|Mariam & Jerry's excellent adventure
updated 8 November 2021
Mariam's 2 month sabbatical was triggered by Jerry's retirement and Stanford's closure of the Manoukian Medical office. She will return to their Grant Rd location in November.
Mariam arrived to Armenia September 6 and Jerry arrived a week later. Our itinerary as included Mariam's teaching of Armenian physicians, mainly primary care physicians in a number of settings. She gave classes in Endocrinology (targeting primary care physicians) at the National Institute of Health in Armenia's capital, Yerevan, as well as in rural locations in Armenia's north. She saw patients in consultation with the local physicians in a number of settings.
Armenia is a former Soviet country, population approx. 3 million, half of whom live in Yerevan. The other half are spread throughout cities and villages in the "Marzes", roughly equivalent to counties in the US. The economy is bolstered by tourism, high tech, farming and construction.
Initial impressions of Armenia tip the balance in favor of charms:
3 main arms of the medical industry include the Ministry of Health, the National Institute of Health, and the Yerevan State Medical University. Additional medical universities compete with YSMU, and there is a recognized glut of undertrained physicians and nurses. Several of Mariam's students at the NIH had scarcely seen a patient during training or since graduation.
| Our experience in the marzes was facilitated through 2 nonprofit organizations which have made major impact in Armenia over the past several decades since the devastating earthquake in 1988 and independence with the breakup of the USSR in 1991. The Children of Armenia Fund (COAF) and the Fund for Armenian Relief (FAR) support many projects including medical education and medical clinics.
Additionally, we were able to visit several schools as part of Education of Armenian Children through Sports (EACTS), a program spearheaded by Mariam and supported by the Armenian Healthcare Association of the Bay Area.
|We went to Gyumri, a city in NW Armenia that was heavily hit by the earthquake. The city has made a strong recovery during the past 3 decades. We visited several schools and noted gymnasiums in various states of decay. One school renovated by the United Kingdom following the earthquake has a modernized gym but use is greatly limited by a nonfunctional heating system. Medical clinics supported by COAF in the Gyumri area employ primary care physicians and nurses serving pediatric and adult clients. Mariam gave endocrine consultation on approx. 30 patients in the village of Maralik (and Jerry saw 5 patients with general medical complaints). Jerry also found his Kardia handheld EKG to be quite useful for several of the thyroid patients who complained of palpitations.|
We also noted an abundance of potatoes grown in the region and sold for 100 Armenian Dram per kilogram. 100 AMD is approximately 20 cents. Mariam is researching the possibility of supporting a potato chip industry to serve the restaurants, bars and markets. Such an industry has been studied with business plans created, but the majority of chips in the country are imported Lay's and Pringle's chips. We oughta change that.
Visiting a clinic in Horom, outside Gyumri, we learned of a fortress on a nearby hill dating back between the bronze age and the Urartian kingdom approximately 3000 yrs ago. The site is marked by "cyclopian" structure, huge boulders stacked on one another to build walls. The name comes from the assumption that the rocks are so large that only a cyclops could have lifted them. The ground is strewn with pieces of pottery, presumably dating back 3 millenia, as well as small pieces of obsidian. Many of the obsidian pieces could have served as cutting tools. Notably, there is not any obvious presence of obsidian in the soil as there is in other areas of Armenia. However there is significant obsidian in nearby Maralik, and presumably these pieces were brought to Horom by the ancient inhabitants. The site has been partially excavated, and may offer significant archaeologic riches if further studied. (It is worth mentioning that Armenia has significant ancient sites including a cave with a 6000 year old shoe and wine operations from the same period.)
A second foray into the marzes involved the FAR center in Berd, a small city in the Tavush Marz, not far from the border with Azerbaijan. Mariam offered 2 afternoons of endocrinology classes to local physicians at the FAR center. Jerry found an abundance of wild hops, raising the possibility of a farming option to provide income to local farmers as well as support Armenia's burgeoning beer industry.
