Spring 1994 (2.1)
Hospitals in Baku
Empty Shelves, Barren Closets, Compassionate Doctors
- by Margaret D. Fox
Unocal's Medical Administrator
For the last several years, I've been working internationally as a Medical Advisor for Unocal. So when I was assigned to Azerbaijan, I barely hesitated; in fact, I was rather eager to go to this country that the Western world knows so little about.
When I arrived in Baku several months ago, one of my first tasks was to check out the local medical amenities and identify suitable local facilities, clinics and hospitals for our personnel to use should such a need arise. Now, I've seen many hospitals in my travels throughout the world, many of which were in Third World countries. However, nothing in the whole world prepared me for the situation that exists in Azerbaijan. In my entire experience, I have never seen such shortages of medical supplies and equipment in so many hospitals as I have in this country.
The dissolution of the Soviet Union's interrelated infrastructure, which is now compounded by the war, has left, virtually, all the Azerbaijan medical closets barren. There is a severe shortage of all supplies, equipment, and pharmaceuticals. One doctor confided to me, "How do you go about deciding which medical supplies are more essential than others when everything is vital for the successful operation of a hospital?" Prices of every item relating to medicine have escalated at an unprecedented rate, making it almost impossible for hospitals to buy anything.
Left: Though Baku families tend to have only one or two children, the national average is four. One in ten refugees is a child under the age of five.
Refugee mother from Agdam (Summer 1993).
Photo: Oleg Litvin.
Not a single one of the medical establishments I visited had more than a few dozen disposable syringes and needles. Many had none. They have to wash and sterilize glass syringes in boiling water, and clean, sharpen and sterilize the needles. Even though disposable syringes and needles are relatively cheap, they are impossible to buy in sufficient quantity.
In one of the maternity hospitals, I was told that women in labor have to provide their own pain killers, as none are available in the hospital. Despite the trend for natural childbirth in the West, I think most of us would be horrified to know there would be no analgesia available were it needed. One can only speculate of the pain and suffering endured by women who have difficult labors and who could neither afford, nor find, suitable pain killers prior to their admission to the hospital.
I noticed that there is a great lack of even the most basic equipment in the hospitals. I saw surgeons operating without gloves, and, in some cases, even without anesthetics. Equipment , which we normally take for granted, such as X-ray machines, scanners, and electric support equipment are in very short supply. There are very few diagnostic machines and breakdowns are frequent. Many are caused by power cuts and surges. Almost all of the equipment is imported, and, therefore, it is virtually impossible to find anyone who can provide service, much less, provide spare parts. Even items such as electrical bulbs and other minor spare parts that we would regard as inconsequential, are almost impossible to obtain.
Consumable items for x-ray ma-chines-developing fluid, for example, and reagents for the pathological diagnostic tests-are unbelievably difficult to find. Hence, there is (to us, anyway) an unacceptable delay in arriving at a diagnosis. This is not due to the ineptitude of the medical staff, but rather the contrary. The fact that they are able to reach any diagnosis at all is an incredible tribute to the medical staff under such circumstances.
The doctors and other health care staff are as frustrated as anyone by their total inability to purchase what is needed for the welfare of their patients. Even if the money were available, it is dubious that the supplies would be. As is true in city pharmacies in many countries, both prescription and non-prescription drugs are available for purchase, but only in extremely limited quantities. Even when a doctor writes a prescription or recommends a treatment, it may not be available. The patient then has to inquire of all pharmacies, return to the doctor for a revision of the prescription, or settle for the nearest prescribed treatment that is available.
When I visited one of the children's hospitals, I again witnessed extreme shortages of medical equipment and the total unavailability of medical equipment. Despite these shortages, surgeons carried out fairly complex operations to correct deformities of the spine and long bones. Without such surgery, the children could not hope to live normal lives. The hospital was extremely Spartan and there was certainly no money for books, toys or tuition for the children during their stay. However, the nursing staff appeared to be extremely caring, and did their best for the children despite these very difficult circumstances.
In spite of the pain and discomfort following major surgery, the summer heat and total lack of any distractions, the children, for the most part, weren't complaining. Visitors are allowed into the hospital for most of the day as is the current trend. Many of the children had relatives around their beds, helping with meals or trying to amuse and distract them from their discomfort.
In many places in the world, attempts to run a hospital under such conditions would have long since been abandoned. But in Azerbaijan, patients are still admitted to the hospitals. Since there is a shortage of bed linens, relatives simply bring them along. Here in Baku, this is almost business as usual. Despite the difficulty in obtaining sutures and dressings, operations are still performed.
Babies are still delivered and illnesses are still treated. I've been in hospitals where it's almost impossible to see where one is going in the corridors because there are no light bulbs.
One can only admire the resourcefulness of the Azerbaijani hospital staffs who cope with the shortages and constraints. Doctors work for a salary of approximately $15 a month, and nurses earn much less. Despite this, the work goes on.
Left: Despite shortages, surgeons still carry out complex operations to correct deformities on bones.
Humanitarian aid has been donated from several sources over the last twelve months. However, this is only a comparative drop in the ocean when one considers what is actually needed. The other problem with humanitarian aid, of course, is that hospitals receive only what is sent. Supplies, welcome though they may be, are not necessarily what is most needed. Nor can one ever be sure how long it will be until the next shipment arrives. When one is dependent on goodwill, patience is required, so some of the aid is reserved "for when it is really needed." Since all of these supplies have expiration dates, out-of-date supplies are often used out of sheer desperation.
During my visits to these medical establishments, I have always been made to feel welcome. The medical staff were eager to share their concerns and problems with me, together with the solutions they had found. As "necessity truly is the mother of invention," innovative answers had been found to problems which I would have considered insurmountable. Several of the doctors with whom I spoke had attended international conferences to present very original research.
While ideas of medicine here differ vastly from what we, in the Western world, are used to, new ways to improve techniques and standards of care are being sought vigorously. There is a thirst for knowledge and for an exchange of information with Western countries, something which has previously been impossible. Western medical textbooks and journals are eagerly sought so that the medical professionals in Azerbaijan can find out what developments are taking place in the rest of the world.
No one can expect the people in Azerbaijan to be content with these drastic shortages. But they are coping with fortitude, resourcefulness, and realism. Many of them speak with hope for the future when the situation in Azerbaijan will have stabilized, both politically and economically. At that time they believe there will be money available for equipment and research. One can only speculate what Westerners would do if faced with similar circumstances in their own countries. Hopefully, we shall never know.
From Azerbaijan International (2.1) Spring 1994.
© Azerbaijan International 1994. All rights reserved.