For the wounded soldiers of the Artsakh War, the battleground has shifted to recovery and rehabilitation
By Araks Kasyan and Gevorg Mnatsakanyan
On Nov. 9, Armenia signed a ceasefire agreement brokered by Russia that brought an end to 44 days of all-out war with Azerbaijan over the autonomous region of Nagorno-Karabakh. The fighting left more than 5,000 dead and many more with complex multiple injuries that require sustained post-operative rehabilitation care.
For Hayk Hayrape-tyan, 20, and the thousands of 18-to-20-year-old conscripts like him fighting in Artsakh (the Armenian name for Nagorno-Karabakh), the ceasefire agreement signaled a stop to their struggle on the battlefield. The one for their health is only just beginning.
Between Life and Death
An infantry combat vehicle commander who took missile shrapnel to the head just hours before the warring stopped, Hayk was rushed from Artsakh to the National Oncology Center in Yerevan for a six-hour surgery that saved his life, but not his ability to walk, which remained compromised.
That job has since fallen on the experts of the Homeland Defender’s Rehabilitation Center, who visited Hayk in what the center’s chief physician Lusine Poghosyan calls “the golden hour” of post-op care to assess his condition and plan his rehab. “I’m proud to say that we were the only ones to do this both during and after the war,” she says.
Because we’re the only hospital in Yerevan to have a helipad, we got the worst cases, both physically and mentally. And while we saved most of them, for some, it was just too late.
Established in 2018 under the joint auspices of Support Wounded Soldiers—a non-governmental entity—Yerevan State Medical University and the Ministry of Defense, the center represents the pinnacle of NGO head Haykuhi Minasyan’s seven-year effort to restore justice to the thousands of army disabled that she felt were neglected by the state. “I couldn’t bear it. Something needed to be done.”
One of six centers available to veterans for rehab in Armenia, Homeland Defender’s accommodates all injured in the line of duty free of charge—“a basic principle here at HD,” says Minasyan, who also heads the center. Instead, their expenses are picked up by the Ministry of Defense and a small contingency of charitable foundations and individual donors, who also finance the purchase of the center’s high-end equipment.
The rest of the money comes from profits generated from treating civilians, including those from abroad, who pay out-of-pocket and account for less than 10% of patients to guarantee access to the army wounded. “Our first priority are our soldiers,” explains Minasyan.
Recently, Minasyan secured additional funding from the Ministry of Health to cover treatment costs under a state assistance program beginning 2021 and alleviate the financial burden shouldered by the center’s benefactors.
Admitted to Homeland Defender’s last December after a brief struggle with Covid-19, Hayk has already restored some mobility in his arm, also impacted by the injury, and is working hard towards his first step outside a wheelchair.
His mother, Anna, who thanks God every day that her son is back home alive, has every confidence in the center’s experts. “We’d heard a lot of good things about this place, how many had come here with no hope and left walking on their own two feet,” she says. But for Hayk, the outcome was far less certain. “When I first got here, I was very depressed,” he says.
Because Homeland Defender’s takes in the most severe cases, close to 90 percent of its patients—most of them no more than 20 years old—are bound to some form of disability, says chief physician Poghosyan, and “to have your life turned upside down like that at such a young age is psychologically taxing.”
Hayk, who’s now been through more therapies than he can remember, credits the center staff and their caring attitude for lifting his flagging spirits and helping him adapt to his new environment. “And then there are my fellow servicemen, some of whom are also being treated here and who have made socializing all the more easier,” he says.
Group interactions among veterans of past and present wars over Nagorno-Karabakh, including those from the 1990s, are an integral part of the healing process, explains Poghosyan, “because they push the boys to draw inspiration from one another and believe in a life beyond their disability,” she says, adding: “The important thing is never to pity them, but rather help them become independent again. You don’t pity heroes. Instead, you respect and honor them.”
Though he has yet to walk again, Hayk’s dreams for the future remain unabated. A law student in his hometown Ijevan, his long-held wish is to become an actor, even as he learns to play the guitar again and has begun taking German classes—all courtesy of the volunteer staff engaged in the framework of the One Window initiative.
