New Nation Takes Tentative Steps Toward Family Medicine

The country, a former Soviet republic, became independent in 1991. It adopted a new flag, printed Uzbek money, threw out history books crammed with information on Vladimir Lenin and Josef Stalin, and rediscovered its own Uzbek heroes and poets. Uzbekistan boasts new cultural centers and has color-coated some of its Soviet-gray edifices. Beautification is in; the KGB is out.

"In the Soviet Union, all our doors were closed," Dr. Akbarali Atakhanov, Andijon's public health minister, told Copeland at a lavish meal for him and others in a Physicians With Heart delegation. "Before independence, we could not have imagined having foreigners around the table with us. We felt threatened by America; we feared it. Your people and ours were poisoned by propaganda. But now our doors are open. If you ask what independence did for us, it gave us a lot of friends."

Atakhanov thanked the Physicians With Heart team for the medical supplies it brought to the area's poor people. The $5.2 million Physicians With Heart shipment was divided and then distributed in five areas of Uzbekistan: Tashkent, Andijon, Nukus, Samarkand and Karshi.

Two years ago, Uzbekistan began rebuilding its subspecialist-oriented health system on a primary care base. Atakhanov assured Copeland family practice would be an integral part of the system. But first the country is updating its general practitioners.

"GPs serve as traffic cops at the polyclinics (multispecialty clinics)," said AAFP member Don Ellsworth, M.D., who has worked in Andijon 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.

All this may change in the next decade. Starting Oct. 3, the region's next crop of GPs was to begin hands-on clinical training in a remodeled wing of Andijon's medical college. Fifteen physicians have already graduated from a program qualifying them each to update 15 rural GPs who may have practiced for years but lack new knowledge and skills. And within one or two years, GPs should have the option of entering a proposed two-year family medicine residency in Tashkent.

Copeland tried to bolster that possibility. He left in Andijon a model family medicine residency curriculum, translated into Russian. At a delivery table in a rural clinic, Copeland -- who has delivered 1,500 babies -- asked the staff, "Why couldn't you deliver babies here? You could!" And after the Andijon seminar, Copeland told a university teaching assistant it would not take a lot of money to set up a family practice. Copeland said, "You can be a family physician with your brain and your heart and your stethoscope."