Two days before New Years, Hrant, a United States citizen of Armenian descent, slipped and fell on an icy Yerevan street. “It all happened in the blink of an eye. My right foot slipped out from under me and twisted with a crack. I knew that a bone was broken.

We took a taxi to the Saint Grigor Lusavorich Medical Center up in Nork Massif. My friends suggested we take a cab rather than calling an ambulance to avoid mounds of paperwork,” recalls Hrant who has been residing and working in Yerevan for the past two years. Luckily that evening the hospital was near deserted. They took some x-rays and the diagnosis came back - a closed fragment fracture of the right shin-foot joint. “The doctor strongly advised surgery to insert metal pins to join the fractured bone fragments,” Hrant continues. On January 6 the surgery, osteosynthesis with metal lamina and screws was performed, under spinal marrow anesthesia. Hrant remained in the hospital until January 13. “It was the holiday season, so there weren’t many people milling about the place, especially at the cashier’s office. The doctor just happened to stop by my room and asked me if I was aware that the huge amount of 750,000 drams was listed on my patient’s report. He said that he was telling me this just as a precaution. Officially, no one from hospital management ever came up to the room to explain the hospital fees or to explain why I was to be charged such a large sum. All they ever told me, in passing, was that not being a citizen of Armenia I had to pay five times the normal amount,” Hrant recalls. The 750,000 drams collected as the hospital’s fee wasn’t the only sum that Hrant wound up paying for medical services. He paid 42,000 drams for the hospital room (3,000 per day) and several thousand more for sundry health expenses (dressing changes, tips, etc). “The Chief Physician at the hospital was a man named Orgusyan. My friends called on him prior to the surgery to see if anything could be done about the fee. He told them that since I was already here and the pre-surgery tests had been made, it made sense to go ahead with the operation. The fee, he said, would be discussed afterwards. He seemed sincere so I decided to stay. After the surgery, I talked to the department head as well; asking if anything could be done to lower the fee a bit, and was told that the fee was stipulated by the law and that there was no way around paying the full amount. The hospital administration even went so far as saying that they’d send the police after me if I tried to leave without paying the full fee. I had already managed to scrape together some 500,000 drams from here and there and had paid this to the hospital, but they were adamant about the balance. I told them there was no way I could pay the rest at the moment and wanted to leave, offering to pay the balance later, on installments. It was then that they asked for my Armenian and U.S. passports. I realized it was a safety measure on their part, to prevent me from slipping away in the dead of the night. When I asked why, I was given some flimsy excuse that they needed to check certain information.  I handed over the Armenian ten year passport as a hostage. After paying the full sum, it was returned to me,” explains Hrant, adding that he has been living and working in Yerevan for the past two years and that he possesses a ten-year special residency passport that, in practical terms, only serves as “glorified visa”. In cases like this, its existence is all but overlooked. We should also point out that Hrant is a taxpayer and that taxes withheld from his wages go into the state coffers. “In the hospital they advised me to apply for dual citizenship so that when I return in June to have the metal pins removed I could avoid paying the 300,000 dram fee; five times the 60,000 fee charged to RoA citizens. I might have to find another hospital for this operation if I don’t receive the citizenship papers by then. For example, the Erebuni hospital said I could have the pins removed there for much less,” states Hrant. Hrant has not applied to either the Ministry of Healthcare or to the Diaspora Ministry for redress. We tried to get some answers from the Ministry of Diaspora Affairs and to see if they thought that such treatment meted out to an Armenian from the Diaspora was legal and moral. Hamlet Aghoyan, who heads the legal department of the Diaspora Ministry, which claims to be a “home away from home” for Diaspora Armenians, told us that they didn’t have the time to answer our questions and requested that we present our queries in writing. An answer from the ministry was late in coming. Deputy Minister Stepan Petrosyan explained the delay by stating that, “The Ministry of the Diaspora had consulted with the Ministry of Healthcare.” In reply to our questions forwarded to Hranush Hakobyan, Minister of Diaspora Affairs, what we were given was a folder full of legal definitions and laws. We wanted to know what rights and privileges are afforded a diaspora-Armenian who possesses a ten-year Special Residency Status passport, what protocol is applied regarding health issues facing diaspora-Armenians and what assistance does the ministry offer in such cases. According to the package of documents we were given, a diaspora-Armenian is considered to be a foreign citizen whose rights and responsibilities are defined in the RoA “Law on Foreign Nationals”. If, in reality, there is no distinction between a diaspora-Armenian and a foreign national, perhaps the question should be asked what pressing need is there to justify the operational existence of the Diaspora Ministry. Deputy Minister Stepan Petrosyan, perhaps expecting that such a question would come up after