FROM YEREVAN TO YALE

The Armenian General Benevolent Union is moving full speed ahead with its Plastic and Reconstructive Surgery Center (PRSC) in Yerevan, Armenia. In fact, the vanguards of the Center's Armenian medical staff are well into their yearlong training program at the Yale University School of Medicine in New Haven, Connecticut. Technical preparations for the multi-million dollar Center - including the purchase by the AGBU of equipment and surgical instruments - are also moving just as fast thanks to the untiring efforts of PRSC Project Director, Regina Ohanyan and volunteer Chairman, Zaven Dadekian. At Yale, the group of surgeons, anesthesiologists and nurses from Armenia are developing newly acquired cognitive skills together with medical surgical practices. One of the most rewarding developments has been their growth in professional relationships through integration of the team approach. It is hoped that this growth will serve them and their patients well in the Plastic and Reconstructive Surgery Center the AGBU is establishing at the All-Union Scientific Surgical Center in Yerevan and that it will inspire interest amongst their colleagues. The two surgeons, two anesthesiologists and seven nurses from Yerevan will complete their intensive training at Yale in September, under the supervision of renowned plastic surgeon Dr. Stephan Ariyan. The AGBU has not only taken it upon itself to provide the training of the surgical team and equip and set up the state of the art Center in Yerevan, it is also meeting all the costs of the Armenian medical trainees now at Yale. These costs include food, housing, transportation, health insurance, emergency medical and dental expenses, books and other educational materials and supplies. Thanks to Dr. Ariyan's efforts, some prerequisites have been waived and the Armenian surgeons are following the same residency program as that of American doctors. Dr. Ariyan cleared the surgeons and anesthesiologists with the Educational Commission for Foreign Medical Graduates (ECFMG), thus paving the way for the Armenian doctors to get the same kind of hands-on training as any graduate of an accredited medical institution. "They are doing regular residency programs - just like American doctors - They are lucky, because there are people in this country who would cut off their arm to get what they have now." Since their arrival at Yale, the two surgeons on the training team have each performed and assisted with over 100 surgical procedures. These include hand surgery, wide excision of melanomas with flap, debridement and skin grafts for burns, repair of cleft lip and palate and other congenital deformities, reconstructive surgery involving tendons, peripheral nerves and free flaps, surgery for facial fractures and emergency surgeries such as replantation of fingers and other extremity parts. As for the two anesthesiologists, the training has been as intense - or even more. They have each performed and assisted with over 300 procedures including general, spinal and epidural anesthesia. In short, the training the Armenian medical team is receiving is as diverse as the various branches of surgery at Yale. Like their American "colleagues" at the hospital, the Armenian surgeons and nurses are actually treating patients. Assisting Dr. Ariyan in the training program at Yale are Dr. Paul Barash, Professor, Chairman and Chief, Anesthesiology; Karen Camp, Clinical Director of Surgical Nursing; and Jeffrey Heinrich, Coordinator of the training program for visiting medical personnel at Yale. Once operational- now scheduled for sometime toward the end of 1991 - the Plastic and Reconstructive Surgery Center will not only fill a major medical vacuum in Armenia, but also possibly constitute the cornerstone for a much larger and ambitious program which will have the potential of developing into a modern medical institution that in time can attract patients not only from Armenia, but other parts of the Soviet Union and neighboring countries. The AGBU plans to sponsor American professors to go to Armenia in the coming years to train more Armenian doctors and nurses at its Plastic and Reconstructive Surgery center in Yerevan. "The potential exists - If we were to build an American unit - an American hospital in Armenia, we could attract patients from many other places outside Armenia," Dr. Ariyan said in a recent interview. Dr. Ariyan, who first came to see the need for such a medical unit during his visits to Armenia after the Dec. 1988 earthquake, said the Armenian trainees at Yale were making very good progress and upon completion of their year long stay will be fully equipped for the task ahead. "Dramatic is the difference of what they were capable of doing then, and what they are capable of doing now ," Dr. Ariyan said. "When they first came here, the nurses had not even changed simple wounds. Here we are training them to be part of a team - They change dressings, read Electro-cardiograms - They are, in fact, training to be the right hands of the doctors in and out of the operating room," Dr. Ariyan said. Living in apartments a few blocks away from the Yale New Haven Hospital, the trainees are up and around on their rounds or scrubbing for surgery at daybreak, five and sometimes six - days a week. "We work very closely with each other - When Dr. Gagig (Stamboltsyan) operates on a patient, one of us is the attending nurse in the operating room. Another one of us could be in the intensive care unit while a third could be helping the floor supervisor. It's a totally new experience," said Pooj Kouyr (nurse) Gayane Militonian. At the end of a "usually ten-hour day" the trainees return to their apartments where "the only topics of discussion are either the situation in Armenia or which patient is how or what kind of a work day we had at the hospital," she said. Homesick, yes, but the very experience of the learning process at Yale is enough to keep their perspectives in place. "What these young people are learning here is not how to fix noses. Plastic and Recon Reconstructive Surgery is not aesthetic surgery and these doctors and nurses are not going back to Armenia to improve the looks of movie stars - They will be more involved with microsurgery, reconstructive surgery, and the treatment of facial fractures, open wounds, congenital abnormalities and even some forms of cancer," Dr. Ariyan said. "If there is such a term as 1000 percent, then that has been the level of progress in as far as the nurses are concerned.. . They have come to see a whole new world which they had not seen before," Dr. Ariyan said. "The doctors have also made tremendous progress ... More than technique, we are trying to teach them concepts. I am happy with their progress," Dr. Ariyan said.