July 10, 2005

The Sunday Times

Authors in the Front line: DBC Pierre

The land of tortured souls

More than a decade after a disastrous war, Armenia is still entrenched
in poverty and neglect. Among the most vulnerable are a staggering
number of mentally disabled people living in appalling conditions. Yet
there’s a glimmer of hope for this dislocated society. The novelist D B
C Pierre reports

Here I am in a sunny house with an unexploded rocket-propelled grenade
embedded in its cellar floor. Granted, I’ve had some brandy. I look out
onto the back garden where white mountains rise, humps of ice cream
towering into a cobalt sky. The lesser reaches of the mighty Caucasus;
just there, in the garden, sparkling, where the bird table should be.
And I struggle to reconcile the extremes of this place.

Noah’s ark came to rest in Armenia. Leopards still roam here. Apricots
and cherries originated here, as did wheat. All still rustle wild.
Armenian minds disproportionately dot the catalogue of human
achievement. Forests whisper with oak and almond, pistachio and wild
jasmine. The first Christian state arose here. Winston Churchill
declared the brandy finer than any cognac. And it’s impossible to pass a
dwelling without being invited in for coffee and chocolate, if not brandy.

Paradise. I’m in paradise with a live missile. It blasted a hole through
two storeys and, without exploding, set fire to the roof. It’s one of 11
lobbed over the mountain one winter’s day. The others went off. The man
who owns the house takes me to see this one. It’s stuck 21/2 ft into
the floor, at a slight angle. Outside in the sun it’s supposedly -20C.
In here it feels -30. The man mutters, frowns at the projectile, then
kicks it. There’s a pause. We remain unexploded.

Leaving the house for the warmth of an icy, still sunlight, I take in
the mountains around us and pinpoint the man’s problem: a hostile border
straddles them.

Azerbaijan, a bullet’s flight away. We stand for a moment, gazing. A man
dressed like a shepherd passes on the road behind us. I ask the obvious
question: how does the man with the missile live with such a threat in
his house? He tells me he’s moved his family of six into the garden shed
until the missile is made safe.

‘And how long have you lived in the shed?’ He crinkles his eyes, has an
empty chew behind his whiskers. ‘Thirteen years,’ he says eventually.
‘But I have many acquaintances in Azerbaijan,’ he adds. ‘I’ll ask them
to come and fix the thing.’ He looks at me; a smile creases his face.
‘Come – we’ll have some brandy.’

Nothing prepares you for Armenia. My stated aim was to get as close as I
could to the Caucasus without getting shot; but the journey is wilder
than fiction. For all her ripe beauty, her whimsical charm, I see
hardships that challenge belief. I’ve come to sniff out Transcaucasian
settings for the heroine in my next novel, Ludmila’s Broken English. At
least, that’s what I thought when I boarded the plane. But my stupid
duty-free bag, my pointless choice of chicken or beef, the tinkling crap
on the plane’s speakers, all became an insult to reality when we
ploughed the mists over Yerevan and set down on a runway carved into
snow and ice.

Within memory of those little comforts, the little plankton cloud of
ego-floaters that is our western sustenance, I sat in a stench of shit
and piss for lack of running water, in the one-room apartment of an
83-year-old woman. She said to me: ‘When the war started, I wanted to
bring my family to safety. It was midsummer. My son, my daughter-in-law
and my grandchildren – an eight-year-old, a six-year-old and a
six-month-old baby – I made them go in a different car to me. But the
Azeris set them on fire. I went to the hospital to find them. There were
five coffins there, made for them.’

With the unravelling of the Soviet Union, Armenia – Hayastan as she’s
known here – was the first firework in the Transcaucasian chain to go
off. Now watch the rest of them bang. She has an unfriendly border with
Turkey to the west, the result of Turkey’s refusal to admit the genocide
of 11/2 m Armenians early last century. She has a hostile border with
Azerbaijan to the east, after the conflict that raged from the late
1980s into the early 1990s over the disputed Armenian enclave of
Nagorno-Karabakh. The only open route left is north to south, from
Georgia to Iran. And with war came a repatriation of Armenians and
Azeris to their respective territories, whole villages being swapped in
some cases, furniture, livestock and all. For most, however, it was an
ugly flight; luckier families were forced from their homes in the
clothes they stood up in; intermarried couples and their children were
split apart.

