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PROBLEMS
Estimated two abortions for each live birth
Contraceptive prevalence 25%
Condom usage married women 6%
One-third of women do not see physician during first trimester of pregnancy
42% of women receive inadequate prenatal care
Stillbirths: 20 per 1000 births
30% of women have yearly gynecologic exams
Only 23% of women perform breast self-exam
Only 4% of sexually active women have ever had a Pap smear
New cases of syphilis increased four times from 1993 to 1998 (12.1 to 46.6 per 100,000)
42 cases of congenital syphilis per 100,000 live births in 1998
(Figures from Reproductive Health Survey, Georgia, 1999-2000 by Serbanescu et al.)ACCOMPLISHMENTS
Kutaisi-Atlanta Partnership
Sponsor: American International Health Alliance
Type of Partnership: Healthy Communities / Women's Wellness
US Partner: Grady Health System, operating under the auspices of the Fulton & DeKalb County Hospital Authority, has a long history of providing comprehensive women's services to the greater Atlanta community. It has 10 strategically located community-based primary centers and two medical schools that employ staff from Emory University and Morehouse School of Medicine. Grady Health System also partners with the Georgia State University (Departments of Nursing and Management), Kaiser Permanente, Fulton County Health Department, and the Rollings School of Public Health.
NIS Partner: Kutaisi, the capital of Imereti region, is located four hours from Tbilisi. The population of Kutaisi is 243,500 out of a total 737,600 in the region. The primary partner institution involved in the partnership is the Regional Health Care Management Department of the Imereti Region. The Department is responsible for health care delivery for the region's population, for implementation of federal and municipal health care programs initiated by the Ministry of Health and the regional administration.
Partnership Objectives: The main goal of the Kutaisi-Atlanta Partnership is to establish a Women's Wellness and Primary Care Center in Kutaisi, using a healthy communities approach. The partnership will develop and improve access to quality services to meet the identified needs of women in Kutaisi and improve access to services with an emphasis on disease prevention and health promotion.
Key Accomplishments to Date:
The first Women's Wellness Center in Georgia was opened by the partners, March 10, 2000 in Kutaisi. In addition to representatives from Atlanta and AIHA senior staff, a number of dignitaries attended the opening ceremony including the US Ambassador to Georgia and representatives from USAID, the Georgian Minister of Health and Social Affairs, senior representatives from the President's office and several international organizations.
A radiologist traveled to Atlanta, Georgia in November and had the opportunity to observe ultrasound procedures at the Grady Health System Radiology Department as well as the Regional Perinatal Center. By the end of her training, the cytologist/oncologist from Kutaisi demonstrated an understanding of and competency with interpreting pap smears and other laboratory procedures. Following her trip the Women's Wellness Center began to conduct PAP cervical screening. This represents the first time in Georgia that a Women's Wellness Center has provided this service.The US team who traveled to Kutaisi in December worked with the staff of the Women's Wellness Center on diagnostic procedures, primary care and women's health. One of the physicians focused on assessing the competency of the cytologists and trained them in various procedures and diagnosis. A second physician worked with the Kutaisi staff on assessing, diagnosing and treating women who utilize the Center, with emphasis on documentation to ensure preventive tests are performed and documented correctly.
The Director of the Regional Health Department and the Director of Public Health from the Imereti region attended meetings at the Georgia State Capitol, Centers for Disease Control and Prevention, Dekalb County Health Department and the US Food and Drug Administration during their visit to Atlanta. They discussed priority health issues for Kutaisi and the region. US partners provided a review of current educational materials and progress at the Women's Wellness Center. The delegation was provided with extensive health education literature in the following areas: women's health, osteoporosis, menopause, prenatal care, hypertension, anemia, dental care and diabetes.
The partners held ongoing meetings with the Regional Health Department regarding sustainability of the Women's Wellness Center. Grants from CDC and US FDA were discussed.
