By Peggy McInerny, Director of Communications
The Promise Armenian Institute, May 13, 2020 — Funded by The Promise Armenian Institute at UCLA, two UCLA faculty are working tirelessly to provide real-time Covid-19 assistance to medical and public health professionals in the Republic of Armenia and the Nagarno-Karbakh region of the Caucusus.*
Associate Dean Alina Dorian of the UCLA Fielding School of Public Health and Dr. Shant Shekherdimian of the Geffen School of Medicine and UCLA Health have long histories of working with medical and public health experts in both places.
The “day” jobs of these two Bruin faculty are extraordinarily demanding, spanning teaching, administrative, research and clinical work (and in Dorian’s case, a second job as a Los Angeles Public Health Commissioner). Factor in the first global pandemic in a century, and their workloads are staggering.
Yet Shekherdimian and Dorian are also devoting precious free time (and countless hours of lost sleep) to coordinate with experts worldwide to identify and deliver medical equipment to Armenia and Nagorno-Karbakh, as well as share the latest Covid-19 knowledge and practices with health professionals.
In so doing, they draw on a long history of collaboration in medical research between UCLA faculty and health and university professionals in Armenia, their own professional and personal networks and the global Armenian diaspora. (The Fielding School even has an Armenian-language fact page on Covid-19; see https://ucla.in/3cwtrnn.)
An undergraduate alumna of UCLA, Dorian is an expert in public health disaster planning and response, with experience working in Armenia, Georgia, Eritrea, the Dominican Republic, Macedonia, Kosovo, Haiti and Peru. She joined the faculty of the Fielding School in 2004, where she is currently associate dean for public health practice and for diversity, equity and inclusion, as well as adjunct assistant professor in the department of community health sciences. Previously, she served as associate director of the school’s Master of Public Health for Health Professionals Program and its Center for Public Health and Disasters, as well as field studies director of the community health sciences department.
Shekherdimian is assistant professor at the Geffen School of Medicine and a pediatric surgeon at UCLA Health specializing in neonatal and minimally invasive surgery and surgical management of inflammatory bowel disease. Also an undergraduate Bruin alumnus, Shekherdimian completed his surgical residency and an executive M.P.H. at UCLA before joining the faculty in 2014. He has longstanding research interests in global health and is currently conducting a study of cancer screening in Armenia, with support from a Fulbright Scholarship and the assistance of UCLA medical students and residents.
Rapid response planning gives way to real-time technical assistance
In early 2020, The Promise Armenian Institute (PAI) at UCLA awarded financial support to a project proposed by Dorian and Shekherdimian that would provide expertise on the novel coronavirus pandemic to the Armenian government. Created in late 2019 with a generous gift from the estate of Kirk Kerkorian, PAI seeks to advance scholarship on Armenia and its diaspora, as well as to leverage UCLA’s expertise to support the work of Armenian communities in Los Angeles, Armenia and throughout the world.
Based on her previous experience of rapid response teams, Dorian assembled a team of public health and medical experts (including many UCLA faculty and UCLA Health practitioners) with the goal of embedding them in the Armenian Ministry of Health as a mobile operational unit. Shekherdimian, who was scheduled to conduct research in Armenia in early March 2020, refocused his trip instead to work on the details of how to embed the team at the ministry of health.
Rapid developments soon derailed their initial plans. Travel restrictions implemented by the U.S. administration made it impossible for the experts to go to Armenia and forced Shekherdimian to return home almost as soon as he arrived in Yerevan, the country’s capital. As Covid-19 infections began to rise in Los Angeles, moreover, the experts slated to travel — who included a senior emergency medical services and health disaster management officer for Orange County — were soon overwhelmed with local responsibilities.
Dr. Shant Shekherdimian (right background) with U.S. colleague Dr. Armen Aboulian (right foreground) and Minister of Health of the Republic of Armenia Arsen Torosyan (left foreground) at a meeting at the health ministry. (Photo courtesy of Dr. Shekherdimian.)
Dorian herself is one of five public health commissioners in Los Angeles County who meet regularly with Dr. Barbara Ferrer, director of the LA County Department of Public Health, to work through the issues of the county’s pandemic response. She is also a member of the Covid-19 task force for the Fielding School.
