ARMENIAN EYE CARE PROJECT OFFERS REWARDS TO ITS PATIENTS, VOLUNTEERS
By John A. Hovanesian, MD
OSN SuperSite NJ
Cataract Surgery
Ocular Surgery News U.S. Edition September 15, 2007
Thanks, in part, to ophthalmologists’ efforts dating back to 1992,
the country boasts state-of-the-art technology and research today.
Why would a practicing ophthalmologist, at the last minute, delay
a family vacation and fly alone through 12 time zones to a country
where he had never been?
John A. Hovanesian – Photo
"Because I got a fax asking for help," said Roger Ohanesian, MD,
of Laguna Beach, Calif., the founder and president of the nonprofit
Armenian Eye Care Project (AECP).
The fax arrived in September 1992 from the foreign minister of the
then newly independent Republic of Armenia. It was sent to dozens of
U.S. physicians, asking for help in the fight against a "growing wave
of blindness" shortly after the Soviet Union collapsed in 1991. Within
2 days of a scheduled family vacation, Dr. Ohanesian gathered whatever
medical supplies he could and rescheduled his itinerary to instead
travel to the Caucasus region, while his wife and 12-year-old son flew
to London. Dr. Ohanesian had no idea that this would be the first of
30 trips to Armenia.
Bad old days
"Armenia is a country the size of Maryland that borders Iran, Turkey,
Azerbaijan and Georgia," Dr.
Ohanesian said. "In addition to the economic challenge of its new
independence, it had two other significant setbacks during this time:
a 7.2-magnitude earthquake in 1988 that destroyed most of Armenia’s
infrastructure and a war with neighboring Azerbaijan in the same
year that tapped its resources and touched off an epidemic of ocular
trauma."
"When we arrived on those trips in the early ’90s, people were
literally lined up for half a mile to see us," said Richard Hill, MD,
professor of ophthalmology at UC-Irvine, who has been to Armenia with
the AECP more than 20 times, each time traveling at his own expense,
as do all of the volunteer physicians. "Many of the slit lamps were of
an old Soviet style with horrible optics and nonfunctional bulbs. We
used penlights for illumination instead of the slit beam."
Sleeping only a few hours on cots in a spare hospital room,
Dr. Ohanesian, Dr. Hill and a number of other volunteers (see sidebar)
learned to improvise in the early days, as did the Armenians. "I
remember a freezing cold day in the operating room doing a membrane
peel procedure," said Sanford Chen, MD, a retinal specialist
from Laguna Hills, Calif., and clinical assistant professor at
UC-Irvine. "Just as I had grasped the premacular fibrosis with forceps,
the lights went out. I had to hold the instruments steady while the
staff ran to the hospital basement to fire up the generator. It took
forever. I later learned, because someone had stolen the fuel for
the generator, they had to find more."
Teaching a man to fish For several years, Drs. Ohanesian and Hill
traveled to Armenia twice a year, each time spending 2 weeks. "I soon
realized that I was spending one-twelfth of my life with my friend
Roger in a Third World country," Dr. Hill said. "We just couldn’t
do all the surgery ourselves, so we designed a residency program in
Armenia similar to ours at UC-Irvine. Very quickly, Armenia’s best
and brightest young ophthalmologists stood out, and we allowed a few
to come to the United States for fellowship training."
Baruch Kupperman, MD, professor of ophthalmology at UC-Irvine said,
"I still enjoy a close friendship with Armen Vardanian, the AECP
retina fellow who trained with me."
Dr. Kupperman, who has traveled twice to Armenia, has witnessed
Dr. Vardanian, and other AECP trainees, not only perform much of his
own surgery for free but also duplicate his training in the other
young doctors.
"It’s incredibly gratifying to see that we have built an entire
tertiary care ophthalmology department from a vacuum."
The mother of invention
Still, Armenia’s health care system had many needs.
"One of the oddest innovations by our residency graduates in Armenia
was the use of sterile cigarette filters in place of expensive
Merocel sponges," said Anthony Aldave, MD, associate professor at
the UCLA Jules Stein Eye Institute, who has also traveled twice
to Armenia. "They actually work extremely well for wicking away
aqueous, blood and vitreous. They start with a 6-inch long strip
of round cigarette filter material with the end cut at an angle to
make a point, and when the tip becomes wet, the nurses simply cut it
shorter to create a fresh, absorbent end."
Dr. Aldave laughed as he recalled, "They actually use the word
‘cigarette’ in the Armenian language, and I remember one case where
the surgeon asked the assistant in Armenian for ‘another cigarette’
and the patient, under local anesthetic, asked, ‘Doctor, is this
really a time for smoking?’"
Expanding to rural areas "I’ll never forget a tiny, 4-foot tall
grandma from the villages," Dr. Ohanesian said. "After her cataract
surgery, she took off her patch and looked at her 3- and 6-year-old
grandchildren for the first time. We all cried together." She, like
two-thirds of Armenia’s population of 3 million, lives outside the
capital city of Yerevan, but many local villagers are too poor to
travel for medical care. To reach them, the AECP between 2002 and 2004
raised $1 million to build a fully functional eye hospital on wheels.
"Every expert in Third World medical care told us that a mobile
hospital program was a mistake – that it just wouldn’t work,"
Dr. Ohanesian said. Yet in the 5 years since its deployment,
the AECP mobile hospital program has screened 160,000 patients,
performed 6,000 major surgeries (mostly cataract/IOL), 2,500 lasers
and has diagnosed tens of thousands of patients with disease requiring
medical intervention. "Because of the support of our donors, all this
care has been completely free of charge," Dr. Ohanesian said. The
mobile hospital program has been so successful that the U.S. Agency
for International Development has asked the AECP to provide guidance
on developing mobile programs for other medical specialties in Armenia.
Research in the Third World "Who knew that … Armenia could
offer a valuable research facility?" said Sarkis Soukiasian, MD,
of the Lahey Clinic in Massachusetts. So far, the U.S. Food and Drug
Administration has accepted data from Armenia for phase 2 and phase
3 clinical trials for two different intravitreal injections and one
glaucoma tube-shunt device.
Today, the department supported by the AECP boasts its own telemedicine
consultation lab, a training classroom and library, a wetlab with
four Alcon Legacy phacoemulsification machines and video relay Leica
surgical microscopes, three modern operating rooms, and its own eye
bank. All these resources were either donated to the AECP by industry
sources or purchased by the AECP at substantial discounts with funds
from private donors.
"What’s most exciting now is that many patients travel to Armenia from
neighboring countries like Iran, Georgia and Russia because they’ve
heard it is an ophthalmic center of excellence," Dr. Ohanesian said.
The rewards
All of the AECP volunteers agree that friendships with patients and
other doctors, both Armenian and American, have been their greatest
payback for the work in Armenia. And many return trips for some have
only heightened their connection with this beautiful little country.
For more information: John A. Hovanesian, MD, FACS, is a
clinical instructor at the UCLA Jules Stein Eye Institute and
is in private practice in Laguna Hills, Calif. He can be reached
at Harvard Eye Associates, 24401 Calle De La Louisa, Suite 300,
Laguna Hills, CA 92653; 949-951-2020; fax: 949-380-7856; e-mail:
[email protected].