“I am so incredibly glad that the knowledge I obtained during Primary Health Care Reform [PHCR] trainings helped save a baby’s life,” exclaims Dr. Varditer Iskandaryan, 35.

One day, in the Tavush region of Armenia, Dr. Iskandaryan set out to make a routine home visit to a woman who had returned from the maternity hospital with her new baby, Tatoul. As Iskandaryan checked Tatoul, she became concerned about the infant’s breathing pattern and the rapid beating of his heart.

Four months earlier, Iskandaryan had participated in a series of trainings for family physicians and clinical preceptors organized by IntraHealth International through the USAID-funded PHCR Project. As Armenia moves toward a health care system in which primary health care doctors—as opposed to specialists—can cover more of the health care needs, additional training is required. A PHCR partner, IntraHealth is creating training packages for family physicians’ training and continuing medical education in eight of 33 topics from the existing Unified Family Medicine Curriculum. The authors, who are leading specialists in particular areas of medicine, also conduct training-of-trainers course for family medicine faculty and clinical preceptors. The faculty and preceptors then take what they have learned and teach other physicians. So far, packages have been completed for skin diseases, urinary tract infections, pediatric illnesses and cardiovascular diseases—the topic crucial to Tatoul’s life.
 
“I immediately recalled everything I learned as part of the ‘When and why to suspect cardiovascular problems in neonates and infants’ module of the PHCR training,” Iskandaryan said later. She strongly advised the parents to take the baby right away to cardiologists at the children’s department of the Yerevan Nork Marash Medical Center, despite the 130-kilometer distance from their home. Fortunately, the family followed Iskandaryan’s advice.

After examining little Tatoul, doctors at Nork Marash Medical Center diagnosed him with a combined heart defect of critical coarctation of aorta (a narrowing of the largest artery in the body) with patent ductus arteriosus (a congenital heart disease wherein a child's ductus arteriosus fails to close after birth but could be closed within the first two months of life). In this case, the latter was compensating the flow of blood into the aorta, and its closure would lead to the baby’s death. With this combined heart defect, the baby still looks healthy at birth, and for this reason the condition is rarely timely identified in Armenia. With the current development of cardiovascular surgery in the country, this defect can be fully eliminated if addressed on time. Iskandaryan’s early diagnosis was key.

Training family physicians like Iskandaryan is critical to strengthening family medicine in Armenia. For the training to be as effective as possible, not only a unified curriculum, but also uniform training packages need to be in place. This is one of the existing gaps that PHCR, led by Emerging Markets, Ltd., has endeavored to address. The training packages focus on up-to-date evidence-based medicine standards and provide teaching and assessment tools that enable competency-based and problem-based learning. The courses are designed using IntraHealth’s innovative Learning for Performance methodology, which connects learning to specific job responsibilities and competencies.

“The main gap in Soviet medical education was that it was too theoretical and not practical, all that you learned for years could not be used in practice,” says Armine Danielyan, IntraHealth training advisor working on the PHCR Project. “Whatever is changed in the health care system . . . the true quality can't be changed in case where there are no up-to-date and practical clinical standards, and the physicians’ knowledge and skills are outdated.”

Iskandaryan is one of many doctors welcoming the updates. “I am expressing my gratitude to the training organizers hoping that similar trainings will be often organized,” says Iskandaryan, “to ensure that we—the physicians—have the opportunity to apply every progress reached in the sphere of medicine in correct and timely diagnosing and treatment of diseases.”

As for Iskandaryan’s young patient, little Tatoul immediately underwent heart surgery. He has since fully recovered.

The five-year PHCR Project has a primary objective of increasing the utilization of sustainable, high-quality primary health care services in Armenia. Led by Emerging Markets Group, Ltd., the Project’s other partners include IntraHealth, Overseas Strategic Consulting, Ltd. and American University of Armenia’s Center for Health Services Research and Development.