Whether people die amidst sophisticated medical technology or relying on the most basic care, our common needs as human beings are universal: comfort, dignity and love.
The care provision and resource availability in palliative care vary enormously around the world.
Significant progress has been made on palliative care development in Georgia. With the contribution of international and local non-governmental organisations, major changes are being implemented on the availability of controlled medications, as well as on policy, education and service provision.
Currently, an inpatient palliative care unit with 18 beds functions in Tbilisi, based at the Universal Medical Centre.
The cost is partially covered by the state. Due to financial issues (very low cost of a patient day) other inpatient units were closed in Tbilisi and other cities of Georgia.
Ambulatory services function with limitations under the state programme and only physician’s service costs are reimbursed.
Also, the holistic approach of palliative care still remains inadequately acknowledged by policy decision makers in Georgia. This causes many problems and challenges for the management, staff and practitioners.
Availability of medications
Despite these challenges, one of the major achievements in palliative care development in Georgia is the modernisation and liberalisation of opioid prescription rules and regulations.
Currently, medication containing narcotic substances can be prescribed for the management of pain for chronic, incurable patients for seven days. Before, the limit was three days.
Two different narcotic substances and their different forms can be prescribed on one prescription.
Also, significant changes were achieved with regard to availability of opioids – management of chronic, severe pain using opioids extends not only to cancer patients, but also on other somatic chronic diseases in advanced stages.
Primary healthcare staff, family doctors and village doctors are allowed to order and prescribe morphine independently.
Education and capacity building
Important steps have been accomplished in terms of capacity building in palliative care, that contribute to further development of the field in Georgia.
Several accredited continued medical education programs were prepared and implemented. One of these was a special four-month subspecialty course in palliative care, elaborated by the Georgian Palliative Care Association in 2014 and adopted by the Ministry of Labor, Health and Social Affairs.
As a result, currently there are 24 licensed medical doctors trained in palliative care through this programme.
With the financial support of Czech Development agency, Cancer Prevention Center and Caritas Czech Republic in Georgia, Tbilisi State Medical University accredited intensive training course for family doctors, conducted in the frame of the project: ‘Oncologic Education of Family Doctors’, have been delivered.
Training was on issues of oncology with the special module on palliative care. The module is developed and delivered by international palliative care expert, Dr Ioseb Abesadze.
This module is based on the multidisciplinary approach in palliative care and gives primary healthcare staff basic knowledge and skills for the practical provision of care.
Special topics of the module also concerned interdisciplinary work of the palliative care team, including social work as well, that was delivered by the alumna of St. Christopher’s Palliative Care bursary program – Salome Vadachkoria.
Overall, the training program highlights the holistic approach of palliative care, emphasising the role of medical professionals, social workers, psychologists/psychiatrists, spiritual counselors and other team members.
Family doctor trainings aim at laying the foundation for community based palliative care model development in Georgia, which will increase the availability of basic palliative care services in Georgia and also increase recognition process of patients with special needs for transferring them to the specialised palliative care units.
Developing palliative care social work in Georgia
Important steps forward have been accomplished in terms of social work development in palliative care in Georgia.
In August 2013, a university course on palliative care was established for social work students.
The Georgian Association of Social Workers (GASW) participated in a World Hospice and Palliative Care Day celebration.
A subsequent step was the initiation of a joint project in palliative care development with Tajikistan.
In process, GASW hosted a delegation from Tajikistan in Tbilisi. Delegation members visited Ivane Javaxishvili Tbilisi State University, where a module in palliative social work is currently in the curriculum.
In addition, Hospice in Tbilisi and Palliative Care Association of Georgia presented their space for discussion with delegation members.
Sharing experience on the international level
On the international conference held in Georgia for the 10th anniversary of GASW foundation, a special symposium was devoted to the discussion of the role of social work in palliative care.
The discussion was fruitful with participation of Salome Vadachkoria and Christina Martines, president of the International Federation of Social Workers (IFSW) from Portugal.
As an outcome, professional awareness was raised about the role of social work in palliative care. Also, GASW board members visited Portugal to see palliative care services in that country. Therefore, there is collaboration with IFSW around social work development in this field.
Overall, the foundations for further collaboration with the international palliative care community have been even more strengthened.
This will hopefully contribute to accomplishment of more partnership projects.