Wigmore and Valley Children’s Healthcare sum up the first visit to Armenia

Since 1 July 1 “Wigmore Women's and Children's Hospital” is hosting the inaugural mission from its partner “Valley Children's Healthcare”, one of the leading pediatric healthcare institutions in the USA.

This is their first visit to Armenia within the framework of the partnership established between the two medical institutions about a year ago. Prior to this, three groups of “Wigmore” physicians and administrative staff traveled to the USA to learn and exchange experiences at the partner hospital.

As they say in “Wigmore”, this is a unique collaboration in the field of pediatrics in Armenia, focusing on systemic improvements and the establishment of a new culture of medical care that aligns with highest international standards.

During the two-week visit, the mission worked together with “Wigmore’s” medical teams in the respective departments, sharing experience and knowledge to organize joint medical care for patients. Rich educational agenda was an important component of the visit.

At the end of the mission, before returning to Fresno, members of the “Valley Children’s Healthcare” delegation and “Wigmore Women’s and Children’s Hospital” team shared with Mediamax their impressions from the inaugural visit and the collaboration, in general.

Tatevik Koloyan: This collaboration is exceptional, anticipated and motivating

Anticipated and motivating – this is how Chief Development Officer of “Wigmore Women’s and Children’s Hospital” Tatevik Koloyan describes the visit. As she notes, hosting theժ inaugural mission of “Valley Children’s Healthcare”, here in “Wigmore” is thrilling. According to Tatevik, this partnership is really unique: despite being half-a-world apart geographically, these two institutions share the same values and a significant goal — to elevate pediatric healthcare in Armenia and provide the best possible medical care for children all around the world.

“This collaboration encompasses various aspects. First, it was important for our partners to familiarize themselves with Armenia's healthcare system, organizational structure, and management practices. This firsthand experience is crucial to better understand how to further develop and strengthen our collaboration.

Another key aspect is that this mission aims to exchange experiences and support continuous learning among doctors, nurses, and administrative staff. “Wigmore” is a multidisciplinary medical institution hence, it’s important to host a multi-disciplinary mission from “Valley Children’s”, including pediatric neurology, pediatric neurosurgery, pediatric surgery, infection disease specialist, pediatric emergency physician and nurse.

This partnership extends beyond physician education; we also prioritize nursing education and place special emphasis on quality and patient safety issues.

An integral part of this partnership is the active educational agenda, aimed at acquiring new skills and learning from the best international healthcare standards to further implement and adapt them locally”, - Tatevik mentioned.

During the visit a “Pediatric neurosurgery and neurology” educational conference was organized at “Wigmore” hospital for specialists across Armenia. Over 70 participants from ten different medical institutions, including two from the regions of Armenia were hosted – significant indicator for “Wigmore”, highlighting the need within the professional Armenian community.

Dr. Karen Dahl: We want to make an impact not just on individual patients

Vice President of Medical Affairs and Physician Wellness and Development of “Valley Children's Healthcare”, Dr. Karen Dahl, says that her expectations were to learn more about the culture of medical care here in Armenia, both from the providers and from the patients and their families. Summing up the visit, Dr. Karen says, that she realized that what they do in Madera, California, might not be appropriate here, so this visit is a great chance to observe what could be done on site, because it's crucial to understand the resources and the culture before offering advice.

“We cannot just say “this is what we do in Madera”․ Coming to Armenia, to “Wigmore”, and participating in the care here in place, gives us a much better understanding of how we might be helpful in this system”, - tells Dr. Karen

“Our expectation from this first visit was to truly recognize the hospital's culture, the available resources, and to get to know our colleagues here. From that perspective, this visit was very successful for us, because the impact of this mission is different from other medical missions where the focus is mostly on individual patient care. Here, we want to make an impact not just on individual patients: it is vital to teach, advise, explain and hand over our thought processes, how exactly we care for patients. For example, when caring for a patient with pneumonia, to explain, to illustrate why we might change an antibiotic. It's not just about this specific case, but about helping set mindset about future patients in similar situations.

