23 minute read
SOCIETY
from Issue #1318
BY NINA KOPALEISHVILI – PR AND COMMUNICATION OFFICER, CARITAS CZECH REPUBLIC IN GEORGIA
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Scaling up primary healthcare (PHC) interventions across low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030. Caritas Czech Republic actively works to improve the quality of primary healthcare (PHC) services in Georgia and provide it with comprehensive IT solutions.
PHC’S ROLE IN A STRONG HEALTH CARE
It is scientifi cally proven that PHC is the most inclusive, equitable, cost-effective, and effi cient approach to enhance people’s physical and mental health, as well as social well-being. An international study comparing the strength of primary care in 13 high-income countries found that strong primary care led to improved population health and lower health expenditure (WHO).
Having qualifi ed medical personnel and quality standards in PHC is a cornerstone in a strong healthcare system. Timely visits to family doctors that may avert citizens from paying for further expensive medical services and prevent them from potential complications in their health condition also plays a vital role in strengthening the whole system.
Within the Czech Development Agencysupported project, Caritas Czech Republic works to strengthen the primary healthcare system in Georgia through the introduction of improved medical guidelines for family doctors, the development of countrywide comprehensive IT solutions, and updating qualifi cation standards/requirements for PHC professionals.
THE IMPORTANCE OF IMPROVED MEDICAL GUIDELINES
A clinical protocol is a medical guideline – a document consisting of best practices for managing a particular medical condition, which includes a treatment plan founded on evidence-based strategies and consensus statements in the fi eld.
Caritas Czech Republic has been asked to develop clinical practice guidelines and protocols and pilot them at primary healthcare facilities (in the municipalities of the Mtskheta-Mtianeti and Samegrelo-Zemo Svaneti) based on the clinical topics selected jointly with the Ministry of Health of Georgia.
At this stage, the Ministry of Health of Georgia has approved six out of 10 developed clinical protocols. Based on those documents, Caritas Czech Republic experts have already started to train doctors and nurses in the Dusheti Municipality. "Over the next two years, we will provide rural doctors with the most up-todate and evidence-based practice from the world clinical practice. This will guarantee that a patient in a rural ambulatory receives the same quality of service as a citizen in the best clinic in the capital," says Nato Shengelia, a family doctor and Caritas Czech Republic expert. "We have been engaged in training based on the improved protocols since June 2021,” says Lamara Paghava, a family doctor in Choporti village, Dusheti municipality. “Currently, we are undergoing the module about arterial hypertension. I’m a family doctor, responsible for three districts of the village, 1600 people in total. Seasonal variability in blood pressure is a common problem for numerous patients here and new approaches and standards are very important for my work.”
Project experts are also working on creating a system for improving the quality of PHC services and facility-level performance management through intensive clinical training and supportive supervision of ambulatories’ medical personnel.
COMPREHENSIVE IT SOLUTIONS TO PHC
One of the core challenges to improving PHC is digitalization of medical services and health systems. Compared to manual registration, electronic medical records are characterized by much greater accuracy and a higher proportion of correct information. Besides, this practice requires less time and fi nances.
Caritas Czech Republic is working to create a unifi ed and standardized e-management information system. In addition, it will introduce countrywide e-queue management, telemedicine, and e–referral management systems to the Georgian healthcare system. "A unifi ed medical record system will facilitate the collection of patient information at the PHC level and contribute to informed medical decisions,” says Marina Shikhashvili, an expert in family medicine and Caritas Czech Republic project expert. “In addition, a unifi ed e-queue management system is a very convenient tool for receiving medical services in one space. A unifi ed electronic information system also created within the project will be the most important tool for those clinics which do not have internal electronic systems for data-collection.”
“PHC has a “gatekeeping” function in the whole healthcare system, the main purpose of which is ensuring that a majority of patients receive basic medical services at the primary level and, consequently, the next levels of the health care are not overloaded,” says Rusudan Chkhubianishvili, Caritas Czech Republic project manager.
