The provision of surgical services in under- served and disaster-stricken areas of the world is becoming an issue of increased interest. At the
same time—and most experts on the subject would
agree—although traditional medical missions have
had positive short-term benefits for patients, training
native physicians to deliver the type of care available
in economically strong countries has a greater long-term and sustainable impact. As this trend of training
local physicians in resource-poor regions continues to
evolve, I thought it would be useful to describe how
a team of U.S. health care providers responded in the
aftermath of an earthquake that struck Armenia in
1988, registering 7.0 on the Richter scale. Indeed, the
lessons learned from that event are as meaningful today as they were nearly 28 years ago.
The earthquake hits
It was a typically cold morning on December 7, 1988,
for Artashes Aznauryan, MD, the Minister of Health for
the Soviet Republic of Armenia—a country of approximately 3. 5 million people at that time. Dr. Aznauryan
was in his office in Yerevan, the nation’s capital, reviewing reports from his section managers, when he felt a
rumbling under his feet and noticed that the tea in the
glass resting on his desk was shaking.
Less than 30 minutes later, one of his assistants
informed him that they seemed to have lost telephone
contact with the hospital in Spitak, located 74 miles
northwest of Yerevan. At the time, Spitak was a city
of young, educated, middle-class families with new
schools, new factories, and a new hospital. The repub-
lic was proud of this modern city and was hopeful for
Dr. Aznauryan told his assistant to check with the
telephone company to see if there were any disruptions to the transmission lines. The assistant reported
that there was complete disruption of telephone communications with Spitak. He had called the police
headquarters in Yerevan and been informed that
wireless communications with the city had yielded
no response. The police were sending a helicopter to
assess the situation.
Sensing a potential tragedy, Dr. Aznauryan immediately dispatched his deputy and several physicians to
Spitak. They soon reported that a major earthquake
had hit; all the buildings were either collapsed or damaged severely.
Dr. Aznauryan had a serious situation at hand. The
physicians and nurses in Yerevan worked in shifts, and
the day shift personnel had already gone home, leaving the smaller afternoon shift in the capital’s hospitals
to provide care to the victims of the earthquake. He
rushed to the state television station to announce the
catastrophe and to ask that physicians and nurses return
to their hospital posts. Every single physician and nurse
immediately reported back to work.
Post-earthquake devastation in Spitak.
• Describes U.S. health care
providers’ efforts in response
to an Armenian earthquake in
the late 1980s and the enduring
lessons from that experience
• Discusses the long-term benefits
of training native physicians
in resource-poor areas
• Describes the challenges of quickly
and efficiently training Armenian
physicians and nurses in the U.S.
before they returned to their
native country to provide care