Emory, Grady and Morehouse
collaborate in Georgian Republic
For 75 years, Soviet medicine developed largely without reference to
advances
in Western medicine. In most areas outside Moscow and St. Petersburg, the
technology and level of care lag behind medical developments in the
United
States by 40 years.
Though Tbilisi, Atlanta's sister city in the Georgian Republic, was one
of the
chief Soviet cities and its citizens enjoyed one of the highest levels of
academic and scientific achievement in the former Soviet Union, health
care in
the Republic has deteriorated seriously over the past five years.
In the spring of 1992, the American International Health Alliance (AIHA)
worked with the Emory School of Medicine, Grady Hospital and Morehouse
School
of Medicine to set up an Atlanta-Tbilisi partnership, one of 21 such
partnerships between U.S. institutions and republics of the former Soviet
Union. An office was established in Tbilisi in June 1993 headed by Public
Health alumna Sherry Carlin.
Reform
Health care reform, the partnership's earliest and currently most
advanced
effort, has been spearheaded by Richard Saltman and Jim Setzer of the
public
health faculty. The challenges within the republic are immense: 10 times
the
physicians and hospital beds of the state of Georgia with a comparable
population, 6,000 medical students, incredible subspecialization. Carlin,
Saltman and Setzer have worked closely with a Georgian Task Force on
Health
Reform comprised of economists and physicians.
These efforts have led to involvement of the World Bank, which is
providing
advice and, potentially, a $20 million loan. In addition, a health care
reform
package has been approved by the Council of Ministers.
Women and children
The second large project involves maternal and child health, and
reproductive
health. Physicians Susie Buchter, Al Brann, John F. Huddleston, Kathryn
Huddleston and Robert Hatcher, all of Emory's pediatrics and
gynecology-obstetrics departments, have spent nine months putting
together a
plan that involves transforming the children's hospital and maternal
hospital
in Tbilisi into a model, national perinatal center, in addition to
establishing
a perinatal data surveillance system, assuring perinatal care for
mothers,
neonatal care, infant and child care including immunizations, and family
planning.
Information highway
Carol Burns of Emory's Health Sciences Library is planning to establish
Internet in Tbilisi and to develop a regional library network with access
to
Western electronic databases. An information resource center will be
established in Tbilisi and linked to Internet and to regional libraries.
The
Resource Center will provide access to Western electronic databases of
all
sorts, will train librarians in informatics, develop a union catalogue,
and
create a plan to digitize priceless ancient Georgian documents so Western
scholars may access them.
Medical education
Jonas Shulman, associate dean for student affairs at Emory's medical
school,
and Jeffrey Houpt, dean of the medical school, have met extensively with
their
colleagues in the Tbilisi State Medical Institute. A major curriculum
revision
is being planned to move the school from a 1920s European-style to a
modern,
Western one.
Four junior medical students from Georgia come to Emory every six
months. They
are housed at Grady and spend time with Emory students on the clinical
clerkships. Four Georgian interns are in the Emory Affiliated Hospitals
program
this year as transitional interns.
A hospital facelift
The partnership is working to transform City Hospital No. 2, a 400-bed
general
hospital, into a modern Western-style academic hospital that will train
the
future clinical teachers of Georgia, as well as deliver excellent patient
care.
The Georgian chief of hospital engineering spent much time with Mark
Manion of
Grady's engineering department, to see that the hospital was designed to
meet
Western standards.
A long-term commitment
Emory's goal in working with the Republic of Georgia is two fold. It is a
rare
opportunity to assist the Republic of Georgia in developing a modern
health
care system. A second goal is to use the project as a role model for the
United
States in assistance to the many countries that need such help, from the
republics of the former Soviet Union to South Africa and Asia.-- H.
Kenneth
Walker and Paul Klever
This article was originally published in Atlanta Medicine. Walker
is
professor of medicine in the School of Medicine; Klever is the
administrator of
the Atlanta-Tblisi Partnership.