CCR CONTRIBUTING TO GEORGIA’S HEALTHCARE
Within the Czech Development Agency supported project, Caritas Czech Republic carries out activities in close cooperation with the Ministry of Health of Georgia and the Emergency Situation Coordination and Urgent Assistance Center (ESCUAC). The project will ultimately benefi t the whole of Georgia, as the results of all deliverables will be handed over to the Ministry.
Currently, the project is being piloted in the selected municipalities of the Mtskheta-Mtianeti and Samegrelo-Zemo Svaneti regions. At the same time, the project continues to enhance the system of quality measurement and improvement at fi ve pilot medical facilities in Tbilisi as part of Phase I. In total, 46 primary medical facilities will be included in the project.
EXCLUSIVE INTERVIEW BY KATIE RUTH DAVIES
One of the great privileges of working for the UN is you get to live and work in some wonderful places, and you get to know some amazing people. Georgia has transformed itself so fast over a few years into a democratic state, creating growth, lowering poverty and heading towards a prosperous inclusive future. Can that trajectory be maintained? The UNDP works to strengthen democratic governance, protect human rights, resolve confl icts and realize sustainable development goals. In Georgia, I get the sense that there is everything to play for, and so I could not look for a more engaging and I hope rewarding place to live and work. – says Nick Beresford, the new UNDP Resident Representative in Georgia.
Nick Beresford is a development professional with over 20 years of experience with the United Nations. He was appointed as UNDP Resident Representative in Georgia in September, prior to which he served in Cambodia, Bangladesh, Somalia and East Timor, as well as in the UN headquarters in New York (USA). He holds a Master of Science in Development Economics from Sussex University and degrees in audit and accountancy and English literature. GEORGIA TODAY spoke to him to fi nd out what his impressions are of the country, and where he sees room for the kind of improvements the UNDP excels at facilitating.
“Georgia is strikingly beautiful,” he tells us. “The city of Tbilisi is unique. History, culture and art are everywhere. The people are exceptionally warm and friendly. As a guest, you are really made to feel welcome. Georgian cuisine is a sensation, and they literally invented wine. As fi rst impressions go, this one is very hard to beat!”
THIS IS A CHALLENGING TIME FOR MOST COUNTRIES. WHAT DO YOU SEE AS THE MAIN PRIORITIES FOR GEORGIA TO ACHIEVE ECONOMIC RECOVERY?
washing hands and social distancing. As people become confi dent to return to work, shops and markets, so the real economy for working people can pick up.
On the social and economic side, we have learned a lot in a short time through COVID. More than 120 countries around the world introduced new social protection schemes, including here in Georgia. Social protection builds resilience so more people are kept out of poverty and in the working economy. Expanding universal health care, another very welcome policy seen in Georgia, strengthens human capital, reduces the burden of ill health and so adds to economic growth. Just as we can’t separate the health responses from the economic response, they are complements, not alternatives, so we need to invest in people to make growth that is stronger, locked in for the long term, and shared widely, not just accruing to the wealthy. WHAT HAVE YOU IDENTIFIED AS THE MAIN GOALS FOR THE UNDP IN GEORGIA IN THE FORESEEABLE FUTURE?
I would list four priority areas. The fi rst rounds of local elections have just ended with a higher turnout than in previous years. I’m glad UNDP and others supported programs to encourage young voters to participate and to increase women’s engagement in decision-making. Deepening and strengthening democratic governance, respect for human rights, equality and the rule of law are essential to ensure Georgia does not stall on its development journey.
We have an opportunity here, as in many countries, for an economic recovery that emphasizes green growth. This is about protecting our health, our environment and planetary wellbeing, but it’s also about jobs. Green growth investments, dollar for dollar, bring high economic multipliers and create more jobs – and ones that take us to higher skills too.
