{"id":13074,"date":"2018-11-20T08:26:15","date_gmt":"2018-11-20T16:26:15","guid":{"rendered":"https:\/\/familymedicine.uw.edu\/medex\/?post_type=post&#038;p=13074"},"modified":"2022-04-04T19:06:15","modified_gmt":"2022-04-04T19:06:15","slug":"passing-the-torch","status":"publish","type":"post","link":"https:\/\/familymedicine.uw.edu\/medex\/magazine\/2018\/11\/20\/passing-the-torch\/","title":{"rendered":"Passing The Torch\u2013 Mother to Daughter, Feldsher to Physician Assistant"},"content":{"rendered":"<p><span class=\"dropcap\">I<\/span><strong><span style=\"font-size: 18pt\">n August 2018, Iryna Kylyukh graduated<\/span><\/strong> from MEDEX Northwest\u2019s Seattle Class 50. Iryna\u2019s walk across the stage of UW\u2019s Kane Hall to receive her diploma and claim the title of Physician Assistant completed a major step on a path that began as a 15-year-old\u2019s decision to join the healthcare profession. But a closer look into Iryna\u2019s story reveals a journey that reaches further back to her family\u2019s former home in Ukraine. It\u2019s there, in the small village of Sobishchytsi, that Iryna\u2019s mother Lyudmila Kylyukh made her own decision to make a living caring for others. She would become a feldsher.<\/p>\n<p><iframe loading=\"lazy\" title=\"Passing the Torch: Mother to Daughter, Feldsher to Physician Assistant\" width=\"1020\" height=\"574\" src=\"https:\/\/www.youtube.com\/embed\/ZFxS3i_V5ws?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" allowfullscreen><\/iframe><\/p>\n<p>&nbsp;<\/p>\n<p><span class=\"dropcap\">F<\/span><strong><span style=\"font-size: 18pt\">eldshers are to a large degree<\/span><\/strong> professional equivalents of physician assistants: non-physician providers tending to the needs of both rural and urban patients in primary care and specialized settings. This is no accident, as feldshers were among a number of healthcare professionals operating around the globe that caught the attention of early developers of the PA profession in the United States back in the late 1960s and early 1970s. Feldshers remain essential components of healthcare systems in Russia and the countries of the former Soviet Union, including Ukraine, where Lyudmila Kylyukh spent 30 years as a community-based feldsher.<\/p>\n<figure id=\"attachment_13090\" aria-describedby=\"caption-attachment-13090\" style=\"width: 600px\" class=\"wp-caption alignright\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/20171011-_Z7A7197.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-13090\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2018\/11\/20171011-_Z7A7197.jpg\" alt=\"\" width=\"600\" height=\"400\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2018\/11\/20171011-_Z7A7197.jpg 1200w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2018\/11\/20171011-_Z7A7197-300x200.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2018\/11\/20171011-_Z7A7197-1024x683.jpg 1024w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2018\/11\/20171011-_Z7A7197-768x512.jpg 768w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><\/a><figcaption id=\"caption-attachment-13090\" class=\"wp-caption-text\">Iryna Kylyukh during a MEDEX clinical rotation in 2017.<\/figcaption><\/figure>\n<p>In the shared stories of Lyudmila and Iryna Kylyukh, we celebrate the passing of the torch from one healthcare professional to another, from a mother to her daughter. And along the way, we trace the historical connections between healthcare professions: from the feldsher to the physician assistant.<\/p>\n<p><span style=\"font-size: 18pt\"><strong>Responding to a Crisis in Healthcare<\/strong><\/span><\/p>\n<p>The development of the PA profession came about at a time in the United States when healthcare was hitting a point of crisis. At the center of the crisis was a shortage of doctors. This shortage was felt just about everywhere in the country, but especially so in the rural areas of the country, where fewer and fewer docs were burdened with more and more patients. Many urban centers across the US were also experiencing the urgency of an increasing population in need of medical care and not enough providers to reach them all.<\/p>\n<figure id=\"attachment_13094\" aria-describedby=\"caption-attachment-13094\" style=\"width: 250px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/Patterson-Removing-Sutures.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-13094 size-thumbnail\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2018\/11\/Patterson-Removing-Sutures.jpg\" alt=\"\" width=\"250\" height=\"186\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2018\/11\/Patterson-Removing-Sutures.jpg 1175w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2018\/11\/Patterson-Removing-Sutures-300x224.