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Poverty and access to health care in Armenia

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naira family.jpg

Sometimes I really hate my job. Having first been inspired some 27 years ago by the potential for photojournalism to effect change, the situation in regions such as the South Caucasus can instead be depressing. While there have been some successes such as managing to get the Armenian government to finally admit there was a homeless problem in Yerevan and to open a shelter, by and large the media is pretty impotent in countries such as this. So, when I had to today photograph 34-year old Naira Thomasian, a kidney dialysis patient living in poverty, for the World Health Organization (WHO) in Geneva, I was dreading the question she would of course end up asking.

That is, will this interview and photographs help to change her situation. Of course, I couldn't say that it would, only that I hoped so. A few years ago, statistics showed that just one in three Armenians sought medical care when they needed it thanks to a system of informal payments or a lack of resources at hospitals themselves, and I doubt the situation has changed much since. Thankfully, Naira mostly has free treatment, but what about some of the other problems she faces? Problems, for example, such as living in poverty, being unable to work, and there being insufficient funds in the State budget to provide adequate social welfare or assistance.

"I was first diagnosed 10 years ago and I didn’t know what to expect. I wasn’t working then as I was married and had my child to look after, but when I was diagnosed with this illness my husband left me. He didn’t understand or want to help. My son was just a baby and life has been hard ever since.
[...] by law they have to provide the medicines, but what happens if they don’t have them? It’s not their fault and they have the main medicines I need.
We don’t even have enough money for food so I don’t eat properly either, but what about the health of my mother and son? 
He’s 11 and she’s 71 and they never go for treatment because we can’t afford it. Nobody is working and the 16,000 AMD (about $43) we receive in social benefits on top of my mother’s pension is not enough to cover much more than renting these rooms.
Of course, they say they’re healthy, but my mother has constant headaches. She says has to look after me so can’t find the time to even think about looking after herself. We have no money for food and so she spends a lot of her time going out to find herbs to bring back to cook."
A local NGO working with dialysis patients helps Naira out with advice and support, but despite a huge amount of money on show in the form of flash cars and expensive restaurants or boutiques in the center of Yerevan, her situation is not unique. Indeed, UNDP recently warned that poverty looks set to increase this year now that the global economic crisis has hit Armenia. The Diaspora could help, but generally doesnt. There are exceptions, of course, but by and large many ethnic Armenians from abroad either don't want to see the reality faced by individuals such as Naira or simply won't because they stay only in close proximity to where the (usually) corrupt money is.
Not a good day for me at all. Quite depressing in fact, and made worse by Naira having had dialysis a few hours before I arrived. She was in pain and very weak, but still welcoming and accomodating to allow me to do my work. Humbled, here's hoping that increased attention from the international community will finally see issues such as poverty and access to medical care in Armenia resolved so that there won't be as much need for me to continue to enter into the lives of people such as Naira before walking away into a far different world 30 minutes later. I've been photographing poverty in Armenia for 9 years now. Isn't it time something changed so that I don't have to?
Photos: Naira Thomasian, Yerevan, Republic of Armenia © Onnik Krikorian for the World Health Organization (WHO) 2009 


Ani | May 22, 2009 8:09 PM | Reply

One of the greatest shames of the countries of the former Soviet Union are their treatment of the sick and disabled—really, of course, anyone “different” (such as minorities, another topic). Such people are considered “losers,” and thus the attitude “out of sight, out of mind” is widespread, unless, of course, you are one yourself or have a relative or friend you must care for. And even then, as in Mrs. Thomasian’s case, the relative you had counted on simply walks out.

A few cases in point: On a visit to Moscow some time back, I was struck by the absence of anyone in a wheelchair, and also by the utter impossibility of getting anywhere in one. The Moscow underground is impenetrable for anyone with an ambulatory disability; the underground crossings for multilane streets are stairway only; very, very few buildings have any wheelchair access, and many are without elevators. As for other disabilities, a story from Russia Today documents a blind air passenger who was denied a seat simply for his blindness: http://www.russiatoday.com/Top_News/2009-04-29/Blind_air_passenger_sees_victory.html?fullstory

In Armenia last year, a report in Armenia Now documented that less than one percent of voting precincts were accessible to the disabled—I don’t know whether that has been improved for this year’s election, but somehow I think it’s doubtful: http://www.armenianow.com/?action=viewArticle&AID=2803

So without an electoral voice, and shuttered away, the sick and disabled are too often simply forgotten. Except perhaps when a journalist comes round and tries to make the invisible visible—and that’s a big thing, not a little one! Because when they are visible, then just perhaps some change is possible, but if they are invisible, nothing ever will change. Real change, though, comes with an attitudinal shift in society that sees “irregular” people as valuable commodities, not disposable ones. I’m not sure how that is to be achieved in the former Soviet states, but I wish that those who have the power and means will start working on it.

Nanul | May 22, 2009 9:57 PM | Reply

Thank you Onnik for covering this story. It just breaks my heart. It reminded me of my neighbor who was in in his mid-30s and had to drive to Yerevan from Vanadzor every other day to get his dialysis treatment. The disease, the poverty, the struggle to find money for the treatment, and the inaccessibility of the available care were just too much:-(

nazarian | May 28, 2009 5:18 PM | Reply

Ani, given the fact that there are a lot of war vets who are disabled because of the Karabakh war, it is shameful that they are shunned, and there ae very few accomodations available to them.

I just don't know how the situation for H.C. can be fixed. Health care requires resources and Armenia simply does not have them. The Cuban experience is probably the best model to adapt for resource-poor societies like Armenia - it's not the best health care but it's the best health care for the amount of money spent. Instead, after the independence they tried to adopt the American health care model; the worst model on the face of this Earth. They hoped to stamp out corruption by privately delivered care but it has not worked

It seems like whatever issues I see in the country, the root cause is corruption.

Onnik Krikorian | July 28, 2009 7:54 AM | Reply

The article for the World Health Organization has been published in its bulleting this month:

Armenians struggle for health care and medicines

Private financing constitutes about half of total health expenditures in Armenia and most of that comes directly out of the consumer’s pocket. In the current economic downturn, fewer and fewer people can afford it. Monika Mkhitaryan and Onnik Krikorian report.

In the Communist era, Armenia enjoyed one of the best health-care systems of all the Soviet republics, delivering comprehensive care on a centralized basis. Since then the system has fragmented along partially free-market lines and is today failing the majority of the people it is supposed to serve. Skewed towards expensive hospital interventions that swallow up more than 50% of the national health budget, the Armenian health system falters at the local community level and is often totally absent from rural areas.


Liana | July 28, 2009 8:08 AM | Reply

Great article and photos - this is the type of stuff the diaspora needs to see - thank you for this!

What do you think?