As we cope with the pandemic, we can see that social protection investments in people have been essential to help people rise to their full potential and also to strengthen social solidarity. Georgia has come a long way in reducing poverty, now at 21.3%, and we need to keep that momentum to end poverty by 2030. When people escape poverty, they don’t just realize their human right to a life with dignity, they start to contribute to the wider economy, and this is something that benefi ts everyone.
Finally, I would note that many communities, including internally displaced persons, still suffer the impacts of past confl ict. We must invest in these communities to ensure no-one is left behind. Confi dence building measures that bring communities together can set the basis for fi nding ways for lasting and peaceful resolutions.
WHAT CHALLENGES DO YOU EXPECT, AND HOW CAN/ WILL THESE BE OVERCOME?
Development agencies are often good at producing technical solutions on paper, but sometimes less impressive when it comes to seeing them into action. We need a sharper focus on the political landscape: the incentives that drive our partners in government, civil society and the private sector. If we can listen more carefully to these, we can make better choices on which doors to push and which ones are perhaps shut tight. The point is to work in partnership with government, civil society, and other development partners to fi nd a pathway ahead so we can make real systemic change. That’s how, on a good day!, we can move bright policy ideas into real development impact.
AHF Georgia Joins Global Vaccine Access Campaign “Vaccinate Our World”
Continued from page 1
AHF Georgia also joins the above campaign with social media activities and a “Die - in Action” performance. The area around the German Embassy in Tbilisi has been selected for this purpose, as the aim of the campaign is to call on vaccine manufacturers to have access worldwide. Germany is one of the major developers / producers of Covid-19 vaccines and, at the same time, a member of the G20. It’s support for the goal of this campaign plays an important role in the world.
Wealthy nations have drawn global criticism for hoarding vaccines and not urging pharmaceutical companies to share their know-how for vaccine research and development funded primarily by taxpayers. As of early October, 3.6 billion Covid-19 vaccine doses had been administered globally, with 78% of those going to people in high- and upper-middle-income countries. Less than 7% of the 1.3 billion people on the African continent have received even one dose. The discrepancy is worse for low-income countries, where less than 1% of people have gotten a shot.
“The Covid-19 pandemic has posed many challenges to the world. The problem of access to vaccines is acute, especially in third-tier, poorer countries,” said Nino Khetaguri, Country Program Manager for AHF Georgia. “While large and powerful countries bought lot of vaccines and a large part of the population is already vaccinated, in many lowincome countries, only small groups of people are vaccinated and some countries have no access to the vaccine at all. Vaccines must be fairly distributed to all countries: if there is one nation with Covid-19 and no vaccine access, then all countries are in danger. Availability of the vaccine was a big challenge for Georgia until recently, but now a considerable quantity of the vaccine has entered the country. Therefore, the topic is no longer as relevant in Georgia as in other countries. Nevertheless, Georgia is joining the campaign, because it’s critical that world leaders do more to ensure that all countries have the requisite vaccines to ‘Vaccinate Our World’ and end the pandemic. This includes demanding that vaccine makers share their recipes to boost worldwide production, and ensuring international cooperation on all matters of global public health, particularly pandemics.”
“The ‘VOW’ performance in Tbilisi and other cities across Europe are vital for sending a wake-up call to EU and G20 leaders ahead of their Rome Summit – we will not sit idle while billions of people worldwide go without vaccines!” said AHF Europe Bureau Chief Zoya Shabarova. “Wealthy countries have secured enough vaccines for their citizens, some of which have enough to vaccinate their populations multiple times over. It’s now time for those leaders to pay it forward and show the same care and concern to people in Africa and other hard-hit regions struggling to get lifesaving vaccines and recover from the pandemic. Enough is enough – the G20 must Vaccinate Our World!”
In order to achieve the global campaign “Vaccinate Our World” goals, the world must take several important steps:
ENSURE THERE IS SUFFICIENT FUNDING FOR VACCINE PROCUREMENT.
$100 billion must be pledged to secure enough vaccines to inoculate the entire world. Leaders from the G20 and global fi nancial institutions, such as the International Monetary Fund and World Bank, must VOW to step up their contributions immediately.