But not too many steps away from the old lady wearing socks over her
boots for traction on the ice in her apartment, I begin to learn that
war isn’t the whole story here. The story of this small, landlocked
jewel between the Black Sea and the Caspian is more deeply layered.

The man harbouring the missile comes to best symbolise Armenia’s
situation for me. Malicious fortune blasted into the country over a
decade ago; the earthquake of 1988 took more than 20,000 lives and made
500,000 homeless; the eruption of hostilities with her larger neighbour
Azerbaijan; and the collapse of the Soviet Union, under whose control
she enjoyed a measure of stability and growth. At the time, there was
much attention paid to her plight, and helpful forces rallied from near
and far. But as the flashpoint passed, as more exotic and pressing
catastrophes caught the popular mind, much of that support melted away.
And as high-priority crises grew out of control here, important strands
of more basic existence fell into neglect.

More than a decade after the announcement of ceasefire, much of Armenia
still lives in a state of poverty, her infrastructure in decay.
Pensions, when they’re paid, amount to little over $6 a month, yet fuel
costs approach those in the United States. A young republic for the
third time in her history, Armenia has no mineral resources to speak of
and relies heavily on diaspora Armenians for support. She struggles to
find the tools to clear the mess that the 1980s lobbed into her house.
In a world intent on the immediacy of conflict, on the savage,
newsworthy glamour of unfolding crises, this forgotten place seems a
bitter taste of things to come. The taste of a chronic, festering aftermath.

With occasional shelling and sniper fire still erupting around the
eastern defences, and having been told in one town that the mayor has a
new gun and might be out shooting stray dogs on the street, I hook up
with a team from Medecins Sans Frontieres (MSF), who have large ‘no
Kalashnikov’ symbols plastered over their vehicles. These suddenly seem
more helpful than the skull design on my snowboarding jacket.

MSF came here in the immediate aftermath of the 1988 earthquake, and
never left. When issues of front-line care were dealt with, MSF crews
saw a disturbing residue emerge. As a result, and unusually, the medical
charity decided to channel some of its resources into perhaps the most
vulnerable target of trauma and neglect – mental health. From a regional
base in the lakeside town of Sevan – a collection of glum Soviet
buildings scattered over a high plateau, with a decrepit Ferris wheel
strangely creaking in the wind at its entrance – the young Belgian
sociologist Luk Van Baelen leads me on a journey into the dark world of
the uncared-for mind. Nothing could have prepared me for what I was
about to see.

Not far from the house with the missile sits the border town of
Chambarak, comfortably settled into the folds of a high valley. The town
is a mixture of rusticity and post-Soviet neglect, an occasional
apartment block rising between traditional houses of lava and stone, and
smatterings of hay and dung. Some windowsills sport old US Aid tins as
flowerpots or buckets, souvenirs of support long gone. A nutty haze of
dung smoke hangs over Chambarak, from ubiquitous solid-fuel heaters like
large, iron shoe boxes with stovepipes attached. The market building is
a vacant shell, attended every day by a crowd of heavily-wrapped men
doing nothing and talking about doing nothing. Only one trader is there,
selling twigs for broomsticks. ‘There used to be nearly 100% employment
here,’ says a man. ‘Now, it’s nearly 100% unemployment. Every day there
are five funerals, but never a birth.’

The man, like half the town’s population of around 6,000, is an Armenian
refugee from the town of Artsvashen, 17 miles over the mountain in
Azerbaijan. He left everything behind to flee the war. With the border
so close, combat fatigues and military fur hats are more in evidence on
the streets. Armed watchtowers look down from the mountains. When we
take our Jeep off-road to view the town from a hillside, soldiers
quickly appear out of the snows and make towards us. We vacate the hill.

