Kazakhstan's independence and collaboration with the United States in 1991 meant an end to our children being welcome to receive correction of anorectal defects in Moscow. Our hospital is the referral hospital for most complex cases in the country. Children and adults continue to receive life saving colostomies, however using oiled cloth for containment leaves these patients socially unacceptable, and many find life with colostomies unbearably isolating. Most children are abandoned to orphanages and some have tried to commit suicide. Desperate to help these patients we accessed the internet, read scientific abstracts, and discovered new techniques for anorectal repairs, however, our first outcomes were unsuccessful. We were fortunate to visit the United States to observe surgeries and learn about repairs and products available. We went home inspired and received permission to start a colostomy clinic. Our objective is to open a colostomy clinic for adults and children. We have identified a building, and personally cleaned and painted the space in preparation for opening the clinic. After review of data, our goal is to treat 200 adults and children our first year. We have received some training in Eastern Europe, but in order to achieve practice innovation we still require quality of life (QOL) assessment tools in order to document QOL semiannually and use this information to drive continuous improvement in care and also to advocate for funding for continuation and government help in purchase of supplies. We are planning to train other staff and hope to find patient and nursing materials to have translated. We know that attendance at the WOCN conference in 2009 will help us meet these goals. Our goal of helping patients achieve their highest attainable quality of life in this new clinic will require perseverance, but the rewards and the needs are compelling.