WiRED’s Work in Armenia

BY WIRED DIRECTOR GARY SELNOW, PH.D.

 

The Armenian countryside is breathtakingly beautiful. The lush, green fields in the mountainous northeast are deeply creased and laced with rutted paths etched by livestock over the centuries. The land in Armenia, and its history, stretching back to the Bronze Age, are tightly bound. When visiting here, it’s tempting to visualize shepherds during ancient times, tending sheep on the sides of these hills. The Armenian story thus tells about its great beauty, and its rich and complicated history. Sadly, it also must include its long-standing conflict with its neighbor to the east, Azerbaijan. Fighting, which started a century ago over Nagorno-Karabakh, has of late picked up steam. Although hostilities occur mostly in the southeastern portion of Armenia, where, last year, more than 200 people on both sides were killed, tensions remain high along the entire border.

 

And so it was in this setting, in 2012, that I was traveling with Sebouh Baghdoyan (the engine behind WiRED’s work in Armenia), Artak Dadoyan (working with several non-profits including Armenian Caritas) and Armen Avakyan (our driver). We were heading north, passing the village of Voskepar on the M16. Voskepar dates back to the 6th century and curiously sits between the Azerbaijan mainland and the small enclave of Verin Voskepar, which is part of Azerbaijan but controlled by Armenia. Nothing is simple about the politics here.

 

We were cruising along, passing the time with casual conversation, when, for no apparent reason, Armen hit the accelerator, pushing the small car to race toward 70 mph on the narrow, twisting road.

 

“Why are we going so fast?” I shouted over the engine roar.

 

Sebouh shouted back, “See that ridge?” as he pointed to a few houses on top of the hill overlooking the road.

 


Sebouh Baghboyan

“Yeah, I see it.”

 

“Snipers,” he said. “They’ve been shooting from there, and it’s best to get past this place as fast as we can.”

 

Best to speed past it, indeed. And so, Armen kept the hammer down for several miles until we were safely past sniper alley and then returned to our normal cruising speed, while the conversation returned to details of our upcoming meeting in Noyemberyan, now just a few miles ahead.

 


 

We had planned general introductions for the meeting in Noyemberyan — a chance to meet and greet — but it turned out a lot better than that; it set the stage for our work in Armenia and began the relationships with some of the people who would eventually help form WiRED-Armenia. We started our discussions at a clinic and then moved to a restaurant, a venue, I would soon learn, where a lot of business in Armenia takes place. Our small group included Sebouh Baghdoyan, Dr. Arevhat Avalyan (a physician at the clinic), Hasmik Azibekyan and Stewart Brewster.

 

Stewart Brewster, or Skip, was a Peace Corps volunteer from California who came to Armenia to assist in the health sector. He was setting up an innovative program in Noyemberyan to help people with diabetes understand their illness and access the proper foods and other resources needed to control their chronic illness. After overcoming minor resistance from the local medical community, Skip and his colleague Hasmik Azibekyan, who had years of experience in community service, began to firm up their plans.

 

They would start by chartering the Noyemberyan Diabetes Support Group. Their focus would be education and access: teach people about diabetes and make arrangements with local food stores to carry diabetes-supportive products. They would agree to bring their business to local grocers who stocked healthy items such as fresh fruits and vegetables, whole grains and low-sugar foods. They would negotiate with the town’s bakery to produce whole grain breads, important to a healthy diet for anyone, but especially for people with diabetes. They also would hold education sessions, where they would instruct people on the many aspects of diabetes. Their plan was to use pamphlets in the training programs. They didn’t have the pamphlets yet, but they were prepared to buy them or, if necessary, write them from scratch.

 

At this restaurant meeting, Skip and Hasmik described their plans, now well underway. The missing piece was the educational component — the pamphlets. Sebouh and I described how WiRED’s educational modules were designed precisely for group presentations. The modules are prepared for people with no medical background; they’re interesting and stimulate group interaction. Moreover, they’re written by medical professionals, peer reviewed and packaged for computer presentations using a projector or large screen monitor. In all, the diabetes collection consisted of 14 modules, each covering a specific aspect of the disease, such as proper diet, care for teeth and gums, and care for eyes.

 

WiRED’s modules provided the piece that was still missing in their program: the educational component. Pamphlets can be useful, but they don’t work very well in a group setting, and they can be costly and difficult to update. The comprehensive, diabetes series would provide support group members with a thorough understanding of the disease. Moreover, with 250 modules in the health library at the time (now more than 400 modules), group members might discover other health topics they would want to study.

 


 

During the five years that WiRED has worked in Armenia, I’ve had a chance to see much of the country as we met with the volunteers who are part of WiRED-Armenia, a registered non-profit and partner of WiRED International. This dedicated group of health professionals, community organizers, teachers, young people, retired people and parents make up an eclectic team whose aim is to help communities benefit from an understanding of basic health practices and a specific knowledge of infectious diseases and chronic illnesses.

