20% of the doctors at the “Berd Medical Center” located in Tavoush Marz have reached retirement age. Some of them have reached an age where they suffer from certain physical disabilities. The problem is that there is no one to replace them. Medical Center Director Aram Harutyunyan told “Hetq” there is no permanent anesthesiologist on staff at the hospital. “We hire an anesthesiologist from the outside.

They serve for one month and then a new one comes. Our specialist was indicted about two years ago and is now in orison. We’re also lacking an X-ray specialist, psychiatrist and respiratory physician. We are in need of specialists across the board. We’ve been submitting this list to the Ministry of Health for the past twenty years but they just aren’t sending specialists to the regions. We’re not the only hospital suffering. Specialists are lacking in all the regions. It’s getting harder for us o provide adequate health care,” noted Mr. Harutyunyan. The shortage of specialists at Berd Medical is tackled by having physicians do more than one job. The neurologist, for example, doubles as the psychiatrist and the therapeutic doctor also takes care of respiratory ailments. “The average salary of a physician is 45,000-50,000 AMD. We pay the anesthesiologist 250,000, but no one is applying for the job here in the provinces,” added Director Harutyunyan. There is not only a lack of qualified physicians her at Berd Medical located close to the Azerbaijani border. Hospital equipment is long overdue for a major overhaul. Much of it needs to be updated. The medical building itself is in need of repair. Plaster on the walls is cracked and peeling. A preliminary cost analysis for repairs has been drafted and the government is now reviewing it. Director Harutyunyan says that repairs were put off this year due to the financial crunch but he still doesn’t know for certain if the 2010 state budget will include provisions for the repair work to proceed. Necessary repairs have been estimated at 430 million AMD. Director Aram Harutyunyan noted that Berd Medical primarily treats area residents suffering from a variety of cardiovascular ailments and that his patients have gotten younger over the years. He now sees people coming in to the hospital in their 40’s. Women, on the other hand, are mostly treated for tumors. “In a word, I can say that the ailments are increasing while the age of patients is getting younger. Residents today just can’t afford to get treated properly. About 90% of our patients get government financing. They often apply for state-sponsored medical eligibility when it’s way too late.” We asked Director Harutyunyan why many patients who are able to pay turn to hospitals in Yerevan for treatment and is it due to a lack of trust in regional facilities? “I wouldn’t say that it stems from a lack of confidence. It’s mainly because they have friends and relatives there,” he replied. We should add that one rarely finds a publicly displayed list of fees at regional medical facilities clearly stating what a patient is required to pay for this or that treatment. Berd Medical Center was no different. The only notice affixed to the wall was a list of those eligible for free, state-sponsored treatment. There was nothing about hospital or medical fees. “The price list is located at the cashier’s office and the registrar. Why do we need to display it anywhere else? The list is available at the various medical units as well. All our doctors have a copy of the price list,” stated Director Harutyunyan. We toured the various units and didn’t spot the list displayed in any of them. It seemed to us that the director wanted to avoid any prominent display of the fees charged by the hospital. Medical specialists are also in short supply in Armavir Marz. There is not one urologist to be found anywhere in the region and patients often make the trip to Yerevan. Larisa Mouradyan, Deputy Armavir Regional Governor and Health Affairs Department Head stated, “We’ve submitted our request to the Health Ministry at every occasion. Recently, we’ve proposed that a young physician receive state assistance for post-grad education on condition that he gets retrained as a urologist and that we’d offer him a job here.” Ms. Mouradyan also didn’t believe that there was public mistrust of regional medical facilities. In her view, people traveled to Yerevan because they wanted the best care and treatment possible and that the impression was that such services were only to be found in the capital. “Then there is something in our make-up where people are directed to see a doctor in Yerevan by relatives or friends. People who can pay usually don’t avail themselves of services in the regions that are fee-based,” she stated. With financial assistance from the World Bank and other international agencies, 40 of the region’s 50 dispensaries have been renovated. Ms. Mouradyan also said that the region’s obstetrics centers will have been renovated by 2010 as well. “There is a problem with the maternity ward in Etchmiadzin. It’s in poor shape and lacks certain equipment. Births registered at the ward have dropped. Now that the state is picking up the tab for child delivery, expectant mothers can pick the facility of their choice. The maternity ward at Etchmiadzin is not high on their list,” she concluded.