A Sister in Need
Emory has joined a partnership to improve the health care system in Tbilisi,
Georgia
By Andrew W.M. Beierle
Tbilisi, Georgia, Atlanta's sister city, hugs the banks of the Mtkvari River as
it wends its way through a steep mountain valley on a land bridge between the
Black and Caspian seas. The capital of the Georgian Republic, Tbilisi is
constructed largely of low, whitewashed buildings topped by red tile roofs and
embraced by thick stands of pine trees, giving it a Mediterranean aspect. In
sharp contrast, structures such as the UFO-like Dynamo Stadium and tall, white
apartment buildings stand as reminders of the architectural tastes of the
city's most recent occupiers: soldiers and administrators representing the
now-defunct Soviet Union.
The recent break-up of the Soviet Union has placed the city in a precarious
position. Rent by brutal civil war and cut off from the financial reserves of
the Soviet Union with no source of income of its own, Tbilisi faces myriad
problems, among them its deteriorating infrastructure and public
services--including its outdated, disintegrating health care system. 
Writing in
Atlanta Medicine, Emory Professor of Medicine H. Kenneth Walker and Paul
Klever, administrator of the Atlanta-Tbilisi Partnership, called health care in
Georgia "just short of agony."
In 1992, the U.S. Agency for International Development (AID) funded programs to
improve health care in the USSR's former republics, as it had done in Eastern
European countries after the fall of Communism three years earlier. AID gave
$20 million to the National Association of Public Hospitals to establish the
American International Health Alliance, which created twenty-one partnerships
between U.S. hospitals and medical schools and similar institutions in the
former Soviet republics.
One of those partnerships involved a collaboration between the Emory School of
Medicine, Grady Hospital, and the Morehouse School of Medicine to assist in the
modernization of facilities, patient care, and education at City Hospital No. 2
in Tbilisi. The vision of the project soon expanded.
"I privately decided that while working with a hospital was fine, that was sort
of like giving someone with a temperature of 104 an aspirin, when what you
needed to work with was the entire health care system," says Walker, who, with
Professor of Surgery Roger Foster and Susan Buchter, associate professor and
residency director in the Department of Pediatrics, was among the first members
of the Emory community to become involved in the partnership.
The project now has three basic goals: to help the Georgian Ministry of Health
identify and address national health care goals; to improve medical education
at Tbilisi State Medical Institute; and to modernize City Hospital No. 2,
transforming it into a Western-style academic facility that will train future
physicians as it provides vastly improved patient care. Walker says the scope
of the program continues to expand, and the Atlanta-Tbilisi Partnership is now
juggling many projects. Ongoing initiatives include:
- Health care reform: The Republic of Georgia has a "Hillary Clinton" committee
to study changes needed to transform its health care program into a modern,
Western model. With the assistance of faculty and students from the Emory
School of Public Health, Georgians have developed a program that includes a
central insurance fund, guaranteed benefits package, privatization, shrinkage
of facilities and personnel, accreditation of medical schools, and licensure of
physicians.
- Medical education: Former Dean of the School of Medicine Jeffrey Houpt and
Associate Dean for Student Affairs Jonas Shulman have led the initiative to
improve the quality of education at the Tbilisi State Medical Institute. The
curriculum, based on a European model dating to the 1920s, is being transformed
to a modern, Western one. Among other things, this will mean a change from a
six- to an eight-year degree track, four in a premed curriculum and four in
medical school. Fourteen Tbilisi medical students and faculty already have
spent up to six months at Emory, experiencing Western medical education
firsthand. Similarly, six Emory medical students have gone to Tbilisi for a
one-month elective.
- A national information learning center: At a time when information technology
in the United States is growing and changing exponentially, the medical library
in Tbilisi consists of piles of dusty and often damaged books. The Emory group
is particularly interested in improving the amount and quality of information
available to the medical community in Tbilisi and Georgia. Librarians at
Morehouse have worked with librarians at the national medical school and at
City Hospital No. 2 to establish a hospital library that will be a model for
medical institutions throughout the country. Carol Burns, director of the
Woodruff Health Sciences Center Library, has made a number of trips to Tbilisi
to begin the process of bringing the Tbilisi medical community online and
establishing a regional library network with access to Western electronic
databases.
- An emergency medical services training center: Dr. Gail Anderson of Emory
helped plan the center, which opened in January 1996. This center now trains
about one hundred policemen, firemen, and medical personnel per month.
Previously, accident victims and those with sudden onset of serious illness
were not treated until they arrived at the hospital. Walker believes this
program has the potential to have a profound impact on Georgia, which has a
high level of vehicular trauma and cardiovascular disease (many Georgians
smoke, have high blood pressure, are under significant stress, and have poor
diets).
- Maternal and child health and reproductive health: This project, carried out
by Emory's pediatrics and GYN-OB departments, involves transforming the
children's and maternal hospital in Tbilisi into a model national perinatal
center. No vaccinations or immunizations of children had been offered for three
years prior to the Atlanta-Tbilisi partnership. In the future, perinatal care
for mothers; neonatal, infant, and child care, including immunizations; and
family planning will be priorities.
- Improvement of nursing education and skills: Project participants from the
Georgia State University School of Nursing and Grady Hospital have plans to
improve nursing education, especially at City Hospital No. 2, and are
contemplating the establishment of a modern school of nursing in Tbilisi.
"The concept of integrating everything you are doing in health care--to work
with the ministry of health, to work with the medical students, to work with
the hospitals--is highly productive," Walker says. "The concept of working with
the health care system of a developing country on not only short-term or
mid-term goals but also on things of long-term consequence is something that is
not done often in the foreign aid area."
Click here to return to Autumn1996 contents page.
Click here to return to Emory University Home Page.