Current needs of the hospital in priority

1. Ultrasound machine: to cover a wide range of investigative procedures, particularly obstetric and surgical problems such as gallbladder disease, renal calculi.

This will serve several purposes:

• Generate income for the hospital
• Reduce the need for trips to Telavi and Tbilisi for investigations
• Speed up the process of patient through put.

Estimates of daily use would range from 20-30 patients a day, as the Akhmeta Raion is poorly served with advanced diagnostic technology. The hire Ultrasound is functioning poorly.
A good ultrasound machine will put the Hospital on a strong financial footing and rapidly attract a wide patient base as the entire region and neighboring countries have a very limited service for diagnostic analysis. Tbilisi has sufficient facilities apparently for repairs.

2. Gastroscope:
   to provide diagnostic modality and treatment arm for peptic ulcers and gastrointestinal bleeding  which is a common problem in the locality.
   This could be purchased locally for <$1000 from Tbilisi, using reliable Russian technology. The Western equivalent would be from $2-5000, but provide high quality income generating equipment.
   Gastroscopic. Investigations in Tbilisi cost 50 Lari and in Akhmeta we would charge 30 Lari to private patients. Estimates of daily patients would be 2-3. There would be difficulties in a greater turnover without more scopes as these have a ½ hour turnaround time for sterilization.

Clearly the Gastroscope is a good investment and would pay for itself within a year quite comfortably bringing in $200 -$250 per month if one private patient is treated per day.

3. Ambulance/ Patient Transport
   We could purchase an ambulance and a UAZ jeep for long distance patient transport. The ambulance would be used to transport people from the local villages to Akhmeta, and the Jeep used to transport patients from more rugged terrain. It is not a fuel efficient taxi service to Tbilisi though!
   The UAZ costs $500-600 and does 100km/20 litres of petrol, which in turn costs $1/litre.
   The trip to Tbilis and back is 360 km, therefore a round trip should cost $70-75 in a UAZ. A new Japanese Ambulance typically does 10km/litre which would cost $35-40 for a round trip to Tbilisi and would need to transport 4 people at the current going rate just to meet its fuel bill. People currently pay $8 for a round trip to Tbilisi.
   Therefore there is no cheap way except by mass transport of patients to cut down travelling costs to and from Tbilisi. The presence of high tech diagnostics in the locality would obviate many of these transportation costs.
   An ambulance stationed in one of the villages would be best placed to respond to emergencies amongst the Chechen community, minimize response times, and save unnecessary fuel wastage. While I was there, one young male died in a car crash on the road out of the villages. A well equipped Ambulance could certainly save lives or buy time to bring them to Akhmeta for definitive treatment.

4. Operating Theatre
   It’s basic but adequate for short operations under General anesthetic. We will look into purchasing a good quality operating table, as the current one is quite primitive and not adequate for complex surgery. We shall also look to purchase microsurgical equipment and burns debriding knives which would significantly increase our Doctors’ capacities.
   New this blade has a quote of £446 with 10 blades spare.
   Burns are common injuries in children due to open stoves and floor level cooking hobs, and the appropriate surgical equipment is not available.
   Trauma cases resulting in severed small vessels and nerves would be optimally treated if our Doctor has a microsurgical kit available. Another vital purchase will be to buy European suturing material, as the Russian made material is particularly difficult to work with and of dubious quality.

5. Medicines
There are apparently tight controls over importation of Medicines into Georgia. Clearly we will need a guarantee from the Ministry of Health before we attempt to involve ourselves in this aspect of healthcare. Currently the monthly budget allocated is estimated to be sufficient.

 What has been done for the Hospital this trip

1. Established a Bank account at the Local branch in Akhmeta to facilitate international money transfers, which can be used for the monthly payment of salaries.
2. New computer purchased with MS word and Excel spreadsheets.

I sat with the Accountant and set up a simple ledger for monthly outgoing costs covering Wages, medical equipment purchases, medicine expenditure, fuel bills.
When internet access is established, these will be sent by e-mail for monitoring.

3. Contract signed for 1 year as of November 2006. Contracts signed by a Lawyer in Tbilisi acting as Witness.
4. Priority list of needs for the hospital
5. Estimate of cost to renovate four further rooms (800 Lari or £200)

The Refugee Problem

We visited the Villages and stayed in Duisi for 4 nights. It was very cold in the night, and clearly warmth is a major problem for the refugees. Having spoken with a number of local people, village elders and our Doctor and his wife it is clear that the following problems exist.

1. Staying warm at night in the winter months
2. Poor access to warm water
3. Poor hygiene because of the lack of warm water
4. poor winter clothing
5. poor quality accommodation
6. lack of job/ educational opportunities for young people
7. Inadequate calorific intake
8. Appalling dental hygiene

1. Winter Clothing: The Charity shop network in the UK sells clothing at very low cost.  £1-3 for a bin bag of clothes. A very large amount of clothing could be purchase for less that £1000 for transport. Duisi alone has 700 refugees resident.
2. Educational Opportunities: I have asked our local contact to find four students to study in Tbilisi from this September. I have asked her to find at least two who wish to apply for teacher training college. I will fund this myself. This is something we could develop as a Charitable partnership linking the UK public with sponsorship of Refugee youngsters to pay for their education.
3. Inadequate Calories: This is a problem for refugees who do not have access to land in order to cultivate livestock. Several tried rearing hens for eggs and failed. In addition they do not have the resources to buy the feed necessary. Animal husbandry is not easily done without land and capital, nor are there opportunities to grow fruit and vegetables. One solution maybe to but some land and organize the refugees into a collective to cultivate and share amongst themselves the harvest. Clearly land is a major issue here. The UNHCR provides 100kg wheat per year per person, 3kgs of sugar and 1litre of oil per 3 months. A low space requiring, high energy yield food would be honey. It would only work on a large scale, with somebody specially trained to cultivate the bees and harvest the honey. However it could generate revenue, needs little space, and would provide much needed calories during the winter months.
4. Dental problem affects the entire refugee problem causing a huge amount of misery and likely contributing to general ill health. The connection with dental sepsis and cardiac disease is well known. A Dentist paid to occupy a ‘Kabinet’ in one of the villages could serve the entire refugee population. This would be enormously appreciated by the refugees and locals alike. A salary would cost $50/month.

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