When Lilit Garibyan left her native Armenia in 1991, the Eurasian nation was at war with neighboring Azerbaijan, and Garibyan was a 12-year-old who knew she would go back someday, but, she later decided, not before she had something to offer.
Garibyan returned in 2013, bringing medical expertise and high-tech lasers to the capital, Yerevan. On that first trip, she and the two doctors who accompanied her worked long days treating disfiguring skin conditions, including scarring, the bright-red vascular tumor called hemangioma, and the capillary malformation that results in the discoloration known as port-wine stain.
Garibyan, a Massachusetts General Hospital (MGH) dermatologist and assistant professor of dermatology at Harvard Medical School, has since visited annually and worked with U.S. and Armenian partners to secure donated lasers, train local physicians to run them, and establish a nonprofit, Face of Angel, to foster the work.
“It was emotional to go back after being away for 22 years, to see the country you came from. I saw my relatives,” Garibyan said. “I hadn’t gone back because I wanted to go back when I could give something back. I didn’t just want to go say, ‘Hi, I’m Lilit. Nice to see you again.’”
Garibyan, a physician-scientist at MGH’s Wellman Center for Photomedicine, said that the targeted conditions can have serious complications, including blindness when they occur near the eye, cognitive issues if in the brain, or bleeding and functional difficulties in affected body parts, particularly the hand and foot. But, she added, the most common — and often most debilitating — effects are often psychological.
“The psychological impact is huge,” Garibyan said. “Kids don’t want to go outside. They don’t want to interact with others as they feel embarrassed. They’re ostracized because they appear different from others.”
In the U.S., port-wine stains are typically treated with lasers when patients are young, as are hemangiomas when they fail to fade over time, as often occurs. The precision laser treatment, given over the course of several months, can effectively erase them, Garibyan said. In developing and middle-income nations, however, both the sophisticated lasers used to seal off leaky, malformed blood vessels and knowledge of how to run them are scarce. Those barriers to treatment are what Garibyan and a team from the Wellman Center, including the center’s director, Professor of Dermatology R. Rox Anderson — who ran a similar program in Vietnam — seek to clear.
Statistics aren’t available about how widespread the conditions are in Armenia, in part because, without effective treatment, individuals tend to keep to themselves or hide affected skin under clothing, according to Khachanush Hakobyan, executive director of the Armenian American Wellness Center, one of two centers collaborating with the American doctors. Seven years into the program, demand for treatment shows no signs of lessening. The Armenian American Wellness Center — which charges nothing to treat children — is actively reaching out, advertising on Facebook, and appearing on local television programs, and the patients keep coming.
Hovik Stepanyan, an Armenian physician whom the MGH team trained to use the lasers, said the center sees about 20 new patients a month, and the yearly totals have increased to about 220 today and are still rising.
Stepanyan, who has become a local expert in the laser treatment and is consulted widely in the region, said that what has been helpful to him has been not only the initial training, but also the ongoing collaboration, which allows him to send images and consult with the MGH physicians on tricky cases. He’s also traveled to Boston several times for the Harvard continuing medical education laser conferences.
