutions to these problems by each country.

The Russians face a perfect storm with issues effecting their population on three fronts, a declining life expectancy, a declining birth rate and an increasing disease rate.  For more on declining population rates, please visit

The Russian response to the drug addiction and alcoholism issues are very different from the response in America.  Russians see alcoholism as a social issue and are attempting to decrease alcoholism through media campaigns and requiring an increase in the cost of Vodka.  Currently, it is reported that the average consumption of Vodka is 18 liters per person in Russia, the equivalent of 60 bottles per year per person.  This contributes to the declining health status which contributes to the low birth rates and incidence of infants born with congenital disorders.  It also contributes to the decline in life expectancy.  The high increase of alcoholism has contributed to the abuse and neglect of many of Russia’s children.   For more on the health problem of alcoholism in today’s Russia, please visit


There is an ever increasing number of homeless and street children in Russia.  These children also engage in alcohol use and huffing, since a bottle of water costs more than a bottle of alcohol in Russia.  Drug addiction and in particular heroin addiction have contributed to the HIV/AIDS crisis in Russia. One reported reason for this was the refusal to acknowledge HIV/AIDS as anything but an “African sexually transmitted disease.”  IV drug use is considered a criminal offense not an illness and treatments like methadone are outlawed.  There are treatment facilities for alcohol but not so for drugs.  The Russian states bordering Afghanistan have the highest incidence of heroin addiction and HIV due to the availability of heroin along with the decline of industry and unemployment rates for youth.  In one interview, a Russian youth described his class of 25 stating that 5 are now drug addicts and 10 are alcoholics.  That is 60%, a fair assessment for Russia in general.  Recently, monies were promised by the Russian government to address the growing problem of HIV infected citizens.  For more information on HIV/AIDS in Russia, please visit:

There also has been an increase in the number of cases of Tuberculosis (TB) that has coincided with the rate of growth of HIV/AIDS.  This is partly due to the fact that the two diseases are often spread together because individuals infected with HIV are more prone to catching TB (Shpilko, 2006). “In 2007 HIV co-infection among new TB cases was 16.3 %” (USAID, 2009).  Russia ranks 11th on the list of 22 high-burden tuberculosis (TB) countries in the world (USAID, 2009). More than 25,000 people dying of TB each year (Netesov, Sergey, & Conrad, 2001).  There is a low treatment success rate which is thought to be due to death, especially when co-infected with HIV, medication noncompliance, and treatment failure due to drug resistant strains of TB.  “Globally, Russia had the third largest number of multidrug-resistant TB cases in 2007, with close to 43,000” as well as “approximately 6% of these cases being considered extensively drug-resistant TB” (USAID, 2009).

Table on TB statistics    (USAID. 2009).

A common belief by Russians reported in all literature was that cold weather is responsible for most ailments including the common cold.  A common health practice for colds and flu is the use of “banki” or heated cups placed on the back and shoulders.  These may leave marks which can be mistaken by health care providers as evidence of abuse.  Since the belief that the cold temperature causes colds and flu rather than viruses, most homes are kept very warm and children bundled up They will not  drink cold drinks and ice is never used.  In the event of a sprain, many Russians are reluctant to “ice” the area but will comply with heat to an effected area.  There is of scientific evidence to support this belief in that hypothermia suppresses the normal immune system.  Other common remedies include Vodka and sugar for a cold, soaking feet in hot water for sore throats and the use of many alternative medicines.  These types of alternative medicine regimes are routine prescriptions by doctors in Russia to be compatible with other western medicine prescriptions.  Russians are also reluctant to participate in numerous requests for x-rays with the belief that these will cause sickness.

Women’s health care is quite different in that most women receive their exams in a room with another woman and give birth in a room with up to 8 other women.  Family and visitors are not allowed and women are asked to disrobe and discuss intimate details of medical care in the presence of strangers and other patients.  Length of stay is usually one week after giving birth, two if the birth was C-section.

Mental illness is regarded as a shameful thing and mentally ill family members are hidden from the community.  It is shameful to place parents in extended or assisted living as it is the families’ responsibility to care for the aged.  Many Russians who have immigrated to the United States will use over the counter medications and do not seek medical care unless absolutely necessary.

Cultural Taboos/Things to note

It is rude to give a baby gift for a child before it is born and is considered to be bad luck.

When caring for a deceased patient do not close the patient’s eyes or mouth.  Only the family may do so; if done by someone outside of the family it is considered a bad omen. Just for awareness the family may also wish to place coins on the eyelids and a may place a roll of cloth under the deceased’s chin (Milshteyn & Petrov, 2004).

When speaking to older people it is considered to be ill mannered if you stand with your hands in your pockets or with your arms folded across the chest.

