The issue of personnel in Uzbekistan’s healthcare system (Surkhandarya region, 1940s-1950s)

Бюллетень науки и практики / Bulletin of Science and Practice

UDC 94                                            

In the studied period, the main problem of the medical field in the Surkhandarya region was the lack of medical personnel. Most of the doctors sent to work in the region from other regions of the republic returned in 1-2 years for various reasons. Mistakes were made in solving the problem of personnel in the field of medicine, as a result of bringing doctors from other regions, attention was not paid to the training of local youth in medical universities. As a result, the withdrawal of doctors led to a shortage of personnel, and the shortage of personnel escalated. Specialist doctors from the center would return after a certain period of time. From 1953 to 1961, attention was paid to local youth in medical universities, and during these years 611 local youth were trained in preparatory courses of medical institutes of Samarkand, Tashkent and Andijan. Nevertheless, in the early 1960s, there was a need for 1,285 doctors and 4,930 paramedics in the region. Importantly, during this period, due to the increase of experienced doctors and their initiative, the health department made a number of achievements and progressed forward.

In every country, the healthcare system is one of the most important directions of the social sphere, and the development of this sphere is one of the most important factors that increase the standard of living and well-being of the population. In the 1940s and 1950s, there were a number of problems in the field of medicine in the region. The material and technical base of medical institutions was very weak, and after the war there was a shortage of doctors and paramedics, along with other professions. This was especially noticeable in Surkhandarya region. Because medical personnel were still not trained in the oasis, and the personnel were mainly sent to the region from other regions of the republic. Nevertheless, in these years, a number of targeted works were carried out in the region to protect the health of the population.

The article is covered on the basis of generally accepted historical methods - historicity, comparative-logical analysis, principles of objectivity. Archival materials, statistical collections and scientific literature related to the field of medicine were used in the research.

From the end of the 1920s , multidisciplinary medical institutions began to be established in Surkhandarya district. In 1934, in order to provide these institutions with medical personnel, a training course for nurses was started in the Termiz military hospital, and the first medical personnel were trained in the oasis. In 1939, one of the hospitals in the western regions was moved to the city of Termiz. This hospital was placed in the “Pravda Newspaper School and Kindergarten named after Okhunboboev” in the city of Termiz [1].

In those years, the graduates of the course called “Nurses of Compassion” worked in the military hospital that operated during the war years [2]. In 1947 , according to the decision of the People`s Commissariat of the Republic of Uzbekistan, a school for training nurses was opened in the city of Termiz, and nurses were trained until 1951 [3].

In 1951, this school was reorganized under the name “School of paramedics” based on the decision of the People`s Commissariat of the Republic of Uzbekistan. Although this educational institution partially satisfied the need of secondary medical workers of the population of the region, the need for medical workers with higher education always remained. For example, in 1955, out of 450.5 physician states, 321.5 state units were occupied and 128.5 (28.5%) state units were vacant for 1 year (Table 1).

Table 1 MEDICAL STAFF

№	Specialists	State		Busy		Individuals
		1954	1955	1954.	1955	1954.	1955
1	Health management staff	30	32	27	30	4	7
2	Therapist	69.75	72.75	45.5	58.75	33	33
3	Infectious	23	25	16	22	7	10
4	Surgeon	31	39	23.5	30	16	24
5	Oncologist	1.5	1.5	1	1.5	1	1
6	Obstetrician-gynecologist	24,25	23,25	21	19.25	14	16
7	Urologist
8	Pediatrician	28.5	53.75	33.75	42	14	20
9	Ophthalmologist	21	22	13	10	7	7
10	ENT	9	10.5	4	5	4	2
11	Neuropathologist	6.5	9.0	2.5	4	3	1
12	Physiotherapist	2		2		1	2
13	Physiologist	23.5	21.5	13.5	16.5	6	8

