Since that time, it has been suggested that whereas
the then-Soviet leader Mikhail Gorbachev had been
trying to reform the Soviet system with his policy
of Perestroika (a political movement for reformation
within the Communist Party of the Soviet Union
during the 1980s) this earthquake actually may have
played a role in improving relations between the Soviets
and the West. Mr. Gorbachev happened to be in the U.S.
on an official state visit at the time of the earthquake
and cut the trip short to return to Armenia and evaluate the magnitude of this disaster. He then formally
reached out to the West and requested humanitarian aid—the first such request from the USSR since
World War II.
During our telephone conversation, I explained
to the Secretary that while some of the rescued citizens would die in spite of all efforts, it was possible
for others to receive adequate care from their own
physicians. The bulk of the survivors had experienced severe injuries and would need subsequent
reconstructive surgery. I informed the Secretary that
I would form a surgical team as soon as possible,
but, in the meantime, they should bring in dialysis
machines to care for the many patients who would
sustain renal shutdown from their crush injuries and
the resultant myoglobinuria. That aid was quickly
provided by a team from the University of California, Los Angeles.
AmeriCares, a not-for-profit relief organization
headquartered in Stamford, CT, was one of the first
U.S. agencies to arrive in Armenia and evacuate patients
to the U.S. One of the first U.S. facilities to treat victims of the disaster was Yale-New Haven Hospital, CT,
which accepted two patients.
I went to Yerevan with Jeffrey Heinrich, PA-C, Ed D,
a physician assistant (PA) in my plastic surgery section,
to assess the medical needs of the earthquake victims.
We met with Dr. Aznauryan, who briefed us on recent
developments and progress, and deputies of the Ministry
of Health, who described the infrastructure and levels of
training of physicians and nurses in Armenia. We were
able to visit several hospitals and evaluate the seriously
injured patients and the many more who had less severe
injuries but would still need reconstructive surgery.
Some physicians spoke English, but most did not,
and virtually all of the nurses spoke only Armenian
and Russian. Specialty surgeons were largely trained in
Armenia, but many competed for these training positions in Moscow before returning to their homeland.
Many surgeons said they had trained in the subspecialties of plastic surgery (such as burns, hand surgery,
microsurgery, facial fracture surgery, facial cleft surgery, reconstructive surgery, and cosmetic surgery),
but we were unable to identify any plastic surgeons
who had trained in the provision of the full scope of
plastic surgery services as we know them in the U.S.
Anesthesia was administered by physicians trained
in that specialty, but many procedures we witnessed
were performed under general mask anesthesia; few
patients who were under general anesthesia were intubated, even patients who were undergoing surgery
in the prone position. Regional block anesthesia was
nowhere to be found.
Nursing education was under the direction of a
physician in the Ministry of Health, and nursing care
appeared to be at a level not seen in the U.S. since
the early 20th century. Nurses were given no clinical
responsibilities and served simply as caretakers. They