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Healthcare in Armenia: Experiences from one of our Speech Language Pathologists

Have you ever been frustrated by the medical system in America? Do you ever feel like your or your loved ones medical needs were not met within the care continuum? Now, take that frustration and multiply it tenfold. That’s what it’s like receiving medical care in a second-world country, and it wasn’t until I moved to Armenia that I truly understood just how GOOD we have it in the USA.

For those of you wondering, Armenia is a nation in the mountainous Caucasus region between Asia and Europe. While it is home to one of the oldest civilizations in the world, its medical system is far from perfect. Here are some facts & statistics to give you a better idea of Armenia’s healthcare system:

  • 1.6% of Armenia’s GDP is spent on healthcare; the World Health Organization (WHO) recommends the minimum value to be 3.5%.

  • There is NO concept of primary care in Armenia, as well as no feedback mechanism within the medical system to allow for interdisciplinary care.

  • For a population of 1,000,000 people in the city capital of Yerevan, there are a total of 41 hospitals (a major maldistribution of patients to providers to facilities).

  • Armenia has the HIGHEST out-of-pocket spending on healthcare than any other country in the world (a monumental 84%).

  • Every year, 2.5% of patients become impoverished (poor) due to paying for medical expenses.

  • In Armenia, more people die due to the care they receive VS. lack of care.

Why the gaping gap in services, you may ask? A big part of the reason is the way the medical system functions in Armenia. Since Soviet times, the focus of the healthcare system has been on treating illnesses and diseases, as opposed to preventing them. There is no concept of primary care, only a network of specialists who over-refer, over-diagnose, and over-prescribe treatments and procedures. As you can imagine, this extreme fragmentation does not allow for quality interdisciplinary care.

And while the profession of Speech-Language Pathology exists in Armenia, nearly all SLP’s are trained to work with the pediatric population. The concept of adult rehabilitation, from all therapy standpoints (i.e. speech therapy, physical therapy, occupational therapy), is only just beginning to emerge. That means, anyone with aphasia, dementia, apraxia of speech, or any other neurogenic communication and/or swallowing disorder is unlikely to receive the services they need. With regard to dysphagia, in particular, there is NO place to find liquid thickener, should one require it. This poses a huge risk for increased fatalities that may very well be avoidable.

While bringing about positive change to a corrupt medical system will not happen overnight, it is not impossible. The most effective impact that can be made is by creating policies which restructure and re-invent healthcare as it exists in Armenia today. By conducting & publishing research studies, generating epidemiological statistics, and presenting this information to the Armenian Ministry of Health, the shift from an illness-based approach to a preventative one is much more attainable.

In recent years, organizations such as Therapists for Armenia (TFA) are laying the groundwork for change in this sector. TFA is a group of volunteers from occupational, physical, and speech therapy backgrounds who strengthen rehabilitation and disability services in Armenia through inclusive, sustainable approaches. It is their goal to make international connections, strengthen service delivery, fight disability stigma, and help Armenian communities thrive. It is this kind of interdisciplinary approach, one which we are fortunate to have in America, which will set the tone for healthcare reform in Armenia moving forward.

**Written by Nathalie Halajian

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