Voices from the Field: Armenia Training Providers, Generating Change

“I’m so happy and grateful to my doctors for having my baby in my arms after all the stress I went through,” says Lusine, a patient whose baby’s life was saved by physicians trained by IntraHealth through Project NOVA, a USAID-funded initiative to improve reproductive and child health care in rural Armenia.

Lusine was looking forward to giving birth to a baby girl in April, but in February she woke up in the middle of the night bleeding. Scared for her life and for the life of her unborn child, she rushed to Vayk Medical Union, which serves the southern region of Armenia’s Vayots Dzor province. In the past, doctors at Vayk preferred to refer patients such as Lusine “because they were uncertain what to do.” Now, thanks to NOVA’s trainings in emergency obstetric and newborn care, they were well prepared to manage Lusine’s hemorrhage.

Using Lusine’s recent ultrasound exam, Dr. Gayane Petrosyan, an OB/GYN, knew there was no threat of placenta previa—a dangerous condition often leading to bleeding during pregnancy. Further examination determined that cervical dilatation was almost complete. Dr. Gayane Petrosyan delivered the baby, but the newborn was not breathing. Dr. Nune Petrosyan, a neonatologist, immediately diagnosed respiratory distress syndrome and promptly cleaned the baby’s airway, dried and warmed the newborn, and began treatment for respiratory distress. Due to accurate, timely and organized care, the newborn’s condition was stabilized in a few days, and the baby could start breastfeeding.

On-site training for the staff at the health facility covered antenatal care, postpartum care, emergency obstetric care and newborn and infant care. Participants’ clinical skills and knowledge increased by 30%, resulting in changes in service delivery: “After . . . NOVA’s newborn care training, we started providing counseling to postpartum women. We explain to them the newborn danger signs [to watch for] and the steps [to take] for breastfeeding,” notes Dr. Nune Petrosyan.

“Now I use some new approaches,” adds Dr. Gayane Petrosyan, “. . . such as active management of third stage of labor and use of a partograph.”

An unanticipated outcome of NOVA’s trainings has been the new level of enthusiasm they generated among management and staff. As one manager reports: “. . . the project inspires them and makes their routine work more interesting.”

Overnight, the delivery department head—Dr. Metaxya Hovhannisyan—mobilized her staff in reorganizing the delivery and women’s consultation departments to make them compliant with the infection prevention measures introduced during the training. The result? Vayk Medical Union has had no cases of fever or diseases among postpartum women for the past six months.

Project NOVA also established a quality assurance team of Vayk staff who worked on strengthening existing maternal and child health care services using self-assessment instruments. Following the very first self-assessment, the team created a suggestion box for patient feedback and posted the warning signs of complications during pregnancy, as well as clinic hours. In addition, they resolved an issue they had faced with medical waste disposal. They have raised the quality of their services by applying new approaches in service delivery and by using new equipment received from Project NOVA. Thus far, team members are proud of their accomplishments and satisfied as “the patients feel the difference and appreciate it,” as one staff member remarks.

Project NOVA is managed by Emerging Markets Group in collaboration with IntraHealth International and Save the Children. Major partners are the Ministry of Health of the Republic of Armenia, regional authorities, medical training institutes and several local non-governmental organizations.

Since October 2004, Project NOVA has set up 18 clinical training sites throughout Armenia. More than 1,600 obstetricians/gynecologists, nurses/midwives and other health professionals have participated in trainings and about 20,000 community members have attended reproductive health and maternal and child health (RH/MCH) events. The number of people using RH/MCH services subsequently doubled.