A shipment of furniture, equipment, and supplies arrived at the Women's Wellness Center. The shipment was a donation by Carelift International.Other accomplishments:
1. Health promotion/prevention community publications developed for Breast Self Exam, Reproductive Health, AIDS, prenatal care, postnatal care, Nutrition, STD's, domestic violence, Planned parenthood and a passport to health for women that outlines continued follow-up throughout the women's life cycle.
2. The WWC has seen over 6000 patients since it opened vs 900 listed. It
also has a NGO that receives Government grants. They are working three
grants now.
a. 2968 teachers[women] will receive 2 physicals, receive psychological
consultation and education.
b. Pregnant women receive prenatal and postnatal care.
c. A government reproductive health grant to treat STD's and provide
contraceptive counseling[free birthcontrol]
3. Dr. Angelina Akhvlediani, Psychologist, Kuaisi Women's Wellness Center,
has been invited to present a poster presentation at the American
Psychologist Convention in October 2001, Washington D.C.
4. Healthy Community education conducted in Atlanta, Grady Health System,
for the Women's Wellness Center Staff, Community Mobilization principles
taught resulting in the establishment of a Imeriti Region Community Advisory
Board. The Board consist of lay persons, Health professionals, teenagers and
elderly to discuss the health needs of the community age specific groups.
Issues, concerns, educational needs are are presented to the WWC and health
dept. One of the Board members is the Public Health Director.
Since October, 951 patients were served at the Women's Wellness Center.
Excerpt from speech by K. Walker at opening:
The notables arrived and we had the opening ceremony. Dodo Shelia, the deputy mayor and an obstetrician/gynecologist, presided. Talks by the Governor, Temur Shashsiashvili; the US Ambassador, Kenneth Yalowitz; Kent Larson, the head of AID for Georgia; the AIHA representative, Laura Keyser; Laura Hurt; me; the Mayor of Kutaisi. I had this to say:
Ambassador Yalowitz, Governor, ladies and gentlemen.....when I came into this center today I smelled a smell I have never before smelled in Georgia--new paint. This center is blessed by having the support of the government of Kutaisi and the US, working with AIHA, all of who have participated in establishing it. Life has priorities, and one must choose them. It is often useful to see what God has chosen for his priorities, in deciding those for one's own life. God has made it clear that reproduction--survival of the species--is amongst his highest priorities. One has only to look around at the myriad of wonderful ways in which reproduction occurs in nature to see that God must have spent six out of the seven days of creation thinking about reproduction. Upstairs a few moments ago we say three women with three new babies. This center is the right thing at the right time for Georgia. It is our statement that we recognize and agree with God's priorities: the health of women and children.
DESCRIPTION OF VISIT TO KUTAISI AND ACCOMPLISHMENTS AND PLANS OF DODO SHELIA; MAY 1998
Raining constantly. Apparently has rained for almost two months most days. When we arrived at Kutaisi visited the Mayor and Dodo Shelia. She is a gynecologist and the deputy mayor, and head of the health care sector of the province. They want us to start a regional center there as part of our new plans for next year. Archil had cannily asked Temur, the governor and power of the region, if he would support this. We had seen Temur for five minutes at the end of the TSU celebration. Temur said yes, and that is like shaking hands with an old Southerner. Done deal. Temur is about 47 or so. A rising star in the young Communists when the Soviet Union ended. Rapidly adapted to the new circumstances, and is outstanding. I have met him on many occasions, and like him a lot.
Kutaisi is the second largest city in Georgia, about two-thirds or a bit more of the way between Tbilisi and the Black Sea. Very ancient city--like 3000 years or so of continual inhabitation. Metropolitan area 1-1.5 million. Used to have many factories, especially a large automobile factory. Now of course they are all mostly quiet. But Temur has been attracting new projects and money. Quiet, neat, clean city.
Dodo took us to her statistics center. About five Pentium computers, people busily entering data. Then she described her programs for the city and the region:
A 'Nurse Communicator' program, or 'Health Prevention in Communities.' There is a nurse in every small village who has been contracted by Dodo. The nurse gets paid when he or she turns in statistical forms (births, deaths, maternal deaths, vaccinations, diarrhea cases, etc.). The nurse is primarily in charge of women and children's health. Basically, said Dodo, the nurse is a 'nurse communicator.'
