Friday, November 1

It started with skepticism on Monday. But by Friday, Uzbek physicians were excited about using the AAFP's Advanced Life Support in Obstetrics program to standardize care of obstetric emergencies throughout Uzbekistan.

In the intervening days, the cadre of physicians – top OB-Gyns from throughout Uzbekistan – completed the ALSO Provider Course presented by a North American faculty, then the ALSO Instructor Course, where they learned to teach the ALSO curriculum. Then the Uzbek doctors tried their wings by presenting the ALSO Provider Course to other Uzbek physicians, under the guidance of the American faculty. By the Friday graduation for that provider course, many of the Uzbek physicians had really "caught the ALSO bug," said Chip Taylor, M.D., of Fairfax, Va., who headed the ALSO faculty in Uzbekistan.

While ALSO has been presented in 18 countries, it never before has been part of a Physicians With Heart airlift project. And the obstacles to presenting it in Uzbekistan were daunting.

"I expected success from the outset because we had a faculty of experienced ALSO instructors who were flexible and had a sense of humor in the face of adversity. But we were operating on faith most of the time coming in," said Taylor. "For example, even up until the first day, we didn't know if we would have a slide projector and ALSO slides in Russian, or overhead projectors."

And then there was the skepticism. The Uzbek physicians brought a wealth of obstetrical knowledge and experience to the course and were unsure what the ALSO course might have to offer them.

"During the first morning's lecture, the body language of many physicians in the audience said it all," said Taylor. But by that afternoon – when attendees began practicing what they'd learned on course mannequins – they became openly enthusiastic about the course.

By the end of the instructor course on Wednesday, one of the attendees invited the ALSO faculty for a tour of her brand-new perinatal facility in Tashkent. And during the second provider course taught by Uzbek physicians, she gave a powerful lecture, Taylor said.

What happens next? If the Uzbek Ministry of Health develops a plan for disseminating ALSO training and secures grant funds to carry it out, many more Uzbek physicians and their patients may benefit, Taylor said. Indeed, one Uzbek physician reported using ALSO techniques to help in a shoulder dystocia delivery right after her ALSO training.

The possibilities extend beyond Uzbekistan, Taylor added. "The Russian-translated syllabus is transplantable. It would be great if we could bring additional American faculty to partner with ALSO-trained Uzbek physicians and spread ALSO training to other former Soviet republics."