Wandering the icy streets of Chambarak – little more than compacted
humps of ice glacially layered with hay and dung – I note that there’s a
feeling around a place that has had shells lobbed at it. Bombs
sensitise, not desensitise, as is often romantically supposed. A
quivering nerve stays raw long after the gunfire has stopped.

In the middle of the town is a Soviet block that was once either a
prison or a collection of minuscule apartments without plumbing. It
stands gutted and derelict. Van Baelen takes me inside. ‘When I first
saw this place,’ he says, ‘I knew immediately why I was in Armenia.’

A fetid stench upholsters the block, sharpening as we move upstairs. The
building has been stripped to bare, sooty concrete, and in places
genuinely gutted by fire. Litter migrates in icy drafts. Some flights
up, noises can be heard behind a door. We knock. The door opens onto a
cloud of dung smoke from a wood stove thick enough to burn the eyes and
throat. In one room just big enough for a single bed, a small table and
a dresser, sits a woman called Hamest. Three children sit with her. They
fled Azerbaijan 15 years ago. The building is a refugee hostel.

A handful of families are camped there still, waiting for a change in
their fortunes.

And there’s something more; a curiousness, an unexpectedness in the
make-up of the family’s features and in their manner. The boy has a
strangely elongated face and a detached, doleful gaze. Then the father
arrives and bids us welcome. And there’s something unusual about him,
too, behind his beard and in his eyes.

Hamest and her husband are mentally retarded. So are their children. And
their life’s routine after the door closes behind us is one of
unthinkable abuse. Hamest’s husband often trades their bread for vodka
and drinks with other men in the building, often in that tiny room. He
regularly beats Hamest, and there is reason to suspect her daughters
suffer sexual abuse at the hands of the men. Hamest’s mother is dead,
and she has lost all contact with the family she knew when she fled
Azerbaijan’s capital, Baku, in 1990. She is utterly powerless.

MSF provides Hamest with a grant for electricity, and its psychologist
tries to convince her to send her adolescent daughter to a boarding
facility, away from the horrors of home. But Hamest is afraid she will
lose her daughter as well. I retire from the building with questions.
Not least, what are the odds of a mentally handicapped couple finding
each other, and going on to raise a handicapped family?

To discuss and absorb what I’ve seen, we make for a river gully just
outside town. Here, two old portable cabins and a gazebo-like shed sit
wide apart from each other in the snow. One of them is green and is a
kitchen. The other two hold a table each with chairs. Between them they
form a restaurant. Barbecued pork and traditional flatbread are served
with pickled, seaweed-like greens and luminous green pop tasting of
melted Strepsils. A woman trudges 40 yards each way across the snow,
back and forth with our food. The tiny gazebo ends up having comfortable
seating for eight. We dub it the Pork Tardis.

I learn that when Hamest’s husband is out, ranking soldiers from the
local base come to the hostel for sex. The kindlier officers might
sometimes leave a bag of pasta, or a loaf of bread, for her troubles.
The hostel’s inhuman feel palls over me. I’m staying in a Soviet
apartment in Chambarak, without running water, and with intermittent
power. The snow at its entrance has compacted into grey ice, and a
puddle of bright blood – hopefully from a freshly killed animal – gilds
its shine. Suddenly, it is relative luxury.

On another edge of town, we visit a rustic house whose yard is absorbed
by a tower of hay. Animals orbit it noisily. A young bearded man in an
old sports jacket tends the stack with a pitchfork, and waves. Inside
the house I meet Anoush, a pretty young woman with quick eyes and a
bright, earnest demeanour. She is a refugee who found a way out of the
hostel. She speaks in crisp Russian. ‘On January 13, 1990,’ she says,
‘nine people came early in the morning to our apartment in Baku, when we
were asleep.

They came in and slammed the door. I had three very young children. The
men asked to see our passports. When they saw our Armenian surname, they
told us to get out.’

