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From War Zone to Classroom: Vicky Herkelian Joins CHS

After nearly two decades of experience in the medical field — including humanitarian field work in a variety of combat contexts — Vicky Herkelian joined the American University of Armenia (AUA) faculty this summer as a lecturer in the Turpanjian College of Health Sciences (CHS). She brings her rich and diverse knowledge to the College’s new B.S. in Nursing program, in an effort to advance nursing as a profession in Armenia. Read on to learn about her fascinating humanitarian work abroad, her passion for nursing, and more! 

Tell us about your background.

I was born in Lebanon and studied at the American University of Beirut (AUB), graduating with a B.S. in nursing. I worked at the AUB Medical Center for 4 years, after which I moved to the Clemenceau Medical Center nearby. I then moved to Dublin, where I worked at the private Blackrock Clinic while simultaneously studying for my master’s in humanitarian action. I stayed there on and off for a total of 13 years, but every 3-4 years, I would leave for volunteer work. The first time, I went to Mongolia for 8-9 months, where I worked with and trained the nurses in the government hospital in Nalaikh, a mining town. I also did some research on all levels, working with educators, the licensing body of the Ministry of Health, and nursing students. At the time, the conditions there were quite similar to the situation in Armenia, similarly a post-USSR country, and nursing was not a profession as we knew it in Ireland or Lebanon. They had just started a B.S. program there. 

I also did another short volunteer stint in South Sudan with Medecins Sans Frontieres (Doctors Without Borders). It was quite challenging to work in the field: there were two of us responsible for a clinic near the war zone. We also planned and executed a measles vaccination campaign that targeted 10,000 children. Subsequently, I worked 3 months at the King Faisal Hospital in Riyadh. Then, I went to the north of Lebanon with the International Committee of the Red Cross to treat wounded Syrian volunteers who were injured in the Syrian War. It was quite challenging, because we were coordinating our work with different NGOs, assessing the existing needs, including social and psychological. After that, I went back to Ireland and worked in Dublin for a while. I spent the past three years at the Kingdom of Saudi Arabia Ministry of Health in the National Guard Health Affairs in Jeddah. While training nurses of different levels, I also worked as a senior nurse and counseled on the hospitals’ guidelines and policies.

I always wanted to settle in Armenia, but was unsure what job opportunities I would find here. The launch of AUA’s B.S. in Nursing program attracted me because I knew that the nurses in Armenia are not in good standing: they’re not recognized as professionals and, overall, there’s a lack of knowledge, awareness, and standards-based practices. Most of the large international hospitals in the world follow the U.S. model, because it embraces research and sets forth most of the current policies and accreditation requirements in the medical profession. The nurses here lag behind mostly because of the language barrier, they can’t benefit from those policies and procedures or establish contact with foreign institutions. They also lack the commensurate education, since they’re mostly practical nurses; so we must raise their level to a BSN, for them to become degreed nurses. We’re focusing on theory here while showing them the best practical ways to meet all the international standards. I’m happy to be a part of that transformational process at this stage. 

How long have you been in Armenia?

I applied for this position in January 2023, and I officially started in July.

What were some of the challenges you faced in your humanitarian work?

Different places posed different challenges. In South Sudan, it was mostly related to safety. We had over 20 international staff in the Lankien area in South Sudan, where the MSF project is based. We worked in a pretty big field hospital, which had been operating under tents for 10-20 years. As an outreach travel nurse, I was assigned to a smaller area, called Yuai, just a 2-hours’ walk from the frontline. We tried three times to get there by small MSF planes, but couldn’t stay long: we would just work on the ground for 1-2 hours and leave, considering the proximity of the frontline. Only on one occasion it was a bit safer, so a Kenyan colleague and I stayed there for a week to plan and execute the administration of the measles vaccine to children: due to malnutrition and other factors, youth were getting infected by measles and dying very quickly from complications. 

