AMIC’s Newsletter, Montreal, Canada
AMIC’s Info-Flash
2340 Chemin Lucerne # 30
Ville Mont-Royal, Quebec
H3R 2J8, Canada
Tel: (514) 739 8950
Web:
Email: [email protected]
December 2007
1. Article 1: Message from AMIC’s President: 2007 Realizations and
Future Perspectives.
2. Article 2: The State of Paediatric Epilepsy Care in the Republic of
Nagorno Karabagh (NKR)
3. Article 3: News from the "Fighting Infectious Diseases in Emerging
Countries" (FIDEC) Foundation
4. Article 4: What is AMIC?
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I – Message from AMIC’s President: 2007 Realizations and Future
Perspectives
Dear Friends,
2007 has been quite a busy year for AMIC. I would like to share with you
some of my thoughts and inform you of what AMIC has accomplished during the
past year.
Karabagh now has a new President and a new health minister. Also, Dr.
Kushkian is the new health minister of Armenia. We worked with both
ministers and President Bako Sahakian. I am pleased to inform you that for
the first time since its foundation, AMIC has been recognized as partner and
primary contact for medical issues in the diaspora by the Ministry of Health
and the Ministry of Foreign Affairs of the Republic of Armenia.
We accepted to work in partnership with "Hayastan Himnatram" (Armenia Fund)
in the Poverty Eradication Program spearheaded by Minister Oskanian. The
program consists of a poverty eradication and repopulation project for 144
villages surrounding Armenia. AMIC will look into the feasibility of
planning to build or remodel medical and dental facilities operating in
those villages. Although our involvement will be strategic and not
financial, AMIC will need your utmost help in the planning of such an
important project.
I would like to acknowledge and praise the work done by my predecessors
throughout the years to bring AMIC to date and become recognized as an
Armenian Medical International Committee representing all Armenian Medical
Associations throughout the world.
I will ask for your continuing support for AMIC. Without it, AMIC will not
survive. I have already begun visiting medical associations in Europe and
holding meetings with them to strengthen our relations. Together we will
make the difference; the smile on the faces of our sisters and brothers in
our motherland will depend on our efforts.
We are having a General Assembly in New York in May 2008. I invite you all
to attend so that we can meet and set our goals; your input in AMIC
activities is very important.
I take this opportunity to wish you all a Happy and Healthy New Year.
Finally, let there be peace and prosperity in our beautiful homeland,
Armenia.
Dr. A. Bogosyan,
President, AMIC
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II – The State of Paediatric Epilepsy Care in the Republic of Nagorno
Karabagh (NKR)
Report by Berge A. Minassian, MD. Contact: [email protected]
On behalf of the delegation of the Neurology Division of the Armenian
Medical International Committee (AMIC)
Members of the delegation:
Gaspar Israelian MD, Adult Neurologist, Toronto, Canada
Berge A. Minassian MD, Pediatric Neurologist, Toronto, Canada
Arthur Partikian MD, Pediatric Neurologist, Los Angeles, USA
Arousiak Varpetian MD, Adult Neurologist, Los Angeles, USA
Accompanying the group:
Varsine Jaladyan MD, Pediatric Neurologist, Yerevan, Armenia
The delegation visited NKR from July 1 to 5, 2007.
Half to one percent of people worldwide have epilepsy. Precise numbers for
NKR are not available. We estimate that approximately 200 children in NKR
have epilepsy.
The Neurologist
NKR has a number of physicians who participate in the care of children with
epilepsy in the capital of Stepanakert and in the regions. These health
care professionals each possess a varying degree and quality of training in
neurology and psychiatry. However, there is only one properly specialized
neurologist who works through the Stepanakert Pediatric Hospital. The
visiting group spent one day seeing ~30 patients with her. Though she has
adequate basic training in Pediatric epilepsy and can easily take care of
routine cases, she is somewhat lacking in depth and breadth in the field.
She is however highly motivated and more than capable of garnering the
missing knowledge base. This can be achieved through further training at
the Arabkir Pediatric Centre in Yerevan.
