In a year of unprecedented challenges due to the COVID-19 pandemic, which has largely dominated world news, another tragedy is creating stress and sorrow for fourth-year DMU osteopathic medical student Nelli Ghazaryan, M.P.H.: war between her homeland, Armenia, and Azerbaijan in Eurasia. Fighting that again flared in late September over the disputed mountain territory Artsakh, also called Nagorno-Karabakh, is a continuation of decades of strife over both territory and history, with roots going back more than a century.
“This is happening in light of a global pandemic that has brought Armenia to its knees,” Nelli says. “The region in question is occupied by Armenians, and the land was ancestrally Armenian. Though few sources report this, the war did not just break out. This was an attack on the Armenian people peacefully living in the region of Nagorno-Karabakh (Republic of Artsakh) and was a repeat of an offensive strike that had happened in 2016 in a very similar fashion. We lost 120 people then, including civilians.”
She and her immediate family emigrated from Armenia, a nation of approximately three million people, to the United States when she was 10 years old. She has many extended family members who still live there. “This event has turned our world upside down. Many of us have family who have volunteered to fight and are currently at the border.”
While both countries, which used to be part of the former Union of Soviet Socialist Republics (USSR), are accusing the other of being the aggressor in the battle, regardless the situation is heart-rending. As of Oct. 23, more than 800 Armenians, including dozens of civilians, and an unknown number of Azerbaijanis have died. (Azerbaijan does not disclose its military death toll.) A cease-fire brokered over the weekend of Oct. 10 has failed to hold. In addition, many fear the situation, which has drawn in Russia and Turkey, will escalate into an even wider regional conflict.
For Nelli, the conflict is personal.
“I want people who have never heard of Armenia to know how rich its history is. Armenians are one of the oldest peoples in the world,” she says. “The historical homeland of the Armenians sits north of the Fertile Crescent, a region of substantial importance to modern human evolution.”
Archaeologists discovered the world’s oldest known leather shoe and oldest known winery in what is now Armenia. It was the world’s first nation to accept Christianity as its official religion, in 301 A.D. Tragically, it also experienced what many historians consider the first modern genocide, when the Ottoman government carried out the systematic murder and expulsion of an estimated 1.5 million Armenians between 1914 and 1923. That triggered a major diaspora of Armenians who fled to other countries.
“The genocide carried out by the Ottoman Turks and the wounds that it has left are woven into the Armenian psyche,” Nelli says. “The effects range from the social and political to actual measured epigenetic change seen across generations of survivors’ progeny.”
She has returned to her homeland many times to visit family. She also spent one summer shadowing staff and studying the intervention program at the country’s only domestic violence shelter, the Women’s Support Center, through a grant from the University of Southern California, while she was earning her master of public health degree at George Washington University. Her M.P.H. thesis was based on her exploration of how health care infrastructures in post-Soviet countries – namely, Belarus, Armenia and Georgia – developed as they broke away from the USSR.
While the pandemic is on the forefront of the news (and our minds), Nelli wants people to be aware of the war, its causes and its dangerous implications.
“The first reason people, especially those going into health care, should care about this is because this is a much bigger issue than a fight over who has legitimate claim over a small mountainous region. This is a human rights issue, an issue of continued aggression from a larger, wealthier and better-connected dictatorial country over a smaller democratic republic,” she says.
Nelli admits that “endlessly watching” and rallying against the unfolding devastation in Armenia have been a lot to bear. She has been among the tens of thousands of people in Los Angeles who have protested the violence. Southern California is home of one of the largest Armenian diasporas.
“This year has been terrible on a lot of levels, but this is a different horror. The thing that hurts most, quite honestly, is how quiet the world has been,” she says.
Yet her homeland and its history give her a deep commitment to human rights and equality that has been evident throughout her time at DMU. As the wellness representative for the Student Government Association (SGA), she played a key role in founding the DMU Wellness Taskforce comprised of students, staff and faculty. She created Mindful Music Mondays, a series centered on sharing music as a form of therapy in clinical settings, as a tool for self-healing and as a way to foster community unity. She and Daniel Masin, a classmate and fellow SGA leader, worked with the Refugee Association of Central Iowa on a plan – yet to come to fruition – to establish a recurring DMU mobile clinic for refugees in central Iowa. She also mentored undergraduate participants in the University’s Health PASS program, which exposes students from populations under-represented in the health care profession to careers in medicine and science. And she gave the keynote speech one year to grade-school girls in DMU’s annual Girls Exploring Medicine and Science (GEMS) program.
Now, from her home in Los Angeles, Nelli is doing a virtual rotation focused on equitable health care with the Johns Hopkins School of Medicine. Topics of the rotation have included understanding and addressing racial disparities in health care, treating vulnerable populations such as incarcerated women and refugees, and providing trauma-informed care.
“Having just completed a community medicine rotation at a homeless shelter, the Midnight Mission on Skid Row in downtown LA, this has been the perfect shift to help me challenge myself and my own perceptions, biases and understanding of the multilayered health care system that we all have to one day work in,” she says. “This current rotation has given me both a sense of confidence that can have a career that makes positive change within that system, but it has also given me actual skills on how to do it effectively as a soon-to-be resident.
“A lot of my career goals have to do with working toward health equity for vulnerable populations, especially immigrant peoples and women,” she adds. “Hearing some more of my story and the history of where I come from, I hope it is easy to see why I feel called to that mission.”