A Swiss–Uzbek partnership

The thread that led to a beautiful friendship: a Swiss–Uzbek partnership in medicine

It all began with an e-mail that no one answered. Olimjon Saidmamatov, an Uzbek economist attending an energy conference in St. Gallen, learned that ESTHER offers grants for Institutional Health Partnerships between Switzerland and low- and middle-income countries. He came from a family of doctors and was interested in helping to close the gap between Uzbek and Swiss medicine. Saidmamatov sent an email to more than 100 doctors in Switzerland, looking for a collaborator.

Published: 20. November 2020, Author: Jeannie Wurz

Dr. Jumaniyazov learns to operate a robot in Geneva

“I also received the email,” says Dr. Attila Louis Major, a gynaecological surgeon from the University of Fribourg and Fribourg cantonal hospital. “I saw ‘Uzbekistan’ and I didn’t respond. I thought every country ending in –stan is very dangerous,” he admits.

But Saidmamatov sent a second round of emails to Swiss doctors, and coincidentally, Dr. Major was scheduled to give a talk in Almaty, Kazakhstan. This time he responded. He spent a few days in neighbouring Uzbekistan, and the two men hit it off.

Dr. Major spoke a little Russian. He signed an agreement with doctor Kudrat Jumaniyazov, setting up a collaboration between the Fribourg Cantonal Hospital and a branch of the Tashkent Medical Academy in Urgench.

A patient watches her operation on an overhead monitor

Dr. Major—who had done almost all of his medical studies in Switzerland—discovered that the region of Uzbekistan where he was staying had a rich tradition of medicine and healing, based on the work of Avicenna, a Persian physician, astronomer and philosopher considered to be the father of early modern medicine.

“There’s a lot we have to learn from the East,” says Dr. Major. The Uzbeks “have another cultural background, they have another school of medicine. In the western world, everything is written in English. But the Uzbeks use Russian textbooks, and many things in Russia are not translated, are not published; they are only in Russian.”

A fruitful exchange followed, with Dr. Major travelling numerous times to Uzbekistan and Dr. Jumaniyazov travelling to Switzerland.

“In the beginning I stayed in hotels,” Major says. “After a while, my colleagues invited me to stay in their houses.” From the very beginning, Dr. Major was surprised to discover that he and his Uzbek partners had many common interests in medicine and philosophy. The partnership pointed out “how ignorant we are about other cultures and civilizations,” he says.

“They had very bad suture material, but they had developed a technique that uses very small amounts of thread, and they taught it to me.”

Dr. Attila Major
A lecture hall in Urgench

Dr. Major had expected to be the teacher in Uzbekistan. But he discovered that he was also learning from his hosts. In the operating room “they had very bad suture material, but they had developed a technique that uses very small amounts of thread, and they taught it to me.” Switzerland is rather advanced when it comes to technology. “We are quite privileged,” says Major.

Because they had limited equipment, the Uzbeks preferred to operate with spinal anaesthesia instead of general anaesthesia. Dr. Major was astounded to watch gynaecological surgeries with awake patients in Trendelenburg position (on an incline, with head down and feet elevated), an approach not used in the western world for fear that anaesthetics in the spinal region would migrate from the pelvis to the thorax, blocking breathing.

Instead, in Uzbekistan, the awake patients watched their own operations with interest on a monitor above them. Trust and teamwork between the patient, the anaesthesiologist and the surgeon are key to success, Major says.

“As far as I know, in Uzbekistan we now have the greatest experience of laparoscopic surgery in gynaecology using spinal anaesthesia worldwide.”

Dr. Attila Major

Dr. Major did have the opportunity to teach laparoscopic surgery to gynaecological surgeons at Urgench University. “In Fribourg we have a lot of experience with this,” he says, “and so I gave lectures to the students in Uzbekistan. We did all kinds of operations together.”

Dr. Attila Major of Fribourg (left) and Dr. Kudrat Jumaniyazov of Tashkent, outside the Fribourg cantonal hospital

In 2020, the group received a start-up grant for CHF 9’875 from ESTHER Switzerland for a partnership titled “Capacity building of Uzbek gynaecologists on implementation of spinal anaesthesia in laparoscopy”. In Western countries, laparoscopy is almost exclusively performed with general anaesthesia, says Dr. Major. “As far as I know, in Uzbekistan we now have the greatest experience of laparoscopic surgery in gynaecology using spinal anaesthesia worldwide.”

The collaborators’ ultimate goal: to prove that spinal anaesthesia is better than general anaesthesia in laparoscopy.

According to Dr. Major, without ESTHER Switzerland, the partnership would never have existed. “ESTHER brought us together, and it turned out to be not just a cultural and medical exchange, but the beginning of a beautiful friendship.”

«In Dr. Attila Major I found a person, a colleague, a true friend and the teacher with great experience and knowledge that I have been looking for all my life. I think ESTHER will be the backbone of our friendship and give us an incentive to improve medical science and practice, exchanging experience with doctors from other countries».

Dr. Kudrat Jumaniyazov: surgeon at Urgench Perinatal Hospital and associate professor at the Tashkent Medical Academy

Laparoscopy is a surgical procedure in which a small objective and surgical instruments are inserted through small incisions in the abdominal wall to view the organs in the abdomen and to permit surgery. Laparoscopic surgery is also called “button-hole surgery” because incisions of at most 12 mm are made in the abdominal wall. In Greek, “laparos” means abdomen and “scopos” means to look out.

The Trendelenburg position is placement of a patient with the head down and the legs up during surgery. This position allows a good view of the inner gynaecological organs because the intestinal organs will slide down.