RX For Armenia

RX for Armenia

Second opinions from Armenian medical and public health experts from around the world

Professor the Lord Darzi of Denham OM, KBE, PC

Professor the Lord Darzi of Denham OM, KBE, PC

Country: United Kingdom

Specialty: Robotic Surgery

Affiliations: Co-Director, Institute of Global Health Innovation (IGHI); Paul Hamlyn Chair of Surgery at Imperial College London, the Royal Marsden Hospital and the Institute of Cancer Research; and Honorary Consultant Surgeon at Imperial College Healthcare
NHS Trust. Recently elected President of the British Science Association from September 1, 2020. Member of the Advisory Board for the Foundation of Armenian Science and Technology (FAST) and Chair of the Selection Committee of the Aurora Humanitarian Prize.

Research led by Professor Darzi is directed towards achieving best practice through innovation in surgery and enhancing patient safety and the quality of health care. He has pioneered the advancement of minimal invasive surgery, and in the development and use of allied technologies, including surgical robots and image-guided surgery, which have been instrumental in the safe and systematic introduction of both advanced robotic and laparoscopic surgery in the UK. His contribution within these research fields has resulted in the publication of over 1250 peer-reviewed research papers to date.

My philosophy of health has always been rooted in the belief that the health of a nation is the driver of the wealth of a nation, which is why health must be central to any governmental decision about the national well-being.

In recognition of his achievements in the research and development of surgical technologies, Professor Darzi has been elected as an Honorary Fellow of the Royal Academy of Engineering; a Fellow of the Academy of Medical Sciences; and, in 2013, was elected as a Fellow of the Royal Society.

He was knighted for his services in medicine and surgery in 2002. In 2007, he was introduced to the United Kingdom’s House of Lords as Professor the Lord Darzi of Denham and appointed Parliamentary Under-Secretary of State at the Department of Health during which he led the National ‘High Quality Care for All’ review (2008). The report identified what the UK National Health Service (NHS) could do to improve the prevention of ill health in partnership with other authorities and agencies. It focused on quality, which was defined as safe, effective and efficient care.

In 2018, the final report of the Lord Darzi Review of Health and Care was published outlining a 10-point plan for the 2020s around funding and reform to secure the NHS and social care for the future. Upon relinquishing this
role within central government in 2009, Professor Darzi sat as the United Kingdom’s Global Ambassador for Health and Life Sciences until March 2013. During this appointment and beyond Professor Darzi has developed his status as a leading voice in the field of global health policy and innovation. Professor Darzi was appointed and remains a member of Her Majesty’s Most Honourable Privy Council since June 2009.

As a member of the Advisory Board for the Foundation for Armenian Science and Technology (FAST), Lord Darzi is committed to its mission of building an ecosystem of innovation to lead scientists, technologists, and innovators in Armenia and beyond to find success on the global stage. In addition to serving in an advisory capacity to the government of Armenia, including the President, Lord Darzi also participates in global health and health policy initiatives that include Armenia in their scope.

I know from first-hand exposure that every member of the team, up and down the chain of command, has an important role to play in delivering the best possible healthcare outcomes for patients.

Following the success of the first Global Health Policy Summit in 2012, he was involved in the establishment of the World Innovation Summit in Health (WISH) in 2013 (and subsequent summits in 2015, 2016, 2018), organized by the Qatar Foundation, and for which he is the Executive Chair—the latest WISH Summit which took place virtually in November 2020. These have brought together a network of the world’s most influential health policy makers to analyse, debate and form policy on major global health issues.

There are several core recommendations I would put forward to any country seeking to enhance the quality and safety of its healthcare system. The first of these would be in investing in health, and not just health care. By that I mean, not just paying for hospitals and key equipment, but rather, addressing whole disease pathways where we look to pre-empt, delay or mitigate the disease—months, years or even decades in advance.

Obesity is a pressing example and can be viewed as a ‘pandemic’ in its own right, only we don’t call it a pandemic. It needs to be addressed early in schools, educating students and families about the importance of nutrition with a view to preventing diseases in later life such as diabetes and cardiovascular disease.

Economic policies aimed at reducing the consumption of sugary drinks, as well as nutritional support programs in communities and secondary care management protocols should also be implemented, calling on people to embrace a healthier lifestyle and to lose weight where necessary. We have seen in the current pandemic how being obese or overweight increases the risk of serious illness or death and of needing hospital admission or intensive care with a weakened immune system. Furthermore, a vaccine against coronavirus could be less effective in obese patients.