 

Since we’ve been working together, the creative people in WiRED-Armenia have come up with several very useful innovations. Let me tell you about two of them.

 

As part of their ongoing community health training program, the volunteers had been holding classes on hypertension and diabetes, which are chronic illnesses common throughout Armenia. People come to these classes because of their general interest or because they were persuaded by a health worker to attend. Presenters typically go through the WiRED education modules, discuss the illnesses and relevant lifestyle factors, and then the attendees complete a final exam as a group. In most community health training sessions elsewhere in WiRED’s network, the class ends, and people go home . . . but not here.

 

Teach and Test

 

The staff in Armenia has come up with an innovative and effective approach to promoting good community health. Providing education is critical to advancing healthy practices within a community; joining group training programs with screening measures is a creative way to put training into immediate action. This strategy can be of enormous benefit to communities in Armenia and beyond.

The trainers in Armenia had a brilliant idea: While they had a group assembled to learn about a particular health disorder, why not use that opportunity to test people for that disorder? For instance, at the end of the class on hypertension, offer free blood pressure tests. At the end of a class on diabetes, have a medical professional on hand to offer instant blood sugar tests. This is a logical strategy for any audience; it makes particular sense in WiRED-Armenia’s classes for expectant mothers, where both high blood pressure (pre-eclampsia) and high blood sugar (gestational diabetes) can threaten a pregnancy. Especially in these cases, early detection can save the lives of mothers and their unborn children.

 

This notion of combining teaching sessions with testing opportunities — teach-and-test — has inspired us to consider other ways to follow talk with action; to link a health education session with a health screening event. Joining the two provides the motivation and the means for screening that can identify problems early. It’s a perfect combination of services, especially in underserved communities.

 

Another innovation from our colleagues at WiRED-Armenia has to do with the health training forum itself. Group sessions generally involve a dozen to several dozen people. Typically, the sessions are lively with group discussions and interactions. Questions and answers built into the training modules provide opportunities for people to discuss key concepts which thus reinforce their understanding of the material. As a result, they realize that health education can actually be interesting.

 

The trainers thought about how they could expand their reach into the larger community, to extend the classes to more people and especially to those who might never venture out to take a class. Their answer: television. WiRED-Armenia decided to experiment with television coverage of a diabetes training session in Gavar, a town of some 2,000 people, located in the middle of the country.

 

Twenty people attended the event, while the live TV coverage offered the potential for a much wider audience. We’ve seen many examples where live TV can draw large audiences. The hope is that the energy of a live session, the interaction and discussion, will attract viewers.

 

We don’t know the size of that audience; measurement wasn’t possible, but the experiment was worth running just the same. This venture into a larger medium proposes a creative way to deliver health messages to expanded audiences, which is a perennial interest of ours. Even if the broadcast reached only a few hundred people, it’s a promising lead to a useful outreach strategy, and it got us thinking: TV may offer an opportunity to reach wider audiences in conditions such as pandemics, where entire populations are threatened. Think about flu pandemics, the Zika outbreak in Brazil, the Ebola plague in West Africa, the dangerous Black Death outbreak, which is striking Madagascar at this moment. WiRED has a large library of health education modules that can prepare populations for impending outbreaks. The challenge is to get this information to people in time to prepare — to organize, to recognize signs and symptoms and to know what to do if the disease arrives. WiRED-Armenia started our thinking about the use of audiences-widening approaches for all health issues, but especially for more urgent conditions that can affect broad populations.

 


 

For a native English speaker, at least for this native English speaker, the Armenian language is difficult. It is in the Indo-European language family and is one of the oldest languages on earth, going back to many centuries BC. An outsider’s understanding of the language is complicated by the fact that there are several varieties of Armenian: Old Armenian (Grabar), Middle Armenian (Mijin hayeren), and Modern Armenian (Ashkharhabar). If that isn’t enough, Ashkharhabar has evolved into two dialects, the Western and the Eastern standards. Today, nearly 7 million people speak Armenian, about half of whom live in Armenia, while the other half live around the world. Those living within the country generally speak Eastern Armenian, while people living outside the country tend to speak Western Armenian. Both Eastern and Western Armenian are marbled with dialects and variants, so the language is even more complicated than I’ve described, but let’s move on.

 

The Armenian alphabet, invented by Mesrop Mashtots in 405 AD, is still used throughout Armenia in schools, in the media and in commerce. I find the printed word to be beautiful, and I enjoy looking at blocks of text, even though I’m unable to understand a word of it. For instance, here’s a translation of text from WiRED’s training module on hypertension. The beauty of the printed word is evident:

 

 

But this is an essay about WiRED’s health education programs in Armenia, why talk about language and alphabets? Although many young Armenians speak English, the majority of the people do not, and so translations are necessary. This is nothing new; we translate many of our health education modules into other languages, such as Spanish, Arabic, Mandarin and Portuguese, but most of those languages are spoken by hundreds of millions or billions of people, and finding translators is easy. When we began our partnership with WiRED-Armenia, we turned to our usual sources for translators and came up dry. We couldn’t find translators whose services we could afford, and so we reached an impasse.

