Deliver purchased hospital equipment
Thanks to the money raised in previous months we have been able to purchase a few simple but essential medical equipment tools – plastic surgical skin drafting (skin drafting), skin drafting blades, electrical syringe driver, rigid cystoscopy kit, Ultrasound with facilities for examining general surgical conditions - obstetric, gynecological and urological conditions, i.e. very versatile equipment -, pneumatic tourniquet’ for upper and lower limbs surgery and disposables (gloves, gowns, needles for the operating theatre).
We have also paid the medical staff salaries directly. The bank transfer is not yet efficient and reliable as we would have liked to have and we don’t want to risk our money and the medical staff salaries been lost somewhere in the bureaucratic jungle or falling. As much as we can we would like to have a transparent and efficient “modus operandi” which is not always that evident in Countries and situations like this one.

Assessment of Project viabilities
We discussed a Business Plan for running Hippocrates Hospital with our Doctors.
We have identified a series of low maintenance, high output revenue streams by which the Hospital could generate financial self sufficiency for further investment and expansion of services. Estimates of patient flows and revenue generated would cover costs of wages and medicines at current levels, not taking into account the increase in expenses generated by further expansion.
Therefore we would propose the need for further modest capital investment to initiate this process. We would need Blood testing analyzers, ECG, X ray facilities, gastroscopy and cystoscopy facilities, which play to the strengths of the staff employed and their particular skills.

A specimen of estimated revenues:

Estimated monthly revenue: 12000Lari+  = £3000+/ month

We should be able to complete the Hospital phase of our project with a further investment of £6-7,000. And from then on concentrate on slow self sustained expansion with a lower level of financial assistance.

Dental Cabinet
In Duisi village the MSF supplied minor operating room is now defunct, though with some surgical equipment stored. MSF have closed their office in Pankisi as of end 2006.
The other public health need of great importance in Pankisi is access to free dental care. The Cabinet provides an ideal opportunity to make use of a pre-existing facility. Dental disease is universal, and almost universally inadequately treated in the entire refugee and indigenous Kistin population.
A well stocked dental clinic could be organized for less than £2500 buying modern good quality equipment from China. A salaried Dentist might be obtained locally for $75 month.

Tuberculosis
Anecdotally there are a large number of cases, those of which have been identified in Chechnya by our European contacts, who may present us with an opportunity to provide assistance by the purchasing of their medication. Current treatments for TB involve labour intensive Directly Observed Protocols for drug administration. In plain speech, a six month regime of drug compliance is overseen on a daily basis by health professionals who supervise administration, and follow up complications, whilst performing other relevant functions such as contact tracing and treatment where indicated. In addition there are established players in the field such as MSF who have specialized in tuberculosis treatment under the DOT’s regime for more than ten years. In stepping into this field we would have to exercise great caution in not antagonising other humanitarian aid partners.

Ambulance
We looked in Tbilisi for second hand Ambulances. There are no cost effective options locally. The Soviet Vehicles are shambolic and barely more than a Van and overpriced, although a new one could be purchased in good running order for £2-3000. Alternatively we can purchase a good second hand Mercedes Benz Ambulance from German with some equipment included for £3000- £4000 maximum.
This would then be driven across Europe with the bulkier medical supplies that we anticipate purchasing.
The Mercedes Benz option has the advantage of an abundance of spare parts locally, has superior fuel efficiency and is a rugged design to cope with poor roads. We would estimate saving at least one life per month, that is the current attrition rate in the villages due to lack of transport to the local hospital.
It could also be used to provide an outreach service to reach more remote populations to provide on the spot diagnosis and treatments.
Certain pieces of Emergency medicine equipment have been purchased in anticipation of equipping this vehicle, geared towards life saving measures in traumatic or acute medical situations. This includes a fracture immobilization splint, fully equipped trauma bag with inflatable splints,.
This Ambulance will likely be stationed in Duisi by the planned dental- cum medical clinic cabin, thereby providing a rapid response to emergencies in the community. I myself witnessed the results of a fatal road traffic accident in January, and two stabbings in March, that would have been appropriate for transfer by such an Ambulance service.

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