A social assistance program for the army disabled and their families set up by Support Wounded Soldiers, the initiative involves social workers from legal, medical and other relevant backgrounds to help assess its beneficiaries’ needs and provide solutions by engaging the state.
With more than 3,000 applicants serviced since its inception in 2014, One Window also assists soldiers in choosing a career that is mindful of their preferences and physical limitations, since “rehab is as much about social and professional rehab as it is about physical rehab,” says Poghosyan.
Director Minasyan is now in talks with the Ministry of Labor and Social Affairs to secure state sponsorship of the initiative, which still relies on the financial support of charities like My Step Foundation and others to function. “We also want to help formulate a more systemic approach to state provision of social services to the wounded in service,” adds Minasyan.
Brothers in Arms
Yerjanik Stepanyan, 19, is also among the 200 or so homeland defenders currently receiving treatment at the Homeland Defender’s center. A missile explosion on the southern front where he was stationed —now in Azerbaijani hands—had sent him flying in the air and fractured both his arms.
Transferred to Erebuni Medical Center in Yerevan after a first short stay in Stepan-akert, Yerjanik (whose name translates to joyous in Armenian) underwent multiple complex surgeries to repair his broken arms and save them from certain amputation. He was one of the lucky ones.
Hasmik Saiyan, deputy director of therapy and head of the Department of Emergency Medicine at the hospital, remembers with tears how they fought tooth and nail for every one of the hundreds of wounded soldiers rushed through their emergency doors at the height of the war. “Because we’re the only hospital in Yerevan to have a helipad, we got the worst cases, both physically and mentally. And while we saved most of them, for some, it was just too late.”
A few days into his recovery, strengthened by the support of his family, Yerjanik learned (accidentally) of Home-land Defender’s, where he was told he could restore his arms to their former mobility to practice his passion—photography. Little did he know of the chance encounter that awaited him there the third time round.
Just days into his stay at the center after his discharge from Erebuni, Yerjanik feels “at home here,” he says. And with good cause. Artyom Arevikyan, 19, an arts student at Yerevan State and Yerjanik’s closest army buddy, is also being treated there. “First we shared a trench together, then it was a hospital ward, now it’s rehab,” tells Yerjanik.
Whereas in 2016 we mainly delt with gunshot wounds, with some instances of blast injuries, these were nothing like the multiple traumas our boys suffered at the hands of drones and missiles in this new war of the machines. It was horrible.
The boys became overnight media sensations after a photo of Artyom feeding Yerjanik from his bedside as Yerjanik lay with his arms still in bandages spread on social media in Armenia. “The photo was meant as a keepsake of our journey together. We didn’t expect it to become so popular,” say the boys, both smiling.
Like Yerjanik, Artyom too suffered a blast injury, this time missile shrapnel to the wrist—the norm in this latest round of fighting over Artsakh, says chief physician Poghosyan. “Whereas in 2016 we mainly delt with gunshot wounds, with some instances of blast injuries, these were nothing like the multiple traumas our boys suffered at the hands of drones and missiles in this new war of the machines. It was horrible,” she says.
Though still unable to make full use of his wrist, Artyom, who preceded his friend at the center, often helps him wheel himself to one of his electrotherapy sessions or some other of the 63 therapies offered at Homeland Defender’s. This even as he too must attend daily acupuncture sessions with the center’s chief reflexotherapist Hasmik Davtyan.
With more than three years of experience working with rehab patients to her name, Davtyan explains that her practice involves targeting the body’s meridian points found in traditional Chinese medicine to heal damaged tissues and restore their functionality. “Rather than eliminate the symptom, acupuncture fixes the source of the problem for longer-lasting results,” she says.
Administered as part of a complex mix of rehab therapies that incorporates physiotherapy and psychotherapy with electrotherapy and others, Davtyan applies acupuncture to treat everything from neurosis and PTSD to phantom pains—by far the most common affliction to haunt amputee patients.
