In palliative care we don’t have three months to wait for bureaucratic decisions to be made

There is a house in the convent courtyard with a large balcony. They told me that in summer, they would simply lay out mattresses there, and everyone would live together. It was chaotic and incredibly difficult. Over time, it became clear that enthusiasm was not enough—a system was needed. Some of the residents—children and their parents—were moved to communities in Dzhegvi and Bediani, where shelters still operate today.

However, Mother decided that care for the dying should remain at the convent. She believed this ministry was deeply connected to monasticism as a form of accompaniment for those transitioning into eternal life. That is how our hospice began—a small house for six people that still stands today.

In the past two years, practical care training has become mandatory for opening mobile services or nursing homes in Georgia. We hold a state licence and conduct government-approved training sessions. Apart from us, such training is available only through the Red Cross or Caritas.

The state is increasingly active in supporting mobile palliative services. Previously, this was a municipal project with very strict criteria: home care was available only to those with extremely low social standing. It was unfair—many people in need didn’t ‘meet’ that bar on paper and were left without care. Now, the criteria have been relaxed.

For a long time, we deliberately chose not to join the state programme to preserve our freedom—to accept everyone who truly needed it, based on medical and human factors rather than formal indicators. Now that the conditions are more flexible, we have begun collaborating with the state, though we have only a few ‘state-funded’ patients so far; we cannot abandon those we have cared for over the years.

Ekaterina: How did you personally find your way into palliative care?

Mariam: As a child, I dreamed of becoming a doctor, but life took a different turn—I studied economics and law. Yet my interest in medicine never waned; I even wrote my thesis on healthcare management.

When I returned to Georgia after years abroad, I remembered the nursing school and the hospice at the convent. I went there as a volunteer, hoping to help out a bit. But it soon became clear that administrative support was needed even more than extra hands, so the Mother Superior gradually handed over management to me.

Thanks to my education, I had a theoretical foundation, but in practice, things proved more complex. In the early years, I was learning on the job—accompanying nurses on home visits, diving into every case, and, of course, completing the palliative care courses myself. In the end, it became my life’s work.

Ekaterina: Was there something personal in your life that specifically drew you to caring for people at the end of life?

Mariam: While I was a student, I cared for my great-grandmother’s elderly relatives. Ever since then, the fate of the elderly has moved me to the core: often, there is simply no one to help them.

Mariam: It began with our acquaintances, and we then launched a social media campaign with the call to action: become a friend of the hospice. The response was excellent—over a hundred people reached out immediately, and most of them have stayed with us to this day. We’ve tried repeating the campaign, but the results have been more modest. I feel we haven’t quite found the way to reach new audiences yet.

We also engage with organisations: we invite them to visit us and share our mission, and some become long-term partners. There is certainly room to grow our fundraising efforts, but we continue to experiment with different formats.

The Tabitha Pop-Up Shop is our lifeline. We’ve held it once a year for four years. We collect brand-name clothing, designer items, and private donations for sale. Even as second-hand items, these pieces have significant value and generate substantial income. We are often almost out of funds just before an event, and Tabitha helps us pull through.

Designer Maka Asatiani plays a major role in this project. Thanks to her connections and influence, our pop-up shop has reached a new level—it’s not just a sale but a genuine, high-profile event. For three years, the Stamba Hotel hosted us, and last year we were at the Marriott on Rustaveli Avenue. Alongside Maka, other public figures also support us, and we are infinitely grateful to each of them.

Additionally, the Patriarchate has provided significant support over the past two years. Previously, they funded only educational programmes, but they now also allocate funds to patient care. Through these collective efforts, we continue our work.

Ekaterina: Do the nuns participate in patient care, or are these roles separate from one another?

Mariam: The roles are clearly defined. The nuns do not participate in clinical care—they visit the inpatient unit to provide spiritual support and speak with patients. If requested, our chaplain can offer Communion or simply have a heart-to-heart talk. As for management, the Mother Superior is fully involved in all processes—she is always present, helping us uphold our values and fulfil our mission.

Ekaterina: In some religious views, suffering is regarded as a spiritual path, and there is an opinion that pain relief is an obstacle to that journey. Do you share this view?

Mariam: No, we take a completely different approach.

Ekaterina: Do patients’ relatives continue to support you after their loved ones pass away? Do they become ‘friends of the hospice’?

Mariam: Usually, no. Sometimes they come to thank us or bring treats, but they rarely become regular donors. This may be because many of our patients come from underprivileged backgrounds and their families simply lack the financial means to provide ongoing support.

Ekaterina: We have an interview with Irakli Vetsko, head of the Firefly World children’s hospice, in which he discusses the specifics of paediatric palliative care in Georgia. In your view, is there a difference in how society perceives children compared with the elderly?

Mariam: It is probably somewhat easier to raise funds for children: people subconsciously hope for a miracle. Yet palliative care—whether paediatric or adult—is a field where there is no hope of a cure. It is psychologically difficult for many to help in a situation where the person ‘will die anyway’. This requires a deep understanding of the value of those final days or months. Usually, this is realised by those who have experienced the loss of a loved one. We still have a lot of educational work ahead of us.

Ekaterina: What is the most pressing issue facing the palliative care system in Georgia right now: funding, legislation, or public awareness?

Mariam: Funding is likely the first priority. We are catastrophically short of inpatient beds and of resources to expand home care. Legislation and public awareness are equally vital. However, the most difficult issue is the shortage of qualified, dedicated nurses and palliative care professionals. Many skilled specialists emigrate from Georgia because salaries are higher abroad and they need to provide for their families. I believe this is our greatest challenge right now.

In fact, all these aspects are inextricably linked: without public understanding, there will be no movement at the top; without movement at the top, there will be no funding; and without funding, there will be neither staff nor public attention. The experience of Europe and the US shows that palliative care must be funded from multiple sources: the state, donors, insurance companies, and volunteers.

To my knowledge, in Spain, palliative care is funded half by the state and half by one of the largest banks. It is very important for our private sector to recognise its importance as well.

Ekaterina: Tell us about your training centre: how many people are involved in the project?

Mariam: The team is small, comprising three or four permanent instructors. Two lead the core care courses, and we also have specialists in communication and first aid. For internal staff training, we invite psychologists and coaches. The centre offers both state-certified programmes and our own short-term courses in dementia, kinesthetics, and wound care.

Ekaterina: Who are your students?

Mariam: Professionals—both those who want to work with us and employees of other organisations—as well as patients’ relatives. We run state training sessions once a quarter and short courses almost every month. We post announcements on social media, and the groups fill up very quickly.

In addition, we are active in the regions: we trained teams in Akhaltsikhe, Racha, and Borjomi ahead of the launch of their mobile palliative services. This was a large-scale project implemented with support from the UNDP.