Asbarez: Armenia Needs Integrated Healthcare Now, a Physician’s Perspective

Dr. Lorky Libaridian at the Dsegh Health Center in Lori, the first clinic in Armenia to offer integrated care, where medical and psycho-social staff work together to support patients

Dr. Lorky Libaridian of the Children of Armenia Fund Points to the Lasting Health Implications of Societal Stressors

BY DR. LORKY LIBARIDIAN and CATHERINE MANUKYAN

“If a patient has diabetes or high blood pressure, their stress levels decrease after working with the psychologist, and the treatment outcomes improve. They are more consistent with their care and adherent to treatment.” – Primary Care Nurse in Dsegh, Lori, Armenia.

Most people have never heard the term Integrated Care, or if they have, don’t understand just how important a part of an effective healthcare system it is. It’s not a sexy machine like an MRI, or a scary sounding term like a heart attack. But, sometimes, the solution that saves the most lives does not easily scream out in a headline or on a billboard.

In healthcare, we understand that health and wellness are directly linked to how we live, and the challenges we face. And sometimes the best care is preventing a heart attack by identifying and addressing, as much as possible, the factors that lead to it—stressors such as financial strain, food insecurity, or unsafe environments, are all closely linked to conditions such as depression, anxiety, and post-traumatic stress.

What Do We Mean When We Say Integrated Care?
When we provide access to a comprehensive team that incorporates a social worker and a psychologist—specialists who can address life’s stressors—alongside healthcare professionals, we deliver the integrated care that individuals and communities need.

In many countries around the world, integrated care is not a novelty, but a standard. In Armenia, this type of integrated care was absent until recently, when the Armenian Ministry of Health teamed up with the Children of Armenia Fund to pilot an integrated care model in the village of Dsegh, in the Lori region of Armenia.

At COAF, We Have Seen the Need for an Integrated Approach First-Hand
When we began, COAF found a healthcare model that was consistent with what we’d seen throughout Armenia, and to be honest, many other places around the world: care at the clinic was purely medical. As COAF’s health team lead, I saw first hand how introducing integrated care improved the lives of patients at the local clinic. And now, we’re ready to share our lessons learned, our successes, and most importantly, its potential benefits to 26 clinics across rural Armavir. 

Here is just one example: An older woman with a chronic condition, grieving the loss of a family member, frequently sought care at the clinic. Just how much her grief impacted her ability to manage her health had not been recognized, nor was there a framework to address it in primary care. With the new model, the integrated care team reached out and began working with her, providing psychosocial support that helped her navigate her grief and improve her overall health. Not all cases have such a striking connection between psychosocial needs and health, but even modest support can make a big difference.

We understand this intuitively, but often neglect this necessary component in discussions about what good healthcare is. Most of us know that stressors affect more than just how we feel. They impact our mood, sleep, relationships, and our daily functioning. During periods of stress, we often neglect our own care, not to mention the physiological changes that stress has on the body.

Though we don’t have good data, in Armenia, we have significant reason to believe that stress, PTSD, depression, and anxiety, are widespread. This is not surprising given what people in Armenia have been through in the past forty years. In a 2018 national study, 21 percent of adolescents aged 11-15 years old reported feeling signs of depression, and this percentage only increased with age. 

If left unidentified and untreated, these conditions increase vulnerability to chronic diseases such as diabetes and hypertension, as well as alcoholism and other substance abuse disorders. It is therefore clear that Armenia requires robust, accessible mental health and social work systems, ideally integrated into primary care.

Today, We Have the Opportunity to Advance Integrated Care in Armenia
The opportunity to disseminate an integrated care model in Armenia is in front of us now. That is why, at COAF, we are engaging our global community to help us scale lessons we have learned in Lori across the Armavir region.

This Spring, COAF has launched a Spring Appeal to expand our health programs across 67 villages. This initiative includes an expansion of preventive dental programs in kindergartens, and capacity building in primary care which will reach 26 clinics—with integrated care being a fundamental building block of that process.

This is an opportunity to support individuals in managing their stressors, improve their quality of life, and the subsequent long-term benefits, including decreasing early mortality.

It is easy to lose sight of the importance of providing integrated care, but it is not every day that we have the chance to come together, as a community, and push forward something so beneficial for families in Armenia’s rural regions.

We hope you will join us in making this vision a reality for thousands of families across the region of Armavir.

Learn more at the COAF website.

The Children of Armenia Fund is a nonprofit, non-governmental organization dedicated to transforming the lives of children in rural Armenia through a comprehensive approach to education, healthcare, social services, and economic development. COAF helps young Armenians expand their universe so that they can shape a brighter future.

Dr. Lorky Libaridian is a graduate of the Yale School of Medicine, former Harvard School of Medicine Faculty, and the Health Team Lead at The Children of Armenia Fund. COAF is a non-profit organization founded with the goal of ensuring that every child can reach their full potential. This Spring, COAF is expanding its healthcare initiative to nurture the healthy foundations families need to thrive.

Catherine Manukyan is an intern at The Children of Armenia Fund.

—