Building a Foundation in Destructive Times

In 2021, collaborators form FSPH, the American University of Armenia, and the Ministries of Health in Armenia and Artsakh used the above billboard to promote COVID-19 vaccines. Translated to English: Millions of individuals have been vaccinated against COVID-19 around the world. Be safe, get vaccinated. The world's leading scientists have combined their efforts to create safe and effective vaccines.

In March 2020, Dorian and FSPH faculty colleagues Dr. Michael Prelip (MPH ’85) and Dr. Shira Shafir (PhD ’06) began providing technical assistance to the ministries of health in Armenia and Artsakh aiming to limit the spread of COVID-19, including working with the American University of Armenia to establish the National Case Investigation and Contact Tracing Program for Armenia. Those efforts were severely hampered by the eruption of a full-scale war in September 2020 in Artsakh — during which Azerbaijan used sophisticated weaponry and subsequently imposed a blockade of the only road in and out of Artsakh, beginning in December 2022 and continuing well into 2023. In April, with the blockade well into its fifth month, Dorian was preparing to meet, virtually, with the leadership of Artsakh’s Ministry of Health to discuss data her team had collected as part of the first and largest demographic and health survey conducted in Artsakh since the 2020 war. “It’s hard to plan when you don’t know what the political reality of the region will be in the near future,” Dorian says. “But I have no choice but to be hopeful. In my work I have been surrounded by mothers who have lost their children, and they say, ‘They died so we can live here — in this place — where we have lived for centuries....’ If they’re not going to give up, no one else can.”

The program Dorian helped establish in Armenia in response to COVID-19 included trainings and workforce development in contact tracing and case investigation, not unlike work led in California by Dorian, Prelip, and colleagues at UCLA Extension, UC San Francisco, and the California Department of Public Health through the Virtual Training Academy. In addition to creating a cadre of trained public health professionals, the effort involved building an emergency call center for the National Center for Disease Control. Dorian’s group also helped to develop messaging on the importance of wearing masks and vaccinations.

When Artsakh was attacked by Azerbaijan a few months later, the effort became “less about COVID-19 and more about getting critical things done under extreme conditions,” Dorian says. Initially, COVID testing was administered in bunkers, often devoid of electricity. Ultimately, the vast majority of the Artsakh population fled into Armenia. Hospital beds were overrun not just by COVID cases but by victims of trauma from the war. In response, UCLA’s Operation Armenia — under the leadership of Dorian, Dr. Eric Esrailian (MPH ’05), and Dr. Shant Shekherdimian (MPH ’09), two additional UCLA faculty leaders who have long assisted in the region — mobilized an effort to provide medical disaster relief and supplies, and to start a home healthcare program to free up hospital bed space.

The attack was one of many developments that posed substantial challenges to COVID-19 public health messaging efforts. “During a time of war and loss, masking and social distancing were not the priorities,” Dorian says. “People were out in the streets in large groups protesting — trying to garner international attention for the war. Meanwhile, funerals and church services were happening all over the country in massive waves. There was a lot of grieving, hugging, and consoling. And with underlying generational trauma, as survivors of genocide, there was more worry around the war and ethnic cleansing — and community — than COVID-19.”

Since then, the Dorian-led work has expanded to encompass a multitude of programs aimed at advancing public health in the republics of Armenia and Artsakh. The Artsakh Public Health Academy, a virtual platform that includes courses taught by UCLA Fielding and American University of Armenia faculty, aims to strengthen the public health workforce and build a more resilient system. In collaboration with the World Health Organization, Dorian continues to design and implement programming to improve Armenia’s disaster response infrastructure, policies, protocols, and training. Among the other initiatives under development are a workforce and pathways program to proactively identify, place, and train individuals in both ministries of health.

In recent years, much of Dorian’s work in Armenia and Artsakh has been supported by Esrailian, chief of UCLA’s Vatche and Tamar Manoukian Division of Digestive Diseases as well as a major philanthropist whose Promise Armenian Institute was established at UCLA in 2019. “Eric has been critical in mobilizing resources, funds, and people at UCLA, for which I’m extremely grateful,” Dorian says.

“I am honored to help Dr. Dorian, her incredible colleagues at the school, and the entire UCLA community with this important work,” Esrailian says. “Armenia and Artsakh now have a stronger connection to a global public health network — with prolific expertise — thanks to this connection to UCLA.”

For all of the hurdles to progress in Armenia and Artsakh, Dorian remains unrelenting in her commitment. “Anyone who has been there knows this is a magical place with tenacious and bold people,” she says. “These are horrendous times, but I’m going to use all of my energy to continue to move programming forward — and honestly, I get a lot more out of this work than I give. I am inspired every day and I know how blessed and privileged I am to be able to do this work alongside such dedicated, positive, and strong people.”