Meduni Promotes Colorectal Cancer Prevention and Healthcare in Armenia

When he returned, according to Martirosyan, he said, “Listen, we have to do something about the fact that there is not even a single laparoscopic tower there. We need to go there not only to donate this equipment. We need to go there to teach them how to perform operations laparoscopically to help remove colon cancers.”

The two decided that if they created a training program, they could use data from this pilot attempt to convince the Armenian government to institute screening on a larger scale. In the fall of 2019, Martirosyan and LaBella went back to Armenia. The latter operated on 12 complicated cases. A laparoscopic tower, which comprises several components, including a camera, was donated to the National Oncology Center and seven or eight physicians were trained in how to use it. Part of the agreement was that these physicians then would perform a certain number of colonoscopies for free.

The pilot program exceeded the originally agreed upon number of colonoscopies, and discovered 64 cases of cancer out of 500 colonoscopies. The total has increased by now. The incidence is very high, Martirosyan said, so it is necessary to act fast.
Why are the numbers so high? Martirosyan said it is a mixture of reasons, beginning with the polluted environment. For example, catalytic converters are removed from cars, and there are no emissions tests, so the air is very polluted. The biggest cause is late diagnosis, due to mistrust of the medical system and lack of proper screening and diagnostic programs. People do not go to the hospital until cancer has spread dangerously far. Diet is another cause.

Interlude of Covid and War

Prevention of colorectal cancer consequently became Meduni’s main mission, but Covid-19 changed things. Martirosyan said, “The Armenian Ministry of health was at the brink of collapse, due to the heavy flow of Covid patients, so in March and April of 2020 we got together and collected a full 40-foot container of medical supplies and equipment such as ventilators, respirators and masks.” These items were delivered directly to public hospitals, which were the ones with the greatest need. Meduni also provided some Covid-related aid to local hospitals in Maryland.

Another major shift from Meduni’s cancer efforts was caused by the Artsakh war in 2020. Martirosyan said, “During the war, we were more successful in our fundraising efforts. We raised about $500,000, which was put into two programs. One was continuous support for frontline hospitals through equipment and supplies, including digital x-rays, digital sonograms and other items. The rest of the funds went to buy homes for 14 families which had more than two children and lost their breadwinners during the war, and another 30 displaced families from Artsakh. The displaced families program we created helped these families from Artsakh find rental or shared homes, and provided them with food and essentials on a monthly basis.” This latter was all post-war.

Martirosyan went to Armenia in December, 2020 to manage this but got Covid and had to stay longer than planned.

Back to Preventative Measures for Colorectal Cancer

Upon his return to the US, he decided to refocus on strategic programs that would not only locally help a few hospitals but could be implemented throughout the entire country. During an August 2021 trip to Armenia, Meduni brought together all the stakeholders. Martirosyan said, “We realized that if we want to change things on the level of the entire country, we cannot do this singlehandedly. We cannot do it without the involvement of different institutions and organizations, including the Armenian Ministry of Health, Yerevan State Medical University, various hospitals, mostly public but also private, and other local stakeholders. We brought them all into one room to discuss how we can implement a new screening program like what we implemented at the National Oncology Center on a larger scale.”

During the same trip, Meduni brought a larger group of physicians from the US to conduct physician training in Armenia on various colorectal cancer-related subjects, including hands-on training in doing operations. Meduni board director Dr. Armen Aboulian was in this group. He previously came to Armenia during the course of the 2020 war, operating in hospitals in Goris and Kapan, and has now moved to Armenia for a year.

Another doctor who has been involved with Meduni, pediatric surgeon Shant Shekherdimian, who is a professor at UCLA and first deputy director of public health of the Promise Armenian Institute there, also moved to Armenia for at least another year and now serves as an advisor to the Ministry of Health. This assists in Meduni’s relations with the government. Martirosyan said that there are daily talks with the ministry, and various local stakeholders about how to implement a colorectal cancer screening program for Armenia.

The funds raised at the Cincinnati gala will be used as part of the first stage of such a screening program. Meduni wants to purchase 25,000 fecal immunochemical tests (FIT), which are comparatively affordable, and can be carried out easily in the comfort of one’s home. A specimen is dropped into a container which will be brought to a drop-off station, just like one does in the US through companies like Quest Diagnostics. If the test result is positive, that means the person has polyps. He will be then called to come in for a free colonoscopy.

LaBella said, “I didn’t necessarily find a lack of education or knowhow in Armenia. The physicians and surgeons knew that it would be nice to have screening programs, but I thought they felt a bit lost on how to start it and the means to do it.” However, he said, Armenia is not that big of a country, so it should not be that difficult to implement the screening program Meduni is promoting.

LaBella added that everybody says that it is expensive, but they are treating these cancers at the end when it is much more costly. He said that a FIT test may cost between 20 and 40 dollars a person depending on the scale at which they are purchased, but compare that to the cost of chemotherapy, radiation, surgery, and hospital stay. In addition, the person will be out of the workforce, creating a loss of income which affects society as a whole. Finally, there is the cost of premature death.

