Pain Control in Georgia
Dr. Mariam Velijanashvili is completing her training as a neurologist in Tbilisi, Georgia. She is strongly motivated to develop the field of neurological palliative care in her country, for which now she is involved in the international fellowship program at San Diego Hospice and The Institute of Palliative Medicine, San Diego, California. She is a member of Georgian National Association for Palliative Care.
The development of palliative medicine as a field and service has been quite rapid in Georgia and many changes have been made since the beginning of 21st century. Through partnerships with many individuals and organizations, Georgia has received guidance and philanthropic and educational support.
Two physicians from Georgia have already been trained as Palliative Care (PC) experts, and they are delivering PC for inpatients as well as home-based care through the Palliative Care Department and the Cancer Prevention Center, both at the National Cancer Center. Palliative care has been initiated in a number of regions of Georgia as well, most of the main cities now have PC consultation. More and more doctors and nurses are being trained in basic and advanced skills in how to deliver PC and pain control for their patients.
Importation of oral morphine has been initiated in Georgia, and education about the use of morphine and other palliative drugs is being delivered to a constantly increasing number of healthcare providers. Textbooks and study materials were published in Georgian, and PC has been introduced into the medical curricula of students and residents. The Georgian National Association for Palliative Care (GNAPC), and its head Dr. Dimitri Kordzaia, have been advocating for policy change with the Parliament of Georgia. With the support of the First Lady of Georgia, Sandra Roelofs, the Parliament and especially the Health and Social Affairs Committee, this advocacy led to amendments in four of the health care laws of Georgia, which made PC an obligatory and indispensable part of medical service in Georgia.Regulations around the importation and prescription of opioids have also changed, allowing improved access to much needed pain medications for the people of Georgia.
Despite these changes, there continue to be significant challenges in access to medications: restrictive prescribing regulations, limited access to PC for much of the population, and continued concern about ongoing government funding in this time of worldwide economic crisis. Public awareness about the meaning and value of PC and hospice care also has to be delivered to the population of Georgia. Another challenge is the integration of PC into the new healthcare system in Georgia, because it is currently under the painful process of reforming and reconstruction. There are still many things to work on.
Despite these challenges, PC is growing in Georgia. There is increasing effort in education, drug policy, drug availability, and patients’ access to care within Georgia and through continued collaboration with many individuals and organizations. With ongoing government and political support, PC can and will be expanded. I think we are on the right path to success, to build society with people who can live well, die with dignity, and be free of suffering and pain, which is actually the essence of PC. Special thanks to our friends and supporters through this difficult path. Their friendship, warmth, and love help us keep doing our best to develop PC in our country, and strengthens our dedication to this field.