Mariam and Jerry spent a morning harvesting wine grapes outside a local village. The Lalvari variety of white wine grapes is characteristic of Tavush's growing wine industry. Many of the grapes will be sold as wine in Russia, while part of the harvest will be converted to brandy by the Ararat Brandy company.
A local lamb joined us for lunch. Mariam's former classmate (and vineyard owner) poured us some of best homemade brandy on earth, from a plastic Coke bottle.
Our third visit to the marzes was also with COAF. We were hosted at the COAF SMART center in the village of Debet in the Lori marz.
Fall colors were shifting into high gear and we saw a bit of snow on hilltops. This center offers after-school training to local children including English, programming, music, agriculture, health and others. Mariam saw approximately 20 patients in the nearby village of Vahagni. Jerry, with his limited Armenian, saw 2. We visited the Vahagni school, with its recently renovated gym.
Lori is some of the most stunning mountains and gorges.
The EACTS project was started in the aftermath of vicious attacks in the enclave of Nagorno Karabagh by Turkish and Azerbaijani forces using Israeli attack drones, cluster bombs, white phosphorus and ISIS mercenaries from Syria.
It is our hope that through team sports, we can encourage physical development and communal mindset in the next generation. I might add that group thinking would benefit Armenia in many ways, including such areas as traffic management, mask-wearing, avoidance of smoking indoors, and control of litter/pollution. In effect, life ought to be a team sport.
|The British-supported gym in Gyumri is used only a few months out of the year, as the furnace is not properly connected to the ventilation ducting. For the past 3 decades it has been dormant November through March when it is too cold, and during the summer months when school is closed. We have made a decision for AHABA to finance the necessary duct repairs.|
On 10/13 we took a day trip to Armavir Marz, southwest of Yerevan. We visited several COAF schools, saw some great gyms, and Mariam saw several patients (under Jerry's supervision, what the hell, I am retired.)
We also saw a nearby hill in Nor Armavir which had the ruins of an old Urartian fortress (approx 3000 yrs old). Like Horom, it was scarcely possible to take a step without treading on fragments of ancient pottery. There weren't all the obsidian fragments that we saw in Horom, but there were a few. The site is called Argishtikhinili and it is spectacular, in spite of the litter. You can scroll down to October 24 where we organized a cleanup crew to get rid of some of the litter.
On the way home we stopped at a magnificent Yezidi temple.
It had some monuments and plaques calling attention to the genocide of Yazidis by ISIS in northern Iraq in 2014. I'm glad that Armenia has some refuge to offer other genocide victims. We still have a long way to go. Humanity has a long way to go.
I made up a joke today. Do you know why they call it a cattle *drive*?
Because it's tavar to walk!
Tavar is the Armenian word for "beef". I thought it was pretty funny. Mariam didn't.
OK. Back in Yerevan. Dinner with Mariam and Raffi, local entrepreneur and journalist.
Beer with Ambassador from Norway. Lunch with colleagues from France. Mariam had breakfast with the President.
We must be big shots!
Side trip to Mariam's Dad's summer home. We have an apricot orchard there, suffered some damage in a grass fire.
Guess I'll have to come back here next spring to see which branches are viable.
There are ruins of an old church in the orchard next door.
Mariam was interviewed by journalist and rock star Lara Tcholakian from Civilnet. They spoke about women's empowerment and lessons learned from Mariam's parents and grandmother. It was a gorgeous morning in the Physics Institute. you can see the interview at https://www.youtube.com/watch?v=SPKQx2Hsg2g
I love it here.
October 20, Mariam took part in an Osteoporosis Symposium for over 200 participants. There were 6 speakers including Mariam and our (rock star) friend Dr John Bilezikian from Columbia University via Zoom call. Mariam spoke about lifestyle in the prevention and management of osteoporosis.
Mariam forgot her phone at the conference hall. Fortunately the Conference Chair, Dr Varta Babalyan,
found the phone and kept it for Mariam. Even better, Varta was out to dinner when we got ahold of her.
It was a posh place on top of the city. So we splurged on a fancy meal, dancing and show for about 60 bucks.
Life on Marz
- Category: Blog