Have you ever been frustrated with the medical system in America? Have you ever felt like yours or your loved one’s medical needs were not being met across the continuum of care? Now take that frustration and multiply it tenfold. This is what it’s like to receive medical care in a second world country, and it wasn’t until I moved to Armenia that I truly understood how GOOD the medical care we have in the USA.

For those of you wondering, Armenia is a country located in the mountainous region of the Caucasus, between Asia and Europe. Although it is home to one of the oldest civilizations in the world, its medical system is far from perfect. Here are some facts and statistics that will help you better understand the healthcare system in Armenia:

• 1.6% of Armenia’s GDP is spent on health care; The World Health Organization (WHO) recommends a minimum value of 3.5%.

• In Armenia, there is NO concept of primary care or a feedback mechanism in the medical system to enable interdisciplinary care.

• There are a total of 41 hospitals per 1,000,000 inhabitants of the capital Yerevan (the main problem of incorrect distribution of patients to providers and facilities).

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

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

• In Armenia, more people are dying because of the care they receive from VS. lack of care.

Why such a huge service gap, you may ask? This is largely due to the way the healthcare system works in Armenia. Since Soviet times, the health care system has focused on treating disease rather than preventing it. There is no concept of primary care, only a network of specialists who too often refer, too often diagnose and prescribe treatments and procedures. As you can imagine, such extreme fragmentation does not allow for the provision of high-quality interdisciplinary care.

And although there is a profession of speech therapist in Armenia, almost all SLP specialists are trained to work with the pediatric population. The concept of adult rehabilitation, from all therapeutic perspectives (i.e., speech therapy, physical therapy, occupational therapy), is just beginning to emerge. This means that anyone suffering from aphasia, dementia, apraxia of speech, or other neurogenic communication and/or swallowing disorders is unlikely to receive the help they need. Especially with dysphagia, there is NO room to find a liquid thickener if you need it. This creates a huge risk of increased avoidable deaths.

While making positive changes in a corrupt medical system won’t happen overnight, it’s not impossible. The most effective impact that can be made is to create policies that will restructure and reinvent health care in Armenia today. By conducting and publishing scientific research, generating epidemiological statistics, and presenting this information to the Ministry of Health of Armenia, the transition from a disease-based to a preventive approach is much easier to achieve.

In recent years, organizations such as Therapists for Armenia (TFA) have been laying the groundwork for change in this sector. TFA is a group of volunteers in occupational therapy, physiotherapy and speech therapy who strengthen rehabilitation and disability services in Armenia through an inclusive, sustainable approach. Their goal is to establish international contacts, strengthen service delivery, fight the stigma of disability and help Armenian communities develop. It is this type of interdisciplinary approach that we are fortunate to have in America that will set the tone for continued healthcare reform in Armenia.

**Written by Nathalie Halajian