Boston University-Armenia Medical Partnership

A group of people gathered for the launch — Armenian Minister of Health Anahit Avanesian (center) at the launch of the Health for Armenia (HFA) initiative, with the HFA fellows and other institutional partners. (Jeff Markuns and Aram Kaligian from the department of family medicine standing, far left)

The Boston University-Armenia Medical Partnership (BU-AMP) is a multi-disciplinary program to coordinate collaboration for the improvement of healthcare in Armenia between the Aram V. Chobanian & Edward Avedisian School of Medicine and health policy and care entities in Armenia.

In June 1991, the School, then led by Dean Aram Chobanian, MD, signed affiliation agreements with the Yerevan State Medical Institute, the Postgraduate Medical Institute of Armenia and the Armenian Ministry of Health. Although affiliations have changed over time as Armenian political and health policies have evolved, the partnership remains committed to support health education and care exchanges and collaboration with colleagues in Armenia.

black and white photo of two men seated, wearing suits and ties smiling broadly — L to r: May 1999, Dr. Derenik Dumanyan, Director, Armenian National Institute of Health, and Dr. Aram Chobanian, then Dean of Boston University School of Medicine and Provost, Boston University Medical Campus, re-signing the affiliation agreement in Boston.

Currently, the BU-AMP has several initiatives at different stages of development:

Primary Healthcare Reform Initiative
Neurological Subspecialty Training
Emergency Medicine Residency
Health Professions Education Development

Primary Healthcare Reform Initiative

Recent reports from the WHO and World Bank have reaffirmed the importance of primary care as the most cost-effective method to advance population health in low- and middle-income countries. Also, reports on the state of Armenian healthcare by the WHO, the Primary Healthcare Practice Initiative (PHCPI), and the World Bank note the lack of a functioning primary care system in Armenia and recommend its rehabilitation. Like many former Soviet Union countries and countries with similarly centralized governments, investments in healthcare in Armenia were targeted at hospitals and specialists, and primary care was neglected.

The Armenian Ministry of Health (MoH) developed a Primary Healthcare Reform (PHCR) Taskforce in 2021 to analyze the primary care system in Armenia and how to enact fundamental change. The Chobanian & Avedisian School of Medicine is uniquely positioned to help with this initiative, since the Department of Family Medicine Global Health Collaborative (DFM GHC) has enacted fundamental primary care reform in southeast Asia, most notably in Vietnam, but also in Cambodia, Laos and Myanmar. The DFM GHC has also helped established a functional medical system in Lesotho in Africa.

The BU-AMP is currently coordinating with the Armenian MoH, the Health Network for Armenia (HENAR), DFM GHC, and other institutions in Armenia to identify initiatives that will guide the development of a fully functional primary care system in Armenia over the next 10-15 years.

Man in suitjacket standing at podium at front of room beside powerpoint slides — Jeff Markuns (Director, department of Family Medicine Global Health Collaborative), speaking at the HFA launch

In the spring of 2024, the BU-AMP, in partnership with the Armenian MoH, HENAR, and other institutions, helped launch the Health for Armenia (HFA) initiative. HFA was founded with a twofold purpose: to improve healthcare access and quality in Armenia’s underserved rural communities, and to create a strong movement of medical professionals who will continue to reform the Armenian healthcare system in the future.

Group of people participating in a workshop in a modern room with big glass windows and large whiteboard and orange sofas — Henry Louis (HFA program director) and Aram Kaligian (director, BU-AMP) leading a HFA Healthcare Academy workshop

Ten core faculty members were recruited from outside Yerevan and began a Training-of-Faculty program in March 2024, to prepare them for the incoming HFA fellows. Then in June 2024, ten recently-graduated Family Medicine physicians began the two-year HFA training program, beginning with a six-week intensive Healthcare Academy, followed by weekly lectures and workshops. In the fall of 2024, the HFA fellows will begin their clinical rotations at select practices to improve their clinical skills.

Progress is also underway to lay the groundwork to reform the two Family Medicine residency programs in Armenia to be much more clinically- and competency-based. The BU-AMP is collaborating with HENAR, which already has experience on the ground in Armenia when, in partnership with Children’s Hospital of Los Angeles, they developed a new, three-year Pediatric residency program in 2023.

Neurology Subspecialty Training

There is a notable lack of Neurological subspecialty training in Armenia. Stroke centers have only recently been developed in the last decade, the only Armenian Pain Clinic was just established in 2021, and Neurologic-ICU care doesn’t exist at all.

BU-AMP has coordinated with the school’s department of neurology to invite Armenian neurologists for one-month observerships at Boston Medical Center for specialized training in stroke, pain management, and neuro-ICU care, beginning in November 2024. BMC neurologists are also projected to travel to Armenia in 2025 to help develop neuro-ICU wards and stroke centers and to demonstrate and supervise procedures in pain management – such as epidural steroid injections and nerve blocks.

Emergency Medicine Fellowship

Historically, there has been no formal training in emergency medicine (EM) in Armenia – neither in medical school nor in residency. As such, there are many poor outcomes in patient care due to delayed recognition and treatment of acute, life-threatening medical conditions that present to the five emergency departments (EDs) in Armenia. These EDs are staffed by intensivists, cardiologists, pulmonologists and other specialists, but have no formal training in emergency medical care.

Faculty at Yale and Brown University medical schools have developed an 18-month short-format emergency medicine residency program to re-train existing ED staff physicians as EM specialists. Beginning in September 2023, 13 practicing physicians began part-time training as EM residents, starting with an intensive introductory bootcamp, and then continuing with weekly virtual lectures and procedure simulations and month-long observerships in EDs in the US. EM faculty from the US also travel to Armenia to provide hands-on training in EDs there. The BU-AMP is collaborating with the EM residency program to enlist the participation of BMC EM faculty and global health fellows in the training of Armenian EM residents.

Health Professions Education Program

Critical to the development of an efficient and cost-effective healthcare system in Armenia is the development of systems-based medical training programs. At present, there is little or no consistent, competency-based curriculum development in Armenia. The BU-AMP, in conjunction with the Armenian MoH and HENAR, is developing a hybrid version of the school’s Master’s in Health Professions Education program for residency program leaders in Armenia to learn curriculum development skills. The goal is to offer training in curriculum development to help systematize and develop competency-based training across the Armenian healthcare system, and is projected to begin in the summer of 2025.