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Wonca 2004
 Professor Pham Huy Dung of Hanoi Medical University, left, tells U.S. and foreign physicians about family medicine in his native Vietnam. Above, Hassan Hadi Baker, M.D., head of Iraq's Family Physician Society, talks with FP Kelly Murray, M.D., about international activities resources offered by the Academy. |
To become an international consultant, you need excellent communication skills, impeccable diplomatic talents and an inspiring teaching style. But there also are some particular personal qualities you'll need, said Brian Jack, M.D., associate professor and vice chair for academic affairs for the department of family medicine at Boston University.
"If you don't like the heat, don't go to Saudi Arabia," Jack advised during a Wonca 2004 workshop highlighting the AAFP's International Family Practice Development Assistance Program. And if you're put off by "mean" bathrooms, he said, international consulting may not be your calling.
Those challenges couldn't dissuade the family physicians, generalists and others who gathered to hear success stories from Jack and others involved in IFPDAP and similar programs.
Strong start in Vietnam
Professor Pham Huy Dung, vice director of the Health Strategy and Policy Institute at Hanoi Medical University, presented an overview of how an international consultation project helped catapult family medicine to the forefront of primary care in his native Vietnam. Alain Montegut, M.D., of Portland, Maine, and his colleagues consulted with Vietnamese physicians for several years to make family medicine a reality there. Although the collaboration Dung described predated IFPDAP, beginning in 1995, it served as a model for the AAFP program.
Traditionally, Vietnamese medicine -- like that in many foreign countries -- has centered on care provided by subspecialists, Dung explained. Patients would visit one of the country's large hospitals for all types of care; there was no history of community-based primary care.
That's all changed in just eight years, Dung said. A series of "commune health stations" now stretches across Vietnam, with each station staffed by physicians specifically trained in family medicine and providing full-spectrum care modeled on that offered by FPs in the United States.
And, Dung noted, the Vietnamese Ministry of Health has recognized family medicine as a new form of medical training -- Level 1 Specialization in Family Medicine. Most recently, he said, the ministry has called on all Vietnamese universities providing medical education to include family medicine curriculum.
Of course, sustainability is key to this development process. A Physicians With Heart airlift to Vietnam in 2001 proved invaluable in maintaining a high level of interest -- and visibility -- for family medicine, said Daniel Ostergaard, M.D., AAFP vice president for international and interprofessional activities. The visit, which included delivery of donated medical supplies, drugs and educational support, helped lend "credibility and prestige" to Vietnam's family medicine training program, he said.
"It was a heavy-duty assist," Ostergaard said. "We had the U.S. ambassador with us for three days -- that's big."
Response to Iraqi request
The IFPDAP session held hope for FPs trying to nurture family medicine against heavy odds. Hassan Hadi Baker, M.D., head of Iraq's Family Physician Society, told Ostergaard after the session, "I came to this Wonca meeting to ask for help from the AAFP -- to see if we can start some sort of collaboration between our two societies."
Iraq has had a fledgling family medicine training program for 10 years and has about 50 physicians in the Iraq Family Physician Society. But the curriculum falls short on family and community aspects of care, Hassan admitted. Obtaining resources from abroad has been difficult, he said: "Until this spring, for about 35 years, no one entered my country or went out" without government approval. "Our doctors have been isolated. We'd like some to get training abroad, and when they return, they can teach in Baghdad University," Hassan said. The society wants to revise the curriculum and set up a board recertification process, he added.
FP Kelly Murray, M.D., now of Fort Polk, La., a member of the Uniformed Services AFP, served in Iraq for 15 months recently and joined the Iraq Family Physician Society. She urged Hassan to attend Wonca 2004 and seek resources.
"We probably gave him more materials than he could carry back to Iraq," said Ostergaard.
Among Hassan's new tools are the Society of Teachers of Family Medicine medical school curriculum information, AAFP materials and Residency Assistance Program criteria for residencies, six years of AAFP Home Study CME offerings on a CD-ROM, and the audiocassette series from AAFP's Family Practice Board Review course. And more help is in the offing.
"We can't send our IFPDAP consultants into danger, but we're going to explore a meeting with some of the family medicine faculty, perhaps in a safe area in northern Iraq or in a nearby country," said Ostergaard.
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
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Copyright © 2004 by American Academy of Family Physicians.