October 9 - 12, 2000
The Physicians With Heart delegates split into three groups: those headed for Nakhchivan, those going to Ganja, and those staying in Baku and taking day trips to Sumgayit.
Baku and Sumgayit
One group of Physicians With Heart delegates visited Baku refugee camps and orphanages there and took a day trip to Sumgayit, a city north of Baku on the Caspian Sea.
"In all my involvement with international work, I've never had exposure to refugees," said Daniel Ostergaard, M.D., AAFP vice president for international and interprofessional activities. "At the camps, we had the opportunity to see the conditions of the refugees. Of course, they all want their land back, and that's probably not going to happen, but we were able to have a glimpse of how we might help."
Physicians With Heart medicine and supplies will be distributed at the camps by the humanitarian groups Medical International Relief and United Methodist Committee on Relief.
Some refugees live in a camp of delapidated unfinished buildings. "There are still cranes atop the buildings," said delegate Ruth Ostergaard of Olathe, Kan. "When we arrived at the camp, about 50 children swarmed around us; I felt like the Pied Piper." Some families live in a dingy basement at the end of a long tunnel bringing both visitors and rain.
At another camp, refugees live in seven-story dormitories designed for college students. Each family has a room, but each floor of 20-30 rooms has only one bathroom and one sink, the families' only source of water.
A refugee physician and his wife, a midwife, live in a dorm and do their best to provide care but have no instruments. The midwife delivered a premature baby there, and the delegates visited with the mother and one-week-old child. "The baby, now about 3 pounds, may survive," said delegate Joseph Hess, M.D., of East Lansing, Mich. "This physician and midwife are doing what they can to teach the mother to care for the baby. That an infant so small could be born here and be gaining weight, doing relatively well, is amazing."
The refugees' physician, probably in his 50s, said, "I want to take care of patients the rest of my life."
Hess reflected, "For me, that struck home. If you ever want an example of the universal ethic shared by physicians, here it is."
The delegates also visited two orphanages and noticed menus at one site indicating the children would eat bread and porridge three times that day, with spaghetti and cake added at one meal -- no meat, vegetables or fruit.
In Sumgayit, the delegates delivered Physicians With Heart donations at the central hospital, held a CME session on use of the medicines, and brought donations to a clinic.
Sumgayit is called "poison city" because of pollution and waste from the area's Soviet-era chemical factories, many of which are now closed and decaying. Reportedly, a few years ago the air was so dense with debris that people walking outside could see only a few meters in front of themselves. "We saw men cutting up pipes, and I'm sure asbestos was falling from the pipes," said delegate Byron Carlson, M.D., of Forest City, Iowa. "Sumgayit looked like a wasteland."
AzTV, a national network, considered the medicines so important to improving health in Sumgayit that it filmed the U.S. physicians talking about the pharmaceuticals at the hospital and unloading them at the clinic. Two days later, delegates happened to see themselves on AzTV in Baku, so the footage was definitely telecast beyond Sumgayit.
Ganja
The delegates who traveled to Ganja in northwest Azerbaijan visited two refugee camps and a hospital that are receiving Physicians With Heart medicine and medical supplies.
Signs of hardship and heartbreak: The hospital had pillows stuck between the windows and walls to keep out the cold; old windows must have been replaced with windows too small. One of the refugee camps was an old building with dirt floors and no heat. "It looked like a chicken coop," said AAFP Past President Lanny Copeland, M.D., of Albany, Ga. The delegates saw a child there with rickets. A lot of land surrounded the camp, but the refugees have not tried to garden there.
Signs of hope: Morning glories are climbing the sides of a shack in the other refugee camp; many families have planted vegetables or flowers. A child was born at the camp the day the delegates visited, so they got to see the two-hours-old baby. "Despite how troubled the world is," said Copeland, "life does go on."
Nakhchivan
Deep in the Caucasus mountains lies the Nakhchivan Autonomous Republic, a region with its own parliament, constitution, capital (Nakhchivan City) and about 350,000 people. Nakhchivan, though autonomous, is part of Azerbaijan. A catch: The republic, a bit southwest of Azerbaijan, is geographically separated from Azerbaijan by Armenian-controlled territory.
Several Adventist Development and Relief Agency staff members took 10 Physicians With Heart delegates to visit Nakhchivan government officials and health care sites Oct. 10-11.
The ADRA staff and delegates traveled dusty, bumpy roads across a stretch of starkly beautiful desert to reach a mountain village with one of ADRA's 40 Nakhchivan rural health posts. The delegates visited with the ADRA-trained woman who's the mainstay of health care for the village's 500 people and another 200 in a neighboring village. She had set up the health post in a room in her home. The examining area was a twin bed set off by curtains; the waiting area had a bench and a few chairs; the consultation area had a table, chairs and a medicine cabinet. The caregiver documents each patient visit and the medicine she dispenses. Twice a month, two pediatricians, an internist and a supervising nurse consult with the caregiver and see patients. The problems they most often treat: malnutrition, anemia, diarrhea, respiratory illnesses and parasitic diseases.
Physicians With Heart medicine to fight some of those problems will soon be in ADRA's village medicine cabinets, not on the side of a cabinet for paying patients but on the free side for vulnerable populations (including pregnant and lactating women, needy children, refugees, pensioners living alone, invalids and households headed by single women).
The delegates also visited physicians and nurses in Nakhchivan City's large maternal-child clinic, a cardiology clinic, and a city clinic for adults and children. The team met with the speaker of the Nakhchivan parliament, who has ordered a children's hospital to be built in the area and encouraged ADRA's health education and care initiatives.
About 60 physicians, including the director and department heads at the maternal-child clinic, attended the delegates' CME session explaining family practice. A few hours later, the clinic director and his six-year-old son met the delegates by chance in a park. "We talked about your ideas for family practice when we got back from your session," said the director. "We'd like to try to start something like family practice here in Nakhchivan." That was probably the quickest response Physicians With Heart has received in years of trying to encourage family practice in former Soviet countries.
"Under the Soviet system, everything was free," says delegate and AAFP Director Daniel Van Durme, M.D., of Tampa, Fla. "Now, they're trying to get to a system with more patient accountability – a profound paradigm shift to change to a process where people would actually pay to go to a doctor. They don't know how they'll do the mix of public/private health services. We're giving them information on family practice because it could help them meet the needs of their people better."
