Guria/La Crosse Partnership Brings Primary Care and Community Mobilization to Rural Region of Georgia

The broken windows of the Ozurgetti District Polyclinic (ODP) in Guria are reminiscent of an orphan's eyes, full of desperation and hope for a better future. They also symbolize the state of the local healthcare system that for many years has been undermined by chronic underinvestment. "Such was our reality for the last decade," says Levan Skamkochaishvili, head of the Guria Healthcare Administration, "but now we finally feel that the help is coming and that we're making steady steps toward dramatic changes for the better." He stresses that due to AIHA's partnership program, the Guria region is receiving substantial support for professional education and the development of modern healthcare programs that address the healthcare needs of its 145,000 inhabitants. The majority of these people have lived below the poverty line for many years—a factor that has contributed to the significant deterioration of the region's health indicators and to the rise of harmful behaviors and unhealthy lifestyles over the past decade or more.

During the health fair at ODP, a local pensioner receives counseling on high blood pressure management. (Photo courtesy of Sandra Mccormick)

A survey conducted by the Guria/La Crosse (Wisconsin) partners at regional high schools has revealed some of the negative consequences of this long-term neglect of health education programs. A prime example is the fact that some 40 percent of the students surveyed have experimented with tobacco and 15 percent of children between the ages of 12 and 17 smoke cigarettes on a regular basis.

In seeking ways to remedy the situation with educational programs, several measures were introduced in 2005. One of them was a series of antitobacco educational sessions provided to 475 school students by trained nursing staff. The sessions received positive feedback from both the students and teachers and provided a basis for the expansion of the program throughout the Guria region.

Another activity designed to educate and empower the local population was a health fair conducted by the partners on October 1 in the town of Ozurgeti. This event attracted approximately 300 citizens from Ozurgeti and adjacent villages, who came to take advantage of the wide range of clinical services being offered free of charge. Blood pressure screening and blood glucose monitoring were administered and specialists were on hand to share information about cervical and breast cancer, sexually transmitted infections, pediatric care, reproductive health, tuberculosis, and malaria. With a primary healthcare consultation costing approximately $2 per person and the average monthly salary in Georgia around $20, the free information and services offered at the health fair were accepted by the local population with gratitude.

At the new training center, Mary Anderson (far right), a nursing consultant with the La Crosse World Health Services Inc., meets with nurses from different institutions in Guria to discuss the nursing curriculum. (Photo: Vira Illiash)

To sustain long-term changes in the primary healthcare system in Guria, the partners opened a newly renovated and equipped training center at ODP that will be used for training and re-training clinicians from the region. At present, six physicians from Ozurgeti and nine physicians from rural ambulatories are working to complete a 940-hour course in family medicine. When they have finished they will be eligible—perhaps as early as April 2006—to take the state certification exam to become licensed family medicine practitioners. It is expected that the four highest achievers among these first trainees will then take a training-of-trainers course to become the trainers for the rest of the physicians who practice family medicine in the Guria region. All the specialists who are presently undergoing training have been given family physicians bags, which include stethoscopes, laringoscopes, and other equipment necessary to provide comprehensive diagnostic services.

"There are 44 rural ambulatories in the Guria region, and we still have a lot of work to do," Skamkochaishvili says, noting his hope that the partners are able to sustain the pace at which they are currently implementing positive changes to the healthcare delivery system. If so, he concludes, they will be able to produce many improvements in the health status of local citizens in the near future, which will contribute greatly to the overall success of primary healthcare reform in Georgia. Then, maybe the windows of local ambulatories will no longer reflect desperation, but rather will be illuminated with the light of change.

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