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2018\/11\/Patterson-Removing-Sutures-1024x763.jpg 1024w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2018\/11\/Patterson-Removing-Sutures-768x573.jpg 768w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><\/a><figcaption id=\"caption-attachment-13094\" class=\"wp-caption-text\">As a student, Mark Patterson of MEDEX Seattle Class 1 did his clinical rotation in rural Tonasket, WA in 1969.<\/figcaption><\/figure>\n<p>The causes of these shortages had plenty to do with the significant social, cultural and political shifts that marked the day. More particularly, the rise of physician specialization after World War II placed an increased strain on the numbers of generalists or \u2018primary care\u2019 docs. [1]. And the passage of Medicare\/Medicaid Act of 1965 had an immediate impact on the situation by increasing the numbers of Americans, especially among previously marginalized groups, who were newly eligible for medical coverage. As the language of the time would have it, the challenge was on to solve \u201cthe problem of medical manpower and the deployment of physician skills to the population \u2026 in a changing climate of medical care.\u201d [2]\n<p>In an attempt to meet this challenge, a number of alternative models were sought out and discussed as the 1960s gave way to the 1970s. Beyond the most obvious, but ultimately least practical of responses \u2013 <em>train more doctors, fast!<\/em> \u2013 these studies came to focus on the potential of what were variously labeled \u201cmid-level providers,\u201d \u201cmedical associates,\u201d \u201cphysician extenders,\u201d or \u201cphysician\u2019s assistants.\u201d At the heart of these alternative practices was just what the overburdened U.S. healthcare system needed:<\/p>\n<p>\u201c[A] number of leaders began to articulate what most physicians already knew: much of what the doctor does each day could be carried out by specially trained non-physicians, working alongside doctors as part of the team.\u201d [3]\n<p><span style=\"font-size: 18pt\"><strong>The Example of Feldshers<\/strong><\/span><\/p>\n<figure id=\"attachment_13081\" aria-describedby=\"caption-attachment-13081\" style=\"width: 250px\" class=\"wp-caption alignright\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/Feldsher-Stalingrad.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-13081 size-thumbnail\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2018\/11\/Feldsher-Stalingrad.jpg\" alt=\"\" width=\"250\" height=\"250\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2018\/11\/Feldsher-Stalingrad.jpg 972w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2018\/11\/Feldsher-Stalingrad-300x300.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2018\/11\/Feldsher-Stalingrad-150x150.jpg 150w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2018\/11\/Feldsher-Stalingrad-768x768.jpg 768w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><\/a><figcaption id=\"caption-attachment-13081\" class=\"wp-caption-text\">A field surgeon or feldsher, Lyudmila Grishina, bandages a wounded soldier at Stalingrad, 1943. During WWII feldshers were deployed at the front.<\/figcaption><\/figure>\n<p>Among the various models for \u201cnon-physician\u201d care that were studied was that of the feldsher. With historical precedents in century 15<sup>th<\/sup> century Germany and 18<sup>th<\/sup> century Prussia, feldshers came to serve as military medics, in effect, in Czarist Russia. By the 1920s, feldshers became more formally included in the Soviet healthcare system as mobile healthcare providers primarily in rural areas. Since the collapse of the Soviet Union, feldshers have continued to serve as essential components in the rural healthcare strategies of Russia, Ukraine, and other former Soviet-bloc countries.<\/p>\n<p>While there have been variations in the training and practice of feldshers over time, the fundamental role of a feldsher has remained that of a healthcare provider who can attend to the vast majority of medical needs among patients in primarily rural settings without the immediate need for attending physicians. And it was this feature that caught the imaginations of those in the US who were searching for new ideas and approaches to addressing the crisis of care.<\/p>\n<figure id=\"attachment_9634\" aria-describedby=\"caption-attachment-9634\" style=\"width: 199px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/Smith-MD-MPH-Portrait.