Dr. Maria Azizian

Small Procedures Yield Major Results for Doctor on Pro Bono Mission in Armenia

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By Maria Azizian, M.D.

FALMOUTH, Mass. — As any physician can tell you, one of the best and most rewarding aspects of this profession is the ability to make a positive change in peoples’ lives by helping them with their health problems. As a general surgeon, I have always been interested in philanthropy. However, my imagination would usually paint a major life-saving or life-improving procedure, such as resection of intestinal cancer or repair of a large and complicated hernia. Several years ago two events happened that have shifted my view.

A friend of mine who lived far away told me of her child who has had a large dark mole on his face. The child was ostracized and teased. My friend was afraid of addressing it surgically, as she had felt it may be dangerous. She was conflicted between having the mole removed and possibly jeopardizing her child’s health by a possible complication from the procedure, and just letting it be, and thus extending the discomfort and teasing that the child had encountered on a daily basis.

Finally, at some point, her child underwent this procedure. I was very happy that my professional advice helped and she made the right choice for her child, which also boosted his self-confidence.

At the same time, I don’t believe that every skin lesion on the face or body needs to be removed. Many of them add character and become a person’s “beauty marks.” However, when the mole is unsightly to the patient or uncomfortable in any way, such as causing bleeding, itching, irritation, or pain, then its removal is much more justified.

The second event was a conversation with my colleague, a fellow general surgeon, who went on a humanitarian mission to Nepal. Like me, he had also thought that he would be performing major surgeries, but, ended up, removing skin tags, moles, soft tissue masses, such as lipomas and cysts.

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Surprisingly, he found this extremely rewarding. He wasn’t saving lives, but he became a mechanism for renewal and hope. It was extremely rewarding for him to have young women and men with large facial lesions, who now started regaining their confidence and getting ready to find a mate.

These events provided a background for my own philanthropic journey. My birth country is beautiful Armenia, an ancient country that prides itself on surviving wars, genocides and economic corruption.

Over the centuries, its lands have shrunken, and at the turn of the 20th century after another genocide by Turks, all there left was a small country of 11,000 sq. miles.

My family immigrated to the States at the dawn of the collapse of Soviet Union in 1990. It was a hard decision for my father who was a prominent psychiatrist during the difficult Soviet times. Prior to asking for a political asylum in the United States, he had a position of psychiatric expert and thus was forced to label dissidents and enemies of the Communist party as mentally unstable or, simply, crazy. He had refused to do so and was hounded by the KGB.

The Soviet policy was that labeling somebody crazy would devalue his/her political views and eliminate the serious threat they posed.

Dr. Maria Azizian in Armenia

My grandfather, who had started our medical dynasty, was a trauma surgeon during World War II, and a chief physician at one of the largest Yerevan hospitals later in his life. In his older age, he worked as an attending physician. Despite being a war hero, he completely supported my father’s decision, as he was always anti-Soviet in private, but never in public, as any disagreement with a Communist party agenda would lead to severe punishment/persecution.

In 1990, when we came to the States, I was a teenager. My dream was to live in a free society with freedom of speech and lack of oppression. My professional dream was to become a surgeon. I had spent the 1990s going through college as a biochemistry major at Clark University and then going through medical school at the University of Vermont.

Meanwhile, in Armenia, the 1990s were economically harsh years remarkable for the blossoming of corruption, nepotism, and a resultant massive emigration out of the country.

Currently, Armenia is an independent country with a newly elected prime minister who is keen on fighting the corruption.

It was coincidental that my philanthropy trip coincided with such an amazing event as the election of an idealistic and honest leader, who conducted a completely bloodless “velvet revolution” that resulted in the resignation of an established and corrupt previous leader.

My friends and relatives urged me to cancel my trip, but I was incredibly excited to be with my people, in my country of birth at such an important time.

I decided to have the first mission in Yerevan, a city which is, incidentally, 2,798 years old.