When sitting, care needs to be taken so as not to sit with legs spread apart, with one ankle resting on the knee, or in a position that allows the Russian person to see the soles of the shoes, as this is considered grave disrespect (Lopez, 2009).

When giving flowers as a gift they must be in odd numbers.  A gift of flowers given in even numbers is bad luck and is reserved for funerals (Lopez, 2009).  If given outside of a funeral it is seen as inviting death.  This is important for a nurse to know because flowers are often given to people in the hospital and if an even number of flowers is spotted by the nurse then he/she can intervene and remove one before the patient sees them.

Too much smiling is seen as suspicious.  Russians reserve smiles for good friends or for things they find to be funny, not for strangers.

Top 5 things a nurse or health care provider would need to know

Cancer, hypertension, cardiovascular diseases, diabetes, arthritis, and gastrointestinal diseases have been reported as the prevailing health concerns for adult Russian immigrants.  Russian immigrants often do not practice preventative healthcare. There are a number of reasons for this.  For Russian people the meaning of health is simply the absence of disease (Benisovich & King, 2003) and therefore they do not visit the doctor unless ill, thus often not becoming aware of a problem until it is advanced.

Alcohol and tobacco consumption

Many Russians smoke cigarettes and drink excessive quantities of alcohol.  Russians drink more hard liquor, like vodka and cognac [than do Americans] and tradition dictates that once a bottle of vodka is opened, it must be consumed (Department of the Navy). Drinking becomes the “measure of a person.” To drink heavily, while maintaining clarity of thought and person, is highly valued” (Department of the Navy).  While alcoholism is a major concern in Russia, it is not as big of an issue with Russian immigrants as many Americans believe it to be.  “Russian immigrants generally do not suffer from this syndrome with the major reason being that immigrants hope to survive and thrive in the US, and alcoholism takes away both hope and vitality” (Shpilko, 2006).  However, as nurses we need to be aware that these patients may not be alcoholics themselves, but will likely have family members either here or in the homeland that do, and therefore may have psychological issues and worries related to alcoholism that need to be dealt with.

Diet

In the former Soviet Union there was little availability to fresh vegetables and fruit, diets consisted mostly of fried and fatty foods, and exercise was not recommended as a preventative measure.  The accessibility of cholesterol and blood pressure testing was inadequate and lifestyle changes as a deterrent to future health problems was not a known intervention and therefore not encouraged by physicians (Benisovich & King, 2003).

Complementary Alternative Medicine (CAM)

Russians tend to rely on traditional and alternative forms of treatment.  “Homeopathies and natural remedies are important in the Russian culture” (Cichocki, 2008) and as a nurse it is important to be aware of this in order to implement interventions that are more easily complied with and to prevent possible adverse drug reactions.

Depression

As previously discussed individuals suffering from depression and mental illness were discriminated against in the homeland, and persecuted unfairly.  For this reason many immigrants will not seek treatment, or even admit to a problem.  As nurses we need to be informing our patients of preventative lifestyle changes and signs and symptoms of depression/mental illness.  In addition we need to teach measures that can be easily complied with and provide the knowledge and comfort necessary to feel confident in the care that is provided to them.

Family inclusion

“Family members should be included in the decision about the time and the way that ‘telling of the truth’ about the illness will take place” (Milshteyn & Petrov, 2004). The problems of the patient are considered “family problems and are discussed by the entire family” (Milshteyn & Petrov, 2004). It is customary for the family of a terminally ill patient to conceal the fact of the terminal illness or at minimum to deliver only the partial truth while still in the doctor’s office or in the hospital.  The delivery of news is given to the family by the physician only and then the family will pass along the bad news to the patient later. (Cichocki, 2008).  This allows the patient to be surrounded by close family and friends who can provide the necessary support to cope with the news of the terminal illness (Milshteyn & Petrov, 2004).  However the diagnosis of cancer is not ever divulged outright to the patient (Shpilko, 2006). This is not done to be untruthful or deceitful but is done because the “family feels that it is their obligation to take on the burden of truth” (Shpilko, 2006).

Morphine

Administration of morphine may be misinterpreted as a sign of a hopeless situation and abandonment (Milshteyn & Petrov, 2004).  Thoughtful consideration of this practice needs to be carried out.

Autopsy and Organ Donation

Autopsy is only accepted if the doctor orders it and organ donation, withholding or withdrawing treatment and signing of durable power of attorney are typically not agreed to (Milshteyn & Petrov, 2004).

The Russian term “Nyekulturno” refers to an action that is considered to be uncultured, in bad taste, or simply the wrong way to do something (Department of the Navy).

The word “drug” (droog) refers to a good friend, someone who is a like a best friend would be a drug (Department of the Navy).  If spoken this would probably not cause too much of a problem, but if it were written could be easily mistaken.