 

I spoke with Sebouh Baghdoyan, whom I mentioned earlier; if anyone could come up with a solution it would be Sebouh. I told him we were unable to locate anyone who could provide translations, and, without translations, we couldn’t move forward.

 

I was right. Sebouh had an idea; he reached out to his network. In short order he recruited several people to form a translation team. Heading up the team is orthopedic surgeon, Dr. Ara Nahabedian, a smart and witty gentleman, with a broad range of interests. Dr. Nahabedian double-checks all translations and ensures that medical terms and references are correct. That process is often complicated by the fact that some terms in English have no Armenian equivalent. In that case, he turns to the original Latin to avoid using English or Russian terms. Dr. Nahabedian is as fastidious in the editing room as he is in the operating room.

 

Three other language experts are directly involved in the translation of modules; Mariam Sargsyan is the coordinator, who arranges for the initial translations and checks the results; and Mariam Hovhanisyan and Vardi Snetsunts generate the primary translations. Because of the team’s donation of time and talent, they are making it possible for people throughout Armenia to understand the contents of the health education modules. To date, this group has translated 20 modules, which are all available online and soon will be available for download, which will allow Armenian communities anywhere in the world to install these modules on laptops.

 

Conclusion

 

The team at WiRED-Armenia has been the fount of innovation, including the use of television and the “train and test” approach to community sessions. They have provided WiRED-International with tools we can share with others and further develop to meet the needs and interests of people in other parts of the globe. Their work offers a valuable example of how WiRED’s networks around the world enable the transfer of information, techniques and tools to improve community health everywhere.

 

 


A Thought about Transferability

 

Several years ago, as our relationship with WiRED-Armenia was taking shape, as the translation team was doing its work, as people around the country were conducting health education sessions for groups in towns large and small, I wrote this statement:

 


Mount Ararat, seen from Yerevan, Armenia

“I find the WiRED-Armenia partnership to be personally and professionally rewarding. Many Armenians contribute their skills in an active program that provides valuable health education to populations throughout the country. We at WiRED International are enthusiastic about this partnership.”

 

I meant every word, and I continue to enjoy our work in Armenia and to learn from it. The creative and dedicated people who run these programs inspire the WiRED International team to explore new ways to distribute our material and to enrich the training sessions everywhere we work.

 

That’s how these global programs go. Someone in one location comes up with a good idea that transfers productively to another location. Consider the need to train rural doctors in China’s Yunan Province. China California Heart Watch director, Robert Detrano, M.D., Ph.D., asked if we could, with his input, prepare a module that would allow doctors to study the sound of a properly functioning infant heart, and then study the sounds of abnormal hearts. The comparisons would allow doctors to determine whether an infant needed additional medical attention. That module worked very well in China, and, it turns out, it also worked in portions of Africa, where nurses and community health workers evaluate the health of newborns and can benefit from such training. So, a program developed for China has been a valuable tool for people in Africa and elsewhere. WiRED is ideally suited to facilitate such transfers, taking good ideas about health education from creative people in one location and providing them to people in other locations around the world.

 

Here’s another example: at Project Amazonas, our partners for work in the Peruvian Amazon described their need for a system to gather patient record data in an electronic form. The system had to be portable, rugged and operate without the Internet, telephone or power from the grid. WiRED’s two-man team of hardware and software experts, Dr. Sameer Verma and Brian Colombe, put their minds to it and came up with a Field Health Record system that did everything Dr. Devon Graham, Director of Project Amazonas, asked for. It turns out that such a system can also help others who work in difficult environments, such as first responders and itinerant medical teams. The need for this portable electronic medical record system in the Amazon has applications around the world. WiRED is now taking this technology elsewhere.

 

 

 

This is the tenth story in a series about WiRED International. How it evolved; how it went from providing computers and Internet connections for towns and villages in underserved regions to focusing on medical and health education using computer technology. How it expanded its work throughout the Balkans to Africa, Central and South America to the Middle East and Eurasia. How WiRED’s training programs, carried by the Internet, have now become global resources, used by hospitals and clinics, schools, other non-governmental organizations and universities.

 

An element of WiRED’s operation that repeats in every story is that all of WiRED’s programs are run mainly by volunteers who have made it possible for WiRED to provide medical and health training programs cost-free to everyone. WiRED’s administration is volunteer, we have a volunteer board, and our writers and editors are volunteers. A small paid staff builds and shepherds the training modules through the production process, but even their work is augmented by that of volunteers. I’m proud of the people in the United States and abroad who donate their time and lend their talents to this organization’s efforts to provide people in low resource regions with some of the finest public-access, health training material available anywhere.

 

 

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