Without even putting on her socks, Anoush went to the police. They sent
her to gather with other Armenians in a cinema, before loading them all
onto a bus for the border. She had a different family then; her husband
was an Azeri seaman, away in the Caspian for a fortnight at a time. He
was away that morning, and never knew how or when his family left. They
haven’t seen or spoken to him since.

After years in the refugee hostel, and with small children to care for,
Anoush was facing starvation. Her escape came when she was married off
to a retarded deaf-mute – the man outside – by his parents, who wanted
him taken care of. He brutally beats her. Her children suffer nightmares
and are being counselled by local MSF staff, but she is finding it
difficult to keep up her own visits to the psychologist and social
worker. Her husband’s parents – whose haystack, livestock and stove she
lives with – are against it.

A more successful escape has been made by a woman I meet called Tamar.
She once lived near the man with the missile in his cellar and also had
the experience of a rocket-propelled grenade crashing into her house.
Except hers detonated on the dining table. She watched her mother-in-law
explode. It kicked off a living nightmare, forcing Tamar into hospital
with psychosis. She later spent 10 years at the refugee hostel in
Chambarak, with neither heating nor a window in her room. But MSF staff
have since reunited her with her own mother, and stabilised her
condition with counselling and medication. Emerging from these visits
into sparkling sunlight, into the natural gloss of the place, is
bizarre. Snow twinkles like tinsel, swirling off ridges and rooftops in
gusts as dry as dust. We travel the snows to a town called Drakhtik,
whose population of around 1,500 is made up entirely of refugees. No
less than half are mentally disabled. Translated, the name of the town
means ‘Little Paradise’.

I’m invited to take coffee and chocolate with the mayor. He takes me to
a dilapidated office with a wood-burning stove, an abacus and an old
typewriter. His assistant is a nurse in a laboratory coat, who fusses
with the coffee on the stove. When we begin to discuss the war, she
chips in with lurid soundbites. ‘One woman watched her sister doused in
petrol and set on fire!’ she chirps. ‘Even people in the middle of a
wedding party were thrown out of Artsvashen!’

The mayor tells me that Drakhtik was once an Azeri town, similar to the
Armenian enclave at Artsvashen, where he came from. With the outbreak of
war he formed a council to swap properties with the Azeris who lived in
Drakhtik. The entire town changed places with Artsvashen, and both sets
of townspeople had two days to relocate. But this was a civilised elite.
Within Drakhtik there is also a refugee hostel for the many who missed
out on a swap. Both Hamest and Anoush first stayed at this hostel.
I learn they are sisters. There is a third sister, Vardouhi, who became
severely psychotic after their flight from Baku and is in a psychiatric
hospital. She hasn’t been heard of for 18 months.

We travel around Lake Sevan, the beautiful blue hole in the doughnut of
Armenia, towards the town of Vardenis. There sits the psychiatric
hospital where the third sister is to be transferred. Between potholes
in the road, and mindful that there is no legally enforced side of the
road to drive on, I grapple with the apparently widespread phenomenon of
mental disability. More than one Armenian has told me it stems from the
Azeri habit of intermarriage within the immediate family.

Understandably, this isn’t the only thing blamed on the Azeris, and, in
fairness, I haven’t met an Azeri to counter the claim.

Nor am I likely to: Azerbaijan won’t admit visitors with Armenian stamps
in their passports.

What is probably true, after some investigation, is that traditional
cultures on both sides of the border believe marriage is good for the
mentally disabled, even thinking of it as a kind of remedy, a
stabiliser. So disabled offspring are married off and abandoned to
family life, where they conceive more disabled children.

We travel long, stark, breathtaking stretches of snow, mountain and high
plateau. At one point, a man on the road flags down the MSF Jeep to ask
if we will dispense him some Tramadol. We come to another border town,
where a new MSF primary-health-care clinic sits reeking of paint. A
vivid crowd of female health workers gathers inside in overcoats, high
heels and lashings of make-up. But there are no patients. It must be
-20C in the building. Vapour billows from our mouths. The sight of an
examination table with steel gynaecological stirrups brings a wince.