It is considered necessary to accompany a woman in the ladies’ room, and then wait for her at this place.

Russians drink only hot tea and typically make it in the morning and at night only (Russian Travel).

References

Alekseeva, E.G. & Alekseeva, D.V. (2004).  Safer sex campaigns in Russia 1998-2003: Broken taboo and      increased condom use. International Conference on AIDS. Retrieved from http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102282734.html

Aroian, K. & Vander Wal, J. (2007). Health service use in Russian immigrant and nonimmigrant older persons. Family and Community Health, 30(3). 213-223. Retrieved from CINAHL.

Benisovich, S.V. & King, A.C. (2003). Meaning and knowledge of health among older adult immigrants from Russia: a phenomenological study. Health Education Research. 18(2), 135-144. Retrieved from http://her.oxfordjournals.org/cgi/content/full/18/2/135

Cichocki, M. (June 2008). Culturally Sensitive HIV Care; Be Aware of Cultural Differences. Retrieved from http://aids.about.com/cs/doctors/a/culture.htm

Department of the U.S. Navy. Gestures and Taboos. Retrieved from http://www.globalsecurity.org/military/library/report/1999/russia/m1gestur.pdf

Kwintessintial. (2010). Russia – Language, Culture, Customs and Etiquette. Retrieved from http://www.kwintessential.co.uk/resources/global-etiquette/russia-country-profile.html

Lopez, E. (2009). Russian Etiquette: 12 etiquette tips for people visiting Russia.
Retrieved from http://russia-travel.suite101.com/article.cfm/russian_etiquette#ixzz0iow27k74

Milshteyn, Y. & Petrov, O. (2004). Culture Clues: End-of-Life Care: The Russian Culture. Retrieved from http://depts.washington.edu/pfes/PDFs/End%20of%20Life%20Care-Russian.pdf

Netesov, Sergey, V. & Conrad. J.L. (2001). International Update: Emerging Infectious Diseases in Russia, 1990-1999. CDC State Research Center of Virology and Biotechnology Vector, Koltsovo, Novosibirsk Region, Russian Federation. USA 7(1). Retrieved from http://www.cdc.gov/ncidod/eid/vol7no1/netesov.htm

Niedowski, E. (2006). Russia Resists Needle Swap: Officially, Exchanges “Taboo” in Nation With High HIV Rate. U.S. Centers for Disease Control and Prevention: HIV/Hepatitis/STD/TB Prevention News Update. Retrieved from http://www.thebody.com/content/news/art23817.html

Pronina, L. (1999). Taboos broken as center offers teen sex advice. The Russia Journal. 40. Retrieved from http://www.russiajournal.com/node/2177

Shpilko, I. (2006).  Bridging the communication gap between physicians and patients. Patient Education and Counseling, 64(1), 331-341. doi:10.1016/j.pec.2006.03.014

USAID. (2009). Infectious diseases. Retrieved from http://www.usaid.gov/ourwork/globalhealth/id/tuberculosis/countries/eande/russiaprofile.html

U.S. Census Bureau. (2000). United States: Census 2000 demographic profile highlights:
Russian
. Retrieved from http://factfinder.census.gov/servlet/SAFFIteratedFacts?_event=&geo_id=01000US&_geoContext=01000US%7C04000US53&_street=&_county=&_cityTown=&_state=04000US53&_zip=&_lang=en&_sse=on&ActiveGeoDiv=&_useEV=&pctxt=fph&pgsl=040&_submenuId=factsheet_2&ds_name=DEC_2000_SAFF&_ci_nbr=554&qr_name=DEC_2000_SAFF_A1040&reg=DEC_2000_SAFF_A1040%3A554&_keyword=&_industry=

U.S. Census Bureau. (2000). Washington: Census 2000 demographic profile highlights:
Russian
. Retrieved from http://factfinder.census.gov/servlet/SAFFIteratedFacts?_event=&geo_id=04000US53&_geoContext=01000US%7C04000US53&street=&county=&cityTown=&state=04000US53&zip=&lang=en&sse=on&ActiveGeoDiv=&useEV=&pctxt=fph&pgsl=040&submenuId=factsheet2&dsname=DEC2000SAFF&cinbr=554&qrname=DEC2000SAFFA1040&reg=DEC2000SAFFA1040%3A554&_keyword=&_industry=

U.S. English Foundation, Inc. (2010). Language data sheet: Russian. Retrieved from http://www.usefoundation.org/userdata/file/Research/Languages/russian.pdf

U.S. English Foundation, Inc. (2010). Languages of the U.S.A. Retrieved from

http://www.usefoundation.org/userdata/file/Research/languages_of_the_usa.pdf

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