There, students of Dr. Vahagn Darbinyan, the father of modern epilepsy care
in Armenia, and the head of the hospital, Dr. Ara Babloyan, have established
a world-class Pediatric epilepsy centre, world-class in terms of knowledge,
though lacking in some equipment. Prominent in the team at Arabkir are Drs.
Biayna Sukhhudyan and Varsine Jaladyan. The Stepanakert neurologist should
spend three to six months, preferably the latter, consecutively or not, at
Arabkir, so that she becomes fully qualified. To gain additional
perspective, she should also rotate through the Erebuni Hospital Epilepsy
Centre where other students of V. Darbinyan (Gayane Melikyan, Nune
Yaghiazaryan) provide outstanding care of adult epilepsy patients.
Although NKR patients from distant regions could find it hard to access the
Stepanakert centre for care, for the moment additional specialized Pediatric
epileptologists in the regions are not needed. Instead, our delegation
recommends that epilepsy courses for general practitioners of the regions be
organized so that such physicians can gain basic knowledge regarding the
management of uncomplicated epilepsy and learn when to refer difficult cases
to Stepanakert. Incidentally, the Armenian League Against Epilepsy, in
collaboration with the AMIC Neurology Division and the International League
Against Epilepsy, are organizing a one-week epilepsy course in August 2008.
NKR physicians are strongly encouraged to attend this course.
Over the longer term, preparation of a second Pediatric epilepsy specialist
for NKR would be desirable.
Medications
Epilepsy is generally divided into focal-onset epilepsy versus primarily
generalized epilepsy, with each group requiring a certain class of
medications. Several medications from each class are available in NKR or
via Yerevan. Some important medications, e.g. ethosuximide for Childhood
Absence Epilepsy, are not available but can be replaced by available
medications, in this example, valproic acid.
An extremely positive aspect is that in NKR, the government covers the costs
of all medication for children until age 16. This immense advantage is not
present in Yerevan and in the Republic of Armenia, where many children
cannot afford their medications.
Testing for medication levels is not available. We are aware that a
diagnostic centre is being constructed in Stepanakert, and this testing can
be made available through this centre. However, availability of this
resource is only useful in expert hands or following adequate training of
general practitioners. It is also expensive. Finally, while it is needed
in many cases, it should not be needed in the majority. In Yerevan, the
Arabkir and Erebouni teams have access to this type of testing and rightly
use it sparingly and selectively. For the present, it is eminently possible
to send selected samples to Yerevan for testing. The medications are
extremely stable in blood and there is transport between Stepanakert and
Yerevan many times each day. Results could then be conveyed back to
Stepanakert within 24 hours, which in most cases is adequate. It is
envisaged that a close partnering of Arabkir and the Stepanakert children’s
hospital would easily solve this particular issue, and many other issues in
epilepsy care and general Pediatric care. A partnering of this type between
these two centres would be highly desirable.
Other epilepsy treatment modalities, such as the ketogenic diet or epilepsy
surgery, are not available, and not realistic for the moment in NKR.
Equipment
Two pieces of equipment are essential in epilepsy diagnosis and care. One
is the electroencephalogram (EEG), and the other is some modality of brain
imaging. Neither of these is available in NKR.
Our delegation will endeavour to obtain an EEG machine for Stepanakert.
Diasporan recipients of this report should kindly try to help us in this
respect.
There is no MRI in NKR. In Yerevan, there is one machine, and a second one
coming on line soon.
There is a CT scanner in NKR. However, for reasons that are unclear, it
remains non-functioning. It has been there for a number of years, is
apparently in excellent condition, or so it was when it was first obtained.
There may be issues with unavailability of technologists to run the machine
and radiologists to read the results. It is imperative that the government
of NKR either gets this machine up and running, or obtains a new one. If
they cannot, for reasons of finance or otherwise, they should approach
authorities in Armenia or AMIC for coordination of the necessary assistance
in this regard. It is unacceptable (to all interested Armenians not just
the local government) that a country of that size, especially one still at
war, does not have a CT scanner.
