Dr. Armen Hovhannisyan, at left, in front of Khndzoresk mobile hospital

‘We Were Defeated in Healthcare Too’: Dr. Hovhannisyan’s War Ended in Kapan

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LOS ANGELES — Dr. Armen Hovhannisyan, an internal medicine and intensive care specialist from Los Angeles, was in Miami, attending his friend’s birthday party when he learned that war started in Artsakh. The party was canceled. He returned to LA immediately, bought a ticket and left for Armenia on October 2. Upon arrival he was appointed by the Ministry of Health of the Republic of Armenia to Goris Medical Center, in Goris naturally, where he treated soldiers during the most critical first days of the war. He continued his journey to Khndzoresk, Ishkhanadzor, Kashatagh, Shushi and finally Kapan, when the war was over. “I was at the surgery room when I got the news that the cease fire was signed. We stayed four more days in Kapan. Then I was back to Yerevan and continued my work in the different hospitals there until December 2. Two months of war…”, remembers Dr. Hovhannisyan now in his private Los Angeles practice, sharing his story over lunch break.

During the entire time Dr. Hovhannisyan was working in critical care at the hospitals and the frontline. He says: “The critical care unit didn’t have any time to rest. Sometimes one patient needed more than one doctor. Everything was going through us: we were the ones who established whether the patient was going to surgery right away or in an hour, or if he was going to be operated on at all. Every doctor concentrated on a patient. The differences of specialization somehow disappeared.”

Dr. Armen Hovhannisyan, at right with stethoscope, at Khndzoresk mobile hospital tent

During the war, doctors rushed to Armenia and Artsakh from all over the world. The work was tremendous. Few had military medicine experience. Even fewer could imagine the magnitude of injuries they were dealing with. Dr. Hovhannisyan says: “None of us was ready for this reality. I don’t want any of my colleagues to get offended, but by my opinion, our enemy defeated us with his healthcare system too. I am not talking about the individual professionalism of my colleagues from the diaspora or Armenia; we have amazing doctors. But overall, military medicine was unprepared.”

Dr. Hovhannisyan agrees that there are a lot of differences in possible approaches of treatment. But all medical professionals were united like never before: “We were sleeping on the floors next to each other for days not even knowing [people’s] names. We were that busy. Days later, I even learned that one of the doctors is my neighbor in Los Angeles. We were asking questions, trying to find better solutions for the patient. The goal was one: to do everything possible to save our soldiers.”

Back in the US, the doctor evaluated his overall experience. He finds some significant structural aspects of foreign medicine absent in Armenia which made the situation worse during the war.

. Dr. Armen Hovhannisyan, second from right, at the Goris Medical Center

“We have brilliant surgeons in Armenia. However, young surgeons who are newly graduated from residency programs, having great theoretical knowledge and being honest doctors, practically were not prepared to perform complicated surgeries. Residency programs in Armenia don’t adequately prepare for practical aspects of surgery,” says Hovhannisyan.

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Next, he finds unpreparedness in the system of medical transportation. Transporting a patient from the frontline to the hospital or one city to another created significant difficulties because of the number and quality of the vehicles and roads. “Sometimes it would take four to five hours to transport a patient. It was impossible to perform any procedure on a patient during the ride. We had to stop the car even to check his temperature. Even when it was driving only with the speed of 20 km/hour, my hand was shaking. It was much easier to transport a patient who was in a deep sleep,” the doctor recalls with noticeable irritation. “There were only two helicopters that supposed to transport injured soldiers. These helicopters were working without navigation systems. Therefore, they couldn’t work during the night. And also, the capacity was so limited that only a doctor and the pilot could fit in there with one patient,” he continues.

Another significant obstacle according to Dr. Hovhannisyan is the shortage of blood. He states that certain types of blood and blood products were hard to obtain, continuing, “In some cases, a patient’s outcome was very bad because of that. We couldn’t get the amount of blood we needed.”

Dr. Armen Hovhannisyan, fifth from left and with stethoscope, at the Goris Medical Center

The help from the diaspora was huge, as Dr. Hovhannisyan confirms. He was receiving boxes full of medication and medical supplies addressed to him from people he didn’t even know. But the issue was its organization and placement. He said: “We were learning that certain medication has arrived. And then, when we needed to use it, it was still sitting in the box in the hallway or someone’s room.”

He remains disappointed in the hospital nurses’ training in the far regions of Armenia, explaining: “We worked with very well-trained nurses from Yerevan. But unfortunately, the majority of nurses in the far regions are still in the era of ‘Analgin-Dimedrol’ [painkiller medication largely used during the Soviet era]. If I am asking the nurse to make me a heart stimulant, she shouldn’t ask me about the dosage. She must know that already. It’s a waste of time, especially during wartime.” All training efforts are centralized in the capital city, according to the doctor.

Dr. Hovhannisyan shared all his concerns with Armenia’s minister of health. The latter explained that no new graduate desires to practice outside of Yerevan. As a result, the population there suffers without a good healthcare system. But Dr. Hovhannisyan thinks that it’s possible to fix this with the proper incentives.

In total, Dr. Hovhannisyan’s team treated several hundred patients, of whom only a handful had gunshot injuries. They encountered a lot of “inhuman” injuries, as doctor describes and explains after a heavy silence, while recalling his difficult early days in Armenia: “In my 22 years in medicine I never said ‘I don’t know’ as an answer when it came to the treating the patient. In Goris, when the first patients arrived, I simply didn’t know what to do. I didn’t know where to start and where to finish. It took me several hours to understand how to act. That was the horror of this war.”

Dr. Hovhannisyan had to practice very close to the battlefield, in the mobile hospitals. These were huge tents inherited from the last century with metallic operation tables and huge gallons of oxygen right next to the tent with their rubber tubes on the floor that “could blow up with a single fired drone.” Doctors established three zones in the mobile hospitals where patients were being placed according their injuries. After every defeat the whole team moved the tent back.

In his work with several hundred patients, Dr. Hovhannisyan considers his biggest achievement to be saving the lives of 27 soldiers who had almost no chance of survival. “If I needed to go back to Armenia only for these 27 kids, I would go again. They are not going to become mathematicians, but they are going to live. That’s why I am proud of my team,” Hovhannisyan says with a tremble in his voice.

Months after the life-changing experience Dr. Hovhannisyan continues his practice with a new purpose. He signed up for classes to learn more about military medicine. He assures that this should be done by every medical professional in Armenia. He values his work even more now and finds new meaning in it. “I love my profession very much but it should not serve for causes like war. It should serve to make our parents live longer, our children to be healthy, our wives and sisters to become more beautiful, our women to have easy labor and delivery. After having that 44 days of experience, I started to love medicine even more. I became a better son, a better husband. I want to have a boy very much… Those kids were the best ones; they weren’t like us, they were better than our generation, they had unimaginable courage,” the doctor says, referring to all the soldiers he met in Armenia and Artsakh.

With over 200 doctors and nurses Dr. Hovhannisyan created a virtual group that meets regularly to discuss the possible ways to support the motherland. They named the group Goris Forever, since everyone initially met in the hospital in Goris.

“All of us established one thing: from now on none of us can go to Armenia as a tourist. We only want to go there to work, to share our experience and knowledge with our colleagues,” Dr. Hovhannisyan says. He promised the same for the doctors in Armenia: whenever they come to the US, he will make everything possible for them to gain experience in hospitals or clinics here.

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