Feeding Armenia

Kim Hekimian’s prescription for a thriving population: nutrition comes first 

The long list of professional credits and affiliations attached to the name Kim Hekimian, PhD, only skims the surface of the remarkable career of this Armenian-American nutrition and public health expert. Juggling a demanding career in America, she has managed to transfer her wealth of knowledge, academic discipline, and lived experiences to what has evolved into a life mission: to save lives and improve health outcomes in the Republic of Armenia.

Over the past 30 years, Hekimian has built an impressive reputation in the field of Public Health, as an Associate Professor of Nutrition (in Pediatrics) and the Institute of Human Nutrition at Columbia University in New York. There she serves in many capacities—educator, researcher, mentor, and advisor. She is also an active member of professional health organizations and boards, among them the Armenian-American Health Professionals Organization (AAHPO). However, this is only one side of the multi-dimensional story of her inspired life.

On the flip side, the ardent advocate for maternal and child nutrition has gone to Armenia almost every year since it gained independence in 1991. In those early days, she was one of around 20 diasporan Armenians in the country, working on her PhD and soon joining the faculty of the American University of Armenia (AUA). Recently, she added the title of Advisor to the Armenian Ministry of Health to her resume, along with her appointment as Senior Policy Fellow of the Applied Policy Research Institute of Armenia, better known as APRI.

Her data-driven presentations and analysis-rich lectures to health care peers in and out of Armenia are balanced with a very humanistic approach to patient populations. This stems from spending many successive summers living among Armenian families in the Lake Sevan region of Armenia and observing firsthand how poverty, scarcity, misinformation, and traumatic events can compromise health potentials. While she did not grow up in an Armenian speaking home, she eventually became fluent in Eastern Armenian through her interactions with peers and locals over the decades.

The explosion of public interest in nutrition as an essential component of preventive and wellness care has also elevated her stature as a trusted authority on the subject. All the more reason why Hekimian is uniquely qualified to bring Armenia—her ancestral homeland and second home away from home—into 21st century healthcare.

She agreed to share highlights of experiences with AGBU, which she credits for awarding her scholarships as she pursued her advanced degrees. Today, the connection has come full circle with the grant she received this year from the AGBU-supported APRI. The funds were allocated to her department at Columbia University, making it possible for her to spend more time researching in Armenia. The timing was ideal for addressing issues of humanitarian aid, prolonged malnutrition, and the stresses of trauma on physical and mental health in the context of the forced displacement of Artsakh Armenians in 2023.


Q What sparked your interest in public health and nutrition, particularly in Armenia?

A The 1988 Earthquake in Armenia had become a world news event that put the then-Soviet republic in the spotlight. I soon learned there was this world of international development and that USAID (United States Agency for International Development) and the United Nations were beginning to discuss providing humanitarian assistance to the victims. This intrigued me, because I had been wondering if there would be a way to pursue my interest in maternal and child health that could apply to my ancestral homeland of Armenia. When I matriculated into a PhD program at Johns Hopkins University several years later, I decided to do my dissertation in Armenia. I met with some people from USAID and UNICEF who had just opened offices in Yerevan, and they advised me to focus on issues of infant mortality. After the collapse of the Soviet system, the newly independent Armenia was thrust into the first Artsakh war, which resulted in an economic blockade that lasted for years. With no electricity, it was difficult to boil the poor-quality water in Armenia, and mothers were mixing infant formula with unsterile water.

The infant mortality rate was accelerating, and it could be argued that the humanitarian aid in the form of infant formula was the cause of severe cases of diarrhea that had deadly consequences. So, I became very interested in studying the benefits of breastfeeding versus infant formula. Just as I was finishing the data collection on the topic, the American University of Armenia (AUA) opened its public health program with Dr. Haroutune Armenian, the dean and later president of AUA. He was my professor at Johns Hopkins. He asked if I would stay on to help implement the master’s program in public health as well as teach and develop a research center. I guess the rest is history. I’ve been an AUA visiting faculty member for over 25 years. 

Dr. Hekimian speaks at an AUA conference titled Nutrition Today Matters Tomorrow.

Dr. Hekimian speaks at an AUA conference titled Nutrition Today Matters Tomorrow.
Dr. Hekimian speaks at an AUA conference titled Nutrition Today Matters Tomorrow.

Q What are the long-term effects of malnutrition in young children?

A One of the most troubling findings is how poor nutrition causes stunted growth in children. The World Health Organization and the American Academy of Pediatrics have nutrition guidance that recommend breast milk for the first six months, then continuing to use breast milk but introducing foods with the vitamins and minerals needed for optimal growth. Without this, a child is at risk for not meeting full potential for musculoskeletal growth. This has other health implications as well.

Fortunately, we can screen for this and intervene early for kids who have chronic malnutrition. Interestingly, they may not look at all thin, sick, or malnourished, because they’re getting enough calories from carbs. They might even have chubby cheeks and thighs and gaining weight. But they’re not gaining height. Often, kids are eating bread and potatoes or pasta for days on end because they like it. It’s easy, it’s cheap, it’s shelf stable, yet they’re not getting any meat, any proteins that they need, any of the essential amino acids and vitamins that are available through vegetables, fruit and legumes.