Conclusions and review of recommendations
Pediatric epilepsy care in NKR has the necessary foundations, a
specialist, a network of regional physicians, medication cost coverage,
potentially a strong support from Arabkir and Erebouni centre in Yerevan,
and a dedicated government and Ministry of Health (Dr. Zoya Lazaryan,
outgoing minister of health (MOH), keenly assisted this delegation and
expressly asked for its recommendations). We recommend:
1- Further training of the specialist at Arabkir under Dr. Sukhhudyan,
and at Erebouni, at least three to preferably six months.
2- Attendance of the Dzaghgatsor epilepsy course in Aug. 2008 by NKR
physicians.
3- Establishment of a system for therapeutic blood level testing by
shipping to Yerevan.
4- Obtaining an EEG machine. The AMIC neurology division should initiate
this. Once found and delivered there will need to be training of the
neurologist, or preferably a technologist, in the use of the machine. This
can be done at Arabkir or Erebouni medical centre in Yerevan, where EEG’s
are available and used routinely.
5- Ensure a functional CT scanner in Stepanakert.
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III – News from the "Fighting Infectious Diseases in Emerging Countries"
(FIDEC) Foundation
In its previous issues (see the April 2006 issue, for instance), Info-Flash
has reported on the FIDEC Foundation (founded in 2001 by Dr. Daniel
Stamboulian from Argentina). In 2006, FIDEC appointed Dr. Liana Hagopian as
its representative in Armenia. Dr. Hagopian made a presentation about FIDEC
activities in Armenia during the Second International Medical Congress of
Armenia last June.
-Vaccination
-In October 2007 FIDEC organized a vaccination campaign (MMR) in Armenia.
According to the Ministry of Health data 1,130 physicians and 1,474
vaccinators participated to vaccinate 776, 451 individuals. The campaign was
very well organized and the social mobilization was strong. Billboards
showing famous singers with members of their families were used to publicize
the whole operation.
-In the coming months a similar campaign will be organized in Karabagh
targeting around 36, 000 individuals. FIDEC Argentina informed Info-Flash
that there was an outbreak of Hepatitis A in four villages, 3 of them in
Armavir and Vayots-Dzor marzes and in Nairi village. Necessary vaccine doses
will be sent to limit the outbreak. FIDEC Argentina informed Info-Flash that
there was an outbreak of Hepatitis A in four villages, 3 of them in Armavir
and Vayots-Dzor marzes and in Nairi village. Necessary vaccine doses will be
sent to limit the outbreak.
-Education
In 2004 FIDEC published 4 booklets in Armenian (translated from their
Spanish original version) to be distributed in schools outside Yerevan and
in an Argentinean funded school, in Yerevan, that has 400 school children.
With colourful drawings, these comic books explain with simple narratives
how to be aware of germs and how to learn simple rules of hygiene. "Clean
hands", "War against lice", "Let’s be Friends with Vacc (vaccine)", "Our
Super teeth".
A fifth booklet ("The Winning Team") will be out soon.
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IV- What is AMIC?
The Armenian Medical International Committee was created 17 years ago. It is
an umbrella organization that unites and promotes Armenian medical
associations throughout the Diaspora, creating thus a large network through
which information and data are exchanged.
AMIC organizes Armenian Medical Congresses. So far nine have been held in
different cities of the Diaspora. In 2007, the "Second International Medical
Congress of Armenia" organized by Armenia was held in Yerevan (June 28 to
June 30).
Since 1998 AMIC has published an online newsletter which is sent free of
charge to all Armenian Health Care Professionals. If you are a health care
professional and are interested in receiving Info-Flash, please send us your
email address ([email protected]). To all those who already receive the Info,
please do not forget to send us your new e-mail address when you change it.
For further information, visit our website:
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As of 2005, AMIC in collaboration with Regimedia, publishes a scientific
journal, the "Armenian Medical Review". The third issue was published in
July 2007. To subscribe please contact [email protected]
Useful information to remember: You can send free of charge from wherever
you are located, medical equipment/medicine through the services of the
United Armenian Fund: Contact: President Mr. Harout Sassounian