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its own, Tbilisi faces myriad problems, among them its deteriorating infrastructure and public services--including its outdated, disintegrating health care system.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:

"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."

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