by Franklin Fisher

In Azerbaijan as elsewhere in the former Soviet Union, decent health care is hard to come by. Unsanitary conditions in hospitals and clinics, a severe shortage of medicines, poor lighting in wards, even requests for under-the-table payments for medical treatment, have plagued the country's already inefficient, Soviet-style health care system.

To help relieve these and other health care problems, and to see that care is provided to women and children especially, the United Methodist Committee On Relief (UMCOR) has several medical projects up and running in the southwest Asian country.

One operates numerous health clinics, and another provides much-needed free medicines and medical supplies. A third brings to the Azerbaijanis the medical expertise of doctors at Baylor Medical College in Houston, Texas. UMCOR has been active in the country since March 1996.

"Essentially, the Soviet system used to finance medicines and medical care," said Rick Spencer, UMCOR program officer for the newly independent states. "That has collapsed."

Now, the health care system itself needs critical care: doctors are unschooled in up-to- date western medical techniques; administrative procedures are wasteful and inefficient; health care costs are out of reach for most cash-strapped Azerbaijanis; and medicines and other medical items are in short supply. Because of the economic troubles, medicines are not only scarce, they're too costly, Spencer said. Behind these problems are the economic crisis that followed the 1991 collapse of the Soviet Union, and the military conflict between Azerbaijan and Armenia in the early 1990s.

For ordinary Azerbaijanis, food for one person costs about $30 a month, but government pensions pay no more than $4 a month. Those Azerbaijanis who have a job may make between $7 and $14 a month, but medicines can cost twice that on the open market in Azerbaijan, Spencer said. If a major injury or illness calls for a hospital stay, the bill can range from $500 to $2,000, he said. The situation is exacerbated because thousands were forced from their homes during the fighting with Armenia over the Nagorno Karabakh enclave. Each country claims the enclave, which has a majority population of ethnic Armenians. A temporary cease-fire was declared in 1994, with Armenian troops in control of the area.

Some 400,000 people have taken refuge in and around the capital city of Baku in the southeast, where UMCOR has put its main effort. They are known formally as internally displaced persons, or simply IDPs. "It's just really putting increased demand on an already overburdened and inefficient health care system," Spencer said. Baku's total population is 1.8 million.

UMCOR operates 32 clinics in Baku and runs another seven in the region outside the city through its Primary Health Care Program, said Spencer. Of those seven, five are mobile clinics that drive from place to place. The other two are fixed sites. The program is funded largely by the United States Agency for International Development (USAID). The clinics are of two kinds, those for women, especially within the child- bearing age range of 15 to 45, and those for children through age 16.

For the Azerbaijani doctors who work in the clinics, the program also provides instructors who teach internationally accepted standards for prescribing medicines. Standards taught are those of the UN's World Health Organization (WHO) and the standard guidelines of the International Network for the Rational Use of Drugs. Doctors trained under the Soviet system have tended to over-prescribe antibiotics, a practice discouraged by the WHO standards, Spencer said.

A second UMCOR program provides free medicines and medical supplies to the clinics. Funded by the U.S. State Department, the Pharmaceutical Distribution Program provides syringes, sterile needles, gauze bandages, and similar staples. "There are medicines available throughout the former Soviet Union but they're prohibitively expensive," said Spencer. "Without a program like this, the IDPs especially would have no access to primary health care," he said.

Under the program, UMCOR this August coordinated the airlift of $25 million worth of medical supplies and equipment to Baku. Since it began work in Azerbaijan, UMCOR has transported more than $6 million worth of medicines and medical supplies to the country. It has also moved $716,144 in other supplies, such as blankets, clothing, sewing kits, and other items.

The Hospital Partnership Program between UMCOR and Baylor College of Medicine aims to present western medical standards and practices to Azerbaijani doctors who were trained under the limitations of the former Soviet system, Spencer said.

Begun this July, the program involves two Baku hospitals, the Mir Kasimov and the Republican Scientific Center of Surgery. A group of Baku doctors traveled to Baylor last month for a program orientation. Currently, a team of Baylor doctors are in Baku holding seminars on western hospital administration, Spencer said.

Future seminars will instruct Azerbaijani doctors in infection control; improved intensive care treatment; clinical laboratory practices; heart, abdominal, gastrointestinal, and vascular surgery; obstetrics and gynecology; women's health; anesthesiology; and hospital management.

	See Also... Topic: Emergencies |  Health |  International affairs |  Refugees |  UMCOR |  Geographic Region: Azerbaijan |  Source: GBGM Mission News
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Date posted: Jan 05, 1999