FAMILY HEALTH CENTERS CHANGING THE FACE OF MEDICINE

UNCLAS SECTION 01 OF 02 DUSHANBE 000308 SIPDIS E.O. 12958: N/A TAGS: EAID TBIO TI SUBJECT: FAMILY HEALTH CENTERS CHANGING THE FACE OF MEDICINE DUSHANBE 00000308 001.2 OF 002 ¶1. Summary: The USAID-funded Zdrav-Plus program has been promoting family medicine in Tajikistan through Centers of Excellence, where family health practice is carried out and where doctors from nearby areas can receive training and support for practicing family medicine. There are four such centers in Tajikistan, and demand is growing as the practice catches on. Though initially resistant, doctors like the concept once they use it, and they especially appreciate the training and information resources provided by the program. A more patient-centered approach is naturally welcomed by the patients, too. Though there are still some philosophical differences with the Tajik government over training issues, the practice of family medicine is gaining ground more rapidly in Tajikistan than elsewhere in central Asia. End Summary. ¶2. In recent months the DCM has visited three of the four U.S.-funded Centers of Excellence implemented by the Zdrav-Plus program in Tajikistan. In September, she visited the Istravshan center which had been specifically requested by local authorities. There she met with center administrators and a group of local doctors being trained in family medicine. These were perhaps the most grateful group of assistance recipients she has encountered to date. In October, she visited the opening of a center in Panjakent, where the basic but well equipped center stood in sharp contrast to a shiny new clinic built by the local government, where spacious rooms gleamed with tile but lacked furniture, equipment, supplies or staff. In February she visited the first pioneering center in Dushanbe, which launched the concept and continues to add new innovations to serve patients. ¶3. At the centers, local patients are each assigned to a family doctor who oversees all their needs. In case a specialist is needed, the family doctor arranges the referral. This contrasts to the Soviet method of specialists only, which required that patients see a different doctor for every ailment, and locate their own specialist. One aspect of this is the entirely new concept of reception/waiting room, where patients check in at reception, their records are retrieved, and they wait to see their doctor, or new patients are assigned a doctor. Under the old system, patients entered the building, wandered the halls, poked their heads into various rooms to locate an available doctor who agreed to see them. This culture apparently has been difficult to break and the first center reported that it took nearly two years to eliminate the hall wandering custom entirely. ¶4. The doctors at the centers all receive six months of initial training which includes both lectures and on-the-job practice with visiting patients. Continuing education then is incorporated into the routine. Once set up, the doctors assigned to the center become trainers as well, going through an eleven month train-the-trainers course. Other donors are also sending doctors from their programs to these train-the-trainer courses as this program is becoming the model for others. Doctors from surrounding areas come for a similar program of lectures and practical training, seeing patients along with their trainers. Once completed, they can use the center as a resource center and their trainers remain their mentors. The centers all have medical libraries and internet access with subscriptions to medical databases, allowing doctors to research symptoms, disease and treatments as needed. While Zdrav-Plus feels strongly that training is best done close to where the doctors live and should incorporate actual practice, the government advocates a central training school in Dushanbe, where doctors would live away from their home for six months and only attend lectures, without seeing patients. ¶5. The doctors who are trained also receive a medical bag with basic equipment like stethoscopes. But one doctor pulled out the ten inch thick doctor's reference manual of symptoms and treatment, declaring it worth more than everything else in the bag together. Though supplies and medicines are often in short supply, doctors feel the lack of information most keenly, making the information resources some of the most coveted aspects of training. They also lauded the emphasis on working with patients to promote a healthy lifestyle, and the fact that by controlling the overall care of the patient, they establish a relationship with and knowledge of the patient that makes treatment more effective. ¶6. The patients seem to like the changes too. Though as Westerners we may see a doctor's waiting room as one of the more DUSHANBE 00000308 002.2 OF 002 frustrating places in the universe, for those forced to fend for themselves in the halls of a strange clinic, an organized reception/waiting area is bastion of calm and order. Patients also like seeing the same doctor whom they come to know and trust. While some initially want "the specialist" for whatever perceived ailment they have, most eventually want no one but their "own" doctor even when a specialist is recommended. ¶7. The first center is not resting on its laurels, but continues to introduce new concepts for patient care. Last year they launched a patient support group for diabetes sufferers where the patients and their family members under the guidance of doctor get information and share their experiences on how to cope with the disease and organize their lives to best manage it. This has been very popular with the patients and their families. The center intends to launch two more groups, including one for those suffering from high-blood pressure. JACOBSON