There is nothing more heartrending than the sight of children suffering. One of the plagues children face everywhere is cancer. In Armenia, their affliction is made worse due to the lack of resources that are more readily available in the West. American Armenians who came face to face with this difficult situation could not but take action. Now they in turn reach out to the broader community in an effort to create a future in which Armenian children get the same level of treatment as in the United States. On April 5, an evening at the Westin Waltham Hotel featuring Anna Hakobyan, Honorary Chair of the City of Smile Charitable Foundation and spouse of Prime Minister Nikol Pashinyan, will give the public the opportunity to support this vital humanitarian cause.
Today, children in Armenia with cancer primarily come to the Muratsan Chemotherapy Clinic in Yerevan for treatment. Amazingly, treatment is completely free. Children from Artsakh and Javakhk also come here, and even occasionally non-Armenian children from other places. Despite the successes that have been achieved until now by dedicated staff fighting heavy odds, there are many difficulties that this clinic and the medical system in Armenia must overcome in order to provide treatment on a level and scale parallel to that offered in Western countries.
Dr. Gevorg Tamamyan, a pediatric oncologist and hematologist at the Muratsan Clinic and Muratsan Hospital in Yerevan, who is also an associate professor of oncology at Yerevan State Medical University, explained that pediatric cancer was a fatal disease in the Soviet era in Armenia. In 1993, Dr. Samvel Danielyan, who had studied and worked in Moscow, returned to Armenia to change this situation, and became the founder of modern pediatric oncology there.
Danielyan started using German protocols for treatment, and because the necessary drugs were not available, initiated the creation of the Help for Armenia foundation in Germany with the aid of German colleagues and philanthropists to obtain drugs for pediatric leukemia. He began to find ways for the professional development of Armenian doctors, who were sent to Europe, Russia and the United States.
The survival rate of children with pediatric leukemia rose from the initial 0-5 percent to 65 percent, and now it is more than 70 percent. Danielyan eventually left his post at the Prof. R. H. Yolyan Hematology Center of the Armenian Ministry of Health in Yerevan and created the Muratsan Chemotherapy Clinic, connected to the Muratsan Hospital of Yerevan State Medical University, in 2008. The Muratsan Clinic treats almost all pediatric solid tumors in Armenia at the present, along with the majority of lymphomas and some leukemias. The clinic treats both children and adult patients with different types of oncological and hematological disorders. Many new types of treatment were started at this clinic which were not originally available in Armenia, with some of the results published formally.
There is no other clinic for children in Armenia in the private or public sectors. Yerevan State Medical University supports the clinic, which belongs to the Muratsan Hospital complex of the university. This means that there is an educational component of its activities, with students, fellows and research.
All of the doctors working at the clinic receive some training abroad and there is ongoing collaboration with different institutions around the world. The clinic also organizes conferences and meetings in Armenia. Last November, together with the Armenian Association of Hematology and Oncology, it hosted the joint master class of European School of Oncology and the American Society of Clinical Oncology. This was the first time not only in Armenia but in the world that these two major cancer organizations joined together for such a program.
However, treatment of pediatric cancers is still done in a fragmented way in Armenia. The Hematology Center treats the majority of pediatric leukemias. Stem cell transplantation is done there, along with treatment of benign blood disorders. The National Oncology Center has the only radiation therapy unit in the country, so if radiation is required children must go there. There are also several other hospitals like Surb Astvatsamayr Hospital in Yerevan with surgical facilities that handle specific types of procedures.
One of the goals for pediatric chemotherapy, Dr. Tamamyan said, is to centralize the care.
The Muratsan Clinic receives some funding from the state and the university, and the remainder from philanthropic institutions. There are a number of major challenges that it faces. It lacks equipment, ranging from infusion pumps to monitors.
There is no family housing for family members who want to be with their children during treatment but live far away. There are no palliative care services or rooms, so that children die at home in pain and suffering, Tamamyan said.
Cancer registries which would allow a better understanding of the problems and challenges in Armenia are lacking. Population-based registries collect basic data to understand the baseline state of cancer in Armenia, including the types of cancers and the age they appear in the Armenian population. Hospital-based registries collect information to give an overview of toxic deaths, including what the causes are, the outcomes of treatments and specific regimens, and give clues as to what measures need to be changed. At present, a collaboration is being initiated with St. Jude Children’s Hospital to create a registry.
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Obtaining medications can be difficult. They have primarily been supplied as donations by charitable foundations, and up until getting them has been one of the clinic’s primary goals. Last month the Armenian Ministry of Health announced that it will procure essential ones on the World Health Organization list starting this year. However, Tamamyan said, there are many other drugs not on this list which are expensive and used by patients in clinical trials which do not exist in Armenia. It will take many steps to bring clinical trials to Armenia.