his reply, wrote that, “The Ministry of the Diaspora keeps diaspora-Armenians in the focus of its attention by helping to resolve issues related to RoA residency status, obtaining dual citizenship and educational matters. Presently, the ministry is in the process of formulating and discussing a series of changes and addendums to some laws and government decisions on the books directed towards improving the residency status acquisition process for diaspora-Armenians and to lessening their college tuition fees.” We also received a reply from the Ministry of Healthcare. First Deputy Minister Hayk Darbinyan stated that, “The designation ‘diaspora-Armenian’ isn’t used in RoA statutes, but rather the common ‘foreign national’ term is employed. Foreign nationals in Armenia have the right to receive medical care and service, and this can vary for citizens of different countries.” The Saint Grigor Lusavorich Medical Center is registered as a CJSC (closed joint stock company) and according to the RoA Law on “Joint Stock Companies” the prices for payable services, as well as charges for individual illnesses and services, are independently set by the given medical establishment or center. Deputy Health Minister Hayk Darbinyan replied that, “The Ministry of Health doesn’t implement a separate pricing policy regarding payable medical and services of medical institutions. The Health Ministry only defines the costs of payable services of those medical establishments when the ministry itself has acted as the initiating or establishing body.” Not only does the Ministry of Healthcare have nothing to do with the “pricing policy” but has the following advice for any diaspora-Armenia disgruntled with the medical care he or she has received – “In order to resolve any grievances or outstanding issues that arise in the course of receiving medical care, a foreign national or a diaspora-Armenian can appeal to the director of the particular CJSC, or to a higher authority, the founder of said establishment. The aggrieved individual can also apply to the courts to seek restitution if they believe their legal rights have been violated,” states Deputy Minister Darbinyan. Hrant agrees that he must obtain dual citizenship as soon as possible in order to avoid paying five times the going rate a second time for future medical costs. “There are many diaspora-Armenians residing in Armenia and God forbid that they wind up in a similar situation,” says Hrant, emphasizing that, “I don’t have any complaints against the individual doctors who treated me. They were very attentive and did a fine job despite the less than favorable conditions in which they must perform their professional duties. I am more irritated with the unreceptive attitude shown by hospital management. All they did was quote the “law” but somehow, in Armenia, such assertions ring hollow. When dealing with Armenians from the diaspora, some of these officials definitely need to improve their personal relations skills, especially those in charge of institutions in the public sphere. And here I’m not merely referring to the treatment meted out to tourists from overseas but to those from the diaspora who have come to Armenia with the intent and desire to stay.” “In essence, hospital management deceived me when they said – let’s go ahead with the operation and we’ll talk about the costs afterwards -  and afterwards claiming that the fees were set by the RoA government and that they weren’t authorized to make any changes on their own. In reality, as a private concern, they could have made some concessions. Rightly or wrongly, I was left with the impression that they stereotypically believed that as a diaspora-Armenian I could pay whatever they charged and so they billed me for the maximum. As proof of this discriminatory treatment, one of my friends witnessed a Georgian citizen only being charged 150,000 drams at the cashier’s office; that’s to say the same as a citizen of Armenia. When my friend asked why they were making an exception for a foreign national, the answer they gave was – hey, he’s a Georgian, they don’t have money,” states Hrant. “If I had the opportunity of meeting the Diaspora Minister I’d advise her to pay more serious attention to the varied problems and issues faced by diaspora-Armenians living in Armenia. It was less than encouraging when, at my request, one of my friends went to the Diaspora Ministry to obtain information regarding dual citizenship and the ministry’s legal division were hard pressed to give any definite answers and merely offered some half-assed generalities instead. They weren’t even aware of the minister’s own directives regarding the proper Armenian translation of names documented in foreign languages. If these basic minimum courtesies are problematic then I can only imagine how the ministry will tackle the more complex issues it has set out for itself. If this example is representative of the ministry’s work ethic, it better think twice before attempting to tackle the conundrums of the Diaspora.  The Diaspora Ministry has a practical, and I’d dare say, much more urgent mission to undertake right here in Armenia. General pleasantries and outdated rhetorical oratory will not be enough for the ministry to justify its existence,” Hrant concludes. In any event, until the required reforms are put into practice, it appears that Armenia’s health system will be welcoming other diaspora-Armenians in the same manner. The doctors, for their part, will most likely come up with some “wonder balm” as a palliative. Just note how the hospital staff attempted to comfort Hrant by saying – You’re lucky you broke your foot here. If it happened in the U.S., you’d be paying out the nose.”