BOOST VACCINE PRODUCTION CAPACITY WORLDWIDE TO 7 BILLION.
Even with current vaccine production ramped up to maximum levels, vaccine manufacturers are still unable to meet the demand for lifesaving Covid-19 doses. If the world is to fi ght this and future pandemics, vaccine production must be increased across every continent. A handful of pharmaceutical companies simply cannot be relied upon to vaccinate the entire world.
VACCINE PATENTS MUST BE WAIVED TO ALLOW FOR THE RAPID SCALEUP OF PRODUCTION.
Covid-19 vaccines are primarily funded by taxpayers, not pharmaceutical companies. We must call for all vaccine manufacturers to openly share their technology and intellectual property – and for governments to ensure Covid19 vaccines are declared a public good. We can look at past examples, such as the AIDS epidemic, and save the world as we did with antiretroviral medicines for HIV.
ENSURE TRANSPARENCY AND INFORMATION SHARING, PARTICULARLY DURING GLOBAL PUBLIC HEALTH EMERGENCIES.
We must advocate for an enforceable mandate to ensure transparency and accountability for all countries and organizations when it comes to global public health.
The bulk of vaccine procurements have been accomplished through closed-door deals between individual governments and drug companies where little information is released on the details of the agreements, which drives up vaccine costs. During this and any pandemic, all vaccine agreements should be made public to encourage increased cooperation and to ensure all countries are able to access affordable medicines and vaccines.
ADVOCATE FOR GREATER INTERNATIONAL COOPERATION AS THE DRIVING FORCE FOR ENDING THE PANDEMIC.
Many nations, including Canada, the US, UK and those in the European Union have purchased enough vaccines to vaccinate their populations multiple times over. With a worldwide shortage, these countries must be compelled to share their surplus vaccine stockpiles. At a time when the majority of the world has little access to vaccines, nations should establish a framework to ensure the rest of the world can also be protected. If one country isn’t safe from Covid-19, none of us are safe.
“VOW” activists organized recent protests targeting the headquarters of US-based Covid-19 vaccine makers Pfi zer, Moderna, and Johnson & Johnson to demand that they halt their ‘pandemic profi teering’ and share their know-how and technologies to increase vaccine production globally. Other advocacy actions have included embassy visits in many countries where AHF operates and a ‘VOW’ protest in Brussels earlier this year targeting EU leaders.
Learn more by visiting VaccinateOurWorld.org, where you can pledge as an individual or as an organization to fi ght for vaccine access across the globe.
The AIDS Healthcare Foundation (AHF) is a global non-governmental organization in the United States. The Foundation, which provides state-ofthe-art AIDS medicine to more than 1.6 million people in 45 countries, is the largest provider of HIV / AIDS care in the United States.
The representation of the AIDS Healthcare Foundation in Georgia (AHF Georgia) was opened in 2018. It provides to the Georgian population free and anonymous HIV rapid testing and webinars on reproductive health. The Foundation actively cooperates with the National Center for Disease Control and Public Health (NCDC), as well as with the medical and non-governmental sector involved in the treatment and prevention of HIV/ AIDS in Georgia.
BLOG BY TONY HANMER
Ifound myself visiting Batumi only three days after the collapse of a seven-story building on 26 May Street led to the deaths of nine, including some children and four members of a single family, and the arrest of (so far) three for criminal neglect of building codes. The friends which I was there to meet were also guests, and they were staying in an Airbnb apartment less than a block from the rubble.
Having watched the available footage of the thing coming down, narrowly missing a bystander, who ran for his life, and the heroic and delicate rescue efforts of 300odd emergency workers through the night of the 8th-9th of October, I was most sobered to see the wreckage in person from mere meters away, and also to spend some moments at one of the memorial walls set up for the victims on the screens put up to keep the public at a distance while the cleanup crew and police did their follow-up work. Photos, toys, drawings, paintings, fl owers, candles, icons and silence as people came to pay their last respects at this site which has gripped the nation with its horror for some days now. The 11th was a national day of mourning.