Another factor is that in the 21st century, there needs a shift to a sustainable use of technology—for example, in the application of telemedicine and novel digital tools, embracing their use in new models of delivery of healthcare. Armenia faces similar challenges to other lower- and middle-income countries, however through partnerships for example, with the FAST foundation there is scope to look at new disruptive technologies such as Artificial Intelligence, and its role in healthcare delivery to accelerate development of the healthcare system.

Armenia’s health system also needs to be simplified to a handful of responsible and well-governed bodies to allow both effective and efficient management.

My philosophy of health has always been rooted in the belief that the health of a nation is the driver of the wealth of a nation, which is why health must be central to any governmental decision about the national well-being. Social care and medical care need to go hand-in-hand.

To fully revitalize Armenia’s healthcare industry, as championed by the respected Armenian physician Avedis Donabedian, quality must be a central tenet, and we should seek to maximise this at every point in the pathway of care of the patient, regardless of cost and affordability. Simply put, ensuring quality is integral into building an effective healthcare system.

Along with my friend and colleague Noubar Afeyan, I also believe it is time to champion health security, by which I mean that we consider health prevention at the centre of policy-making decisions and to support the delivery of initiatives within the community where more can be done in terms of educating the population on the value of prevention and early detection for longevity and wellness.

Armenia’s health system also needs to be simplified to a handful of responsible and well-governed bodies to allow both effective and efficient management. This will allow for a swift and agile response to the changing dynamics that accompany an arising health crisis or disaster-related event, the current COVID-19 pandemic being a compelling case in point. Bureaucracy in such instances can have serious consequences in health outcomes.

Next, is to invest in healthcare talent, from the most prominent doctor to the best nurses and hospital support staff. I have spent time as a hospital porter within St Mary’s Hospital in the UK in the past, and recently also volunteered to join frontline healthcare workers in treating COVID-19 patients in the intensive-care unit. I know from first-hand exposure that every member of the team, up and down the chain of command, has an important role to play in delivering the best possible healthcare outcomes for patients.

Finally, all these aforementioned points take time and resources for transformative and sustained change to occur and it is for the key decision and policy makers to implement a comprehensive strategy that accounts for a long-term funding settlement for health and care, which will provide confidence for the Armenian people to trust in their healthcare system and proactively seek the necessary care they and their families may require, when needed.

Armenia is already heading in the right direction to achieve this; the key is to build consensus. It is important to articulate the right vision and have significant amount of engagement with the relevant stakeholders. If you get in the buy-in of the stakeholders, and you have the right vision, then everything follows.

When people ask me why I continue to stay involved in the health and well being of Armenia, the answer is simple. I was born in Baghdad and went to medical school in Ireland, but I am descended from survivors of the Armenian Genocide and very proud to be Armenian.

Pablo Elmassian, MD

Pablo Elmassian, MD

Country: Argentina

Specialty: Infectious Diseases

Affiliations: Infectious Disease Specialist
at the “Stamboulian Servicios de Salud” Ambulatory Center Clinic, Travel Medicine Specialist, Face of #StamboulianTalks, Certificate in Travel Health (CTH), Scientific Team Coordinator for Travel Medicine Division at of FUNCEI (Fundación Centro de Estudios Infectólogos) Foundation for Infectious Disease Studies

Dr. Pablo Elmassian is best known for his infectious disease expertise on #StamboulianTalks and his fundraising efforts via ultramarathons in the mountains of Argentina. An infectious disease specialist at Stamboulian Servicios de Salud Ambulatory Center Clinic, primarily dedicated to prevention and treatment of infectious diseases and immunization, Dr. Elmassian has been an instrumental leader in the fight against COVID-19. With candid conversations on social media platforms discussing the projections and strategies of controlling the spread of the global pandemic, Dr. Elmassian has reached thousands around the world, informing them of the ins-and-outs of this daunting disease.

