Lusine shares how Armenia’s rural families are bearing brunt of under-resourced health system

Lusine Petrosyan, 29, could have been a happy mother of four, however she has only two children alive– three-year-old Kathrin and two-year-old Armenak. For the loss of her first two children Lusine blames the poor healthcare provision in her area. The health infrastructure in Nerqin Bazmaberd of Aragatsotn region in Armenia suffers from a lack of medical personnel, proper facilities and lack of attention to maternal and child health.Lusine’s family life would not be described any differently than the majority of women living in the rural areas of Armenia. For the past ten years her days have started before dawn, and are spent working between the barn, housekeeping, taking care of the children, husband and her father-in-law. In addition, there is no running water in the house and the manure stove is the only source of heating. It’s only late at night that Lusine can slow down and rest.

...rural under-five mortality rates in Armenia are almost twice as high as those among the urban populationLusine had complications during the first two pregnancies and although she went on to give birth to two healthy children, the pain of her loss still grips her heart.

“During my first pregnancy I was referred to the regional hospital with pains. The doctor examined me, gave me an injection, assured me that everything was all right with me and advised me to go home and have a good rest. On the way home I had a miscarriage”, recalls Lusine.

“My second pregnancy was also tragic. I gave birth on the way to the hospital and the baby was born suffocated”, she shares.

Healthcare provision for the urban population in Armenia is of a higher standard to that provided in remote areas, although more than 40% of the country’s residents live in rural areas. In addition, surveys reveal that rural under-five mortality rates in Armenia are almost twice as high as those among the urban population. These suggest a poor distribution and low accessibility of healthcare services for remote area residents.

Some 20 years ago Armenia began major health sector reforms to develop a balanced healthcare system, enforce prevention and promote a healthy lifestyle. Nevertheless, quality provision of healthcare still remains inconsistent.

...when a pregnant woman is about to deliver, her family has to take care of transportation to the regional hospital on its ownDespite the fact that a functioning referral system is critical to the provision of effective maternal and child health care, often delays in reaching medical care are recorded. The common barriers to referral compliance are transportation expenses or lack of transport, and poor road conditions.

“The two doctors of our local ambulatory serve ten communities in our region and to be perfectly honest with you they hardly manage the flow of patients. The ambulance operating in the area is rarely available; it reaches mainly patients with medical emergencies such as an acute kidney or heart attacks, or diabetic coma. When a pregnant woman is about to deliver, her family has to take care of transportation to the regional hospital on its own. This often creates irreversible troubles for the local families that live below the poverty line”, says Shushan Aslanyan, an active member of the Mothers’ Support Group in Nerqin Bazmaberd.

Even with the regulations that stipulate free of charge access to ambulance services as part of the healthcare provision, this service remains inconsistent and often inaccessible for rural dwellers. Ambulances attached to local ambulatories are often unavailable due to being overloaded in the work schedule. As a substitute, private transportation means are commonly used in emergency situations with patients themselves paying for services.

“Our local ambulance serves around 6,000 residents. The distance between the communities is some 25-30 kilometres”, says Karine Grigoryan, head of the ambulatory in Nerqin Bazmaberd.

I cannot put into words how happy I was to hear Kathrin’s first cryConsidering the distance between the communities and the fact that the population of 6,000 people has to refer to the one ambulatory, the residents of Nerqin Bazmaberd face major issues with either receiving medication or referring to a specialist.

Further still dilapidated infrastructure in rural communities of Armenia is another major constraint for women in labour to reach the hospital in time. The local physician joined Lusine to accompany her to Talin hospital with her third baby to deliver. However, once again, the lack of transport and poor road conditions were major challenges. The doctor had to help with an emergency delivery halfway to Talin hospital. Fortunately this time, both the mother and the child were healthy and safe.

“I had to deliver my baby in the regional hospital which is some 30 kilometres away from where I live. It took quite a while before my husband Armen found a car; afterwards we wasted an immense amount of time on the roads. I was in a panic; I did not want to lose my baby once again.

“My only thought at labour was to do whatever it takes to deliver my baby alive and I cannot put into words how happy I was to hear Kathrin’s first cry”, recalls Lusine.

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