Бюллетень науки и практики / Bulletin of Science and Practice Т. 11. №3 2025

№	Specialists	State		Busy		Individuals
		1954	1955	1954.	1955	1954.	1955
14	Dermatovenereologist	22.25	17	14.5	11.5	8	9
15	Sanitary doctor	53.5	78	40.5	45.5	20	24
16	Treatment physical culture	1.5	2.5	1.5	1.5
17	Dentist	3	5	3	4	3	4
18	The doctor is a laboratory technician	10.5	12	3.5	6	2	1
19	Radiologist	10	11	6.5	5.5	6	7
20	Pathologist	1.5	1.5		1.0
21	Medical center doctors	8	10.75	1	5
22	Dietician		0.5		0.5
23	Judicial expert	2	2	2	2	1	1
Total:		417.25	450.5	280.25	321.5	155	177

During these years, there was a lack of specialists such as a therapist, infectious disease specialist, dermatovenerologist, otorhinolaryngologist (ENT), neuropathologist, pediatrician, phthisiatrician, ophthalmologist, radiologist and sanitary doctor. Due to the lack of doctors, they were forced to work on a temporary basis not only in their own areas, but also in related specialties. For example, in Boisun district, a sanitary doctor also performed the duties of a pediatrician or a phthisiatrician. Such cases were observed even in city hospitals, until 1955 there were no neuropathologists, ENT, radiologists and psychiatrists in the city hospital of Termiz. There is a shortage of 170 medical specialists in the region, in particular, 22 therapists, 21 pediatricians, 35 paramedics and 10 ophthalmologists, which naturally caused a decrease in the quality of medical services. There were also personnel problems in the management system of the regional medical sector. For example, in 1955, there were 17 positions in the Surkhandarya regional health management apparatus, of which 15 positions were occupied, 2 regional chief pediatricians and epidemiology positions were vacant [4, 7].

Due to lack of medical personnel in 16 rural medical hospitals in the region, 9 rural medical hospitals in Denov, Shorchi, Termiz, Sherabad districts and 3 out of 4 rural outpatient clinics in Termiz, Boysun, Sariosiya districts were managed by secondary medical workers. There were no unemployed doctors in the list of the regional health department. In 1955, 20 doctors who graduated from medical institutes were recruited and sent to work in district rural institutions. However, 11 graduates (8 from Tashkent city and 3 from Samarkand region) did not come to the region for various reasons. Nevertheless, there is an increase in the flow of doctors to the region, which can be seen in the fact that the number of new employees is greater than the number of those who quit. In particular, in 1955, 20 highly educated specialist doctors graduated, 1 of them was sent to the regional center, and the remaining 19 were sent to work in Denov, Shorchi, Termiz, Sherabad, Boysun, Uzun, Sariosia and Jarkurgan districts. Women doctors accounted for the majority of layoffs from medical institutions in the province. The main part of them is the family of military personnel, which is related to the change of the military personnel's place of work [5].

In 1951-1955, the flow of doctors in regional medical institutions was different (Table 2) [6].

Table 2 DOCTORS IN REGIONAL MEDICAL INSTITUTIONS

	1951	1952	1953	1954	1955	Total
Those who are laid off	30	37	29	41	30	157
Recruits	30	52	20	37	49	188

We can see from the table that during these years, almost as many people were fired as were hired in medical institutions. One of the main reasons for this was related to residential housing. Because the state could not provide housing for all new medical workers. In 1958, 223 of the 311 doctors working in the medical field were not provided with housing. As this issue was not fully resolved even in the 60s, it was one of the daily urgent tasks to carry out serious work on the issue of the demand for high- and medium-specialized medical personnel [7].

In 1956, most of the chief specialists working in the Zhargorgon district hospital came from Russia, Tashkent and Samarkand, and the lack of doctors due to family and other reasons was very high. For this reason, attention was paid to the issue mentioned in the letter No. 445 of 1952 of Surkhondarya Region SSB “On provision of local personnel to the hospital of Zhargorgon District” and it was emphasized to take urgent practical measures to train medical personnel from the local population. On the basis of this letter, on July 7, 2024, an order of the Zhargorgon district SSB was issued, in which it was determined to select at least 5-10 young men and women to study at medical technical schools and institutes, to conduct regular propaganda and campaigning activities in schools, and to involve the general public in these activities [8].

In 1957, 502.5 posts were allocated for doctors in medical institutions in the region, and at that time the total number of doctors in the region was 202. Even if they worked from 2 rates, they could cover 404 rates and even then 98.5 rates would remain vacant. Due to family circumstances or the specifics of some specialties, doctors could not work on a full-time basis. 16 rural district hospitals in the region lacked specialist doctors, and 6 hospitals were managed by paramedics or nurses with secondary education [9.25-26].