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-9634 size-thumbnail\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/10\/Smith-MD-MPH-Portrait.jpg\" alt=\"\" width=\"199\" height=\"250\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/10\/Smith-MD-MPH-Portrait.jpg 955w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/10\/Smith-MD-MPH-Portrait-239x300.jpg 239w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/10\/Smith-MD-MPH-Portrait-815x1024.jpg 815w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/10\/Smith-MD-MPH-Portrait-768x965.jpg 768w\" sizes=\"auto, (max-width: 199px) 100vw, 199px\" \/><\/a><figcaption id=\"caption-attachment-9634\" class=\"wp-caption-text\">Richard A. Smith, MD, the founder of MEDEX Northwest<\/figcaption><\/figure>\n<p>It is certain that Dr. Richard Smith, the founder of MEDEX Northwest, had the feldsher in mind as he and his colleagues created the nation\u2019s second PA program back in 1969. Looking back, Smith frequently cited feldshers \u2013 alongside other examples of \u201cnon-physician\u201d providers that he had observed in his travels to Cuba, Nigeria and Native American communities in the western United States \u2013 as examples of healthcare providers that were incorporated into the MEDEX model of PA education and training.<\/p>\n<p>And so, in a very real sense, Iryna Kylyukh\u2019s walk to claim her degree and to embrace her place in the world as a MEDEX Northwest PA is deeply rooted not only in her mother Lyudmila\u2019s story, but in the very history of the MEDEX program, and so the PA profession itself.<\/p>\n<p>See the full interview with Lyudmila Kylyukh <a href=\"https:\/\/youtu.be\/9Gk7e-M5VHs\">here<\/a>.<\/p>\n<p><span style=\"font-size: 10pt\"><strong>References<\/strong>:<\/span><br \/>\n<em><span style=\"font-size: 10pt\">[1] Thomas E. Piemme, et al., The Physician Assistant: An Illustrated History, Acacia Publishing Inc: Gilbert, AZ, 2013, p. 2.<\/span><\/em><br \/>\n<em><span style=\"font-size: 10pt\">[2] Patrick B. Storey, M.D., The Soviet Feldsher as a Physician\u2019s Assistant, U.S. Department of Health, Education and Welfare: Washington DC, February 1972, p. 1.<\/span><\/em><br \/>\n<em><span style=\"font-size: 10pt\">[3] Thomas E. Piemme, et al., The Physician Assistant: An Illustrated History, Acacia Publishing Inc: Gilbert, AZ, 2013, p. 2.<\/span><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>When Iryna Kylyukh crossed the stage on the University of Washington campus to receive her Master of Clinical Health Services degree as a PA, she completed a path that started in high school. But a closer look into Iryna\u2019s family history reveals that this really began decades earlier. Her mother, Lyudmila Kylyukh, worked in Ukraine for 30 years as a feldsher, the model for the present-day physician assistant. <\/p>\n","protected":false},"author":1,"featured_media":13077,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20],"tags":[],"class_list":["post-13074","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medex-stories"],"cp_meta_data":{"_edit_last":["1"],"_webdados_fb_open_graph_specific_image":[""],"_webdados_fb_open_graph_specific_description":[""],"student_name":["Iryna Kylyukh"],"_thumbnail_id":["13077"],"_oembed_1bb7745dad0a3b056eab6d4f337dcc16":["<iframe width=\"640\" height=\"360\" src=\"https:\/\/www.youtube.com\/embed\/3Rs1iOvV3Pw?wmode=transparent&amp;rel=0&amp;feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe>"],"_oembed_time_1bb7745dad0a3b056eab6d4f337dcc16":["1542658873"],"_oembed_bdfe10479d967e7a416fd6a151975754":["<iframe width=\"640\" height=\"360\" src=\"https:\/\/www.youtube.com\/embed\/ZFxS3i_V5ws?wmode=transparent&amp;rel=0&amp;feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe>"],"_oembed_time_bdfe10479d967e7a416fd6a151975754":["1542662372"],"_wp_old_date":["2018-11-19"],"_oembed_3316479682d4a47b024ee69306fe8017":["<iframe title=\"Passing the Torch: Mother to Daughter, Feldsher to Physician Assistant\" width=\"1020\" height=\"574\" src=\"https:\/\/www.youtube.com\/embed\/ZFxS3i_V5ws?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" allowfullscreen><\/iframe>"],"_oembed_time_3316479682d4a47b024ee69306fe8017":["1677179673"],"_edit_lock":["1677182162:173"]},"_links":{"self":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts\/13074","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/comments?post=13074"}],"version-history":[{"count":6,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts\/13074\/revisions"}],"predecessor-version":[{"id":21312,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts\/13074\/revisions\/21312"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/media\/13077"}],"wp:attachment":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/media?parent=13074"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/categories?post=13074"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/tags?post=13074"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}