My father’s medical school classmate, the owner of a Vladimir Avagyan Medical Center, kindly allowed me to use a room at this hospital. (Interestingly, it is the first hospital in Armenia that had performed a gender reassignment surgery.) I was asked to submit all my diplomas, and other credentials verifying that I was a board-certified general surgeon with medical licenses in Massachusetts and New Hampshire. The mission was approved after all the paperwork was verified by the hospital.

The mission was called Armenia Cosmetic Beauty Philanthropy.

My trip was relatively short — about 10 days: 4-5 days of work, 2 days spent in travel, and some time for a set-up/preparation.

The focus of this trip would be a consultation of skin lesions, and removal of benign, cosmetic ones.

I decided not to remove any suspicious lesions, and also not to deal with larger excisions — this was due to the fact that I would not be in the country to provide a free follow-up care for these patients. I did not feel comfortable leaving them with sutures, as it meant that they would have to find another doctor to do so. The odds of finding somebody who would do it for free were not known to me.

In my future mission, this could be alleviated by being with a group of doctors and working in tandem, meaning that somebody would be available for an immediate post-op care.

Upon arrival, I acquired the names of local dermatologists and surgeons at the Avagyan Center to whom I could refer patients with suspicious lesions to undergo a biopsy and workup.

If patients qualified on the phone while they were describing their skin lesions, then, they were asked to e-mail a photo/photos of these lesions to a confidential email address that was created only for that purpose.

I would review the photos and let the representative in Yerevan know if the patient could be scheduled or politely declined. Since many patients were providing multiple lesions, it was decided to have one main lesion chosen by the patient with a potential to address others, if there is enough time.

All the consent forms were already translated in Armenian by several very helpful people here in the States, such as St. James Erebuni School Principal, Arminé Manukyan, and my kids’ Cape Cod-based Armenian teacher Elya Gevorkian.

The room was perfect, as it had a partition that had separated the consultation area from the procedure area.

When I had arrived, I had felt like a pioneer, and had realized how spoiled I had become in my office in the US. Now I had to think of every little detail, such as a large trash can, saline bags for washing, containers for different sizes of gauze, etc. From the beginning, I had made it clear to the hospital that I did not expect anything from them. I think that if it were not so, I would not have been allowed to be there.

I even purchased a large glass container for grains that I used for sharps: syringes, blades, etc., since there was no red box for sharps. Most of my equipment was disposable since there was no autoclave. The disposable equipment is, unfortunately, is usually more expensive.

It goes without saying that there was no nurse or medical assistant provided for me.

In one day, I had trained an amazingly talented young woman, who had helped me with the disposal, instrument set-up, and many more aspects of a surgical pre-procedure preparation.

The best part of this mission was seeing patients. People were so graceful and kind.

I was told that Armenians are usually scared and reluctant to have any, even minor, procedures due to old wives’ tales that removing moles was dangerous.

I was surprised to find out that it was only partially true — people were, indeed, more contemplative prior to deciding to undergo the procedure, but most of them were psychologically ready to have them removed. If they were not ready, then I would not proceed with or even offer a procedure, even if it were a very simple one (from the surgical standpoint). Some of them only asked for consultation, as all there were looking for was a reassurance.

One of the most touching patients was an older woman who came a long way from one of the remote villages, with a large skin tag hanging over her upper eyelid. She told me that it had been obstructing her vision for more than 10 years. She was scared but brave and full of spirit.

As I had helped her to a somewhat high exam table, she tolerated the worst part of the procedure, an injection of the numbing medication, very well. When I was done, she had asked for my hand for what I thought was help in getting up. Instead, he gently took it and kissed it with the words of blessing. “I don’t have this thing in front of my eye anymore, and I can see so much better — thank you so much. I hope you come again and help more people.”

This sentiment was shared by many, who had asked me if I would come again.

In 4.5 days, I saw 62 patients and did 26 procedures. It was wonderful that friends and relatives of our patients, as well, as the hospital workers came and asked to be seen. We ended up seeing far more patients than the initial number in our already full schedule.

I am open to going solo or with a group of other doctors. In order to turn this into an annual operation and make a positive impact on many who need help but cannot afford, I am open to work with the local organizations who would be interested to support this mission.

For more information, contact maria.azizian@yahoo.com

 

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