His passion for accessible medical information and knowledge of infectious diseases, however, had come into play prior to this pandemic. In 2005 he was invited by Dr. Daniel Stamboulian, founder and president of FIDEC Foundation (Fight-ing Infectious Diseases in Emerging Countries) to be the Medical Director of the Armenian branch of the Foundation (FIDEC Armenia). One of the first achievements of FIDEC Armenia was the reconstruction of a surgery unit, a neonatal intensive care unit and a Laboratory at the former First Yerevan Children Hospital. In conjunction with the National Immuni-zation Program, FIDEC Armenia collaborated in the 2007 Measles and Rubella elimination campaign. Since 2018, FIDEC Armenia partook in the HPV national immunization program, increasing awareness and ensuring Armenians received quality vaccinations. FIDEC Armenia also translated children’s books to Armenian, further emphasizing the importance of good hygiene habits at an early age. His recent projects include a program for women in Tavush providing free general medical check-ups, preventive screenings for breast and uterus cancer, covering the cost of treatment and surgeries if needed. Continuing to guarantee quality health care for Armenians in the long run, Dr. Elmassian was set to embark upon a 1000-kilometer ultra-marathon across Armenia in October 2020, “Moving Forward Children’s Health in Armenia” to raise funds for the construction of a surgical block and medical equipment for the pediatric neurosurgical department at Sourb Astvatsamayr Medical Center in Yerevan. The declaration of war, however, interrupted his travels, and after four days awaiting at Paris Airport, Dr. Stamboulian had to return to Argentina and postpone the fundraising campaign. 

I am particularly interested in improving the quality and accessibility of medical knowledge, not just for providers, but starting with children.

Following the collapse of the Soviet Union, Armenia introduced the Basic Benefit Package (BBP) for the socially vulnerable population. The budget funds Primary Health Care and emergency services for all Armenian citizens, with co-payments for some services and exemptions or reduced co-payments for low-income citizens. In some cases, patient services are provided for free. While some citizens receive free healthcare coverage under the BBP, the majority does not. This inequity is an area of concern, because the average Armenian income is not adequate to cover medical costs.

To remedy this imbalance, the government needs to increase health spending in order to achieve Universal Health Coverage, improve financial protection and deal with demographic, epidemiological, nutritional, and technological growths and transitions.

I am particularly interested in improving the quality and accessibility of medical knowledge, not just for providers, but starting with children. My team translated materials for children in the format of healthy lifestyle books focused on the importance of receiving vaccines and taking care of their health, narrated to them by a cartoon character named MICROBAC. We distributed these books in addition to working with schools to teach children 5 to 11 years old about the importance of a healthy lifestyle. Now we’re preparing a pilot project to implement a program for people in Shirak Marz to increase general medical evaluations and create a preventive consciousness for the main causes of death in Armenia (cardiovascular diseases, diabetes, and cancer) and free access to medical studies and treatment.

Medical aid to Armenia can begin with anyone. If you are a teenager, you can visit Armenia through exchange programs. If you are an entrepreneur and invest in Armenia, you can collaborate to improve public health like Eduardo Eurnekian from Argentina, developing business and jobs for the community. In this way, he continually creates career opportunities and methods to cover healthcare expenses.

We have many ways to connect with Armenia culturally and virtually. My first trip to the homeland was during the commemoration of the 90th anniversary of the Armenian Genocide. Since then, I have genuinely connected with my Armenian identity and strive to implement long-term healthcare initiatives in Armenia. I was born in Uruguay and I live in Argentina, but I am Armenian. My mantra is that I should collaborate with Armenia, in my position as a medical doctor, to help my fellow Armenians however I can.

After the recent armed conflict, women, men and children fled the violence for safety, leaving their homes and possessions behind, but carrying with them preexisting health conditions: the threat of COVID-19 and the fear of an uncertain future. There is an immediate need for mental health support, particularly for children who have experienced extensive violence. That´s why today, more than ever, let us continue collaborating with the Ministry of Health in its efforts to assist our soldiers and displaced people who are suffering the tremendous consequences of the war.

Shant Shekherdimian, MD, MPH

Shant Shekherdimian, MD, MPH

Country: United States

Specialty: Pediatric Surgery

Affiliations: Ronald Reagan UCLA Medical Center; UCLA Mattel Children’s Hospital, UCLA Medical Center, Santa Monica; The Promise Armenian Institute at UCLA; Member, Armenian Medical International Committee (AMIC); Fulbright Award Recipient

Among the most enterprising of second wave trailblazers in Armenia, Dr. Shant Shekherdimian was first called to his ancestral homeland as a native Californian high school student on a youth discovery tour. Never suspecting that this seminal trip would begin a journey of a lifetime, both professionally and personally, he has made regular return visits since 1997, not only deepening his understanding of the Armenian people and culture, but also their attitudes and values around health care and the resources available to them.  While his medical specialty is pediatric surgery, his Masters in Public Health affords him a 50,000 ft. perspective of Armenia’s healthcare dynamics. This also allows him to contribute to wide-ranging health-related endeavors, either through self-funded initiatives or foundation grants and international partnerships.