As more people came up with roses, I was reminded that an even number of fl owers in this part of the world is for sad commemorations, and an odd number of them (except for traditionally unlucky 13) for happy ones such as weddings or funerals.
Once the quiet respect has fi nished, though, there will be plenty of loud voices, some of which are already starting to speak up, dealing with building safety being ignored for the sake of expediency and simple greed. Not only in this unique case, but across Georgia: where else are buildings either being shoddily made from the start or fatally damaged (as happened here) once built? How much can such doings be discovered early enough to save lives or even outright prevent the stupid actions from being begun? And how can those really guilty, on all levels, from those doing or undoing the work to those offi cially sanctioning it or turning a blind eye, be identifi ed and punished?
The other moment I single out in Georgia’s very current events concerns the unignorable elephant in the room, Mikheil Saakashvili, whom I have met twice as the country’s 3rd president. Back now from his eight years’ self-imposed exile following the defeat of his political party, he has Gone Straight to Jail, Do Not Pass Go, as the game of Monopoly would have it. No-one has any doubt that he knew this would happen and returned anyway. He could not have failed to get expert legal advice while making his decision.
While #freedomforMisha (in Georgian) has emerged as a slogan for this moment, I have a better one: #mishavs (also in Georgian). This is a play on words in several ways. 1) it includes his name, Misha. 2) it follows this with VS, short for versus. 3) it is the opposite of the phrase ara mishavs (“It doesn’t matter to me”), meaning “It DOES matter to me”. My T-shirt bearing this slogan is so far the one and only one. I had it printed as a one-off here in Batumi, but the slogan won’t be copyrighted.
I put it that whatever Misha deserves, and whatever one thinks of him, his return at this moment will and should stir up new currents in Georgian politics and public life, now that we have just had national local elections which must lead to a number of runoffs in areas where there was no outright winner. Misha and his fate and new position in Georgia and all that they mean cannot be ignored. No, these are not uninteresting times.
Turning Points
Tony Hanmer has lived in Georgia since 1999, in Svaneti since 2007, and been a weekly writer and photographer for GT since early 2011. He runs the “Svaneti Renaissance” Facebook group, now with nearly 2000 members, at www.facebook.com/ groups/SvanetiRenaissance/ He and his wife also run their own guest house in Etseri: www.facebook.com/hanmer.house.svaneti
It's a Dog's Life in Georgia
BY HELENA BEDWELL
Itruly believe that street dogs in Georgia have made a more positive impact on tourism and the image of my country than people and culture alone. If anything, these adorable creatures should be the symbol of the capital, kind of like the cats of Istanbul.
While stray dogs are a no-no in many developed countries, it has become somewhat normal here for some reason. In my childhood, dogs of breed were a rare luxury due to the communist regime restricting the varieties, but I do remember every household in the villages having at least one or two in their yards barking away. Then something happened: economic turndown, political turmoil and rapid changes in the post-soviet era, and still that soviet-mentality and wanting foreign breeds- it all made people very cold towards our little friends.
I am sure everyone who reads this would agree that our country is hell for the husky breeds, labradors and hunter dogs, due to its totally unsuitable climate, lifestyle and the wrong choice potential owners make when choosing their companions. When I came back to Georgia after almost 10 years of absence, I was shocked to see so many abandoned animals on the roadsides.
The villagers could not fully explain why they never wanted those dogs indoors while still having idioms like "You have a dog's luck" in their vocabulary. The majority of the public still strive to have them but refuse to accept crossbreeds; they simply abandon them or put them in the shelters in the best-case scenario. I’ve heard some urban legends on why religious people avoid dogs, but at the same time, I see priests and clergy owning expensive bred dogs, so this mystery to me is unsolved. As experts explain, the abandoned crossbreeds spread fast in the streets and the Tbilisi street dog was born. To make matters worse, there are simply no rules or regulations on puppy mills, commercial or personal ownership breeding, nor does anybody get punished for abandonment.