“And it’s not just the pain,” she says. “It’s also the itching that can’t be stopped for example and causes patients great mental stress. It’s a terrible feeling. With acupuncture, we provide a treatment that’s 99 percent efficient.”
Artyom, who plans to pursue his art studies upon his recovery to help develop tourism in his hometown Panik in Armenia’s Shirak region, attests to the success of Davtyan’s methods. “I can already feel the pain subsiding in my wrist,” he says.
Beyond their application to physical trauma, Davtyan uses her needles to mitigate the secondary effects of Covid-19 like respiratory depression, muscle pains and weakened immunity, and helps “restore the energetic disbalance of organ systems as it is taught in traditional Eastern medicine to improve mental health.”
Homeland Defender’s leadership says none of its patients contracted the virus since its outbreak in Armenia last Spring thanks to the center’s strict adherence to the government’s anti-Covid measures, including wearing masks and maintaining social distance when possible.
After a 180 million Armenian dram ($375,000) donation from My Step Foundation, the charity helped Homeland Defender’s start doubling its capacity from 300 to 600 among many more improvements two years ago. Minasyan now has her eyes on the center’s own prosthesis lab, with a veterans hospital not far behind. An HD branch in Stepanakert is also in the making and will be ready in three months despite the setback from Azerbaijani shelling of the military hospital where the new affiliate is set to operate.
The prosthesis lab, meant to be the first of its kind in Armenia according to Minasyan, will group ORs with prosthesis fitting rooms into an all-in-one center for war amputees “to avoid repeated surgeries and the need to look for quality prostheses abroad,”explains Minasyan. The lab’s prosthetics program will also help train the next generation of Armenian specialists “to fill in the gaps in the field” through exchange programs in Europe and elsewhere.
The project is financed by Vereniging Armeniëfonds Nederland, Hayastan All Armenia Fund’s partner in the Netherlands and the Armenian community therein the framework of the fund’s We Are Our Borders global fundraiser.
Pending its completion, Homeland Defender’s has partnered with My Step deputy Narek Mkrtchyan to acquire top-of-the-line hand prostheses from industry leaders like Össur in Iceland and German company Ottobock that will “give new hope” to 15 amputees of the war, says Mkrtchyan.
Launched in January with the help of the relevant ministries and hospitals in Yerevan, the initiative received its first $100,000 chip in from All Armenian Fund and U.S.-Armenian rockstar Serj Tankian, with the fund promising more depending on how much of the $1m needed is raised through online fundraisers.
“The project also has a training component that involves bringing specialists from Iceland and the Netherlands to Armenia, training Armenian experts abroad, and so on,” said Mkrtchyan in a Dec. 18 Facebook post announcing the initiative.
Keeping up with the times, the government has announced plans to provide top-tier prostheses to the war wounded in an effort to “improve the lives of those who risked their health or acquired disability in defense of the homeland by setting up a new culture of service provision that better suits their needs”—this even as it refuses to divulge how many suffered amputation in the war.
At the end of last year, the National Assembly also bumped up compensation rates paid out by employees to the Insurance Foundation for Servicemen from 1,000 Armenian drams (two dollars) to anywhere between 1,500 and 15,000 AMD ($3-$31) depending on their income. Company payments too will be contingent upon income rates and will oscillate between 18,000 and 180,000 drams ($37-$375).
Established in 2017 at the suggestion of former Defense Minister Vigen Sargsyan, the foundation seeks the social welfare of troops injured and of the families of those killed in defense of Armenia through a monthly discharge of insurance compensations.
Calling the parliament’s decision to increase compensation rates “a move in the right direction,” Minasyan is quick to point out that pouring more money into the social and health problems of the army wounded doesn’t guarantee that they will be resolved. “It’s not like the government wasn’t already giving out enough help, it’s just that it’s not adequately dispensed.”
Pending these improvements to the system, Hayk and his buddies have their eyes set on one thing only—their rapid return to health. “It’s going to be fine,” he says. “We’re all going to be fine. For sure.”
Banner photo by Davit Hakobyan
Originally published in the March 2021 issue of AGBU Magazine.
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