‘The power’s off,’ explains the chief doctor, tightening her coat. We
all look through the window onto the southern Caucasus, as if power will
somehow return from there. This clinic is all the district has in the
way of free, basic care. Apart from Armenia’s vestigial Soviet
framework, which doesn’t much encourage visits to the doctor, the World
Bank has, with characteristic wisdom, instructed the government to
develop a private, user-pay system for health care. Except nobody has
the money to pay.

Care at the psychiatric hospital, however, is free. But you don’t have
much say once you get there. Making our way to the hospital, I brace
myself for dark realities. We’re met by the hospital’s director, a
softly spoken man with the bearing of a Russian golf pro. In his office,
a table is laid with brandy and chocolate. It’s 10am. He plays a video
of the hospital’s last Christmas party, opened to the community in an
attempt to soften perceptions of mental disability. The chief doctor, a
dentist by profession, joins us.

Conditions are not unpleasant as we tour the largely rebuilt, freshly
painted buildings. MSF invested heavily in the facility over a decade,
handing a greatly improved hospital back to local authorities. A party
rages in one common room, with Armenian clarinet and drum music
squealing from a portable machine. I’m approached twice in the corridors
by patients begging for help. One smartly dressed man folds a carefully
written letter into my hand, imploring me to help with his release. For
a moment, I’m prepared to believe there are sinister oppressions afoot
behind closed doors. Then he says he has contacts in the FBI, who are
waiting to help him. The chief doctor shakes his head; we move on.

The second patient to approach is a middle-aged woman who speaks in fine
English. She is a doctor of electronic engineering, an author of various
books and manuals, and a psychotic. Our interpreter, Tatevik Avetisyan,
is so fluent in Armenian, Russian and English that there is literally no
overhang between what she hears and says. When the English-speaking
patient begs me for help to escape, tells me she’s cured, the doctor
gives Tatevik a warning to pass on. Without blinking, Tatevik explains –
in Spanish so as not to upset the woman – that we should move along lest
we cause unease.

We visit a common room for more profoundly disturbed patients. Some sit
lifeless and frozen, others writhe improbably. All seem in good physical
health; the room is sunny.

Van Baelen spots one patient frozen over a chessboard. He initiates a
game. The man quietly beats him in 10 minutes. The game turns into a
series; Van Baelen eventually wins.

As the tour proceeds, the pleas of the English-speaking patient sit
heavily in my mind. Some of these patients would be at large, leading
normal lives, if they were in Europe, their disorders easily controlled
with medication. Yet they remain here, often for years, or for life. I
ask the director how this can be.

‘When a patient comes here,’ he says, ‘we take all the details we can
from their next of kin. But if I went to the files and phoned every
patient’s number today, visited every address, more than half wouldn’t
exist. The families have moved on, they’ve changed the number, didn’t
give the correct address in the first place. There are patients here who
could be out, except there’s nobody to sign for them, nobody to see they
take their medication. That’s the problem we face.’ Sixty percent of the
patients here will never leave. The hospital has its own graveyard.

MSF has joined the hunt for relatives, as well as helping in a patient’s
release and reintegration with family. I sat at the table of an
indomitable matriarch who, with MSF support, has taken a patient who is
not a relative into her home.

A picture began to emerge of the net MSF is building round the wider
problem; by providing early counselling and psychological support to
prevent conditions developing; by assisting confined patients who could
be cared for at home; and by trying to break down cultural barriers that
lead to stigma and neglect.

Next day, in nearby Martuni, I meet the region’s chief psychiatrist. His
office is in a seemingly deserted polyclinic that stands alone in the
snow, winds howling through its open concrete foyer. It’s bitterly cold
inside. No power here either, and the building seems largely empty; only
debris and litter are visible through darkened doorways. A nurse ushers
us into the office. When Dr Mikayel Kahramanyan arrives, he goes to a
cabinet at the back of the room and produces plates of freshly sliced
fruit, nuts, chocolate, soft drinks. And brandy. It’s 10.30am.