Additionally, we were performing many, many operations: in one day, we were called to tend for 100 wounded soldiers. We were not allowed to choose the types of patients; the generals there were opting to send us patients that were treatable so they could use them again on the battlefield, whereas the more seriously wounded ones — with chest wounds and brain injuries — were left to die. Another challenge was the lack of equipment. We had a so-called ICU unit where children and adults were admitted, but we only had one small oxygen machine. We managed to find a way to connect the tubes to share the same oxygen machine between patients. It was a makeshift hospital, and we were trying to improvise the treatments. We received some medications sometimes: every ten days, a plane would land full of supplies from Kenya. We would give patients ketamine during operations because we couldn’t sedate them properly. We didn’t have a ventilator or any possibility of intubating the patients.

I heard that 20-30 years ago, the hospitals here in Armenia were operating on a very basic level, lacking necessary equipment and supplies. Some of my students tell me that they improvised a lot in those years. It made them more aware of the processes involved and developed their critical and creative thinking.

In Lebanon, it was better. We were not in the safest area, but we were working in hospitals, so the setting was better: we had a proper operating room and were able to keep the ward clean because it was located in a building. The challenges were the patients themselves, because they were young professionals from various fields: lawyer, professor of philosophy, and so on. There, the challenge was more psychological. The wounds were getting infected because they were not getting treated on time, since they would travel from Syria to Lebanon on a donkey. They had multiple fractures, something I have never seen before: the X-rays looked like a puzzle. We couldn’t manage to save their limbs, legs and arms, so sometimes we had to amputate them. Amputation was a big issue, because they were young and wouldn’t accept it at first. It took them a long time to come around to the idea. They didn’t have family members around, so we were their families in a way. We also had a post-surgery rehab center. I was part of the operating and recovery room staff and worked there according to high international standards. That was possible because we had the equipment, cleaning supplies, and medications we needed. 

In Mongolia, the greatest challenge was the system in which the nurses were operating. They were not given enough knowledge, and the hospital setting was very basic, lacking much vital equipment — from monitors to ventilators. The nurses were subordinate to doctors: they were only meant to do what they were told. The nurses’ self esteem was low, and they were not paid well. The policies of the Ministry of Health were vague and did not offer proper guidance for safe practice. The nurses lacked motivation, as they didn’t see a way to improve their situation. NGOs were the main entity supporting them.

Why Armenia?

It was my childhood dream. Due to financial circumstances, it took me a longer time to come, but I always wanted to live in my motherland. It was a dream that came true last year.

What is your role now in CHS?

I’m a lecturer here. My course has already started, so I’m teaching every day. First, we have the 3-week transition course, in which we provide the nurses with basic information on anatomy, physiology, and essential concepts in contemporary nursing practice so they will be able to understand the types of diseases, the pathophysiology, and the medical/surgical needs of patients. We call it a Bridge One course. This also gives us the opportunity to get to know the students, where they’re coming from, their experiences and existing knowledge. We start again in the fall semester, when I’ll be teaching other subjects.

How did you choose to go into nursing?

I was a bit unsure about what to do when I graduated from high school. I was pretty good at math and physics, and I wasn’t much of a people-person. I was a bit of an introvert: I wanted to spend time in front of a paper solving problems. Then, I was offered a full scholarship to go to AUB and study nursing. Somehow, everything else faded away, and I chose that route. I don’t regret it. It developed my people skills, and the ability to grow deep connections with patients, colleagues, and superiors as I do now and thoroughly enjoy.

How was your transition from clinical work to teaching? 

I’ve always taught: I’ve given lectures for the Red Cross and pro bono to various organizations. Since 2002, I’ve been teaching nurses hands-on in hospitals, so I’ve been involved in instruction for a long time. Now, instead of teaching 1-2 nurses at a time, I’m teaching 10 or 20. I like it. It’s the same concept, just in a more structured way. I cover more general topics, instead of focusing on a specific ward or addressing the needs of a certain nursing or medical unit. We’re starting from the beginning with general concepts.

What are some of the challenges when it comes to teaching?