In the face of a rapidly changing developments, the two UCLA faculty members shifted gears. Shekherdimian, who has longstanding relationships with the medical community in Armenia, is now concentrating on helping organize deliveries of medical equipment and PPE for the country, organizing a webinar series on Covid-19 for Armenian medical professionals and directly advising both the country’s ministry of health and High Commissioner’s Office for Diaspora Affairs on Armenia’s response to the pandemic.
“I am thrilled that The Promise Armenian Institute is able to support this critical technical assistance at a time of urgent need,” says Ann Karagozian, PAI director and distinguished professor of mechanical and aerospace engineering at UCLA. “We are fortunate to have the flexibility to act quickly, enabling us to leverage the work of multiple individuals and organizations helping Armenia prepare and respond to the novel coronavirus pandemic.”
“This type of collaborative work, in which UCLA experts cooperate with their counterparts in Armenia as well as community and international organizations of the global Armenian diaspora, will be a hallmark of The Promise Armenian Institute going forward,” says Dr. Eric Esrailian, chief of UCLA Vatche & Tamar Manoukian Division of Digestive Diseases, a producer of the film “The Promise” and the driving force behind the creation of PAI. “I am very proud that PAI is able to support this project.”
Comments Shekherdimian, “We have a great working relationship with the Armenian government, which has been incredibly transparent. They have been very open in terms of daily lines of communications with stakeholders there.”
On the procurement side, he continues, “We have been trying to tap into the resources of the diaspora, reaching out to Armenians all over the world who either have the financial resources and/or access to medical supplies, trying to figure out contributions and the logistics of deliveries.
“Certainly, global shortages have complicated things, but it’s amazing how active and ready the diaspora is to step up in this time of need. There are many good stories of much-needed supplies making it Armenia because of people in the diaspora.
“The webinar series,” notes Shekherdimian, “is an inter-organizational and inter-institutional effort.” Collaborators in the effort include the Los Angeles–based Armenian American Medical Society, the Armenian Medical International Committee, the National Institute of Health in Armenia, the High Commissioner’s Office on Diaspora Affairs and individual Armenian Americans and Armenians living in other countries.
The online seminars share the latest knowledge and literature on Covid-19 patient care in a wide spectrum of medical fields (i.e., critical care, infectious diseases, radiology, nursing, etc.). “Some of the speakers are UCLA faculty and practitioners, and we hope to eventually incorporate our residents as well,” he adds.
Apart from the pandemic, Shekherdimian has been engaged for several years in helping the Armenian NIH redesign the country’s residency programs to bring their content and teaching methods into line with those of Western countries. He is also a member of two Armenian Ministry of Health committees: one on the quality of health care and the other on human resources (whose task is to develop the healthcare professionals needed by the Armenian health care system).
Professor Alina Dorian (left) with public health officials of Nagorno-Karabakh. (Photo courtesy of Professor Dorian.)
Professor Alina Dorian (left) with public health officials of Nagorno-Karabakh. (Photo courtesy of Professor Dorian.)Dorian, meanwhile, has remained in contact with the team of experts that she originally put together to visit Armenia. The team continues to meet electronically and receive updates on the situations in Armenia and Nagorno-Kabarakh. In addition, Dorian has also been working with organizations such as the Armenian National Committee of America to reallocate part of an existing Congressional appropriation for Armenian foreign aid toward Covid-19 work.
“Most of my work has been in Nagorno-Karabakh (NK),” she explains. “I first went there in 1995 — I helped write the region’s first national health plan in 1996 — and have been working very closely with their ministry of health ever since on many different projects, including a national breastfeeding program and the building of a national hospital.”
Dorian is also working with Shekherdimian and the Armenian diaspora to have scarce equipment and PPE delivered there. “Up until April 7,” she recounts, “there were no confirmed Covid-19 cases in NK and I was working to provide technical assistance on health system preparation and response.” That process is now squarely focused on Covid-19 public health measures and patient care, with Dorian directly advising the region’s health minister.
The public health professor draws on colleagues at the Fielding School of Public Health and the Bloomberg School of Public Health at Johns Hopkins University (her alma mater), as well as other contacts, to provide the expertise needed by NK health professionals at any given moment, primarily by video conferencing.
“The problem is that most people in NK don’t speak English, so I am frequently serving as translator on those video calls,” says the Fielding School associate dean.
Evaluating the pandemic response in Armenia
From the beginning of the coronavirus outbreak, Dorian and Shekherdimian — with help from the American University of Armenia — have been collecting as much data as possible on Armenia’s experience of and response to the pandemic.
