Schlink Attack: Southern Uzbekistan Med Field Trip

Recently, I got to take a break from wearing surgical scrubs in exchange for business casual outfits while taking a work trip around southern Uzbekistan with my doctor colleague. Our task was to visit regional hospitals and private clinics to see what resources were available for Americans living, working, and traveling around the area, and to learn about future aspirations the medical facilities had in store.

Regional hospitals function in a unified network with computerized charting, telemedicine, and blood bank resourcing. When a patient has medical needs beyond the capability of their municipal hospital, they may be relocated to a bigger one within the region, and with relative ease. Their hospital mothership, the Scientific Center of Emergency Care, is located in the capital. Interestingly, though the capital feels like its population is busting at the seams these days, with massive construction projects and mind numbing traffic, Tashkent Region is far from having the most number of hospitals (198). Overall there are 2,696 facilities in the country. Ferghana has the most with 302. We managed to visit three in the Kashkadarya and Surkhandarya Regions, which share borders with Turkmenistan, Afghanistan, and Tajikistan.

Over three days, the good doctor and I got to meet with several hospital directors, all of whom had not just their administrative day jobs, but full loads of speciality patients as well. One was a neurosurgeon, another in vascular, and a few others from intensive care, cardiology, and plastic surgery. We walked through their emergency rooms, ICUs, radiology departments, laboratories, operating rooms, and even a dialysis department. In all three hospitals, the most common reasons people end up in the ER is from car crashes involving traumatic injuries, necessitating a multidisciplinary approach to patient management - telemedicine, they said, has been a godsend. Farming equipment and tool disasters were second.

During a lunch meeting, over plates of shashleek, salad, and naan (Uzbek style), the vascular surgeon showed me pre and post videos of a man's nearly amputated foot from a scythe injury incurred out in the field. Amazingly, he recovered all function and nearly all sensation of his foot. On other topics that surfaced, I was told a blepharoplasty* would cost me 200 dollars, a nose job for about 350, and I could get a mammogram for about 15. Plastic surgery for medical tourism is by far the most profitable and sought after enhancement. I learned that one regional hospital successfully re-introduced several organ transplant surgical cases this past year, after a country wide ban prevented them for several years. Organ trafficking and black market sales got out of control, so all transplant surgeries were shut down. Regulation in the country is tight and limited, and loaded with bureaucratic red tape, but the doc seemed hopeful a measured start become to benefit everyone in need, and that patients won't have to leave the country to find care.

During our all of tours, not a single one of them wasn't interrupted with dozens of phone calls along the way. It offered sobering insight to how busy they were - literally everywhere in this world, patient care simply never stops and it felt so familiar. Even in my clinic with a relatively small population, I can't remember a single day where we've had downtime. Like in the US, these nurses have heavy patient loads, work 12 hour shifts, and sometimes have to get creative with limited resources. Families often hang out on the hospital campuses with picnics and blankets to manage long wait times. Uzbeks have incredible patience and resourcefulness.

Any accident requiring emergency ambulance transport is required to go to their assigned regional hospital. Care is free, including for foreigners, though the notion of integrating health insurance is starting to take hold. Private clinics focus more on speciality care, but that doesn't mean they are without heavy duty surgical capabilities. One clinic in Termez has a cardiac bypass machine and will soon conduct angiography procedures, where as another on in Qarshi touts its reputation for bariatric surgery and weight loss clinics. Every private clinic we visited have robust dentistry, ENT, and endocrine services - getting one's thyroid function tests is considered routine, as is prescribing lengthy periods of time to recuperate in semi-private rooms. Though they require countless hours of logistical planning, many private clinics enjoy the stardom of visiting specialists from countries like Russia, Turkey, India, and South Korea.

Overall, the doc and I were reassured to see what kinds of care are available in this country and what has changed since the last time the health unit was able to step beyond embassy property. After the hustle of three days of hospitals tours and eight clinic tours, 2 hours of flying, and 16 hours of driving, the doc and I returned to Tashkent to complete the week seeing our own patients, writing trip reports, and catching up on hundreds of emails in our absence. I hung up my jacket and blouse and pulled out my worn, comfortable work jammies for another day of nurse life.

*eyelid lift

Medical folk hanging out in Shakhrisabz, birthplace of Temur the Great.
We're standing behind the Ak Saray Palace, builtbetween 1380 and 1404
when Temur was the man in charge.