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Armenian Partners Address Women's Health IssuesBy: Joanne Neuber Armenian Partners Address Women's Health Issuesby Joanne Neuber From America to Armenia, women's health programs are expanding their scope beyond traditional reproductive health services. Increasingly, women's health services now include the comprehensive care--from birth, through adolescence, childbearing, menopause and beyond. To explore this more inclusive view of women's health, more than 75 NIS and American physicians and nurses attended a one-day women's health conference at Erebuni Medical Center in Yerevan, Armenia in July. The conference--which examined an array of issues from sexually transmitted diseases to breast cancer--was organized by the Yerevan-Los Angeles, California partnership and was held in conjunction with the opening of the enhanced Women's Wellness Center at the medical center. "We are united by a common bond [of] empowering women to help them help themselves, and to ensure that they lead healthy lifestyles," said Salpy Akaragian, RN, MN, director of the International Nursing Center, University of California at Los Angeles Medical Center. "Women's health services have been neglected in the past," Karine Sarkissian, administrative director of the Women's Wellness Center at Erebuni, told conference participants. But she said that the expanded center will help provide comprehensive women's health services to the communities they serve. "It is a one-stop shopping concept," said Sarkissian, explaining the scope of the center, which opened five years ago. The center provides gynecological and obstetrical services to women of all ages, including adolescent sex education classes, family planning counseling, and health promotion and disease prevention. Recently, the center received support from AIHA to expand its services to include childbirth and patient education programs. The volume of patients served has steadily increased since the center opened, reaching approximately 12,000 patients per year in 1996, said Sarkissian. And patient fees are kept low to ensure that women of an economic levels have access to the clinic. Empowering Women Through Education. At the conference's general session, Sarkissian encouraged participants to include patients more fully in the process of care. Sarkissian credits the center's emphasis on prenatal screening and patient involvement for a decline in perinatal deaths at Erebuni, from 26 per 1,000 in 1992 to 17 per 1,000 in 1996. The center's prenatal screening programs--which can help detect and reduce complications during pregnancy--were enhanced by the development of patient education materials such as "The Handbook for Reproductive Health" and the "Prenatal Care Guidebook for Pregnant Woman." These booklets were translated into Armenian in 1994 and are distributed to patients at the center "so that women can make informed decisions about their health," she said. Additions to the center in June offer patients an expanded range of educational materials and Lamaze childbirth classes. Promoting Early Screening Programs. Sherry Goldman, RN, CNP, nurse practitioner at the Revlon/UCLA Breast Center in Los Angeles, California, led discussions on ways to prevent sexually transmitted diseases and breast cancer. "The past quarter-century has seen remarkable advances against cancer," Goldman said. "And some of the most remarkable achievements have been in breast screening and early detection in women." According to Goldman, more than 40 percent of all breast cancers go undetected without a regular mammogram. And, in Armenia and elsewhere throughout the NIS, where mammograms are rare, cancer is often detected too late, when a mastectomy is the only option. The risk of an American woman developing breast cancer during her lifetime is approximately 11 percent, with approximately four percent dying of the disease, according to the US National Cancer Institute. The breast cancer rate in Armenia has been steadily climbing, with about 32 women per 100,000 developing the disease annually, according to the World Health Organization. Several factors appear to increase the risk of developing breast cancer, including family history, reproductive history, diet, hormone usage and radiation exposure. Yet, warned Goldman, despite the recognition of these risk factors, approximately 80 percent of the women who develop breast cancer do not have any of these identifiable risk factors. "That is why self breast exams are so important," Goldman said. In the United States, health researchers believe a recent decline in breast cancer mortality is partly a result of mammography screening, which rapidly increased in the US during the 1980s due to emphasis on early detection. Heightened emphasis on monthly breast self- examination has facilitated the shift toward early detection of breast cancer at an earlier, more curable stage, she said. Salpy Akaragian shared with participants her five-year struggle with breast cancer. "I had none of the risk factors," Akaragian said. "But at age 42, I discovered a lump in my breast." Akaragian used her personal story to encourage all participants of the conference to conduct their own monthly checks for breast lumps. "I am living proof that early detection is possible...and was a lifesaver in my case," she said. Early detection of cervical cancer is equally important, Sarkissian told conference participants. If left untreated, the cancer can spread to the lungs, liver and brain, and eventually cause death. "This is a very preventable cancer, if detected early enough," explained Sarkissian, who noted that yearly pap smears are now offered annually to women at the center. Working with partners from UCLA and former US partner Beth Israel Medical Center in Boston, Erebuni implemented a new US National Cancer Institute (NCI) method for taking pap smears, coloring the smears and evaluating the laboratory results. "Thanks to the introduction of this new procedure, we are now able to detect early stage cervical cancer 25 percent more frequently," Sarkissian said. Pap smears may also detect certain sexually transmitted diseases (STDs), like chlamydia, syphilis, gonorrhea, herpes and AIDS. "STDs are on the rise all over the world, and can be responsible for tubal damage, infertility, and even death," said Goldman. Some STDs, like herpes, can be transmitted to the newborn during passage through the birth canal. "[Worldwide] over 45 percent of new herpes cases are among newborns, and 18 percent [of these babies] die from the disease. So it is very important for you to educate your patients about STDs," said Sarkissian. Developing Innovative Laparoscopic Procedures. Although some types of laparoscopic surgeries have been performed at Erebuni for the past six years, the hospital has recently introduced gynecological laparoscopy, said Hripsime Mokatsian, MD, laparoscopic surgeon and director of the maternity department. Between April and June, Mokatsian performed more than 60 gynecological laparoscopic surgeries at Erebuni to treat STDs, pelvic inflammatory disorders and scar tissue in the birth canal, and to perform hysterectomies and tubal ligations. Mokatsian and colleagues from Erebuni's plastic surgery department also initiated what she called "one of the most innovative uses of laparoscopy," for the surgical treatment of tubal pregnancies. The new procedure has some advantages over the traditional, more invasive surgery, including a reduction in average patient length of stay at Erebuni--from six to two days--and a lower risk of postsurgical infection. Mokatsian also performs laparoscopy to treat endometriosis, which affects about 50 percent of Armenian women between the ages of 25 and 40. "Laparoscopy is a reasonably safe method for identifying persistent gynecological complications like tubal ectopic pregnancies and tumors," said Mokatsian, adding that high-risk patients still receive traditional surgical treatment. Although the procedure is still in the testing stage, Mokatsian believes gynecological laparoscopy will soon serve as "an invaluable alternative to more invasive, traditional surgical procedures." From laparoscopic surgery to patient education, conference participants agreed that greater collaboration between US and Armenian partners was needed to further improve their knowledge of women's health and to learn new procedures to improve the health care of women. "These are issues that can affect each and every one of us," Akaragian said. "I hope you help promote heightened awareness of these issues to your female colleagues and patients." |
