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ArmeniaFollowing the collapse of the Soviet Union, tuberculosis (TB) has risen steadily in Armenia within an inadequate healthcare system. The current system does not offer treatment for the drug-resistant form of TB because of its complexity: treatment is long and costly, causes severe side effects, and essential medicines are not readily available.In September 2005 MSF, in collaboration with the Ministry of Health (MOH) and the City Hall Mayor, established a TB program in Yerevan and began treating patients in two pilot districts — Malatia- Sebastia and Shengavit. By May 2006, 65 persons were being treated for standard TB and 25 patients for the multi-drug resistant strain of the disease. MSF renovated two TB dispensaries in Yerevan, where patients are hospitalised. Once the intensive phase of treatment (up to a year) is over, patients are followed for several months through a system of TB “cabinets” that include facilities for collection of sputum samples, directly observed treatment rooms and a basic laboratory. A dedicated drug-resistant unit at the Republican TB hospital in Abovian is also undergoing renovation. Addressing sexually transmitted infectionsIn the Shirak region of northwestern Armenia, MSF runs a sexually transmitted infections (STIs) management and prevention project. MSF is present in six local health polyclinics, where it focuses on confidential testing and treatment of STIs, ensuring access to care is free for all. Awareness and education about STIs and HIV/AIDS are important components of this project. MSF actively lobbies the MOH to adjust the national protocols for STI care — a primary goal is to obtain inclusion of antiretroviral drugs on the Republic’s essential drugs list, so they can be imported. Over 5000 consultations on STI/HIV have taken place since the project’s inception. Alternative treatments for mental illnessIn Armenia, psychiatric institutionalisation has been the frequent solution for persons with mental illness and there is a strong stigma surrounding mental health issues in much of the country. Since 2004, MSF has been supporting and developing outpatient mental health services in an attempt to provide alternative means of care. MSF has developed a program emphasising a multidisciplinary approach to mental illness in the deprived province of Gegharkunik Marz. Between June 2005 and May 2006, 6488 psychiatric consultations, 434 psychological consultations and 1724 social worker interventions were recorded. The program includes a strong information and education component, addressing and challenging the stigma of mental illness. Day centers, offering a range of therapeutic activities and skills workshops for the mentally ill, have now been handed to local partner Mission Armenia, and MSF plans to hand its mental health projects to the MOH by the end of 2006. MSF also provides assistance to the primary healthcare system in this region, renovating ailing health structures in Kharchaghbyur, Tsjambarak, Vardenis, Geghamasar and Daprabak; and providing training and medical supplies to local staff. From June 2005 to May 2006, 14,292 primary care consultations were conducted by MSF-supervised doctors. International donor presence and funds for healthcare infrastructure and support have increased significantly over the past year and MSF will be phasing out its primary healthcare support in this region by the end of 2006. MSF has worked in Armenia since 1988. |
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