In each village the school teacher sets up a Health Committee. The teacher organizes the community leaders into this committee. There are 11 rayons (like counties) in the province. 131 ambulatory clinics. Each of the communities has about 2,500 people.
Dodo publishes a newspaper, Health, which is given free to high schools.
Kutaisi has 43 schools, and Dodo has a chief nurse in each one, who is responsible for seeing to the health of the students, including vaccinations, fitness for sports, and so forth.
Now there are 195 of the contract nurses described above. In 60 of the clinics there are MDs; in others nurses provide all the care. Dodo has a job description for the nurse communicator, which she gave me in Georgian and I will get translated.
Here is a list of all Dodo's programs, proposed and implemented:
1. Nurse Communicator. Implemented
2. School monitoring by chief nurse. Implemented
3. Women's health program for newly weds. Implemented.
4. Physical status of school children, especially those engaging in sports. Implemented.
5. Community health management. General practitioners. Implemented
6. Pre-school evaluation of children. September 1998.
7.. Family planning. Date not set.
8. Family doctor program. Date not set.I got the description for each program in Georgian, and will have all of them translated in the next week or two. Most of the programs are nurse-based, and thus are ideal candidates for our nursing initiatives.
We then visited two sites that Dodo would give us for the regional center. We chose eighteen rooms, or a complete floor, of a hospital Dodo 'owns' that is no longer used. An absolutely fabulous space for all our plans. We agreed the center would contain the following:
1. Satellite of the NILC. Zviad's parents live here, and he can be counted upon
to do a bang-up job.
2. Nursing: Dodo wants 'nurses to be information carriers.' She wants training,
courses, booklets, bulletins, posters, the nursing association, etc.
3. EMS: a disaster center is already open. They need training. Also wants to
start courses for high school students.
4. Health promotion
5. Healthcare managementWe came up with our plan for putting together the proposal for next year's budget:
1. Email with someone fluent in English. So there can be constant communication.
2. One responsible person for getting all the pieces together and doing the writing.
3. A working group consisting of the following: Financial person; computer PhD type; nurse; EMS person; women's issues person; neonatology; health research-statistics; health promotion; community leader.
4. Organization of the proposal:
a. Infrastructure: wiring, sewage, renovation, etc.
b. Layout of the center; who inhabits what
c. Components:
1. NILC
2. EMS
3. Nursing
4. Future programs: health promotion; women and children; others
5. Each component to include:
Goals and objectives
Analysis of current situation/background/justification
Description of the component
Staffing
Equipment & office supplies
Trips to US and US to Tbilisi
Evaluation component: before and after
BudgetMORE INFORMATION
US Coordinator: Laura Hurt
Director, Medical Surgical Nursing
Grady Health System
80 Butler Street
Atlanta, GA 30335
Tel: (404) 616-4320
Fax: (404) 616-5058
E-mail: tblnsg@igc.orgNIS Coordinator: Dodo Shelia
Director
Regional Health Care Management Department of Imereti Region
3a, Rustaveli st.
Tel/Fax: (995 231) 43-743
E-mail: medo@sanetk.net.geInformation Coordinator:
Nino Berdzuli
Gynecologist
11 Javakhishvili st.
160912, Kutaisi, Georgia
Tel/Fax: (995 231) 43-743
E-mail: wwc@sanetk.net.geLINKS
Women's Wellness Center, Kutaisi
[http://www.aiha.com/english/partners/kutaisi/index.htm]Grady Health System [http://www.gradyhealthsystem.org/]
Georgia State University School of Nursing
[http://chhsweb.gsu.edu/nursing.asp?section=SCHOOLS%20%26%20DEPARTMENTS&option=School%20of%20Nursing]
Georgian Nursing Association [ http://212.72.145.221/Maro/nurses/Georgian-nurses.htm ]| Photo Galleries | 1 | 2 | 3 | 4 |
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