AAFP 'PHYSICIANS WITH HEART' AIRLIFT TO MOLDOVA: A DIARY

The Physicians With Heart partnership is an international humanitarian project sponsored by a coalition of three organizations: the American Academy of Family Physicians, the AAFP Foundation (the philanthropic arm of the AAFP), and Heart-to-Heart International (a humanitarian medical relief organization). The partnership's mission is to mobilize resources to improve health, provide medical education and to foster the development of family practice worldwide. The generous support of pharmaceutical companies and transportation provided by the U.S. Department of State has enabled Physicians With Heart to deliver much-needed medical aid to the newly independent states of the former Soviet Union.

Latest Airlift - Moldova, Feb. 18-25, 2002

The 10th Physicians with Heart trip was to Moldova, formerly a part of the Soviet Union. Moldova is one of the poorest countries of eastern Europe, its last decade marked by economic instability. Because of the low level of financial resources available both in the public and private sectors, the health status of most of Moldova's citizens has declined dramatically since it gained its independence in 1991. As is the case in many countries of the former Soviet Union, the high cost of health care makes care inaccessible to the majority of people living there. Common health problems in Moldova include diabetes, tuberculosis, hypertension, hepatitis B and C, and cancer. Antibiotics, anesthetics, first-aid kits and all manner of medicines used in emergency care and primary care are in great demand.

Moldova Overcomes Odds: An Airlift Diary Account

After months of anticipation, the Physicians With Heart delegation arrived in Moldova. Thus began the second stage of the humanitarian aid project that kicked off last October with the delivery of $7.7 million worth (U.S. wholesale value) of pharmaceutical products and medical supplies to Moldova. Additional airlift valued at more than $7.4 million arrived last week, just ahead of the volunteer team.

The Delegation in front of the Virginia Wellness Clinic in Rural Cahul

Monday, February 18: Arrival and Preparation. Members of the 14-member team were eager to begin documenting use of medicines delivered in the fall - and eager to share the concept of family practice with Moldovan physicians. "I really want to get back to that mission spirit I experienced in medical school, to remind myself why I went into medicine," said FP Hai Jin Kim, M.D., of Annandale, Va. "It will reinforce an appreciation for what I have in the United States - even the underserved in America have better access than people have here."

An introductory briefing was held shortly after the team checked into their Chisinau hotel. After dinner, some team members discussed upcoming CME sessions, while others retreated to a hotel room stuffed with bedding, clothing, school supplies and toys that had been collected for the Sarata Galbena Orphanage children's project. In the hallway, 140 paper bags lined the floor as team members sorted, counted and dropped treats and toys into each bag. It was like filling 140 stockings on Christmas Eve!

A Young Boy in a Foster Home Near Chisinau Ponders his Polaroid Image

Tuesday Feb. 19. Sarata Galbena Orphanage. The delegation boarded a bus for the 110-mile trip to Cahul, site of the Sarata Galbena Orphanage. The institution houses close to 140 children - orphans, disabled and abandoned children, and children whose families simply have no money to care for them.
After a grand welcome and tour, during which the delegation was serenaded by the children, the supplies and gifts were unloaded. The children shouted with joy at the mention of footballs, soccer balls, two CD players and a television set (which barely fit through the door of the building).

Children at the Sarata Galbena Orphanage Greet Their American Visitors with Smiles

Wednesday Feb. 20. Medical Symposium in Cahul. The delegation divided into two teams. Half of the members went to the local hospital to document use of the medical supplies delivered in October. The remainder of the delegation gathered at 9 a.m. in a Cahul municipal building for a discussion with local physicians about family practice in the United States. Two dozen Moldovans, wrapped in coats and fur hats, settled in for the two-hour question and answer session.

Daniel Ostergaard, M.D., AAFP Vice President for International and Interprofessional Activities, reminded the participants, "As you continue to develop family practice here in Moldova, remember that the principles of the specialty are universal, but the application of those principles has to be tailored to your economy and culture." Team member Mary Lynass, M.D., of Scottsdale, Ariz., explained what drew her to family practice. "I became an FP because I wanted to take care of the whole family, and the whole body. I enjoy taking care of both the young and the old." "Over the years, our patients become our friends," said Past President Bruce Bagley, M.D., of Albany, N.Y. Elizabeth Burns, M.D., of Oak Park, Ill., talked about women's health issues. "I don't just focus on the anatomy," said Burns. In family medicine, "I work with the patient to try to uncover the significance of past issues such as sexual abuse, domestic violence, and grief over pregnancy loss and the loss of a child," she said.

The audience was particularly interested in how family doctors handle infant and well-child care, how much American physicians earn, and the complex issue of American health insurance. AAFP Foundation Vice President David Massanari, M.D., of Shapleigh, Maine, drew a laugh when he invited suggestions from the audience. "Our economic system is not necessarily the best implementation tool for family practice," he said.

In the afternoon, the entire delegation gathered at the "Virginia" Women's Wellness Center in Cahul for lunch and a tour of the facility. The facility represents a partnership between the Eastern Virginia Medical School, Norfolk, Va., and the Moldova State Medical and Pharmaceutical University. The goal of the EVMS partnership is to improve the health of the population of Moldova through the expansion of the community-based primary care and family medicine training programs.

Thursday, Feb. 21. Symposium in Chisinau. Nearly 150 people gathered in the bright, newly renovated lecture hall at the State Medical and Pharmaceutical University in Chisinau for a full-day medical symposium. The U.S. physicians, including project partners from Eastern Virginia Medical School, Norfolk, Va., gave vivid detail about family practice in the United States. Moldovan physicians shared the stage, describing their struggles and triumphs as the development of family medicine continues in the Republic of Moldova.

Medical students, university faculty, physicians and other health professionals snatched up earphones as they checked into the symposium, which was conducted in simultaneous translation between Romanian and English. Two Romanian translators, sequestered in an enclosed booth to the right of the stage, shared that duty throughout the long day. The event began at 9 a.m. with opening remarks by AAFP Past President Bruce Bagley, M.D., of Albany, N.Y.:
"You have already seen and used some of the medication that we sent in October. Today, we want to deliver something far more important. Today, we bring knowledge to help you, and we bring hope for the future of family medicine. These things will last long after the pills are gone."

Friday, Feb 22. Community health visits. This morning the delegation visited the PRO-SAN Clinic in the Botanica District of Chisinau. The clinic, a project sponsored by the Eastern Virginia Medical School, opened in January 2001 and has seen more than 20,000 patients in just over a year. It is the primary training center for the family practice residents from the medical university. "This clinic is mobbed during the day," said Francine Lutz, EVMS executive assistant, office of the vice president for planning and program development.

After lunch, the delegation visited a children's transitional placement home, which is also an EVMS project. The home holds up to 22 children who are undergoing social and medical rehabilitation as they prepare to return to their families. Some of the children are disabled; others come from homes where substance abuse and physical abuse are prevalent. The foster home also serves as a training site for the family practice residents, who have an opportunity to treat children from ages 2 to 15. Team members carried dozens of plastic bags containing food, cleaning supplies, linens, towels and small toys into the bright, cheery and immaculate residential home.

Article and photos by AAFP Associate Editor Sheri Porter, traveling with the Physicians With Heart airlift to Moldova