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Global growth springs from humble roots, hard work

Academy members' in-terest in international general practice and family medicine has been slow to grow, but it has developed mo-mentum recently with amazing results.

Some early stirrings:

• The 1957 report from the first AAGP Special Committee on the International Academy of General Practice states that "due to limitations imposed by distance, language differences, and lack of funds, our efforts would be limited initially to that of correspondence." This committee recommended establishing an International Academy of General Practice. The committee disbanded in 1961.
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• Warren Heffron, MD, professor of family medicine at the University of New Mexico in Albuquerque, says he remembers sitting exhausted in a clinic in the jungle of central Puerto Rico in the early 1960s and thinking about family medicine.
  
  "I had spent 24 hours delivering about 10 babies," he says. "And I was thinking, `Here I am, a foreigner in the jungle delivering babies, while the local medical students are going to America and learning specialties that won't let them practice in the jungle. This country needs doctors who can deliver babies in the jungle.'"
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• The AAGP's Committee on International Affairs was originally charged in 1962 with "maintaining the Academy's relationships with foreign governments, foreign medical associations, or general practitioners in other countries." After reporting for several years about individual FP visits to medical practices and health conferences around the world, the committee was dissolved in 1971.
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• Former AAGP President Ed Kowalewski, MD, of Arnold, MD, served as the first American president of WONCA, the World Organization of National Colleges and Academies, from 1978 to 1980. Former AAFPPresident Robert W. Higgins, MD, of Anacortes, WA, will become WONCA's president in 1998. WONCA is now known as the World Organization of Family Doctors.
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• In 1990, FPs in Maine took a peek behind the shredded Iron Curtain into the world of Soviet medicine.
  
  "We were given a chance to educate physicians there about family practice here," says Alain Montegut, MD, director of international family medicine education at the Maine Medical Center in Portland. "What we didn't know was how to begin."
  
  Dr. Montegut called Daniel J. Ostergaard, MD, AAFP vice president for education and scientific affairs, and asked how the AAFP could help. "He told me the international family medicine information was in a cardboard box in his office," says Dr. Montegut.

Growing influence

Since 1989, AAFP's international influence has expanded beyond the cardboard box. Family medicine has become a specialty in Russia. A residency director at the University of Cincinnati takes groups of residents to Central America to assist in rural clinics. Groups of family physicians have discussed medical skills with physicians in China. The Physicians with Heart project--a cooperative effort of the Academy, the AAFP Foundation, and Heart to Heart International--has helped to deliver 130 tons of aid worth about $27 million to former Soviet republics and has given the AAFP a chance to encourage family practice in these areas. In addition, FPs around the world can tap into the AAFP Web site and get instant information.

"I'd guess that 50 years ago and even 10 years ago, there wasn't much international activity," says Dr. Ostergaard. "In the beginning, the AAFP focused on fostering the growth of family medicine in this country. But as we became stronger, we began to come out of our cocoon a little bit and recognize that we have a larger responsibility."

That responsibility means stressing the importance of family medicine globally and assisting countries in educating FPs.

"In 1986, we began to realize we had infiltrated American medicine and if what we had accomplished was relevant here, then our ideas and successes would be relevant to the rest of the world," says Dr. Heffron, former AAFPvice president and board member.

There has been an increasing interest from membership in the last 10 years about international activities, says Dr. Ostergaard.

"First, from an academic perspective, our faculty members are more interested than ever in establishing our specialty abroad," he says.

FPs wanting to make a lasting contribution are finding their chance in international missions--clinical or educational, Dr. Ostergaard says. "Several groups of family physicians set up their practices so one person can be gone doing this type of work."

As technology links people throughout the world closer together, FPs are curious about medical practices in other countries. "There's an itch out there that people want to scratch by doing international work," says Dr. Ostergaard. "Even if they're not girded with missionary zeal, they're intrigued by what's going on in the rest of the world."

Success stories

In 1995, WONCA and the World Health Organization developed Making Medical Practice and Education More Relevant to People's Needs The Contribution of the Family Doctor. The document reflects the goals established by the 1978 Alma Ata (Kazakstan) Conference which called for health care for all by the year 2000.

"This historic document recommends ways to improve public health through training and funding primary care physicians, including FPs," says Dr. Ostergaard. "Several Academy members were part of the development of this document. And for the first time the World Health Organization really embraced family practice as an important element in the declaration of health for all by 2000."

This document summarizes the growth of family practice around the world. For example:

• In 1973, Australia scattered 250 family practice trainees across its more than 2.9 million square miles. By 1994, the number of trainees had risen tenfold to 2,500, constituting one of the largest vocational training programs for family medicine in the world.
• In Latin America, the number of three-year residency programs grew from 21 in 1981 to 200 programs by 1991.
• In Estonia, family medicine has been recognized as a specialty since 1993.

And Dr. Montegut, for one, continues his pioneering role in establishing family practice around the world. He is planning a trip to Vietnam to do a needs assessment of its current health care programs.

"We've come a long way in the development of family medicine around the world in just a few short years. We've seen a lot of successful programs," says Dr. Montegut. "But there are still places left to go."

• FP Report is published by the AAFP News Department.