Brain drain of the clinic’s staff is a challenge. There are ten doctors and at present five fellows with three-year terms. Tamamyan said that low salaries (on average $300-400 monthly at present depending on the number of night shifts) and other challenges lead many doctors and nurses to leave Armenia. However, after the Velvet Revolution, some people returned, and there is hope this will continue. The goal is to be able to give a normal salary for everyone.
Aside from the aforementioned challenges, the major goal of the clinic is to be able to turn it into such a comprehensive pediatric center that not only will Armenian patients choose not to go abroad for treatment but also patients from neighboring countries will come to get care there. There are a few sporadic instances of this even now. For example, there is a patient from Iran receiving treatment at present. As with Armenian patients, his treatment is free. Tamamyan said, “Cancer does not recognize religion, race, or nationality, so we will treat any child who comes to our clinic as much as we can.”
The size of the clinic at present is not large. It can treat 26 children at any one time, and there are also a lot of adult patients. Half of the children are from the provinces outside of Yerevan. There are also some ten to twenty other children who come and go for maintenance therapy.
Additional outside resources are necessary to sustain the current number of doctors and nurses. However, at present, there are efforts underway to merge the pediatric cancer clinic with the hematology center. This along with additional outside help would allow increasing the number of doctors, nurses and psychologists, hire new specialists like nutritionists and set up a palliative care unit.
In order to help raise funds for this work, the City of Smile Foundation was established in 2014 by Drs. Gevorg Tam
Meanwhile, the Boston-Armenian community’s connection with Muratsan happened in various ways. When Tamamyan was visiting Boston for a Dana-Farber/Boston Children’s Cancer and Blood Disorders Center training program at the end of 2015, he stayed at Holy Trinity Armenian Church’s parish house in Cambridge. When the church organized a trip to Armenia in 2016, a group of parishioners, including Cynthia Kazanjian, her husband Richard and her 10-year-old grandson Vaughn Krikorian, visited Muratsan along with Fr. Vasken Kouzouian and his wife.
The effect of seeing the children stricken with cancer was profound and led young Vaughn to ask what could be done to improve their situation.
Upon returning, Cynthia, who had already seen the toll taken by cancer among her own family members, together with others was able to make an arrangement with Dana Farber Global Health Initiatives to ensure that 90 percent of funds raised through the annual Jimmy Fund Walk would be sent to Muratsan Chemotherapy Clinic in Armenia. She went back several more times to Armenia to try to help. Meanwhile, the Jimmy Fund walkers and some auxiliary events raised money in 2016 and 2017. Even Kazanjian’s grandsons helped in this.
The final piece of the story came together during the summer of 2018, when Kazanjian was invited to attend an event honoring Anna Hakobyan, who had become honorary chair of the City of Smile Foundation. Hakobyan is spouse of Nikol Pashinyan, leader of the Velvet Revolution and now prime minister of Armenia. Unbeknownst to Kazanjian, she herself was also honored for her support, and the encounter with Hakobyan led to another private meeting to have coffee. Kazanjian invited Hakobyan to Boston for a fundraiser, and Hakobyan accepted. Hovhannissian then met with the executive director of the foundation, Ester Demirtshyan, while in Armenia in summer of 2018, to kick off the planning.
Energized and excited, Kazanjian and Hovhannissian realized that it was necessary to go beyond New Paths, so they reached out to as many Armenian organizations and active members of the community as they could in Boston for their involvement. community noted for pulling together for pan-Armenian causes. They created the City of Smile Charitable Foundation Boston Friends group at the end of 2018 to carry out fundraising and support the mission of Muratsan. This was to become the beginning of a nonprofit chapter of the City of Smile here in the United States. The two women are now also co-chairs of the forthcoming evening program, and their efforts continue to bring people of all backgrounds together in support of a good humanitarian cause. Even people as far away as in Los Angeles have been donating their services.
Kazanjian, encouraging the public to participate as much as possible, said, “I see this as a vehicle to help children with cancer in Armenia. They deserve to have a life. They are young, innocent children who have no choice. They have been diagnosed with cancer and this is devastating not only to their lives but the whole family. It hits you so hard, and more so when you do not have the resources. It is overwhelming to think about how much it costs to help a child in this situation, and they do not have it.”
Hovhannissian added her appeal to the public, declaring: “When I visited the clinic, I knew what to expect as someone born and raised in Armenia, but living in the US for over 20 years and having my own children in and out of hospitals gave me a whole new perspective. It made me realize that the kids in Armenia are no less than the ones here and they absolutely deserve the same highest quality of care. Though this is a major undertaking, we are moved to do this from the depths of our hearts, as we know this is an important cause and we want to do all we can to help these innocent children’s lives. We are beyond grateful to all those organizations and individuals who are in support of this wonderful effort and looking forward to spend a beautiful evening together with the Boston Armenian community!”
This article originally appeared in The Armenian Mirror-Spectator on January 31, 2019 and was republished as a courtesy.