Nestled at the base of the Pamir mountain range lies Gorno-Badakhshan (GBAO), a place of immense beauty within a harsh and rugged mountainous region — home of Nasir Khusraw. The population in Badakhshan is predominantly Ismaili and live in small villages along the slopes of the Pamirs or near the tributaries of the Pyanj River that divides Tajikistan from Afghanistan.

Isolated from much of Tajikistan, the Jamat here is served by a number of agencies of the Aga Khan Development Network. The Aga Khan Health Service (AKHS) in Tajikistan operates health clinics in the various mountainous districts, and has a network of nurses and voluntary community health promoters to provide basic health services for the Jamat.

In 2014, AKHS USA sent a team of physicians and nurses to Khorog to introduce breast cancer awareness to the Jamat, and train local family doctors and nurses in the early detection and treatment of breast cancer. 

Primary care in Khorog is a relatively new concept. In the Russian health care model, most people see specialists for their medical concerns. The Tajikistan government has recently introduced the concept of primary care, and has provided training for specialists to become family medicine doctors.  Since preventive health care was not practiced in GBAO during the Soviet era, cancer screening was not common and women with breast cancer would go to their doctors quite late in the process, with devastating consequences.

The overall goal of the collaboration between AKHB USA and AKHS Tajikistan was to bring awareness about breast cancer to the Jamat, train health care professionals in clinical breast exams, and initiate a systematic process of treating women with a breast mass.

The program began with the first-ever Breast Cancer Screening Campaign in GBAO, with the participation of nearly 400 women from Khorog and surrounding districts. The AKHS USA team trained the local family medicine doctors and AKHS nurses on examination techniques.  At the same time, AKHB USA radiologists and technicians trained their counterparts at the Khorog Regional Diagnostic Unit (KRDU) to improve their skills in reading ultrasounds and mammograms. An Ismaili breast surgeon worked with the local breast surgeon in Khorog to demonstrate minimally invasive surgical techniques, and an Ismaili pathologist performed the first ever immunohistochemistry to diagnose breast cancer at the KRDU.

With the success of this initial pilot project, a second AKHB USA team returned to Khorog and trained six family medicine doctors as master trainers. Subsequently, these master trainers independently trained 147 nurses, and conducted breast screening campaigns across the entire region. Nearly 3,000 women across Badakhshan underwent clinical breast examination, most for the first time in their lives.

In 2016 a gynecologist joined the USA team to expand the collaboration to include a broader range of women’s health issues. With her help, the transfer of knowledge went online, and the two teams connected using an e-learning platform. Between 10 and 15 doctors from GBAO would meet at the e-learning center in Khorog and video conference with a team of doctors from AKHB USA.

Over the past four years, what began as an opportunity to raise awareness about breast cancer, has evolved into a fruitful partnership and friendship between AKHS Tajikistan, and AKHB USA. The transfer of knowledge has benefitted the Jamat of GBAO and has inspired doctors working in GBAO to take their own initiative to continue the work of cancer screening and awareness. Despite differences in language, culture, and even health care systems, the teams were able to work together to illustrate the spirit of One Jamat.