Around 2010, there was a national survey conducted in Armenia, supported by USAID, called the Demographic and Health Survey. In that study, they took height and weight and age measurements of randomly selected households throughout the country. They calculated that almost 20% of children under five had this condition called stunted growth. And that led to genuine alarm. Also, when children do not eat well in these critical years, it can also impair cognitive development, which can trigger a chain reaction: the child may not do well in school, and not attain as much education, and therefore make less money over a lifetime. Plus, there is this continual effect intergenerationally that can contribute to the cycle of poverty we see in families.


Q How did the blockade of Artsakh impact food security and nutrition?

A Even though the blockade was intermittently porous in the beginning, it became airtight starting in June 2023. The resulting food insecurity and threat of starvation were used as psychological weapons. And I believe this played a significant role in the decision of the Artsakh Armenians to quickly put down arms and leave the country. The psychological terror of thinking that you and your children might starve to death became very real. As for the long term physical effects, I was in contact with a special team that was on the ground as the Artsakh Armenians crossed the border. It was difficult then to provide health checks on the spot, but we are now working with Artsakh community members who have since settled in Armenia, taking blood samples and running tests that may show signs of longer term effects of malnutrition and chronic stress. We have a research process in place to make sure that this historically catastrophic event will be well documented from the start. In Armenia, digitized medical recordkeeping is often lacking, so we are trying to improve that with this particular population. I am also heartened by the fact that the Armenian government provides Armenian women with free antenatal and pediatric care as a right, which is extended to Artsakh mothers.

The resulting food insecurity and threat of starvation were used as psychological weapons.

Q What lessons were learned on how to avoid food insecurity in the future?

A There were many lessons learned and one can look on a map and envision areas in Armenia proper that could be blockaded, and we could think about the purchase and distribution of shelf stable high nutrient foods. For example, during the Artsakh blockade there was a shortage of beans, lentils, chickpeas, bulghur—foods that are cheap, shelf stable, and very high in nutrition. Those were not things that the government had stockpiled. They had stockpiled white flour that was easily accepted by the population. However, other than calories, white flour has no nutrition. I also think that every one of the buildings in Stepanakert should have had a chicken coop on the roof or in the area, which would have given families access to chicken and eggs, which are very high in iron protein and other nutrients essential for growth of the fetus, young children, as well as the general population. So, these are things that would have to be planned out.

Also, nutrition education is key. It’s lacking around the world and in Armenia for sure. We know so much more about the science of nutrition and disease. We need to overcome so much misinformation out there. One of the most positive things happening in Armenia in my field is the new school lunch program. Years ago, the World Food Programme started a pilot program in rural Armenia to serve healthy food during school. They installed kitchens on premises and provided the bulk food to the meal preparation staff. Now every school outside of Yerevan is equipped with a kitchen and receives a budget for healthy school lunches.

Q What are your thoughts on intergenerational trauma related to malnutrition?

A The scientific research strongly points to this. We learned from an incredibly valuable dataset that came out of the Dutch famine during the winter of 1944 to 1945 when the Nazis blockaded that area. We have lots of data to show us the women who were pregnant at that time and children who were young at that time, and what happened to those infants when they were born, and those infants' children and grandchildren. So that’s what, in our field, is considered a rich body of evidence. They had good registries, a reliable database that you can follow up on and track the impacts. During WWII, Russia also imposed a famine that killed upwards of six million people in Ukraine. Armies surrounding populations and blocking trade is not a new phenomenon. They trap civilians and cut them off from food and medicine, just like we experienced in Artsakh with the recent blockade. 

I’m not a World War II historian, but we can extrapolate some of the research we know from the Dutch famine to say what very likely happened with some survivors of the Armenian Genocide. Don’t forget that when we say survivors, those were the ones who lived. There may be something about the biological resilience among them. They may have some protective traits against the deadlier outcomes of starvation. Certainly, we can also think about eating habits. For example, my grandparents, both Genocide survivors who also experienced the Great Depression, raised my parents to absolutely finish the plate. And so that value was passed on to me. We were rewarded for finishing the plate. So many of us struggle with weight and eating, even obesity, in part because of family history issues with past traumas.

Dr. Hekimian (left) moderates a panel discussion at the American University of Armenia (AUA) with then-AUA president Dr. Karin Markides and Dr. Noubar Afeyan, the co-founder and chairman of the biotech company Moderna.

Dr. Hekimian (left) moderates a panel discussion at the American University of Armenia (AUA) with then-AUA president Dr. Karin Markides and Dr. Noubar Afeyan, the co-founder and chairman of the biotech company Moderna.
Dr. Hekimian (left) moderates a panel discussion at the American University of Armenia (AUA) with then-AUA president Dr. Karin Markides and Dr. Noubar Afeyan, the co-founder and chairman of the biotech company Moderna.


Q As a Diasporan advisor, how do you engage with local public health decision makers?

A Ever since I became specialized in maternal and child nutrition, I have made many connections with local counterparts. Although I am a policy fellow with APRI, I am physically situated at the health ministry offices. I have a portfolio of areas to advise on, bringing my 30 years in public health to the table at the highest policy level. Fortunately, some of the people that I call my colleagues, I knew back in the day. So we have a very trusting relationship and we value each other’s expertise. In fact, the current Minister of Health and the first Deputy Minister of Health are both graduates from AUA. My input and influence goes only as far as the mutual trust and professional respect afforded to one another. I have had a 30 year head start in this regard, thanks to the convergence of personal intentions and historical events. In other words, I was in the right place at the right time. And, from my perspective, for all the right reasons.

Originally published in the June 2024 ​issue of AGBU Insider. end character

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