A tale of two Septembers

The recent conflict in Nagorno-Karabakh is already a twice forgotten war. Forced to flee twice, Anush Petrosyan describes the experience.

Anush Petrosyan

Anush Petrosyan is a writer now based in Armenia. She is originally from Nagorno-Karabakh.

A sunset dramatically silhouette's a ruined tower and people at its base.

A September 2023 sunset over Stepanakert.

The ethnic cleansing of 100,000 Christian Armenians from Nagorno-Karabakh has left Armenians around the world questioning the world order that allows dictators to have their way without impunity.

Following Azerbaijan’s brutal war of September 2020, the people of Karabakh were subjected to a complete blockade of their region – an exclave of Armenia in Azerbaijan. In the small stretch of land where Armenians had fought for independence following the collapse of the Soviet Union, civilians were being kidnapped, the elderly were dying for lack of basic healthcare, and schools were closing due to no heating gas. To the outside world, Azerbaijan’s President Ilham Aliyev was speaking of peace and integration. Inside the region, experts were warning of genocide by starvation.

In September 2023, Azerbaijan at last got what it wanted - the territory of Karabakh without Armenians. After an attack that left hundreds of people dead, Azerbaijani forces moved into the region as people began to flee to Armenia, forever leaving their homes and homeland.

This is the story of Anush Petrosyan. A native of Shushi, Karabakh, which Azerbaijan took control of in 2020. Since then, Anush had been living in the Armenian-controlled Karabakh capital of Stepanakert, which she was forced to evacuate during the ethnic cleansing.

In September 2020, I left my birthplace in Shushi, Artsakh (Nagorno Karabakh) with a strong conviction that I would be back soon.

In September 2023, I left Stepanakert, my new hometown, with only the hope of staying alive.

In September 2020, I had a father. He drove us to Yerevan in our own car.

In September 2023, I no longer had a father… A kind person from Martakert, Artsakh, who I had not met before, agreed to evacuate my mother and me to Yerevan in his car.

In September 2020, I left Shushi when there were still some people in the city.

In September 2023, I was among the last to leave Stepanakert. The hotel where we had been living as refugees from Shushi for the last three years was empty. I had never seen the streets of Stepanakert look so desperate. There were stray dogs roaming, and those without cars and were waiting for public buses to come and evacuate them.

In 2020, we left behind the harvest of my father's garden in Shushi, and an abundant life.

In 2023, we left a few kilos of buckwheat, rice, and potatoes in our hotel room in Stepanakert. Food we had managed to get a hold of during a nearly year-long brutal blockade.

In 2020, I left Shushi with dreams in my heart. I had not been broken yet, I had no personal loss, and I was confident I’d be back.

In September 2023, I left Stepanakert with a sense of uncertainty about my life and my future. I had lost a homeland, my father, and I was lost in my own life.

I have written much about Shushi since the September 2020 Artsakh War. I left a whole life and a garden of violets there.

But I haven't written a single line about Stepanakert since the violence and ethnic cleansing of September 2023. Maybe one day I will write about this cozy city and its beautiful stadium where I would jog and regain a sense of peace.

In September 2020, for the first time in my life, I felt how alone and powerless a person can be.

In September 2023, for the second time in my life I felt how alone and powerless a person can be.

In September 2020, I started to realize that in any hopeless situation a person should put their hope only in themselves and God.

In September 2023, I became convinced that in any hopeless situation a person should put his hope only in themselves and God.

I went through hell twice, or through different stages of hell. It is difficult to say which hell was worse.... I am only afraid to imagine that there are people whose hell has been more hellish than mine.

But in the midst of hell, I came across the most compassionate people, who made me feel God’s presence in this absurd world of ours.

Stepanakert and Sushi

An avenue of colourful flats beside green trees.

Stepanakert before the exodus.

A hillside road blocked by stationary vehicles.

Cars evacuating from Karabakh to Armenia.

Hunot Gorge State Reserve near Shushi, Nagorno-Karabakh.

War ruins and gardens in Shushi, Nagorno-Karabakh.

Voices of Artsakh is a new series developed in collaboration with The Armenia Project, an educational non-profit in Armenia, that features the stories of the refugees who were forced to flee Nagorno-Karabakh (also known as Artsakh). These personal essays will focus on their experiences, and life after Artsakh as they try to rebuild new homes following the ethnic cleansing from their historic lands.

Article

Change

26 July 2024

6 min read

Are we forgetting how to care?

The profound act at the heart of nursing.

Helen Cowan

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A nurse bends beside a bed and talks to a patient

Marie Curie.

Recently, at a nursing leadership programme in Oxford, attendees focused on the fundamentals of care. Have we forgotten how to care? What can we re-learn from those who pioneered an ordinary yet profound act that affects millions?"

Anam Cara is an old Gaelic term for ‘soul friend’, a person with whom you can share your innermost self, your mind and your heart. It is a term that Tom Hill, former chief executive at Helen House Hospice in Oxford, used to describe the relationship between his staff and the thousands of children and their families who passed through their ‘big red door’ in its first twenty-five years. The hospice (or ‘loving respice’ as it became known) had been founded by Sister Frances Dominica in 1982.