By explaining our thought process, we can improve care for many more patients down the road. In addition to this, we are also working on system-level processes, such as infection control and patient safety. We review existing procedures and provide advice based on our observations and prior recommendations. So far, this has been the most important impact we've focused on achieving”․

Varoujan Altebarmakian։ The principles upheld by Wigmore can aid in establishing a universal system and replicating it across various countries

Representative of Fresno's Armenian community, former Physician-in-Chief of «Kaiser Permanente Hospital», Dr. Varoujan Altebarmakian, who has worked in the field of medical administration for many years, shares that he has been at the core of establishing the partnership between these two medical institutions. He was the link who introduced the heads of the two medical facilities.

“The leadership of Wigmore had a vision, they had the courage, and the commitment to change the culture of healthcare delivery in this country. That's their vision. When they started the process, they realized they cannot do this alone. They needed a partner that will elevate the bar of healthcare system and delivery of care in this country”, - says Altebarmakian.

As he mentioned, he was very excited by the idea of joining this program of changing and improving the culture of the healthcare system in Armenia, including from the point of view that similar cooperation can become a best practice model, and in the future such model can be replicated in other countries.

“So that's how the whole process started”, - Altebarmakian tells.

Hrachuhi Ghazaryan․ We are increasingly confident that our efforts to elevate the healthcare culture in the country and elevate standards are both justified and achievable

Chief Medical Officer of “Wigmore Women's and Children's Hospital” Dr. Hrachuhi Ghazaryan, spoke about the enthusiasm of the entire hospital staff. She says, that everyone, from residents to department heads, was highly motivated and enthusiastic in anticipation of the visit. The team believes that with their partners' support, they would definitely succeed in taking the healthcare in Armenia to a new level.

“Before the “Valley Children’s” team’s arrival the entire hospital was filled with excitement and buzz. The anticipation included professional preparation, where each team had selected different complex cases for discussion, ranging from the most complicated patients to more common scenarios, discussions of diverse situations, thus presenting “Wigmore’s” in-hospital guidelines and jointly identifying the learning gaps and improvement needs.

From the very first day of mission’s visit, medicine and science were thriving in the building. While working with our colleagues from US, we gained even more confidence that, yes, we are on the right path, and our efforts to bring change in the culture of healthcare in the country and raise the bar are justified and achievable”․

Cezar Santos: There is an outstanding group of pediatric neurologists in Armenia

“For a very young country, I think your healthcare is just nothing short of impressive”, - shares Dr. Cesar Santos, “Valley Children’s” Neurosciences Medical Director, Neurologist. “And I have learned that the people of Armenia are very proud, very dedicated, and they like to stay because they say, who's going to help this country but us? And so we at Valley Children's, we're very proud to be part of that journey.

The knowledge of the base of your pediatric neurologists’ team is impressive. They take care of their patients really well. The number of seizure medications here is much smaller than what's available to us. Yet, I will tell you that the number of people who are seizure-free is probably the same”.

Dr. Santos notes, that there are many pediatric epilepsy patients in the country, some of who are medically refractory. That's where he thinks an epilepsy surgery program could help.

“The pediatric neurology group here is excellent. You have a very, very strong pediatric neurology group. You should be proud of that”, - concludes Dr. Santos.  

Steven Ehrreich: Doctors here face limited opportunities, yet they demonstrate exceptional skills with the resources available to them

Pediatric Neurologist Dr. Ehrreich, tells that his experience at Wigmore hospital has been quite rich. He particularly highlights the close interdisciplinary cohesive work among the teams that has impressed him. “Everybody works together and meets together. So that's a dynamic that we don't have, which is really wonderful. Everybody works together like family.

I think the neurology team here is excellent. And they don't have quite as much to work with, medications and tools and equipment, software. I think that we do have some advantages, but they do a phenomenal job with what they have.  The patients really are getting just about the same care we provide with a little bit less to work with”.

Stephanie Jones: At Wigmore, they work as one team, like a family

Pediatric Surgeon Dr. Stephanie Jones thinks that what inspired her to join the mission was the large Armenian community at home and desire to understand Armenian culture better and see how the system works compared to US healthcare system and the exchange of ideas between the two countries.