I enjoy the classes very much. The earlier challenges were related to preparing for the classes. My colleagues had informed me about the level of nursing knowledge and practice, the problems the students were having, and the level of their understanding. I also had to figure out how to overcome the language barrier to teach them medical terminology in English. My classes are quite interactive, so the students participate a lot. When we read a sentence, I make sure they understand the real meaning behind it. If it contains certain difficult words, we keep repeating it, and sometimes I explain it in Armenian. I imagine what it would be like if someone were to explain it to me in Russian — what would I do to try to understand it? How would the instructor explain it differently so I would understand? While preparing for each course, I’ve tried to imagine myself studying basic anatomy/physiology and tailor it to a population on a certain level or with a defined purpose. 

What is your favorite part of teaching and experiences with nursing?

The more I work with people, with vulnerable populations, the more I try to understand humans. At the end of the day, the needs of human beings are more or less the same wherever they are, in whichever situations they may be around the world. Physical needs might vary, but when you hear patients’ stories, you realize that their psychological needs are similar. We’re all craving the same things: love, affection, belonging. It’s more about building this deep connection with people and understanding them and their needs as human beings. When somebody shares their story with me, I feel happy knowing that we’re making a difference, seeing the results: whether I taught somebody and they were able to work in a more conscious, knowledgeable way, or I listened to somebody’s story and they felt heard, or I treated somebody and tended to their wounds, so they trusted me. These are the stories that get repeated wherever I go, in whatever context I work. I’ve worked with a really privileged society in Ireland, where I was in a private clinic, as well as in South Sudan — the people are different, the lifestyles are different, but the basic, psychological needs tend to be the same everywhere. This is how you find a connection with human beings, wherever they are in the world, in whichever situations. Even nurses have similar needs. You give attention to a new junior nurse, you give them the opportunity to understand things, and they will give the same level of attention to their patients. But if they’re lacking this attention and always craving it, they will not be able to attend to the patients properly.

What motivates you in your work?

When I see the enthusiasm and effort of students to understand what they’re being taught and the appreciation they have, it motivates me to work harder. It’s the same with patients. The more they see results, the more they appreciate me, the more enthusiastic I am. Whenever I tell someone, “Don’t do this, it’s not good for your health; do something else,” and then you see the positive outcome — like in the ICU, when you see someone waking up on their own and feeling better after a long struggle — there’s nothing more rewarding. When you see somebody dressed in a suit, whereas two months ago he was being intubated in an ICU and has now come back to thank you, there’s nothing like it. There aren’t words to explain that.

How do your experiences in the humanitarian aid context help you at AUA?

The closest connection I was able to make with the Armenian nursing level was my experience with the Mongolians. Because I worked in a hospital there for eight months, I was very close to the nurses, and with the help of educators and doctors, I was able to understand the whole system, how it works, the problems and issues, etc. Whenever we discuss nursing in Armenia, the standards of practice, and nurses’ level of knowledge, I’m able to relate everything to my own experience: the problems that nurses have with low pay, the lack of support, working long hours — working 24 hours in a single shift is quite crazy. Because I’ve lived and worked with Mongolian nurses, I’ve done some night shifts to understand what goes on during that time — how they attend to patients when they have a larger load and struggle to meet all their needs — from both the patients’ as well as the nurses’ standpoints. Whenever I speak to the nurses here, I see the same issues coming up again and again.

How do you see the development of nursing in Armenia in the next 5-10 years?

I have high hopes. From observing our students, I can see that they’re quite discontent when it comes to the current nursing practice. At the same time, they have lots of enthusiasm for change, so the nurses I’m seeing here are those who have worked on their language level and various skills to be able to see changes forthcoming. I’m hoping that by facilitating learning — by introducing international nursing practices, for example — enabling them to read recently published research papers and nursing books and building an understanding of what’s going on, they will be able to institute changes in their workplaces and elevate the nursing standards here in Armenia, thereby turning nursing into a profession. This is the most important thing. We are not assistants to doctors; we are professionals of our own. We are always trying to emphasize that, but in order to achieve that, you need enough experience and knowledge and must follow the universal standards.

Founded in 1991, the American University of Armenia (AUA) is a private, independent university located in Yerevan, Armenia, affiliated with the University of California, and accredited by the WASC Senior College and University Commission in the United States. AUA provides local and international students with Western-style education through top-quality undergraduate and graduate degree and certificate programs, promotes research and innovation, encourages civic engagement and community service, and fosters democratic values. 

 

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