by Pamela D. Knudson
Photographs by Wanda Weber
They are medical doctors, each has received a fellowship to study medical education in the United States, and both are deeply committed to improving health care for the people of their respective countries. Devendra Pant, MD, from Kathmandu, Nepal, and Orazklychev Orazklych, MD, of Ashgabat, Turkmenistan, came to UND to learn particularly about family medicine and rural health care in North Dakota, the smallest-populated state in the U.S. to offer medical education.
Pant received a fellowship from the Foundation for the Advancement of International Medical Education and Research, based in Philadelphia. Selected through a competitive process, he was among 10 physicians from countries in Africa as well as Nepal, India, Sri Lanka, South Korea, Pakistan, the Philippines and Mongolia to receive the fellowship.
Joining the UND medical school in 2004 as an international fellow, Pant has been a graduate teaching assistant since 2005, pursuing a doctoral degree in educational leadership from UND. He is a faculty member in the Medical Education Department, at the Tribhuvan University Institute of Medicine, which accepts about 60 students (in the Bachelor of Medicine and the Bachelor of Surgery (MBBS) program) annually, slightly fewer than UND’s medical school enrollment. “In 1971, a new National Education System was started in Nepal,” greatly influenced by Western ideas originating in the United States, Canada and Australia, he said. Based on results of a health care survey in the districts of Nepal, a needs-based and country-specific system of medical education and “a first tier of education that affected my generation” was developed.
Pant studied medicine under that system and went on to complete his medical degree at L’Vov State Medical Institute in Eastern Europe. After returning to Nepal, he worked full-time in the Tribhuvan University Teaching Hospital as a clinic house officer and senior house officer. Supported by the World Health Organization, he also studied at the University of New South Wales in Sydney, Australia, where he earned a master’s degree in health personnel education and delved into problem-based learning.
Pant is dedicated to bringing strategies for problem-based learning back to Nepal. When completed in 2010, his PhD will prepare him to assume a leadership position at his medical school, where he and his colleagues “want to create a National Center for Health Professions Education and Development,” he says.
His background includes training people at the grassroots level in primary care with doctors in mission hospitals in Nepal. He sees problem-based learning, with its focus on individual attention and more interactive, engaged learning, as an effective method for producing the type of physician his country needs.
As physicians, “we want to care for the person,” he asserts. “You can know lots of facts, but you work with a person,”
and so must consider the body in its totality, including psychology along with other aspects of the human being.
And the patient must be viewed “in the context of society and culture,” he maintains, adding that medical education “should educate students in this responsibility to society and the community.”
At UND, Pant has noticed “professors are very helpful here, and respect you as a person,” qualities he, undoubtedly, will convey in his new role and in the educational culture when he returns to Nepal.
From Ashgabat to North Dakota
The goal of Orazklychev Orazklych, MD, an internist, is to learn about the American experience of family medicine and use that knowledge in Turkmenistan to train more family physicians. He came to UND on a Fulbright Fellowship in June and plans to return to Ashgabat in May.
“It is very important to develop family medicine in our country,” says the assistant professor of family medicine at the Turkmen State Medical Institute in Ashgabat. The concept and practice of family medicine is relatively new in Turkmenistan where, since 1996, doctors, primarily internists and pediatricians, began to be retrained in family medicine. The need for more family physicians, and national models for family medicine, in Eastern Europe and Central Asia is “urgent,” he says.
His fellowship is a result of a series of visits by UND physician-faculty and administrators to Turkmenistan, an effort to help the new independent countries in that part of the world improve health professions education and health care delivery. The visits, sponsored by the U.S. Agency for International Development, led to an intensive, five-week training program in primary health care for Turkmen health professionals in 2000 in North Dakota and the establishment of the Family Medicine Training Center (FMTC) in 2001 at Ashgabat. The FMTC curriculum, which emphasizes a team approach in the practice setting, was jointly developed by North Dakota and Turkmen partners.
The American Embassy in Turkmenistan selected Orazklych for the Fulbright fellowship based on the pressing need for primary care physicians there. At UND, much of his time is spent in discussion with family medicine faculty members, observing medical classes and learning about undergraduate and graduate medical education.
“Dr. Orazklych has been very engaged observing the education of medical students here in Grand Forks,” says Robert Beattie, MD ’89, chairman of family and community medicine and Orazklych’s advisor. “It is gratifying to see the seeds planted by North Dakota in Turkmenistan have taken root and are producing their own interest in further growing their primary care infrastructure.”
Orazklych is eager to gain firsthand experience later this year at the UND Center for Family Medicine in Bismarck and the UND-affiliated West River Health Services which serves a large geographic area from its base at Hettinger, in southwest North Dakota.
His expertise will be used to train family physicians in the Turkmen State Medical Institute, Department of Family Medicine.