Through building meaningful relationships with his in-country counterparts, Dr. Shekherdimian has conducted numerous original research projects, designed medical education programs and served as a consultant and advisor to the Armenia Ministry of Health, including coordinating global efforts to support Armenia through the COVID-19 pandemic. Among his many research studies, an assessment of the healthcare infrastructure in both Armenia and Artsakh yielded benchmark findings and insights published in the British Medical Journal. A recent game-changing effort was sparing children with cancer the trauma and pain of inserting and removing IV sticks for chemotherapy or nutrition by receiving treatment with long-term, IV-type accesses instead.

The ever-inspired healer offered his thoughts for improving the state of health care in Armenia, a place he calls a home away from home, with his local professional peers and patients as his “second family.”

Healthcare reform is an extremely complex sphere for which there is no magic pill, but there are a few major pillars on which successful healthcare systems rely upon.

Obviously, any healthcare system needs to be financed. That puts Armenia at an immediate disadvantage because the national or public healthcare spending in Armenia ranks among the lowest in the world at around 1.6 percent of its GDP. Most experts believe that at least six to seven percent should be spent on public health care.

By realigning national priorities and reassessing realities, Armenia, with the help of the Diaspora, can achieve sustainable quality care.

Because of this underfunding, Armenia’s catastrophic healthcare expenditures or out-of-pocket spending is one of the highest worldwide. The World Bank calculates that 80 percent is out of pocket, which is just not sustainable for a Middle Income Country with high levels of poverty like Armenia. It would be worthwhile to examine current governmental spending to look for areas amenable to re-allocation of resources to increase healthcare spending. Say you have two countries that spend the same, everything else is equal. But one country has 30 percent public spending and 70 percent private spending whereas the other splits public and private at 50 percent each. Prior studies have demonstrated that as the proportion of public health-related expenditures increases, better health outcomes are achieved.

Another pillar is human resources. Armenia’s medical education system is in need of dynamic reform. We not only need high quality doctors but also nurses, therapists, administrators, and all levels across the chain of care. And the irony is, however, that unlike other Low to Middle Income Countries, where there is actually a shortage of doctors and hospitals, nations that inherited the former Soviet healthcare system tend to have a surplus of providers, particularly in urban areas.

Which leads to the third pillar of infrastructure, where there are issues with maldistribution. In Armenia, there is a surplus of hospitals in the capital city, while many “marz”es have limited infrastructure capacity. Optimization of the infrastructure has not been achieved. Quality of care, rather than quantity of care is what determines positive patient experiences and outcomes.

It may be difficult to fathom but studies show that the most preventable deaths in Armenia are the result of poor quality of care. The infrastructure is there, it just needs to be used properly.

 And that leads to the last pillar, which is policy. In Armenia, healthcare policies, are, in my view, underdeveloped. There was a study that assessed the healthcare policies of 41 European and former Soviet countries, and Armenia was third from the bottom with regards to basic public policy that pertain to, for example, use of car seats for children and tobacco control. So government legislation is part of the equation.

 Another important factor that is peculiar to Armenia is Diaspora engagement. We have this huge resource outside of Armenia that, again, has not been optimally used. We were off to a good start post-independence because the health needs of the country were primarily humanitarian in scope. We really delivered well, but the healthcare system has matured and we no longer need emergency shipments of medications or dialysis machines to the same degree.

Holding an event to raise money to send a container of meds or rebuild a hospital will not deliver the sustainable improvements that the Armenian people deserve. I know the Diaspora has the best of intentions, but those of us in the field can do a better job of educating the organizations and individuals that Armenia’s health-care landscape is very different from 25 years ago, when Armenia and Artskah were literally on life support. The good news is this: By realigning national priorities and reassessing realities, Armenia, with the help of the Diaspora, can achieve sustainable quality care.

Jean-Michel Ekherian, MD

Jean-Michel Ekherian, MD

Country: France

Specialty: Anesthesiology, Medical and Toxicological Resuscitation

Affiliations: Lariboisière-Fernand-Widal Hospital, Paris; President of the HAY-MED organization and Medical Advisor to Armenia Fund France

When the December 1988 earthquake devastated the then-soviet city of Gyumri (formerly Spitak) Armenia, Dr. Jean-Michel Ekherian was eager to help. Thus began a long term engagement with his homeland—one that has branched out into many different channels in support of his quest to improve health outcomes for patients in both Armenia and Artsakh.  The recent war in defense of Artsakh has been no exception, bringing his many years of experience to bear on saving lives.

