Help our local partners realise their vision of hope for their communities
Vardan Tadevosyan served as a tank commander in the soviet army 1985-7. Then his career took a turn; he became a blessing to his country in a more peaceful and constructive capacity. Today he plays a leading role in the reparation of a nation’s attitude towards disability, as well as the rehabilitation of individual lives.
In South Caucasus lies the landlocked, war-torn and unrecognised state of Nagorno-Karabakh (or Artsakh Republic, as it is known locally). The enclave was under the control of Azerbaijan Soviet Socialist Republic (SSR) from the early 1920s until the dissolution of the Soviet Union. With a vision of strength and perfection, the Soviet Union sought a USSR with no ‘invalids’. Persons with various mental and physical disabilities were institutionalised and stigmatised. The ‘imperfect’ of Nagorno-Karabakh suffered greatly from appalling living conditions, segregation and isolation.
The general population and infrastructure also suffered as the 1988 demonstrations seeking unification with Armenia turned into years of armed conflict. Azerbaijani control was ended at the price of massive bloodshed and destruction. An armistice was finally concluded in 1994. 21 years later, tension remains; there is still no peace treaty in place and the devastations of war mark the region. The Soviet attitude to disability lingered, resulting in continued segregation, stigma and inadequate support of the disabled. Instability and a lack of resources resulting from the war made it difficult to address these deeply rooted issues. In 1999, Vardan Tadevosyan founded the Lady Cox Rehabilitation Centre and took up this challenge.
Making Something out of Nothing
Article 21 of the Constitution of the Artsakh Republic (10th December 2006) states: “All are equal before the law. Discrimination based on gender, race, color of skin, ethnic and social origins, genetic characteristics, language, faith, political or other views, national minorities, and propertied or other status, such as birth, disability, age or any other individual and social nature is prohibited.” Compared to the general attitude towards the disabled under the Soviet regime, the new constitution is clearly a step in the right direction. Yet, writing about equality and the prohibition of discrimination is a lot easier than actually eradicating segregation and maltreatment through offering adequate support and make an all-embracing concept of equal value of human life the norm.
Following a major earthquake in 1988 the International Federation of Red Cross (IFRC) set up a large project in Yerevan, Armenia to help survivors, many of whom had suffered spinal cord injuries. It soon become clear that the region was completely unfamiliar with the concept of rehabilitation. It was through involvement in this project, that Vardan Tadevosyan started his career within rehabilitation therapy which would later take Nagorno-Karabakh one step closer to realising its Constitutional goals.
Vardan was educated in various settings, among others the Heidelberg University as well as learning centres in Germany, the UK, the US, Malta and Slovenia. Over years of studies Vardan acquired rehabilitation therapy qualifications for the treatment of spinal cord injury, stroke and head injury, amputation, autism, mental illness and age related issues.
Following the war of the early 1990s in Nagorno-Karabakh, the people identified rehabilitation as their key priority, particularly to help those suffering from war-time injures. The enclave had no permanent rehabilitation centre and a lack of knowledge of the principles and therapies involved. Baroness Cox heard about Vardan’s transformative work in Yerevan and together they embarked on a journey to bring this concept to Karabakh. Vardan was presented with a building partly ruined by bombs to house his Centre. He has since transformed this building into an internationally renowned centre of excellence, with the help of committed and expertly trained staff.
Hurdles and working hours were many at the start of the Rehabilitation Centre. Vardan’s workday could last for 17 hours and included renovation work as well as teaching; “In the beginning, everyday 8 hours teaching others, you have to prepare for the next day lectures, plus to work with the totally destroyed buildings”. As each prospective member of staff has to be thoroughly educated for about a year and then continually supervised, initial expansion took time. In order to be able to offer services to as many as possible, Vardan sought to teach in a manner that would enable his students to educate other rehabilitation therapists. “Now it is easy for me to train for the students, because my staff is trained to be educators. I am just checking their work, sometimes I’m involved, but I am just managing how they are doing.”
Vardan is constantly looking for funding as well as ways of saving money. In fact Vardan and his co-workers construct much of the necessary equipment for the Centre, as a means of keeping costs down. Though the Centre receives extensive support from HART, funds are still insufficient to meet the high demand for its services. Thus, Vardan and his staff constantly have to make difficult decisions about priorities, not only about what equipment to obtain but also about triaging patients to ensure that those in the most urgent condition are assisted first. Waiting times may exceed 6 months as demand is so high.
Yet, in spite of the pressure and difficulties facing Vardan, he keeps the idea of expansion alive. He continues to provide excellent training for students, planning for the establishment of regional centres and to spread a concept of rehabilitation that did not exist under the Soviet rule. When asked about where he gets his exceptional drive and motivation, he reveals his motto: “If not you – who else will do this?”
A Comprehensive Approach
Vardan believes in an all-inclusive approach to rehabilitation. All kinds of patients are welcome to the Centre, no matter their age or background. Many patients have war-injuries, but causes vary. The great majority of patients attend for treatment of physical disabilities (90%), but mental health is also a priority at the Centre. With its staff of 12 physiotherapists, four nurses, two speech therapists, three psychologists, one social worker and one doctor, the Centre assists more than 800 people every year. Eight new student nurses are in training at the Centre and will work at regional hospitals when fully trained. This is expected to lower the waiting time at the Rehabilitation Centre and increase access to rehabilitation services across Nagorno-Karabakh.
Part of the Centre’s success in treating such a diverse range of patients lies in its tailored approach to therapy, and the variety of treatments it has to offer. Patients have access to traditional techniques such as physical therapy, occupational therapy, hydrotherapy, speech therapy and counselling. There are also opportunities for creativity and community through sport, pottery, painting, music and outings. These activities facilitate later reintegration of individuals into their communities and provides a sense of unity and team spirit in the challenges that the patients have gone through and continue to face. The Day Care Centre for young children is open to those with and without disabilities, in order to help early integration, influence a positive attitude towards difference and prevent discrimination from a young age.
Vardan does not see his responsibilities as ending with his patients. He also makes time to visit, support and consult their families. He believes that working with the families is essential to overcome prejudice and segregation, and to remove the sense of shame that relatives of disabled often have in this region. “We will change the view of the community to the people with disabilities, they will be recognised and the families won’t feel shame that they have a person with disabilities in their family”. Families are also trained in how to care for their relatives so that they can live full and happy lives at home.
Vardan aims for increased access to rehabilitation services through expansion and regional deployment of trained therapists. He hopes for general stability and peace in the region, so that everyone can access care no matter their nationality or religion.
As for the Lady Cox Rehabilitation Centre itself, Vardan wishes for modernisation of equipment and structure. The creation of departments for different age-groups and specialisms of staff, would be a great improvement.
Most of all, Vardan looks forward to a time where disability stirs no feelings of shame in individuals or their families. He hopes for a fully equal and integrated society, where treatment and management of disability is simply one of many services assisting people to live full and equally valuable lives.
Disclaimer: This blog is a space for discussion and personal reflection. Any opinions expressed within the blog are those of the author and are not necessarily held by HART. Individual authors are responsible for the accuracy of statements made within the blog.