“Epidemiologically,” says Dorian, “there will be a quiet period after the first wave of the pandemic, then a resurgence. Many infectious diseases of this type have three waves, but every day we are finding out just how Covid-19 will roll out.” The Promise Armenian Institute (PAI) is funding data collection and analysis so that the two UCLA faculty members can help their Armenian peers use the coming quiet period to think ahead, anticipate the equipment and testing conditions that will prevail in several months’ time and plan what they can do better during the next wave.
Professor Alina Dorian (right) with public health officials of Nagorno-Karabakh. (Photo courtesy of Professor Dorian.)
“We are working with PAI to build this analytical capability and identify all the assistance UCLA can offer Armenia on the pandemic,” says Dorian. “We also need to plan for everything else needed in the health care system,” she continues, starting with how hospitals and providers will start to provide services that have been put on hold, such as elective surgeries and cancer screenings. “There is an avalanche of deferred medical services, as well as social services and needs (including food security issues), during a lockdown,” she remarks.
Dorian and Shekherdimian also intend to use data analysis to help their Armenian colleagues continue long-range planning efforts. “The silver lining of every disaster is that you can plan to build everything in a better way. You look at what you have and ask what did we do right, what did we do wrong, where do we go from here?” asks Dorian.
“Health is not just the absence of disease,” she observes. “Public health goes beyond medicine, clinical expertise and funding hospitals: it’s everything that goes into enabling people to be healthy. It’s access to healthy foods and evaluating how to strengthen infrastructure; it’s work leave policies, housing policies, health insurance, food security policy, mental health services and access. You need to really think about these things without silos.”
Pandemic reveals systemic weaknesses in health care systems worldwide
Public health emergencies quickly reveal the systemic problems of any health care system. In the U.S., the coronavirus pandemic has thrown a glaring spotlight on inequities in health care. “It is showing all the problems we already had: underfunding, emergency rooms that were already at capacity, lack of access, etc.,” notes Dorian.
“We are looking at structural decisions and budgets that were already in place that didn’t allow our healthcare system to function well during a pandemic,” she says. “Ideally, you should support the health care system to provide daily health care, including such things as work leave policies. We should have had those policies in place before the start of the pandemic in this country — it’s one of the reasons why we are so overwhelmed.
“Data from this pandemic will show the impacts of inequities and lack of inclusion and highlight the social determinants of health in our country,” she continues. “We are seeing this in real time with African American deaths from Covid-19. It is a moment to examine and rethink the whole idea of ‘haves’ and ‘have nots’ in our health system.
“Your health care budget is your value statement,” she adds. “What you invest in on an everyday basis counts because when a disaster strikes, it’s too late. Look at Singapore: it has a fluid, flexible, capable health care system that can expand and contract as needed.”
Shekherdimian concurs. “What really matters is not the decisions we are making today or over the past month,” he says. “Some 80 to 90 percent relies on how robust a health system is going into a pandemic. And those are things we cannot change overnight.”
In Armenia, he notes that the Soviet system left the legacy of an over-specialized health care system that lacks primary healthcare providers and has historically prioritized numbers of medical professionals and infrastructure over quality of care.
Dr. Shant Shekherdimian with medical residents from Armenia. (Photo courtesy of Dr. Shekherdimian.)
The Armenian public health care system is also severely underfinanced (receiving just 1.6 percent of national GDP) and its fragmented delivery of health care services creates significant resource inefficiencies and outright waste. “All of this ultimately contributes to less-than-ideal outcomes in health care and it all plays into the current pandemic,” says Shekherdimian.
Up to their ears in work in all directions, Dorian and Shekherdimian are nevertheless heartened by the contributions they are able to make to Armenia and Nagorno-Karabakh at this time of crisis.
“UCLA has been a great conduit for all of us to do better in the world. I believe we all feel that very deeply at UCLA,” comments Dorian. “I feel blessed to be under the UCLA umbrella and that all of these relationships mean something in this world.
“I consider myself an expert in disasters, but boy, have I learned a lot. We are all learning and helping each other at the same time. I feel those are the shining moments in all of this,” she concludes.
*Nagorno-Karabakh is a former autonomous region (oblast’) of the Soviet Republic of Azerbaijan. The region, which has a majority ethnic Armenian population, and several neighboring Armenian-majority districts of Azerbaijan are internationally recognized as part of the Republic of Azerbaijan, but have been self-governed since the end of the 1988–1994 Nagorno-Karabakh War. The status of the territory remains in dispute.