Other care in this country can also trace its religious roots. Between 1048 and 1070 in Jerusalem, the Order of St. John was founded for the purpose of helping pilgrims (“our Lords, The Sick”) who had become lost, weary, or beset by other difficulties while on their way to the Holy Land. Today, in the United Kingdom, the British Association of the Order has extended care to older people first in almshouses and later in care homes. A trustee for ten years was John Monckton, a man of ‘considerable talent, enormous integrity and deep religious conviction’; his tragic murder in 2004 led to the creation of the John Monckton Memorial Prize, which recognised and rightly celebrated commitment to care by care workers.

Today, across the world, seen and unseen, nurses, carers and families continue to provide compassionate care. “Assisting individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” is the very essence of nursing, captured by ‘architect of nursing’, researcher and author Virginia Henderson in 1966. Meeting more than basic needs such as breathing, eating, drinking and eliminating bodily waste (which are of essential importance), Henderson recognised the role of the nurse in enabling humans to communicate with others, worship according to their faith, satisfy curiosity and sense accomplishment.

In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care?

An uncomfortable truth brought out in healthcare reports such as the Final Report of the Special Commission of Inquiry (The Garling Report) 2008, and the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report) 2013 is though that this type of nursing is too often done badly or even missed, leading to pressure injury, medication errors, hospital-acquired infection, falls, unplanned readmission, critical incidents and mortality. According to nurse scientist and scholar Professor Debra Jackson, “missed care occurs much more frequently than we might think”. She cites a systematic review in which ‘care left undone’ on the last shift ranged from 75 per cent in England, to 93 per cent in Germany, with an overall estimate of 88 per cent across 12 European countries’.

In one offensively-titled paper, “Shitty nursing - the new normal?” (in which the authors apologise for the title but not the questions raised), real-life pen portraits are drawn of patients lying for hours on hospital trolleys, immobile through infection or injury, ignored by staff. Whilst acknowledging contextual factors for poor care, such as a shortage of nurses and resources, the authors argue that circumstances cannot be the sole cause of missed nursing care.

A report published by the University of Adelaide, School of Nursing, has called for nurses to ‘reclaim and redefine’ the fundamentals of care. It asks whether the cause of the problem (of missed nursing care) lies “deep in the psyche of the nursing profession itself?” “Has something happened to the way modern nursing views and values caring?” it continues. “Indeed, is nursing in danger of losing its claim to care? In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care? Or is this a broader social pattern where individuals are less inclined to show kindness, compassion, and care for others even if it is a necessary requirement of the job?”

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness.

Writing in the British Medical Journal, Professor of critical care medicine Peter Brindley and Consultant in intensive care Matt Morgan wonder whether doctors also “too often default to high-tech and low-touch” when patients are dying – a time “when community and connection matter most”. They powerfully begin with a mother’s comment: “Humans are gardens to tend – not machines to fix.”

Professor Sir Al Aynsley-Green, the first National Clinical Director for Children in Government and former Children’s Commissioner for England, and past president of the British Medical Association, suggests that we as a society need a “momentum for compassion”. Struck by the extremes of compassion witnessed during his wife’s treatment in the last years of her life, Sir Al wants to see a cultural transformation in healthcare: for compassion to be a key operating principle in NHS and care settings, led by the Chief Nurse’s Office; for every organisation to promote the importance of compassion at the professional level; for the views of patients and families to be sought regularly; for much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all staff; for compassion to be inspected against by the Care Quality Commission; and for a willingness to encourage staff at all levels to expose poor practice as well as celebrating excellent care.

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. “It’s putting yourself into somebody else’s shoes – and doing something about it.” Recently appointed the UK’s first Visiting Professor in Compassionate Care at Northampton University, at the age of 80, Sir Al certainly is doing something about it. He has made it his new purpose in life to “embed compassion into every aspect of care”.

Like Sir Al, Queen Elizabeth II, the UK’s longest serving monarch, espoused compassion, in word and deed. Living a life of compassionate service, the Queen made clear that her Christian faith was her guiding principle. She speaks of Jesus Christ as ‘an inspiration,’ a ‘role model’ and ‘an anchor’. “Many will have been inspired by Jesus’ simple but powerful teaching,” she said in her Christmas Broadcast, 2000. “Love God and love thy neighbour as thyself – in other words, treat others as you would like them to treat you. His great emphasis was to give spirituality a practical purpose.”

When nurses do unto others as they would have done unto themselves, and act as role model to colleagues, not only do patient experiences of care and their outcomes improve – but so does job satisfaction for nurses: a critical factor in nurse recruitment and retention – the biggest workforce challenge faced by healthcare organisations. Across the UK, there are currently more than 40,000 nursing vacancies, and thousands of burnt-out nurses are leaving the profession early. Whether nurses decide to stay or go is driven in part by their daily experience at work. The late Kate Granger, Consultant in medicine for older people, inspired Compassionate Care Awards in her name, envisioning that such a legacy would drive up standards in care - and surely also help retain nurses, through restoring a sense of pride, achievement and fulfilment to the nursing workforce.