Armenia

On January 17th, RMF visited the village of Shinuhayr with the following agenda:

1. Meet with the clinic staff and the mayor of the village.
2. Meet with ARK contractor & engineer Sarkis and Zorig to study the building and gather all necessary information pertinent in our construction/renovation endeavor.
3. Identify a non governmental organization (NGO) in Syunik and form a partnership, as this is the protocol RMF follows in every country we implement humanitarian aid.
4. Visit at least six impoverished families and gather first hand information and footage.

Recently, the World Health Report (WHO) 2008 confirmed UN member states’ renewed commitment to core primary health care values; they are based on growing evidence on what people’s expectations are of their country’s health sector:

• to have a say in their health
• to have access to quality, people-centered care
• to live in an environment where health is protected

There is a disconnect in Armenia between these values and the performance of the health system, especially in the rural area of Shinuhayr which also serves as a referral site for the additional 5,000 residents from the surrounding seven villages since it is the only ambulatory with a resident physician, thus making it a pivotal medical resource in the region. However, the structural deficiencies of the ambulatory and the lack of resources have significantly limited the efficient and quality operation of the clinic. Shinuhayr’s citizens’ health is not protected if this clinic continues at the present status quo.

Providing healthcare to this region is therefore an extremely urgent matter. Given the dire state of the clinic, Shinuhayr’s residents do not have access to appropriate, affordable and quality health care. Many patients are forced to make a five to seven hour drive to Yerevan because many drugs, medical supplies and basic equipment are unavailable at the Shinuhayr clinic; the trek to Yerevan is, however, very expensive and virtually impossible to make during the harsh cold winters of Armenia.

On January 17th 2009, Real Medicine Foundation arrived in Yerevan, Armenia and met with country government officials to discuss the project and potential collaborative efforts. The Ministry of Health, the governor of the Syunik Marz (region) as well as the Chief Deputy Aid to the governor, Mr. Ara Dolunts collaborated their efforts with us and within a week we were able to complete the appropriate paperwork and licensure to allow RMF to operate and provide humanitarian assistance in Armenia. Click here to see the letter addressed to Real Medicine from the Ministry of Health.

In Yerevan we also met with ARK Construction Company (www.arkconstruction.am) and their engineer to discuss our collaborative efforts on this project. One of the first components of the RMF-Armenia project is to renovate the existing building in Shinuhayr which is being used as the site for a primary care clinic. Early Thursday morning, we met with ARK contractors, Sarkis and Zorig and together, we drove to the Syunik region. The Chief Deputy Aid to the governor, Mr. Ara Dolunts had already arranged and scheduled all our meetings with the key personnel in Shinuhayr. Upon our arrival to the village, we received an extremely warm greeting by the clinic staff and immediately they set a table full of fruits, nuts and sweets along with their traditional coffee, expressing their love, respect and hospitality to their visitors. 

Staff

All local health staff at the Shinuhayr ambulatory are government employees. Their salaries come from the Ministry of Health budget with the exception of the on-site based project manager which will be paid for by RMF funds. The role of the project manager is to oversee, direct and secure project operations, remain in regular contact with RMF U.S. headquarters and submit monthly utilization, statistical and financial reports. The project will assist the local health care staff in providing appropriate, patient-oriented ambulatory health care services to the community, introduce evidence-based clinical standards and train healthcare staff in the implementation of continuous quality improvement programs.

Presently the ambulatory staffs two physicians, two nurse practitioners with cardiology and pediatric specialties, a midwife, a laboratory analyst, and a phlebotomist. In addition, the ministry also employs a treasurer, housekeeper, janitor, security officer and a driver.

The Ambulatory

The building is in total disrepair. The roof is in complete shambles and the beginning signs of mold are visible. Total roof size is 14,208 square feet and estimated cost of complete renovation is between $73,228 – $79,950.00 USD. This includes a 15-year guarantee on work and 50 years on material. Due to the extreme cold and high wind conditions in Shinuhayr, a unique form of roofing material is to be used.

photos: (L) inside look at the (very damaged) roof; (R) rooftop (tin)

As seen in the pictures below, the building foundation and floors are in very poor condition and require complete renovation. In addition to renovating doors and windows, water, gas and sanitation systems need to be installed and secured.

photos: (L) foundation; (R) floor condition

Upon the receipt of the building blueprint from the local government, ARK engineer and contractors will draft out a detailed report projecting the total estimated cost of renovations/construction, excluding the roof which has already been accounted for. This figure should be available by end of March 2009.