The Diaspora must provide support for health- care initiatives in Armenia but that also means taking a firm position against the far-reaching hand of corruption throughout the health system.

Over the years, he has been involved in multiple projects, particularly in the hospital sector, such as Hospital No. 1 in Gyumri, and the Erebuni and Djebrail hospitals in Yerevan to name but a few. He also taught professional staff and helped source and secure much needed clinical supplies.

Dr. Ekherian also helped implement two computer science classes and a five year grant program for needy students at the Gyumri Polytechnic School, in addition to organizing medical education programs in Artsakh—from intensive care, infectiology, and diabetology to anesthesia, urology, otorhinolaryngology, orthopedic surgery and plastic surgery. Alternatively, he has brought doctors in Armenia to France for further medical training at facilities like the Curie Institute for cancer research and treatment, one of the leading medical, biological and biophysical research centers in the world.

Dr. Ekherian also negotiates prices for vital equipment and medications for five dispensaries in Armenia, and a hospital in Artsakh. Other efforts on the technological side of health care include securing the delivery or repair of medical equipment and conducting three to four medical missions to the homeland along with arranging four shipments of equipment and medicines every year.  With so much exposure to the hospital environments in the two republics, Dr. Ekherian is quite clearheaded on the importance of cost efficiencies, which he proactively works to improve.

There are many important points to discuss to improve the Armenian healthcare system, but we should start with more training sessions for all doctors so as to standardize the knowledge, especially for general practitioners and infectious disease specialists. But another issue that weighs heavily upon the system is the corruption that has long permeated the medical community of Armenia. It could be the ordering of expensive and often unnecessary complementary tests during the course of diagnoses and treatment or purchasing costly medical equipment and supplies without proper transparency in the bidding and procurement of such items.

The Diaspora must provide support for healthcare initiatives in Armenia but that also means taking a firm position against the far-reaching hand of corruption throughout the health system. Though the current government of Armenia has an anti-corruption campaign that is moving in the right direction, the impact of corruption on its health sector is a well known but difficult problem to solve. That is why I have made it my business to negotiate prices or outright procure supplies and equipment on behalf of the hospitals and organizations with which I am involved. This was also the case during the COVID-19 pandemic. As medical advisor to the French branch of the Hayastan All Armenia Fund, which was responsible for contributing to the delivery of PPE to Armenia in addition to the vast contributions of the French national and local governments, I always take it upon myself to ensure that our non-profit organizations are spending wisely. After all, wasting money is not a luxury anyone can afford, when it comes to Armenia and Artsakh.

France may be the country where I reside, but my heart lives in the Armenian homeland. This is what has motivated me for over 30 years to keep coming back and sharing my knowledge and expertise with organizations and institutions working toward transformational change in the country.

Alina Dorian, PhD

Alina Dorian, PhD

Country: United States

Specialty: Community/Global Health; Health Systems Management

Affiliations: UCLA Fielding School of Public Health: Associate Dean for Public Health Practice; Associate Dean for Equity, Diversity & Inclusion; Associate Professor; Principal
of Rose and Alex Pilibos Armenian School

Growing up a proud Armenian in California, Dr. Alina Dorian always felt like she was fighting for a free and independent country. So, in 1991, when Armenia officially declared its independence, she was on one of the first flights out. 

By 1996, upon the invitation of Artsakh’s Ministry of Health, Dr. Dorian had relocated to Stepanakert to write the country’s first national health plan. Training students from Artsakh State University to conduct the first in-depth public health surveys throughout Artsakh and gathering data to inform decisions, her PhD from the Johns Hopkins Bloomberg School of Public Health culminated in her dissertation on healthcare utilization in Artsakh.

Over the past 25 years, Dr. Dorian has worked on a multitude of intersecting public health initiatives and education programs. A baptism by fire, working in Artsakh in the aftermath of the war helped shape her as a public health practitioner. From informing Artsakh’s national breastfeeding program to working on the construction of Stepanakert’s most prominent medical facilities—the Republican Hospital, the National Diagnostic Center, and the State Polyclinic—initiating sustainable change and championing capacity building have been the pillars of her professional career.  

