Nagorno Karabagh,
Family Health Care / Mobile Outreach Services

One of the greatest difficulties faced by the rural population in Karabagh, next to poverty, is their relative isolation created by poor road conditions and lack of transport. This leaves people largely reliant on local village health services which fell into serious disrepair after 1991 and suffer from lack of drugs and equipment, together with medical staff who are largely under qualified for the caseload they need to handle.

Parallel to its region wide assistance programme in maternal and newborn health care (see 4 year of project implementation in Karabagh) Family Care recognised a critical need to improve access for the poor to better quality care. It was possible to upgrade clinics but that didn't solve the problem of having to maintain the system which was run by staff, many of whom were in sight of retirement and couldn't absorb the intensity of training that was required to upgrade practice, even if they could attend distance training which was not feasible for many.

The reality of this situation was escalating self treatment, critical delays in seeking medical assistance resulting in acute emergencies and fatality, a rising numbers of women delivering in villages with complications and an absence of adequate preventative care and prompt referral. This naturally led to spiraling costs at under budgeted referral hospitals as these complicated cases required longer stays and greater intervention. The cost back lashed on the patients, many of whom had to borrow money to cover this.

Since March 1992, Family Care has supported the running of mobile outreach clinics, which continue to take medical teams out from the regional hospitals to village clinics on fixed monthly visits. The cases which cannot be managed by the primary level staff are referred to the team who provide them with consultation, treatment or referral. Each case is managed with the local personnel so that training can be given as apart of the visit. Family Care staff also join the team and cover general training on first aid, hygiene and cleanliness. Family Care health professionals may be asked to give a second opinion but are principally there to train and to oversee clinical practices. The team carry basic equipment and drugs. The patients are charged a nominal consulting fee but this remains in the hands of a community health committee who use it for health related needs, often giving it towards petrol for the transport of emergency cases.

A large amount of attention is given to the follow up of referred patients, especially the poorest who may default due to poverty. Family Care supports the transfer of some patients as far afield as Yerevan in Armenia who need special diagnostic or treatment. This can be considered 'emergency assistance', but alongside it runs a more gradual development process to help Karabagh upgrade skills and facilities and strengthen the health network and information systems. Family Care is also heavily involved in community education which allows people to make informed choices about their own health care.

The teams see about 600 patients a month on their visits and it has brought to the fore the many, many unmet cases who cannot afford health care from children with severe cardiac disease and disability to those with untreated eye conditions and psychiatric illness. Family Care is working with the American Armenian Health Alliance of Greater Washington to provide the type of vehicles which could allow this service to be managed locally.

Needs:
The main programme is funded by the United States Agency for International Development.

However Family Care has welcomed financial donations which have been used directly to fund transport or specialist health care for families who could not otherwise afford it.

Family Care would also be pleased to hear from any primary level health professional (GP, practice nurse, midwife, school nurse, opthalmologist, dentist etc.) who would be interested to give a few weeks to the project. These people need your support and your interest because they are fighting against incredible odds to cope with illness and health staff work long hours to try to meet some of the many needs.