Renovating the entire building will significantly increase the size of the ambulatory and allow us to implement many more value added programs to the community such as infectious disease and HIV/AIDS programs, women’s health, geriatric programs, mental health, physical therapy as well as alternative health. Moreover, it will create the possibility of jobs within the community. This area will be discussed in detail in the future as it is not part of the Phase I of the project.

Inside view of ambulatory (including patient room, pediatric room, pediatric patient files)

Medical Equipment and Pharmaceuticals

During the first phase of the project, medical equipments and pharmaceuticals will also be secured by RMF. The facility has very limited and outdated equipment and the availability and access to medications is limited. RMF is also working with the Health Ministry to establish a comprehensive children’s vaccination program and protocol.

Partnership with a local Armenian (NGO)

One of the key protocol requirements in our humanitarian missions throughout the world is forming a partnership with a non-governmental organization (NGO) within each country we serve. If an NGO does not exist in a particular country, then RMF establishes one.

After several meetings with key informants and officials, and based on NGO track record and history, RMF chose to partner with the Armenian Relief Society’s Goris branch. This branch is located in Goris which is approximately one hour from Shinuhayr. Chairwoman, Ms. Stella Arzumanyan, is our primary contact with the NGO.

The Armenian Relief Society, Inc. is an independent, non-governmental and non-sectarian organization which serves the humanitarian needs of the Armenian people and seeks to preserve the cultural identity of the Armenian nation. It is the oldest Armenian women’s organization, established in 1910 in New York City. Since its foundation, the ARS, Inc. has provided educational and humanitarian assistance to Armenians everywhere. Today, the ARS, Inc. has entities in 24 countries where members of the Society contribute to their communities and the larger world for the betterment of all humankind.

The ARS, Inc. also collaborates with international humanitarian and government organizations, such as USAID, World Health Organization, World Council of Churches, United Nations Children’s Fund (UNICEF), and various Red Cross affiliates. The ARS, Inc. is a roster member of the United Nations’ Economic and Social Committee (ECOSOC) and is an active participant in ECOSOC’s many working groups.

ARS will function as a catalyst and mediator between RMF and all other entities we need to work with in Armenia to be able to effectively implement our project.

The People of Shinuhayr

During our stay in the village we visited with six families living in extremely poor and dire conditions. Due to time restraints and below zero temperatures, we were unable to visit and interview more of the villagers.

Despite their lack of resources due to extreme poverty, these people portrayed an amazing spirit. As we entered their homes, they greeted us with much warmth and kindness. One family insisted that we sit down and break bread with them. Their kitchen was comprised of a table in the corner and was part of the only room where all six of the family members lived in. We could see half a loaf of bread and a pitcher of water. That was all they had and all they wanted to do was to offer it to us. We were truly touched by their genuine hospitality. Their stories were sad but they never complained; they thanked God for their smallest blessings. These people do not have access to work where they can secure an earned income. An economic infrastructure in the village is non-existent. During spring and summer seasons the villagers keep themselves busy with agriculture and farming. However, that quickly ends as fall and winter temperatures hit the region.

RMF is working with individuals who have expressed interest in sponsoring some of these families to help ameliorate their living conditions and increase their quality of life.

Life in Shinuhayr

kitchen stove

Apartment Complex

Summary of Achievements from this Trip:

1. Obtained permit to work in Armenia issued by Ministry of Health.
2. Partnership formed with local Armenian NGO.
3. Government architect to issue building blueprint to ARK Construction Company by end of March 2009.
4. Final roof renovation estimate: Between $73,228.00 – $79,950.00 USD.
5. Final building renovation estimate to be issued by ARK.
6. Continued collaboration and meetings with our government and NGO partner.
7. Funding is being secured by:

• Grants
• Charity/Fundraiser events
• Personal donations

Mr. & Mrs. Varoujan and Inna Gostanyan-Geokjyan provided us with room and board throughout our stay. This lovely couple humbly volunteered and opened their door to RMF and took care of us as if we were family. Their home was very old and worn down; water and electricity was limited and a small heating lamp was all there was to keep us warm in the below zero freezing temperatures. However, their love was immense and they made us feel like royalty.