“What impressed me really was how the team functioned as a group, as a family. We had a very difficult case and a very busy day recently, and they just all pulled together and everybody was taking care of the patient and taking care of each other.

It's not something that you always see in a group, so I think you're very lucky to have these surgeons. I learned a lot from their broad experience. My work in the States is with technology, like robotic surgery and minimally invasive surgery and seeing what they can do here with some limited resources and coming up with ideas for the future with our programs to collaborate, I think, is very exciting”.

Julieanna Sahouria: Every morning, while entering the hospital, I hear the same question: “What will we discuss today”?

“Knowing that the subspecialty of pediatric emergency medicine doesn't exist in Armenia, we knew it was going to be somewhat of a challenge. I was quite impressed with the fact that most of the pediatricians here have two subspecialties and yet not one was pediatric emergency medicine”, - says Dr. Julieanna Sahoria, Pediatric Emergency Medicine Physician.

Taking that pioneering group, that has such a devoted interest in wanting to be pediatric emergency physicians, and taking them to that next level, teaching them new procedures, teaching them how to think about critical situations and really being that first-line provider was something that we had to change the mindset for. And I think compared to when Amy and I first started, we've already seen the change. And so just seeing that change in such a short amount of time has been tremendous.

And that shows to me that the will to continue improving and establishing themselves as a pediatric emergency physician and nurses is there. And I think you (“Wigmore”) will get there, absolutely”.

As Dr. Sahouria emphasizes incredible thirst for knowledge.

“I came prepared with ten medical-based clinical emergency department lectures, and while I was here I wrote another five. I'm just so impressed by even the physicians who come in in the morning, they stay all day, they work their overnight shift, and then because they know we're here and we're lecturing, they stay all day and listen to those lectures”.

According to Dr. Sahouria the sessions have all been recorded.

“We brought here a simulation baby, had to do lumbar punctures, and all day they walk into the emergency department, that baby's on a stretcher, and all day they're doing lumbar punctures.

They're doing interosseous. We taught them about urinary catheterizations. They owned every procedure that we taught them and they got a very positive outcome. Just seeing that, it's going to continue to drive the quality of care. It's going to continue to drive the standard. It's going to continue to modernize the hospital 100%”.

For Dr. Sahouria it was heartwarming. As she says, it went from ownership to collaboration, which is the whole goal of this partnership.

Amy Mauk-Fisher: I'm just like a proud mom. I love seeing the growth.

“I've been working close with the nurses and it's been an honor to work with them», - smiles Pediatric Emergency Nurse Amy Mauk-Fisher. «They are very bright. They want to learn so much. They can't get enough. They want to interact even with the doctor skills. From when I first started seeing them to now, it's a total different change. And I'm just like a proud mom. Because they're doing new things without me asking them. I love it. I love seeing the growth.

Both of us working together I think also helped them see how a doctor and a nurse can actually work together as a team. Everything that we tell them, what Dr. Sahouria tells me to do, what I report back to her, it has built almost like a platform for them to learn this interaction.

We ended up teaching the whole hospital. It was not isolated just to the ER. It was amazing”, - sum up Mauk-Fisher.

Rob Saroyan: There are many positive layers of this young, developing partnership

The President of the “Valley Children’s Healthcare Foundation” Mr. Rob Saroyan says that there are many positive layers of this young, developing partnership. And one of the things they try to do as leadership is try to really engage their providers and create an experience for them to run their talents in unique ways.

“What I'm discovering here, and just talking to our physicians, is they have the ability to really bring their expertise and effectuate change in a short period of time. And they are able to make a measured impact, like you're hearing here today. I mean, that is awesome. And capturing all this, taking it back to “Valley Children's”, and sharing this experience is going to really pay big dividends over the long term. It's not just about us here. It's about future generations playing a role in this partnership.

We shall take this experience over the last two weeks, share it with our constituents, the people who support our hospital, and make a compelling argument to continue on that track.

We're taking American ingenuity, and exporting to a country that happens to be Armenia in this case for a lot of reasons. Maybe we take this to other places like Mexico or the Philippines or wherever in the future, but this is the model we're creating now in Armenia”.

Lusine Gharibyan

Photos: Agape Grigoryan