Outside of Armenia, she has managed projects in Georgia (Javakhk), Eritrea, the Dominican Republic, and Macedonia, and led response teams in Kosovo, Haiti, and Peru. She sits on the Los Angeles County Public Health Commission and currently, as the lead PI representing UCLA in a joint effort with UC San Francisco, Dr. Dorian is implementing a virtual training academy for 15,000 COVID-19 contact tracers and case investigators in the state of California. Given the impact of the virus, her work has expanded to include outbreak management and school/worksite re-openings. Currently, she is working on adapting a national contact tracing training program for Armenia in collaboration with the American University of Armenia’s Turpanjian School of Public Health.

Professor, community organizer, and activist, Dr. Dorian urges us to consider the nuances when addressing public health in Armenia and Artsakh.

In order to build an Armenia with a healthy population, we need to define health. Public health is not just about disease or lack of infirmity, it is a holistic understanding of individual and community health in mind, body and spirit. It’s a different science than medicine. Medicine is one tool in public health’s arsenal. So when we think about improving healthcare systems in Armenia, we have to invest in understanding them in their historical and societal context. 

One of the issues we see globally in public health policy is that it is often dictated by clinicians, who sometimes generalize a whole community’s needs based on their field of practice; a surgeon prioritizes completely differently than a pediatrician does, than a public health practitioner does. Instead of the one patient on the operating table, it’s a region, a city, or a nation to consider.

Public health programming needs to be visionary but well informed of the present reality in order to be sustainable, focused on outcomes, not outputs.

Given Armenia’s resources, priority needs to go towards strengthening the foundations of health and the broader healthcare system. For example, emergency deliveries of supplies are important but they are, as we know, a temporary solution. Let’s work on establishing a pipeline. It’s more difficult to facilitate those changes when funding is coming from the outside, from a diaspora, but the priority needs to be the true needs of the country. Otherwise, the initiative is inappropriate and undermines the development of our country.

Wherever I work, I consider myself a tool that happens to know a little more about public health than the people I’m working with. But, the people in the country are the true experts in their needs and the viability of the most appropriate solutions. Public health programming needs to be visionary but informed to be sustainable, focused on outcomes, not outputs.

Acknowledging that the decisions made for Yerevan will be different from those made for Stepanakert is important. For instance, though the international status of Artsakh doesn’t immediately spring to mind for most when considering health, the psychosocial welfare of the population has always depended on it. As Artsakh recovers from the autumn war and people reckon with the devastating physical and psychological toll, recognition is more important than ever before as it dictates peace, security, and stability. Furthermore, if investment into the region is rife with difficulty and risk, healthcare infrastructure and community health will suffer.

Capacity building and workforce optimization should also be considered. Developing training to build a contact tracing workforce in Armenia that’s not just for COVID-19, is an example of optimization. For any outbreak, whether it’s a global pandemic or an increase of measles cases in a local community, contact tracing has been used historically and will continue to be crucial. So, the question should be: how are we building capacity through this program—through every program? If we invest in a learning management system in response to one emergency, can we repurpose it?

When faced with disaster, the first thing to do is to assess, not rush to provide aid and programming. Even when emergency responders arrive at a disaster site, the first thing they do is what they call a “hot lap.” They run around, even with victims in sight, and assess the situation in order to provide the most appropriate response. It’s the same with public health: you need to understand the totality of the system—the totality of the environment—to be able to empower. You can’t get to where you need to go, unless you know where you need to go.

For this, we need data, but not just the numbers, which on their own mean little. We need to also invest in qualitative research, the stories around the numbers, to understand context. When I began working in Artsakh, we really had no data. Health facilities were bombed purposefully. The data that survived, collected through the Soviet system, was based on quantity indicators without much qualitative meaning. Training students to conduct a population wide survey, with a thousand households interviewed in 1996, not only informed our perspective for drafting policy and programming, but empowered the students to consider the nature of the data necessary to make public health decisions in the future.

As I began my work in public health, I shied away from economics, politics and law, but quickly realized that everything about health is economics, politics and law. Health is a political concept. Disasters bring this truth to light—instantly exposing all the vulnerabilities in our systems, while providing opportunities to reassess. We must embrace those opportunities.

Originally published in the March 2021 ​issue of AGBU Magazine. end character

About the AGBU Magazine

AGBU Magazine is one of the most widely circulated English language Armenian magazines in the world, available in print and digital format. Each issue delivers insights and perspective on subjects and themes relating to the Armenian world, accompanied by original photography, exclusive high-profile interviews, fun facts and more.