In the northern Armenian town of Alaverdi, there are more than 600 patients registered at the local hospital’s ONCO (oncology) clinic.
47 year-old Anzhela Avagyan, who suffers from advanced breast cancer, is one of them.
She lives in the nearby town of Akhtala with her mother, who is also seriously ill. They survive on Anzhela’s 15,000 dram pension and her mother’s 20,000.
The palliative drugs prescribed by her physician (Tramadrol and Paracetamol) are not freely distributed; either by the Alaverdi Health Center or the Alaverdi Medical Center.
To get the palliative drugs, Akhtala Health Center Director Dr. Karen Azaryan writes two prescriptions per week for Anzhela.
Anzhela’s only caretaker, her sister, must make the trip to Akhtala to pick up the prescriptions and then travel to either Noyemberyan or Vanadzor to purchase the drugs.
Dr. Azaryan told Hetq that while the ONCO clinic at the Alaverdi Medical Center is obliged to give the palliative drugs for free to advanced cancer patients, but it doesn’t. He added that none of the pharmacies in Alaverdi has a license to sell narcotic drugs like Tramadrol (a centrally acting opioid analgesic used to treat moderate to moderately severe pain). Thus, Anzhela’s sister must make the trip to Noyemberyan or Vanadzor, towns located an hour or two away.
Hetq contacted Stepan Mosinyan, Director of the Alaverdi Medical Center as to why they don’t provide the opioids.
He said that they are obligated to provide the drugs no cost to all advanced cancer patients in the town of Alaverdi and the Tumanyan region when needed. He added, however, that the drugs were provided to cancer patients living in communities whose medical out-patient clinics operate under the purview of the Alaverdi Medical Center.
“The Akhtala Medical Center is obligated to provide Akhtala resident Anzhela Avagyan opioids at no cost. To do so, the Center’s administration must obtain a license to dispense the drugs,” Director Mosinyan said.
We then went back to Dr. Azaryan for clarification.
“We don’t have the financial resources to obtain an opioid license. I’m not even planning to get such a license because we don’t have the means to store and maintain these drugs. There is just the one ONCO clinic in the entire region that is obligated to provide the opioids to all advanced cancer patients in the communities,” said Dr. Azaryan.
Nurse Hermineh Arakelyan, Director of the Shnogh out-patient clinic, told us that her unit, which serves residents of Shnogh and Tumanyan villages, and isn’t under the purview of the Alaverdi Medical Center, also doesn’t have a license to dispense opioids.
“It’s the Alaverdi ONCO clinic that prescribes and dispense narcotics and opioids to our cancer patients,” Arakelyan said.
It turns out the pharmacy owners avoid selling opioids and narcotic pain relievers to the seriously ill, since they don’t want to pay for the licenses and the additional costs involved in safeguarding the drugs. They also don’t want law enforcement making periodic inspections to see that the drugs are safe and secure.
Many pharmacy owners said that those drugstores which already dispense no cost drugs under the government’s subsidized system should also dispense narcotic drugs to cancer and other seriously ill patients. They said that the pharmacy currently dispensing drugs under the government plan in Alaverdi is owned by Alaverdi medical Center Director Stepan Mosinyan.
We informed Lori Provincial Governor Artur Nalbandyan about this bureaucratic nightmare and how cancer patients like Anzhela can’t get the palliative drugs she needs for free.
Nalbandyan promised that he would look into the matter but that he would take immediate steps to get Anzhela the drugs she needs.
This, however, is a stop gap measure and hardly resolves the underlying matter.
Anzhela’s case isn’t the only one in Alaverdi and surrounding communities.
Relatives of cancer patients have always complained about not getting the narcotic palliative drugs for free. They still continue to complain.
Despite the ongoing problem, the Lori Department of Health and Armenia’s Ministry of Health have so far failed to adequately resolve the issue.
In the meantime, Anzhela and hundreds like her are forced to fend for themselves.