Almost every district in Tbilisi, Kutaisi, and Batumi, and almost every region of Georgia has their own colorful stories to tell of a local pooch or a feline living in the streets and quite accustomed to the situation. Think of Kupata, the chubby black and white crossbreed in the streets of Batumi, which captivated the hearts of global social media for helping kids to cross the zebra crossing safely.
Think of Chorna, the old, chubby dog living near the fl ower market in downtown Tbilisi.
And everyone knows Salvador, the old, almost blind dog living near a famous ice-cream parlor. He doesn't like ice cream, but he does love the affection from customers.
Recently, I met Marco through a very kind, young girl called Taso Losaberidze. Marco is a beautiful, blue-eyed chocolate labrador crossbreed which Taso sheltered in her neighborhood in Gldani almost two years ago. At fi rst, Marco appeared to be an obedient dog, but suddenly he started jumping on public buses and traveling across the city; this dog regularly rides a bus alone to take himself to the airport, cafes, hair-salons.
“He's a travel-loving dog, that's why I named him Marco, in honor of Marco Polo,” Taso tells me. She says that Marco had a special tag on his ear. Sometimes, she gets calls from the municipality to alert her that Marco has decided to stay in Vake for a week or two. But he’s not likely to stop for long. Marco even has his own Facebook page to update followers on his adventures and help his guardian fi nd him quickly.
Taso writes on his page that Marco is smart enough not to create any havoc in shops and other public venues, and doesn't get into any trouble. He is also very disciplined when crossing the busy streets, so police offi cers won't fi ne him.
There are plenty of adorable stories about dogs similar to those mentioned above; the list is endless. And some are harder to hear. I personally met the wonderful duo Masho and Misho, also known as Custard and Cream, in the streets of Bagebi two years ago when I bought an apartment there. These cream-colored dogs had been tagged and had lived in the neighborhood for years, but it seemed more residents disliked their presence than enjoyed it. Every evening, my husband and I would go for a walk with them after dinner in the nearby park, where we would sit on the bench and talk to them in Georgian and English. It was fascinating how the street dogs showed a strong desire to be near humans, despite having experienced the cruelty of others who never welcomed them. When cruel neighbors decided to destroy the wooden house I had put up for them to spend winter in the warm, I decided enough was enough. Today, Custard lives with her new wonderful owner Sophie, who adopted her gladly, and Cream is living happily near Lisi Lake, hanging out with new friends.
I believe no-one should live outside a comfy home; not humans, not animals, unless they are born wild in the forest. There are several organizations, charities, individual groups and activists, like myself, helping them. Unfortunately, the number of street dogs is not decreasing, and according to the unoffi cial statistics given in 2015, there are up to 46,000 stray dogs and cats living in and around Tbilisi. According to Jano Japaridze, Head of the Tbilisi State Municipality Shelter, around 26,000 of those have been tagged, neutered and vaccinated.
As much as I like the tourists adoringly patting the dogs in the streets and allowing them to eat at the roadside cafes, it still bothers me to portray a country of such high culture and history as a place of ill-treatment of dogs and cats. Unless awareness begins from a young age, no actual laws will be helpful. The love of animals should start in childhood and right now, to eradicate Georgia's stray dog problem.
I remember seeing the famous movie ‘Mimino’ by genius director Giorgi Danelia. The movie was about a Georgian pilot who decided to try his luck in larger planes during soviet times; about his love of his homeland and everyone who had ever been to Georgia. I recently found out that the small dog ‘Zarbazan,’ featured in the movie, was actually a stray dog. The movie director had spotted him near the set and decided to put him in the movie. Zarbazan gave the best dog performance of all time and got adopted by the director himself after the movie was shot.
That’s the kind of happy ending I’m talking about.
Custard and Cream
