Tuberculosis in Armenia
Tuberculosis Dispensary, Abovian, Kotayk Region, Republic of Armenia © Onnik Krikorian / Oneworld Multimedia 2006
When Nessuna over at di cavoli di re mentioned that she was going to be visiting some children at the Tuberculosis Dispensary in Abovian and asked if I would like to accompany her, I jumped at the chance to see inside the country’s main treatment center for the disease. I’m hoping that Nessuna will blog about her visit later, and when she does, I’ll change this post and quote from her, but until then, just to say that the problem of tuberculosis in Armenia is a real one.
The disease is pretty much linked to living conditions and poverty although it is believed that many more people carry the disease in a passive form.
Tuberculosis is one of the most deadly and common major infectious diseases today. As of 2004, 14.6 million people have active TB disease with nine million new cases of the disease and nearly two million deaths, [1] mostly in developing countries. However, developed countries are not spared the burden of tuberculosis. There is a rising number of people in the developed world who contract tuberculosis because they have compromised immune systems, typically as a result of immunosupressive drugs or HIV/AIDS. These people are at particular risk of tuberculosis infection and active tuberculosis disease.
Most of those infected (90%) have asymptomatic latent TB infection (LTBI). There is a 10% lifetime chance that LTBI will progress to TB disease which, if left untreated, will kill more than 50% of its victims. TB is one of the top four infectious killing diseases in the world: TB kills 1.7 million, and malaria kills 2-3 million.
HIV/AIDS, the neglect of TB control programs, and immigration have caused a resurgence of tuberculosis. Multiple drug resistant strains of TB (MDR-TB) and Extreme Drug-Resistance in Tuberculosis (XDR-TB) are emerging. The World Health Organization declared TB a global health emergency in 1993, and the Stop TB Partnership proposed a Global Plan to Stop Tuberculosis which aims to save an additional 14 million lives between 2006 and 2015.
Unfortunately, nobody knows how many people fall victim to tuberculosis in Armenia, but there are very definite concerns, and not not least with regards to Multi Drug Resistant (MDR) TB. The French Wing of Medecins Sans Frontieres have responded to these fears by launching a programme to tackle the problem of MDR TB in Abovian and Yerevan since 2005.
MSF will also rehabilitate and re-equip special laboratories and ambulatory rooms in polyclinics situated in the Malatia-Sebastia ( Bangladesh ) and Shengavit districts of Yerevan as well as diagnostic departments in two tuberculosis dispensaries. A special department for the treatment of MDR Tuberculosis will be established jointly with the Ministry of Health in the Republican Tuberculosis Dispensary situated in Abovian.
Additionally, during this new four year programme that is scheduled to run until 2008, MSF will provide specialized training for medical personal. After construction and rehabilitation work is complete, MSF anticipates treating the first patients in February or March next year. Social and psychological support for patients and their families will also be provided as part of the programme.
According to the Ministry of Health there are 6,000 cases of Tuberculosis in Armenia but the actual number is thought to be much higher. As a result, Christian Ferrier, the current Head of Mission for MSF (France) says that a survey will also be conducted during 2005 to form a clearer picture of the problem.
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“In resource-poor countries like Armenia it is impossible to cure people infected with multi-resistant tuberculosis. That is why we have decided to embark on the implementation of this program,” Ferrier told journalists present at the press conference.
Ishkan, Kharberd, Ararat Region, Republic of Armenia © Onnik Krikorian / Oneworld Multimedia 2004
Today’s visit wasn’t the first time I’ve encountered TB in Armenia and it probably won’t be the last. In 2004 I took Edik Baghdasarian, Editor-in-Chief of Hetq Online, to meet one sufferer in Kharberd, a village situated literally a few minutes outside of Yerevan. At that time, Ishkan wanted his identity kept secret and so Edik used a pseudonym, but doctors at the Abovian dispensary found out and apparently threatened him for telling Hetq that drugs that should be available free of charge, as dictated by the law, were instead being sold to patients.
If I buy medicine it will cost me 4,000 drams a day. Just figure out how much that comes to per year. How am I supposed to pay for it? I had a beat up old car; I sold it. I’m missing one lung, and I only have half of the other one left. What should I do? I just have to bear it for a few months and then die,” Aram said, hopelessly. He also told us about what really goes on at the Abovyan T.B. Hospital . Even there, Aram was unable to get the medicine that was supposed to be his free of charge. “They would sign the medicine out in my name and then sell it to me. If only they had the conscience to charge me 400 drams instead of 800.”
[…]
After receiving his treatment at the hospital, Aram ’s condition improved. To pay for it, Aram sold his old car, and his sister sold her two piglets. Now they have no more money, and no possibility for further treatment. “When I receive treatment I feel better. If I continue it will help, but how can I continue?” Aram Martirosyan asked.
Now, Ishkan’s anonymity is unimportant because he died from the disease soon afterwards. The same year I also took a visiting academic from the Diaspora, Asbed Kotchikian, and RFE/RL’s Emil Danielyan to a run-down hostel in the Erebuni District of the Armenian capital where we ran into another sufferer. Emil wrote a story on the woman and even managed to get her medical treatment.
A single woman facing starvation in a rundown residential complex in Yerevan has been diagnosed with tuberculosis and hospitalized by medical authorities after they were alerted by RFE/RL.
Zarik Hakobian, 44, is one of several hundred low-income residents of a former factory hostel in the city’s southern Erebuni district reduced to a slum dwelling after years of government neglect and indifference. She shares its damp and disease-prone ground floor with about a dozen families mired in extreme poverty.
They said last week they have long suspected that Hakobian, a white-haired skeletal woman who looks much older, is suffering from TB. Their fears were borne out by doctors from a local policlinic who visited and examined her several days later, following an instruction from the health care department of the Yerevan municipality.
The head of the policlinic, Marieta Andreasian, told RFE/RL that Hakobian was taken to a special tuberculosis clinic in Abovian, a town north of Yerevan, early on Monday. She said all of the woman’s neighbors, among them small children, will now be checked for symptoms of the potentially deadly disease which has spread dramatically in Armenia in recent years.
Andreasian confirmed that poor living conditions and a lack of sanitation were the main cause of the TB infection. “Tuberculosis is a social disease that results from poverty,†she said.
For reasons still unknown, Zarik Hakobian didn’t stay long at the Abovian Dispensary and was back at the hostel a few days later. She died less than a month after that.
Zarik Hakobian, Erebuni, Yerevan, Republic of Armenia © Onnik Krikorian / Oneworld Multimedia 2004
Still, to end on a brighter note, conditions at the Abovian TB Dispensary were not as bad as I was expecting and the children were being treated free of charge although parents were of course expected to supply food for their kids and to provide round the clock attention. However, this is unfortunately the norm for Armenia’s under-financed health sector.