Born June 26, 1958
Yerevan State Medical University, Assistant in the department of Anesthesiology and Intensive Care
Palliative Care working group member
When there was a campaign of “Life Without Pain” in the street, you could notice a woman, who was patiently explaining everyone, what palliative care is, who has the need for it, and why it is needed to make the access to painkillers available for those, who have the need for it. Especially the moment when she sat in the chair of torture was influential, to show on her own example the psychosis and suffering of those people, who need painkillers, which are not available for them yet. With such a dedicated work example Narine inspires to ordinary passersby, specialists working in various spheres and instills a way to treat good in her students.
– Would you speak a little about palliative care? What is it and who has the need for it?
Palliative care was first introduced by Cicely Saunders in London. She created the “Saint Christopher” hospis, where people who had pain or pain syndrome gathered. In Mrs. Cicely Saunders opinion, pain was everything, not only physical pain, but also psychological and spiritual pain. Those people, who were already helpless from medical perspective and who were alienated from society were involved in the hospis. Mainly people with cancer were involved in the hospis and the care they were getting there started to be called “hospis care”. Because in Francophone countries the word “hospis” has another meaning, in connection with that specialists came to conclusion to call that type of care a “palliative”. Palliative care comes from the word “palliate” or “pallium” (palliare in latin), which means to conceal, dissemble. This means, that the disease cannot be healed, but mainly the symptoms get treated. Saunders’ slogan was the following: “A decent life until death”.
– How and why did you start doing palliative care? Why do find it important?
My first profession is anesthesiologist-reanimatologist, a person who’s directly dealing with pain, does anesthesia, who controls pain after surgery. In civilized countries the idea of pain management and the relevant specialty has been invested long ago. When in case of a acute pain a surgery can be held on, the cause or inflammation may be eliminated, the chronic pain becomes a disease or a pain syndrome itself, which is a peccant condition and leads to work disability, decline in life quality and as well as pushes out the person from his/her balanced life.
Being retrained in Austria on the topic of palliative care for three times I came to conclusion, that it can also be established here. Knowing that I deal with it, my colleague involved me in that work. Accordingly our working group was created, where people who directly deal with palliative care, specialists from the Ministry of Health, legislative bodies and others are involved. In that group I am the responsible person for education, as I also teach at State Medical University named after M. Heratsi.
There is a lot of things still need to be done and there are many obstacles in the sphere of investing palliative care in Armenia. Even in the countries, where the sphere of palliative care is quite developed, there are still many prejudices concerning the use of opioids. Especially the stereotype that using opioids make you addicted is widespread. But in reality there is no such thing, as they are being used for medical, painkilling purposes and it depends on receptors. Illegal drug circulation exists and develops anyway. In the case of palliative care the pain is being evaluated according to scale, which is developed by World Health Organization (WHO), and according to which the amount of medicine is assigned (moreover, various opioid derivatives are presented as different types of medicine in the list of drugs of WHO). The dose may be increased because there is a physiological basis for that, and not because the person becomes addicted.
According to need assessment of Ministry of Health, 3500 persons a day need a palliative care in Armenia, from which 70-80% need anesthesia. However, currently anesthesia is available for only around 200 persons.
– You also appear to be an active public figure, civil society representative in frames of “Life Without Pain” project. How do you feel about it, and what successes have you achieved so far?
That is my nature; if I know something, it must be shared. And I have my opinion about patriotism: it should be applicable. I won’t stand with a flag and shout that I love my country, but instead I prefer to make real steps. If I can somehow change the life quality of an ordinary Armenian, then I do it, in a result of which in some extent the welfare of the society changes. If there’s an opportunity today to change something in the society, then I do it no matter how it is implemented: from tribune of university or during the campaigns. That is my mission. And my last name coincides with my mission.
– Besides being a practical doctor you also teach in Yerevan State Medical University: How can you combine these two difficult jobs?
It’s not only these two jobs that I combine. About two years ago I applied to an international project “Leadership Development Initiative for Palliative Care”, which makes leaders from all around the world in the sphere of palliative care. I won that competition and now I receive online education, we meet three times in a year for trainings and experience exchange. In 2013 I will get a diploma in palliative assistance. In frames of this project the elite of palliative care gathers worldwide.
Besides, I also came up with my individual initiative; I’ve read lectures in Dilijan, Sisian and Goris in topic of “Palliative care as healthcare problem and a profession”. I’ve also initiated to make a course on palliative care in Yerevan State Medical University named after M. Heratsi and I hope that those lectures will be conducted in 2013-2014. I think that life should work that way, the more complete, the better.
– What do you consider to be the greatest achievement in your life?
The first achievement I think of is that being anesthesiologist I’ve saved people’s lives. There were cases, when people got injuries dangerous for life and even a slight mistake could cause a person death. Years ago there was a case, when I understood what I am living for. 17-18y/o boy was heavily stabbed and brought to hospital. It was a big problem to hold anesthesia for him. Of course everything was done and the boy got recovered and left the hospital. Years passed. I moved to “Muratsan” hospital and was working there with kids. A man approaches to me in the hospital: “Hello doctor, don’t you remember me?”
Well, I’ve held anesthesia with so many kids during that time, I thought the case was related with a kid: “Would you please remind me? I can’t remember the child.”
That was the guy who was recovered and later made a family. That is an achievement. Healthy people make achievements; those who already die without pain also make achievements.
Changes made in educational institutions are also achievements. We are not just reading lectures for students. I try to change their attitude towards their profession, so they understand that they came to serve for the people. Medicine is a great thing. And I do not tolerate the ignorance. I’m offended with that, because I devoted all my life to medicine, I’ve gone through many barriers, I’ve put many resources. Even if human quality is changed, I won’t let it to cover medicine.
When you eat, do not forget, that there are people, who cannot eat. Stay human.
Nvard Margaryan