Consider yourself fortunate if you live in a thriving city like Yerevan. However, if you’re from a rural village or smaller town, you may have to wait hours for emergency medical services to reach you and your loved ones. Since gaining independence in 1991, Armenia has made great strides in development. However, emergency medical care remains severely underdeveloped.
Greater investment is needed in hospital-based emergency care and education regarding acute conditions, particularly in the stabilization of stroke, myocardial infarction, trauma and sepsis, as outlined in the International Journal of Emergency Medicine. “Ischemic heart disease in Armenia is responsible for 37% of all deaths, with a rate of 248.5 per 100,000. Armenia ranks 35th out of 175 countries in cardiac-related deaths. The country falls in the Eastern Europe/Central Asia (EE/CA) region, which has the highest per capita burden of cardiovascular disease,” according to the International Journal of Emergency Medicine.
Armenian Prime Minister Nikol Pashinyan highlighted the healthcare issues facing the country during a parliamentary session on May 1, 2018, stating, “The problems the healthcare area faces are due to low effectiveness, corruption risks and limited financial resources… It is possible to solve the existing problems only by taking these factors into account.” Since 2019, the World Bank has classified Armenia as a middle-income country. This financial growth raises a big question: Why is Armenia unable to improve its medical system? This suggests deeper systematic failures within the country beyond regional instability.
Gohar Hakobyan, now a paramedic in New York City, was born and raised in Etchmiadzin (Vagharshapat), Armenia. She recalls the unjust treatment her grandmother received from paramedics:
“Throughout the entire day, my grandmother was extremely sick,” she told the Weekly. “I called 9-1-1 in the morning, then during the day, because they would just look at her and leave without doing anything. They didn’t even consider taking her to the hospital. The third time I called, it was around midnight, because she got even worse—she couldn’t breathe, and they still didn’t provide her with oxygen. The doctor walked in and said, ‘Why are you calling all the time? She is old; let her die.’ I’ve never felt so helpless in my entire life. The next morning, she died in the house, on the same bed. I felt devastated and heartbroken that I could not help her. It’s as if a hospital bed is considered a waste on older people, as though their lives aren’t worth the effort.”
Melina Mnatsakanyan (M.M.): As a paramedic now, would you ever say something like that to a patient who called you to save their family member?
Gohar Hakobyan (G.H.): Of course not. How could you say that to anyone? You have to do everything you can to help them, unless they have a signed DNR [Do-Not-Resuscitate Order]. It also comes down to morality—some people can be inhumane, especially towards older individuals. But in the United States, you would never be allowed to say something like that.
M.M.: Do you think that, with your education and experience now, you could have helped your grandmother if you were the paramedic in Armenia?
G.H.: Absolutely, I could have helped her—at least in the moment, until she could be taken to the hospital. The issue wasn’t a lack of intelligence among the medical staff but a lack of human care. They aren’t paid well, which I think contributes to their unwillingness to treat patients. I remember one of my first classes as a paramedic in the U.S., where we were learning about oxygen tanks. The professor emphasized how vital and precious they are, saying, “Treat these tanks like a luxury. Be careful with them because, in many parts of the world, people don’t have this privilege.” As he spoke, I couldn’t help but think of my grandmother. It was a painful reminder of how something so essential can be taken for granted in some places and denied in others.
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This example shows a lack of care and compassion toward the older generation in Armenia. Human behavior plays a significant role in perpetuating an unjust system. While in many countries, the elderly live well into their 80s, in Armenia, many families must say goodbye a decade or more earlier. A system that fails to provide better resources is responsible for preventable deaths throughout the country. Acknowledging this issue is the first step toward meaningful change.
Residents in Jermuk, an Armenian town bordering Azerbaijan, experience a lack of medical services. “Our doctors are skilled and compassionate, but their efforts are often hindered by the lack of proper equipment and facilities,” Jermuk resident Nushik Vardumyan told the International Committee of the Red Cross (ICRC) in June 2023. “The sole operational hospital in the area is not adequately equipped, compelling people to travel to Yerevan—a three-hour journey—even in emergencies.”
It is frustrating to know how to save a life yet lack the resources to do so. “During the escalation, more than 120 people were admitted to the Jermuk Medical Center. Although the staff performed their duties proficiently, the lack of proper equipment resulted in a decline in the quality of services provided. As a result, a decision was made to establish an emergency department at the medical center,” noted Vigen Tatintsyan, health staff of the ICRC. The field treatment for injured soldiers worsens these conditions, increasing casualties, as witnessed during the war in 2020.
It is unjust that advanced medical equipment, such as ECG machines, defibrillators and ventilators, should be available only in urban ambulances, while rural Armenians struggle for survival. The class divisions and economic disparities that give rise to these problems warrant deeper exploration. Discrimination against those without privilege or status only exacerbates the problem, according to Hakobyan. To those who engage in such discrimination, I ask: Where is your sense of Armenian righteousness? We can often be our own worst enemies, without even realizing it.
While we admire Armenia’s beautiful mountains, they also present logistical challenges. Yet Switzerland, another mountainous country, has proven that landscape need not be a barrier to effective emergency medical care. Unlike Armenia, which has limited air rescue and relies on slow, underfunded ground transport, Switzerland has built an efficient, advanced system. Those with the privilege of reliable emergency medical services (EMS) in the city can hardly imagine such life-or-death struggles.
I had the honor of interviewing Omar Serrano, a paramedic based in the United States with 30 years of EMS experience, to gain insight from beyond our community.
Melina Mnatsakanyan (M.M.): How would you feel about being in a situation where you have to save a life without the necessary tools or proper training? How often do you rely on advanced equipment like ECG machines or defibrillators?
Omar Serrano (O.S.): It would be frustrating. Part of being a good EMS provider is to improvise—within reason. If you don’t have [critical equipment], you make it, or you find a way around it.
M.M.: Do you think it was ethical for Armenian paramedics to dismiss Mrs. Hakobyan’s grandmother?
O.S.: Absolutely not. Heads would roll over here. In the South, where race is an issue, it is possible to hear, but in a city like New York, you can’t get away with that.
M.M.: What protocols are followed in the U.S. to ensure elderly patients receive proper care? Would it be possible for a paramedic in the U.S. to refuse treatment to an elderly person?
O.S.: Absolutely not, and you can’t treat them poorly either. There are a couple of things to take in consideration—we have an oath to take care of a patient, no matter what.
M.M.: How is the level of training and education for paramedics in the U.S. compared to other countries?
O.S.: The best way to answer that really honestly would be… you know how every country feels that they do it the best? I would assume they feel that they meet or exceed American standards, but in reality, I don’t see it happening. There is not enough money, and there is not enough equipment. Why would a country train you to a standard which you are not going to be able to provide?
M.M.: In your experience, do you see a difference in the quality of EMS care based on a patient’s socioeconomic background or location?
O.S.: Absolutely, and I am sad to say this happens by providers. I noticed that some providers deal with a certain class of people differently than they do with others.
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While the U.S. is far from perfect, its history of inequality in medical care is a clear reminder of systemic failures. We should analyze examples where progress has been made. Armenia continues to struggle with ongoing conflict and genocide, making direct comparisons to the U.S. or Switzerland difficult.
However, the country’s failure in EMS cannot be ignored. We are left with the question: How can more resources be allocated to prioritize essential services like emergency medical care? Government action—or rather, inaction—suggests that the well-being of Armenian citizens is not a priority.
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