The diaspora, historical buildings, and doctors

Last week I met several interesting people in Armenia:

(Diaspora: A dispersion of a people from their original homeland. This includes Armenians in Glendale, CA and other parts of the US, and those in Russia, Italy, France, etc.)

The first person was a young woman who had recently graduated from the University of Vermont. She was spending a month in Gyumri. She is of Armenian descent, had studied Armenian through her church in the States, and comes from a family that has been actively involved in Armenian issues within the diaspora community. Her grandmother had been forced to flee this area during the 1915 Turkish genocide. We had a little heated discussion about the current state of affairs in Armenia. Her points were that America does not provide enough aid to Armenia (USA per capita aid to Armenia is the second largest in the world after Israel), that Turkey must apologize for the genocide and pay reparations, and that until this happens the status quo is OK. I feel strongly that this country receives too much ineffective aid, that the government is not committed to make the changes necessary for an effective economy (revising tax system, customs regulations, banking regulations, and consumer protections), and that the government is relying on the international community to help its farmers while expressing no interest in helping them itself. (Half of Armenians live below the poverty line. Two out of ten of them are extremely poor.) In a country the size of Maryland, it is surprising how few people have ever been out of this country, which would expose them to new ways of considering the world. The closed borders isolate this country from trade and cultural exchanges. The anger at Turkey and Azerbaijan is palpable here; an anger that dates from 1915 and 1992. Russia has a significant presence in Armenia (8,000 soldiers) as it patrols the closed Turkish border. I can’t help but feel that this situation is to Russia’s advantage as it keeps Armenia tied to it economically and Russia can maintain a military presence in the Southern Caucasus. Armenia is at war with Azerbaijan (an oil-rich country) which requires mandatory two-year military service for all Armenian males. Turkey has a fast-growing population of over 70 million versus 3 million in Armenia which is experiencing a low birth rate and significant outward migration. Armenia is on Turkey’s less-developed, poor, and Kurdish-populated eastern border. Other than because of pressure from the international community, it does not appear that opening the border is a Turkish priority. It has been 95 years since the genocide and the diaspora community seems more concerned about recognition than the fate of Armenia today.

The next day I met a woman in Gyumri who is an architect and a professor at Mississippi State University. She has been coming to Armenia since 1992 during the summers (while her husband teaches at the American University in Yerevan), is currently a Fulbright alternate, and is doing research on Gyumri’s historic houses with the goal of finishing a book and, hopefully, creating interest in preserving Gyumri’s historic homes. She has not been able to get the government interested at all. The current mayor of Gyumri is building a huge city hall, which will not have a tourist office, though he does have a “tourism” person whose focus is outdoor concerts. He is not interested in promoting the churches, historical homes, home stays, reliable maps, or signage that might draw tourists. During the 1988 earthquake, most of the Soviet-era buildings (1922-1988) were destroyed or suffered major damage. Homes from the pre-Soviet era survived, and many of those survived because of their vaulted foundations according to the architect. She talked about going into one of these buildings in the Gyumri city historic district where several families live. There was a courtyard with an outhouse shared by about thirty people and there was a single spigot for water from which all residents drew their water. She interviewed a mother and daughter who lived in a basement-like vaulted area in the worst poverty conditions she had ever seen. This “home” is less than 1/4 mile from the new obscene mayor’s office. We had a long discussion about corruption in Armenia. She was reading a Russian history book which brought up the subject. She said that the corruption is not a recent phenomenon. It has been a part of the culture of all Soviet countries since at least the time of the tsars (about 1500.). She feels that it is so endemic to this area that the custom of “payments” for services by public officials, jobs, political offices, grades, etc., can never be changed. She was also discouraged by how little improvement has been made in individuals’ lives since 1992.

In Yerevan, where I went for R&R, I met the American Embassy medical officer. This doctor and his New Zealand-born wife are tri-athletes (and they definitely looked the part) with three very small children. They do not live in the embassy compound because he said that they do not want to socialize with people he treats. They have actively embraced living in the Armenian community, which I really admire, because the compound would be so much easier. Then another man, an American doctor who is evaluating rural health care delivery systems in Armenia, joined in our discussion. This doctor said that Armenia has at least three times as many doctors as the country needs, and that the majority of these are very poorly qualified. (Current doctors graduated from high school at sixteen, then went to medical school for six years, and became doctors at 22.) These doctors are not “qualified” for internships or specialized study at any European or American universities or hospitals. Armenia is putting in place tougher requirements for a medical education but it is not limiting the entrants into medical school. Most graduates of medical school are not able to find jobs in their field. Diabetes is a huge issue in Armenia. The first doctor said that there are no endocrinologists, and that when doctors prescribe for diabetes they often do too little too late because they do not understand the disease. Another issue is “stones”, gall stones and kidney stones because of diet and because of the fact that most Armenians do not get enough fluids. They said that people suffer hugely from these stones. Another issue is the lack of diagnostic tools. Many tissue samples have to be sent to France for diagnostic purposes because there is little faith in the labs here. While there is a huge excess of doctors, there are very few medical technologists and pathologists.

Medical school graduates, who have “paid” for their grades, have to “pay” to get a position in an office or hospital. They recoup this expense by charging (off the records) their patients for services. As a result rural areas are under-served as these patients are often barely surviving and cannot afford to pay for supposedly free services. There are a few rural clinics supported or staffed by German and Belgian organizations, and by Doctors Without Borders. The second doctor said that Armenia pays about 1.5 percent of its budget for medical services which is the lowest of any country he knows of. (Just think about Medicare and Medicaid in the US.)