He said, “It is such an extensive cost but nobody wants to look at this. Our goal is really to raise awareness, to say you really need to look at the whole picture. This really is a public health issue, not a crusade.”

Martirosyan said that two more endoscopic/laparoscopic towers have been purchased, and a further two must now be bought to deal with the aftermath of such a program. The polyps will be removed and sent for biopsy. Martirosyan said that if the biopsy confirms cancer, the Ministry of Health will then take over due to a ruling two years ago that the state will provide free treatment to all cancer patients. This is subject to limitations in practice, he added, such as for medications. Since screening is also not covered, Meduni wants to provide it free of charge to encourage more people to do the testing, instead of waiting till a cancer reaches Stage 4 and metastasizes.

Martirosyan confirmed that rumors about the theft of donated medical aid are true. He commented, “We cannot change the mentality of people overnight. That is a process that will take decades.” To ensure the secure use of money raised through Meduni, he said that its Armenian affiliated, established in January 2020, rents its own warehouse space, sufficient for two forty-foot containers, and all items sent from the US are first accepted directly by Meduni Armenia, not any state body.

When items are received, he said, “We take them to the warehouse, divide things according to each hospital’s needs, and then deliver them directly to the hospitals. When we deliver them to a hospital, we ask for a letter of receipt that specifies what we contributed. Then we send one copy of that report to our major donors, another to the Ministry of Health, and a third to the state revenue body (since when we received an item, it appears as an asset of our organization, and we then have it removed as such).” In addition, often hospitals issue letters or certificates of appreciation to Meduni.

Outside of Armenia, all Meduni operations are based on the work of volunteers, starting with Martirosyan and including its entire board. LaBella exclaimed, “The heart and the soul of it, no question, is Vahagn Martirosyan. When you do something that you don’t really have to do and there is no gain, well, we all talk a lot about what can be done, but – you have to hand it to him – he is really doing it.”

The only paid Meduni employees are five people in Armenia. In the US, about 15-20 people are actively involved as volunteers, Martirosyan reported. On the agenda, when Dr. Aboulian returns from Armenia, is the creation of chapters in different parts of the US.

In California, there are organizations like Armenian American Medical Society, Armenian Medical International Committee and Armenian Healthcare Association of the Bay Area raising aid for the Armenian health sector, and there are organizations like Eternal Nation raising aid for the Armenian wounded. In New Jersey and New York, there is the Armenian American Health Professionals Organization, the Armenian American Medical Association of Boston, and there are many more throughout the US, France and other countries outside of Armenia, including programs of larger Armenian philanthropic organizations and churches. When asked whether the multiplicity of efforts to provide medical aid from the diaspora can be coordinated to become more efficient and avoid duplication of efforts, Martirosyan said, “That is one of the major things we are bringing up. What we are now working on is a way through which we can centralize everything so we are more aware of each other’s work. We opened up Meduni Armenia as an affiliate organization so we can be on the ground and directly involved in the different programs we implement. During the war, we became connected to so many different organizations about which we didn’t know before. What we are working on now is a strategy of how to put all the stakeholders together and connect the diaspora to Armenia through a centralized system with checks and balances. We need to know which organization is involved in which program, what we need and what is missing.” The Armenian Ministry of Health, Yerevan State Medical University, and many other Armenian institutions will also be integrated into this plan.

The Final Word

The most recent news from Meduni is that it is in the process of obtaining a US Agency for International Development (USAID) grant for $1.2 million to open the first palliative care center for end of life in Armenia. Martirosyan said, “There is a big need there as there are no such places available in Armenia at this point. It is another big gap in healthcare practice there.” Without palliative care, in Armenia people with incurable diseases are just sent home to die. Their agony and pain affect the patient’s family members, who usually are the caretakers at this stage at home, causing negative psychological impact. The new Ministry of Health budget which will be in place for January, 2022, includes funding for elder care and end of life care, so helpfully this will mark a shift, Martirosyan said, to recognition of hospice and palliative care as a critical human rights issue.

Martirosyan encouraged more involvement in improving healthcare in Armenia. He said, “The more people that become involved, the more impact can be made. A lot of people are frustrated with the government, and I totally understand that – so are we – but if we say the government is bad and we are not going to do anything, that is not going to fix the problem. If we want to see change, we have to be part of that change.”

LaBella, meanwhile, gave a final message to diasporan Armenian readers on colorectal cancer and beyond, declaring: “Everybody wants to change the world overnight, but no one realizes, it is one step at a time. As long as you keep taking those steps, you get there. At the end, everybody has to do something in life, and everybody has to help. This is the battle we chose, and I think it is a good one…I would say, especially to the diaspora, reach out to family and friends to change the culture. This should not be something taboo, but instead encouraged…Literally, prevention is the cure.”

For more information, see www.meduni.org or Meduni’s Facebook page.