By Viorica Vladica
Patients awaiting treatment at the new mobile eye hospital.
One person is getting a diagnosis, another is being examined, a third is being operated on and three others await their turn while a team of doctors rush into tiny rooms. It might be a common scene in a regular hospital.
But not on a truck. And not in the backyard of an apartment building. And not in Ashtarak, Armenia.
Not until three weeks ago might such a sight be imagined in such a place. But the Armenian Eye Care Project (www.eyecareproject.com) is about vision. And this is the realization of such foresight.
On July 7 the Mobile Eye Hospital of the AECP, a 48-foot tractor-trailer truck equipped with fully sterile and self-powered operating and examination rooms, made its maiden voyage from its home base at Malayan Ophthalmic Center (Republican Eye Hospital) and anchored in Arshtarak. Working seven days a week for the next three weeks, ophthalmologists from America and their Armenian colleagues performed about 200 surgeries and laser treatments, screened some 5,000 patients and referred 500 to the rolling hospital. About 90 percent of the surgeries were done by local doctors.
The vehicle (including equipment) is believed to be the first of its kind in the world and was created at a cost of about $1 million. It arrived in Armenia last November. After months of final preparation and testing, the truck was readied and AECP founder Roger Ohanesian of California came to Armenia for its inaugural run. Doctors Richard Hill, from the University of California Irvine, and John Hovanesian, a partner in Ohanesian’s California clinic donated a week each of their surgical and training services.
Ohanesian founded AECP 11 years ago and, after twice-yearly visits for teaching and supplying updated equipment, the surgeon created the mobile hospital, realizing a dream to make 21st Century eye care available throughout all of Armenia.
The AECP initially came to Armenia to assist in surgeries that local doctors had little experience performing. Over the years they trained local doctors and took some to the United States for training. And, significantly, donors to the organization provided more than $5 million in equipment, spent to upgrade hospitals in Yerevan, Gyumri and Stepanakert.
“We soon realized that every eye clinic in Armenia needed the same kind of attention we’d devoted to the Malayan Center, the main hospital in Yerevan,” Ohanesian said. “Of course it would be impractical, if not impossible to try to renovate hospitals in every region.
“So we decided that we could build one hospital for all regions, put it on wheels and take it to those who for whatever reasons could not come to us in Yerevan.”
Staff intend to take the hospital to every region of Armenia.
The project chose Ashtarak to launch its program, since the town is close to Yerevan and doctors could commute from the Malayan Center. Eventually, however, the hospital on wheels will be spending several weeks a year in each of the 11 regions of Armenia, plus Karabakh.
The initial phase of treatment is a series of screenings, in which doctors gather information and determine what treatment patients will require when the truck arrives in a certain place.
Part of the screening is also to learn if a patient’s social status corresponds with the “socially vulnerable” eligibility criteria established by the government. Those who meet that requirement are given free treatment, including surgery.
The Mobile Eye Hospital’s first mission found that most patients are the elderly, some of whom have never sought treatment either because they could not pay for it, or because many did not trust the health care system in Armenia.
But even the mobile hospital did not remove skepticism in some, as some would-be patients still do not trust doctors – a suspicion left over from Soviet times. Others are afraid of what doctors might say about their health.
But Nune Yeghiazaryan, AECP country director, says that eye care in Armenia is mostly hampered because people do not realize the importance of preventative-care examinations.
Heriknaz Mkrtchyan, 75, has never been to an eye doctor and only now, being examined by the staff of AECP, she discovered she has a cataract. Because her family was deported to Siberia under Stalin’s regime, Heriknaz is eligible to receive free treatment.
But even though she is aware that her eye surgery will be done by highly-skilled doctors, and for free, she says that her destiny is in God’s hands only.
Suren Aramyan, 72, who was also appointed for a surgery, found out about the hospital from his neighbors. Unlike Mkrtchyan, Suren believes that exceptionally trained doctors can make a difference and save his sight. He knew he was suffering from cataracts for more than four years but he never went to a doctor because he couldn’t afford an examination of $20-30 or a surgery of $100-200 on his pension of 6,000 drams ($10) a month.
Ohanesian says that Armenian doctors working for this project are extremely talented and well trained. He says the assumption that only Western doctors can do complex operations is not only a false impression, but is damaging to overall healthcare. If before such surgeries were impossible, it was because proper equipment and training didn’t exist. Now, they do.
Local doctors working with AECP can perform up to 12 surgeries a day on the mobile unit. They say that even though the work is exhausting, the activity creates energy far more intense than in a stationary clinic or hospital.
“We are getting very tired but the work we do is not complicated,” says Hovik Simonyan, one of the mobile eye hospital’s doctors. “Each doctor provides much more services here than in any other hospital, therefore we get better qualified.”
Dealing with an extensive load of work is also a great experience for residency students. Knar Sahakyan, a 24-year-old medical student, says it is very important for her to work side by side with knowledgeable physicians – a chance that she might never be granted within a simple hospital.
And, as the hospital travels throughout Armenia and Karabakh, doctors will have the possibility to carry out a very complex study of the incidence of eye diseases among the population of Armenia.
AECP drafted a questionnaire, which is filled out by people being screened and which includes questions about each patient’s health problems.
Ohanesian says that the situation of health care in villages is very poor and that many people turn blind because they do not treat problems in time. He adds that it is not easy to identify either what causes so many eye disorders in Armenia or why so many children suffer disease.
It is hoped that the work of the Mobile Eye Hospital will provide essential data currently lacking in Armenia. The government says it does not have the means to do nationwide canvassing, so AECP will share its information as a service to the government.
While free surgeries are only for the indigent, all applicants are eligible for other services, including screening and diagnosis, which should help in providing thorough research.
After three weeks in Armenia, Ohanesian said that if subsequent missions are as successful as Ashtarak, the Mobile Eye Hospital will have serviced the whole country in about three years.