One of the reasons I do international work is that I aminspired by the s/heroes I meet, working against the odds to make life betterfor their communities. Dr. Amjad is one of those. He is in his forties, and oneof today’s leaders in family medicine. With his abundance of expertise, energy,and ideas he squeezes more into 24 hours than most people I know. After a yearand a half of working together, we just succeeded in publishing a paper in BMJ Open. One year ago, we presented thisproject at the Annual Family MedicineGlobal Health Summit. Dr. Amjad participated via Skype. Although hisEnglish is excellent, it is a second language, and he needed a native Englishspeaker to help him prepare the manuscript for publication. Here is thearticle.

Pilot studyto build capacity for family medicine with abbreviated, low-cost trainingprogramme with minimal impact on patient care for a cohort of 84 generalpractitioners caring for Palestinian refugees in Jordan

Here are a few highlights:

• Every year about 3000 medical students graduate in Jordan, but only 10% of these young doctors (300) have a residency slot in Jordan for specialty training (internal medicine, surgery, family medicine, etc.).
• Those who don’t go into a specialty can practice medicine as general practitioners (GPs). However, their clinical experience is limited to a one-year hospital internship rotating through pediatrics, surgery, internal medicine, and gynecology. They have little outpatient training and no education about the psycho/social aspects of health, or how the mind effects the body and the impact on health. They work in many of the hospitals, open their own practices, or are hired by organizations like UNRWA.
• The United Nations Reliefs and Works Agency for Palestinian Refugees in the Near East (UNRWA) was established in 1948 to provide services, including medical care, to Palestinians who fled or removed from their homes during the 1948 Palestine war. UNRWA works in five areas: Lebanon, Syria, the West Bank, the Gaza Strip, and Jordan. (In the last year, the US pulled all funding for the program.)
• In 2013, while Dr. Amjad was consulting at UNRWA/Jordan to help with the implementation of an electronic health record, he realized that their GPs needed better ambulatory skills. There were too many referrals to specialists, little use of evidence-based medicine, no understanding of somatic illness, and too much poly-pharmacy (too many medication prescriptions).
• He developed and evaluated one of the first low cost training programs with both didactics and on-the-job components, designed to enhance the knowledge and clinical skills of the GPs.

He found the time to do this while he was doing the consultingjob! Remember, I said he was inspirational.

In 2012, as refugees from the war in Syria trickled acrossthe border into Jordan, Dr. Amjad, who lives in northern Jordan, opened aclinic in his home. He continued until people were knocking 24/7, and it interferedwith family time with his wife and 4 children. Nevertheless, he collected dataon the patients he saw, as well as the Syrian refugees who settled throughoutJordan until 2017. We are now working on that paper.  

I met Dr. Amjad in 2018 when I traveled to Jordan to learnmore about Family Medicine training along with colleagues trying to grow familymedicine in Palestine. He arranged a whirlwind tour of family medicine inJordan which was started twenty years ago. (Family Medicine in the US is fiftyyears old.).

One of the most impressive academic departments and training programs was at the Jordanian University of Science and Technology (JUST) not far from Jerash, one of the largest and most well preserved sites of Roman architecture in the World. We met the retired chair of Family Medicine who started the department in the early 1990s and opened the first family medicine clinic in the region. Initially he was the only physician and started by serving JUST students, then faculty and university employees. The word got out that he had something special. Soon surrounding colleges began sending students and faculty. Eventually the clinic, staffed with many more family physicians, opened to the public at large. Now the health center is open 24/7, no patient waits more than 30 minutes, and patients make appointments on-line, by phone, or walk in. He talked about his vision, not unlike what we refer to as the quadruple aim: decreased cost, better quality and patient satisfaction, better outcomes and happier physicians.

Despite the brokenness of our US health care and myfrustration with the current state of affairs, my international work helps me appreciatewhat we have in the US. Many Jordanian (and Palestinian) physicians see 90patients a day, or one every 3-4 minutes per. And I have complained about every15 minutes! Physicians at UNRWA don’t get money for continuing medical education(CME). Most physicians in the US receive several thousand dollars a year forCME from their employers. In the US we have a surplus of residency slots, so manythat they are filled by internationally educated physicians.

Born in the US to a professional household with two loving parents,I was educated well in the US and hold a medical license that is viewed withesteem. I am reminded to be grateful for all I have. And reminders of my good fortune,remind me that it is important to continue to find ways to give back. Thank youfor the privilege of helping and to congratulations Dr. Amjad!