Family medicine didn't gain immediate acceptance as a specialty in the United States. The same is true in Paraguay, but a decades-long partnership between KU School of Medicine-Wichita and the South American country is changing views and adding more family doctors in the southern hemisphere.

Since the Paraguay-Kansas Family Medicine Faculty Exchange Program began in the late 1990s, expanding on work begun in the 1980s, the number of residency programs has grown from one to seven. Where there were once 15 residency spots, there are now 120.

The partnership involves Wichita faculty sharing their expertise during visits to Paraguay. They also mentor family doctors and faculty from Paraguay who come to Wichita to learn about U.S. health care and our medical training system. The Department of Family and Community Medicine on the Wichita campus has assisted Paraguay in medical student education and residency program development.

Spanish-speaking Paraguay, with an estimated 7 million people, lies between Argentina, Bolivia, and Brazil. Although increasingly industrialized, it remains among South America's poorest countries. Medical school there is similar to the way it is here, but after graduation is drastically different. If a matriculated medical student cannot get a residency spot, which are in short supply, he or she can practice medicine anyway. This is different than the U.S., where a minimum of three years of postgraduate residency is typically required before an M.D. can practice without supervision.

Dr. Wesley Schmidt, a U.S.-born, Paraguay-raised family doctor who did his family medicine residency in the United States, developed the first family medicine program in the country and has been involved in the partnership since it began.

"We have been able to gradually increase the number of M.D.s training in family medicine, and the quality of this training has been improved by our participation in this exchange program," Schmidt said.

Schmidt said that the program was instrumental in the formation of the first department of family medicine at a Paraguayan university, but much work remains to be done. "Unfortunately, many students still complete their training without ever coming in contact with family medicine," he said.

"When I came to Paraguay as a family physician in 1981, I was the only family medicine specialist in the country and no one knew what it was," Schmidt said. "Now we have over 800 Family Health Units in Public Health and a number of private institutions requesting family docs. At least 80 percent of the country does not have family physicians. There needs to be more emphasis in medical schools, and better recognition of the specialty."

A link is made

The partnership is an outgrowth of older and broader efforts - the Partners of the Americas program launched by President John F. Kennedy in 1963 and the Kansas/Paraguay Partnership, which has conducted faculty and student exchanges since 1968.

After former KU Chancellor Robert Hemenway challenged all students and faculty in the late 1990s to have an international experience during their education, the family medicine ties between Kansas and Paraguay became more formalized. Members of the Department of Family and Community Medicine discussed ways and places that the department could have a lasting impact on international health. They chose Paraguay for several reasons, including earlier trips there by faculty and strong ties among some Kansans to the country.

"It's a poor country and we thought we could have a more lasting impact on improving the health care delivery system by concentrating our department efforts in a single country," said Rick Kellerman, M.D., chair of the Wichita campus' Department of Family and Community Medicine.

Over the years, Kellerman, Drs. Scott Moser and Doug Woolley and other full-time faculty have gone to Paraguay. "We try every year to have one of us go down there or one of their faculty come up here. We have pretty much hit the mark every year," Kellerman said.

Most recently, Dr. Laura Mayans, family medicine clerkship director, visited from Nov. 19 to Dec. 2 with her husband, David Mayans, M.D. They traveled to three cities - the capital city of Asuncion, Encarnacion and Ciudad del Este - and visited medical schools and facilities in each, staying with host families during the trip.

Mayans gave a presentation on obesity and also did some research so that she can help guide KU School of Medicine-Wichita students who choose to do an international rotation in Paraguay, as a dozen students from Wichita and 15 from Kansas City have done since 2000.

"My focus was to look at the different opportunities our students would have if they wanted to do a rotation," Mayans said. "In the fourth year KU medical students can choose to do a month there, and we're hoping to get more students down there."

"Each city has its own flavor and depending on the student's interests I can direct them," Mayans said.

Learning lessons in Kansas

Kansans are not the only visitors in the partnership. Faculty and students from Paraguay also come to Wichita to learn about family medicine and the American medical system.

"We send our young family physician leaders to get a taste of the training programs in family medicine in a very different setting," Schmidt said. "These visits have impacted the lives of a large number of our teachers of family medicine."

"When they come, we put them through a 10-day program to educate them as deeply and efficiently as we can about the U.S. medical education system," Kellerman said. "We take them to urban hospitals, rural hospitals, private practices, federally qualified health centers. They're very busy. It's no vacation. They meet with medical students and resident physicians and faculty. They lecture to medical students on a disease process we may not see in the United States like dengue fever. It's a packed 10 days."

One 2003 visitor, Dr. Maria Teresa Baran, is now deputy minister of public health and social welfare for Paraguay.

Mayans said that during her trip she came across many physicians who had been to Kansas and remembered the experience well. "You can see how our KU and Kansas influence has had an impact. You see how much they enjoyed it," she said.

"It's taken a lot of dedication in both countries," Kellerman said. "We learn as much from our colleagues in Paraguay as they learn from us. There has been a lot of work by a lot of people to make sure the faculty exchange program is sustainable and ongoing. That's one of the things we are most proud of."