From October 23 through November 1, I traveled in the Physicians with Heart delegation to the country of Tajikistan, one of the poorest of the former Soviet Union republics with a per capita income of about $364 per year. It has suffered a significant reduction in health care spending since its independence in 1991, and went through a long civil war from 1992-1997.

Physicians with Heart is a partnership of the American Academy of Family Physicians, the American Academy of Family Physicians Foundation, and Heart to Heart International. This partnership was started in 1993, and currently there are several goals:

• To donate and document the physical presence of products at the hospitals and clinics
• To provide clinical information about the medications distributed
• To provide educational updates on family medicine and other topics as requested
• To present the Advanced Life Support in Obstetrics Course to physicians in Tajikistan
• To participate in a Children's Project

Other partners were essential to the success of this particular visit and include the Department of State of the United States, the Ministry of Health in Tajikistan, Project Hope, Counterpart, ZDRAV Plus, and the translators and transportation locals who kept us moving forward.

Tajikistan is in Central Asia, just north of Afghanistan and Pakistan. It has a very mountainous terrain, with some of the highest mountains in the world - the Palmir and Alay mountains. It has a population of 7.3 million people. The official language is Tajik, but Russian is spoken in many areas and especially in medicine. The predominant market is agriculture with cotton, grain, fruits, vegetables, cattle, sheep and goats. The official data place the country at 90% Muslim, although the Russian influence has limited religious participation.

As part of our journey, we distributed 6.4 million dollars of pharmaceuticals and equipment to the physicians and hospitals in central Tajikistan, including 100 otoscopes as requested. We represented 22 American family physicians and were part of a 35 member delegation that participated in the visit. The American Family Physicians presented family medicine educational symposia to more than 160 physicians in two cities - Dushanbe and Tursunzade. We visited clinics and hospitals, made available information on the medications that we brought, conducted rounds with Tajik family physicians, consulted on cases -- and saw firsthand the enthusiasm for family medicine in that country. In addition, 58 Tajik physicians learned life-saving techniques in the Advanced Life Support in Obstetrics courses. The presentations by American family physicians captured the attention of the Tajik physician audience and allowed networking with the physicians of this country, sharing ideas and problems.

Finally, Physicians with Heart benefited more than 350 Tajik children via the Children's Project. Project volunteers brightened the lives of orphans at the Vakhsh Boarding School by providing such needed supplies as towels, linens, hats, hygiene items and school supplies. In addition, the project consisted of reconstruction of part of the facilities at this site and a celebration for the staff and children. Next the delegation went to the Dushanbe Day Care for Disabled Children where they delivered 12 wheelchairs and also supported a small construction project at that site. The volunteers also painted a colorful mural in the commons area and provided a party for the children.

Overall the project was an overwhelming success and a model for what family medicine can do around the world in international circles. As many third world countries are looking at health care reform, they are finding the primary care model offers good health care at an affordable price. Our role is to help