FP Report -- November 1999
Mosques, minarets and family medicine
FPs travel halfway around world to sow seeds of family practice
Modeling family practice: Don Ellsworth, M.D., an AAFP member living in Uzbekistan, examines Timur Solier, who is hard of hearing. The boy's family prearranged the check-up with the Physicians With Heart group, including Ellsworth. Uzbekistan is considering training FPs.TASHKENT, Uzbekistan -- A developing nation, renewing itself after years of Soviet rule: Why not try family practice there?
That's what AAFP Board Chair Lanny Copeland, M.D., of Albany, Ga., and other FPs asked in Uzbekistan Sept. 27-Oct. 3.
The former Soviet republic became independent in 1991. It adopted a new flag, printed Uzbek money, threw out history books lauding Vladimir Lenin and Josef Stalin, and rediscovered its Uzbek heroes and poets. Beautification is in; the KGB is out.
Family physicians preached family practice in this land of mosques and minarets during the seventh annual Physicians With Heart airlift.
Uzbekistan received $5.2 million worth of medicine and medical supplies in the airlift, cosponsored by the Academy, the AAFP Foundation and the humanitarian aid organization Heart to Heart International. Two preliminary shipments were worth $2.9 million in U.S. wholesale dollars, for a total value of $8.1 million.
Uzbek officials are restructuring the country's health care system, trying to orient it to generalists instead of subspecialists and to retrain the generalists. The process requires massive change.
"GPs serve as traffic cops at the polyclinics (multispecialty clinics)," said AAFP member Don Ellsworth, M.D., who has worked in Andijon, Uzbekistan, for five years. "If you've got a sore throat, the GP tells you to see the ENT specialist. If you've got chest pain, you see the cardiologist." Even the GPs at rural clinics send pregnant women to hospitals for deliveries by OB-Gyns.
Next airlift goes to Azerbaijan
Next year's Physicians With Heart airlift will benefit the former Soviet republic of Azerbaijan, on the Caspian Sea between Russia and Iran.
Family physicians interested in introducing Azerbaijan to family practice and monitoring the delivery of airlifted products should contact Maya Singh of Heart to Heart International at msingh@hearttoheart.org or (405) 787-5200.
This year, financial contributions for Uzbekistan from pharmaceutical companies and AAFP members totaled about $10,000. The donations covered the cost of antibiotics and hepatitis A vaccine, selected because hepatitis A is widespread in Uzbekistan, said AAFP Foundation President Gerald Keller, M.D., of Mandeville, La.
If you'd like to contribute to the AAFP Foundation International Fund and help support the Azerbaijan airlift, call (800) 274-2237, Ext. 4452.
Copeland was visiting an Uzbek rural clinic when he spied an exam table with stirrups. Moving to the foot of the table, he asked the staff, "Why couldn't you deliver babies here? You could!" They disagreed, but Copeland, who delivered about 1,500 babies when he worked in rural Moultrie, Ga., had made his point.
Even though health professionals' education and most health care is free in Uzbekistan, doctors' wages reflect the typical Third World devaluation of the profession of medicine. GPs' salaries may be $15 a month, anesthesiologists' salaries may be $20 a month, and restaurant owners and street cleaners may earn more.
During seminars in five Uzbek regions receiving the donated products, family physicians in the airlift delegation led sessions on how to use the medicine and why family practice would fit Uzbeks' needs. Accustomed to pediatricians and internists, audiences learned about doctors who can care for people "from cradle to grave" or, as one translator said, "from crystallization to cremation."
More than 400 medical students, educators, administrators and health providers attended the symposium in Tashkent, Uzbekistan's capital. Audience members asked whether the FPs were content with what they made.
"I'm happy with what I earn," said Copeland. "But I do get frustrated that some subspecialists, such as gastroenterologists, cardiologists and cardiothoracic surgeons, make two to three times as much as I do." The audience applauded. Copeland had struck a chord common to U.S. and Uzbek generalists.
These health professionals and educators in Uzbekistan are among 900 who heard about a concept new to them -- family practice -- in seminars by Physicians With Heart delegation members. The health professionals also received advice about using medicines airlifted to their areas.When a teacher said her students wouldn't have the resources to set up a family practice office, Copeland replied, "It wouldn't take a lot of money. You can be a family physician with your brain and your heart and your stethoscope."
Ellsworth discussed clinical decision-making at the seminar. "In America, decisions we make on how to treat a patient are determined more by our knowledge and what we read in the latest clinical journals, not mandated by the government," he said. "There are advantages both ways. If the decisions are mandated by the health ministry, you have uniformity. In America, it's easier to implement the latest clinical practices because you don't have to wait for legislative changes."
Ellsworth also conveyed the joy of offering primary care. "The longer you stay in an area and practice medicine, the more your day is filled by people who are your friends," he said. "So getting up and going to work in the morning is always exciting, because you're sharing your life with your friends."
FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.
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