‘You have to have a drink,’ he shrugs, ‘it’s just too cold.’ A
delicately patterned tablecloth appears, covers his desk, and the
refreshments are laid out. The doctor sits without removing his jacket
or his Russian-style fur hat. He bears a passing resemblance to Anthony
Hopkins.

He agrees there are many institutionalised patients who could be
released. But he says the country is still dealing with Soviet
structures, and with cultural attitudes. In Armenia, a psychiatrist’s
report is needed to obtain many types of certificate and licence,
including a driver’s licence. People won’t come forward for treatment,
as a psychiatric file would blight them for life. Families shun members
with psychoses, and if sufferers aren’t committed by their families,
they eventually come to the attention of police.

‘The problem then,’ says the doctor, ‘is that nobody will claim them
back. If they’re released on their own recognisance, they feel cured and
forget, or neglect, to take their medication. They suffer an acute
episode, they’re brought back in, and so the cycle goes on.’ I ask the
doctor if things have changed much since Soviet times. He nods, and
pours another brandy. ‘Of course they have,’ he says. ‘The biggest
change is I can sit here and talk about this with you.’

I met many people in the southern Caucasus. Maybe, notwithstanding
psychoses brought about by the trauma of war and dislocation, there are
no more mental disabilities here than anywhere else. But a great stigma
is placed on mental disorder here, and it attaches to anyone within
reach of a sufferer. Lesser conditions, such as depression and anxiety,
are ignored. And this dynamic forms the heart of Van Baelen’s project.
He has started on the task of de-stigmatisation.

Chambarak opened its first MSF day centre in 2003. There is one in each
of the towns I’ve visited, staffed with psychologists, social workers
and assistants. The day centres are a hub not just for the disabled, but
for the wider community; if only for warmth, coffee and conversation.
Every weekday the centre is open for counselling, crafts, music,
fitness, anything that brings the twain together in a relaxed and
constructive way. Picnics and open days are mounted. The able and the
disabled mingle.

‘We use any excuse for a party,’ says Chambarak’s psychologist, Loussine
Mkrttchian. Subscription is steadily growing at her centre.

It’s also at the day centre I see a remembered face. The shepherd who
wandered past the house containing the missile. I meet him. His name is
Petros; a handsome, weather-beaten, profoundly retarded 35-year-old with
airs of great musing and reflection, and a fixation with the buttons on
his coat. A familiar sight, he wanders from morning to night, often in
the mountains, often around the prohibited border zone. His family feeds
him, but that’s as far as his care goes. He’s been left to wander.
He has never spoken a word.

Within a year of the centre opening, Petros was lured in off the
mountain. Now he’s here every day, for as long as the door is open. He
features in every snapshot in the centre’s bulging album. At weekends,
when the centre is shut, he sits on the doorstep. Waiting. And in the
days since I was there, he’s started to speak. His first words were:
‘Good, good.’

Luk Van Baelen’s captaincy of this MSF project will soon end. Local MSF
staff have been trained to take over. And like the little life span of a
dog within his longer life, my journey has ended too. Van Baelen stands
in the bright cold, watching beneficiaries’ horseplay on the steps of
Chambarak’s day centre. I ask him if he’s looking forward to returning
to Europe. He says he doesn’t plan to return.

He hasn’t been back since the project began. ‘I just know if I went
back,’ he says, ‘the first thing I’d hear is someone complaining that
their train was five minutes late.’ He squints out over the snow, up
onto the mountains. ‘I don’t know if I could handle it.’

Authors in the Front line

In The Sunday Times Magazine’s continuing series of articles, renowned
writers bring a fresh perspective to the world’s trouble spots. The
international medical-aid organisation MSF has helped our correspondents
reach some of these inhospitable areas. To donate to MSF, visit
, or call 0800 200 222