VZCZCXRO6269
RR RUEHLN RUEHSK RUEHVK RUEHYG
DE RUEHDBU #0308/01 0701120
ZNR UUUUU ZZH
R 111120Z MAR 09
FM AMEMBASSY DUSHANBE
TO RUEHC/SECSTATE WASHDC 0136
INFO RUCNCIS/CIS COLLECTIVE
RUEHBUL/AMEMBASSY KABUL 0043
RUEHDBU/AMEMBASSY DUSHANBE 0213

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