The lack of personnel in the medical field continued in the following years. In particular, in 1957, 32 specialists who graduated from medical universities in the cities of Tashkent and Samarkand were sent to work in Surkhandarya region, 24 of them were assigned to hospitals in districts and 8 to hospitals in Termiz. However, for unknown reasons, 20 graduates did not come to work at their assigned place [10]. The hired doctors also changed their jobs soon. For example, in 1956-1957, 98 doctors were employed in medical institutions in the region, and 75 doctors left their jobs in those years. 26 of them quit their jobs due to family circumstances (their spouses were in the military, so they moved their jobs to other regions), 4 quit for study, 2 for retirement, 4 for health reasons, and the remaining 6 quit for various reasons. Since 41 percent of the doctors working in Termiz are spouses of military personnel, it is noted that they are also likely to leave their jobs in the future. Also, most of the doctors who were sent from the region to study residency did not return to the region [11].

These factors, in turn, caused a shortage of doctors in hospitals in all districts. For example, there were no obstetricians-gynecologists in Sariosia, Boysun, Jarkurgan districts, sanitary doctors in Sherabad district, therapists in Angor, Sherabad districts, and pediatricians in Boysun district. All rural medical institutions lack specialists such as ophthalmologist, phthisis, venereologist, neuropathologist, otorhinolaryngologist and radiologist. In 1957, 10 doctors in the cities of Moscow and Tashkent and 6 doctors in the regional base were trained. Factors such as refusal to go to study due to family problems, uniformity of specialists working in medical institutions, and more than 3 years of work experience influenced the low number of doctors sent for training [12].

The number of indigenous doctors in the province, especially female doctors, also increased. For example, in 1957, there were 12 female doctors of local ethnicity in the treatment and prevention institutions of the region, 1 of them worked in the city and 9 in the rural areas. Also, 1 person worked as a manager in Denov district health department [13].

In 1957, according to the national composition of doctors working in medical institutions in the region, we can see that there were more doctors of European nationality (Table 3).

Table 3

THE NATIONAL COMPOSITION OF DOCTORS WORKING

IN MEDICAL INSTITUTIONS IN THE REGION [14]

In the cross section of nations	Total doctors		1957
	Male	A woman	Male	A woman
Russians	3	88	1	5
Uzbeks	40	10	12	4
Tatars	4	16	-	5
Jews	8	8	1	2
Ukrainians	2	-	-	-
Tajiks	4	1	-	-
Armenians	3	1	-	-
Koreans	1	2	1	1
Other nations	2	6	-	-
Total	69	133	15	17

The shortage of dentists in the region was at the highest level. Until 1960, specialists in dental treatment mainly came from other republics and cities, among them V.Kh. Asanov and A.R. Molyar, who worked in the districts in those years . In 1959, M.G. Yakubov, who graduated from the Okhunboboev medical school in Tashkent with the specialty of dentist, was the first person to emerge from among the representatives of the local people [15].

Obstetricians, laboratory assistants, operating nurses, connection nurses, treatment nurses, physiatrists and physiotherapists were trained at the base of Termiz city hospital. This year, 141 paramedics, 11 trachomatosis centers and 9 collective farm maternity homes were operating in the region. There is also a personnel problem in this direction, and there is a lack of paramedics in 31 paramedic-midwifery centers in the region. At the same time, the number of medical workers in the region gradually increased. For example, in 1954, there were 584, 696, and 750 medical workers in the region in 1955, and in 1957, their number reached 913. By the end of 1958, 1,025 secondary medical workers were working in the region, and they were in 1,882 state units. In general, in the late 1950s, medical institutions lacked 5 dentists, 10 laboratory assistants, 20 sanitary paramedics, 5 dental technicians, 25 paramedics, 15 obstetricians and 2 pharmacists. The problem of lack of medical personnel also existed in the city of Termiz, the regional center. For example, 1 doctor instead of 5 doctors worked in the regional trachomatosis dispensary, 5 doctors instead of 12 doctors in the regional subdispensary, and 9 doctors instead of 29 doctors in the regional sanitary station [16].