Medea-2011
24 February, 2011
Medea-2011

On February 1st, an organized event was held in Washington D.C. It was not a protest or a demonstration, but a peaceful conference put together by the Embassy of Georgia and the Ministry of Labor, Health and Social Affairs. The First Lady of Georgia Sandra Roelofs presided over the meeting. The Georgian Healthcare 2020: Medea-2011 conference, as it was named, was not announced in any newspaper or on any blog that I could find, and the gathering, at least on the

part of Georgians living in the States, was more or less a word of mouth. The reason behind this was, as Embassy of Georgia representative pointed out, no official database of Georgian healthcare professionals in the US exists. It is not surprising that Georgian community does not have a database for the expats, because Georgians don’t have a community like Armenians do.  Georgians, at least the ones in the US, like to keep to themselves and are rather skeptical of any social gathering with their compatriots. Even so, there are exceptions to this strange code of behavior and those exceptions came together at Medea-2011 conference prepared to work.
The first thing they agreed on that there needs to be a database of all healthcare professionals currently residing and working in the States. Coming up with the name for the said database has proven to be a little tricky, but everyone agreed that the database needs to exist.
With that out of the way the conference continued on to issue of Residency and Board Certification. For those of the readers not in the medical field, let me explain American system of healthcare. First the students out of high school go to Premed. It’s hard to get into, very selective and it just gets worse after that. Medical school is brutal and if the student survives that he or she gets to take the final test and become an MD. Legally that is all you need to practice medicine. But hospitals tend to not even look at doctors who haven’t gone through a Residency program. So unless the MD is about start a private practice somewhere in Utah, he or she needs to apply for Residency program. The Residency program is a 3 to 5 year program depending on the area of study. It is the toughest program in the world. Surviving that takes Herculean effort, no sleep and no social life. Brains and talent do help, but it’s the ability to learn fast and never sleep that pays out in the end. But that’s not the end. After Residency a doctor takes a test called Board. After passing this test he or she becomes Board Certified. In certain field: internal medicine, pediatrics, surgery. If the doctor wants to become specialist in a specific field, for example cardiologist, or pulmonologist (lung doctor), he or she needs to apply for a Fellowship program and complete two to three years of extra training. After completion of the Fellowship program the doctor is expected to take another Board exam in his or her specialty.
After this the doctor who passes all this and doesn’t give out due to exhaustion and malnutrition, he or she will be making the big bucks he was promised in Medical school.
Interestingly enough this system has been deemed good enough to be copied by most of Europe’s leading medical branches.
In Georgia there is a great interest in the Residency program, but no way of paying for it and no hospital to host it. In the US, the Residency program is like the army, (in more than one way) the government pays for the entire time a doctor is in the program. Does the Georgian government have those kinds of resources?  With Board Certification for Georgian Doctors it is a bit tricky, because when doctors in the States take the test they have the advantage of having studied in the States. Unlike their Georgian counter parts that will have to do their best and take the same level test without the benefit of American schools. The participants in the Medea-2011 conference were asked to provide Board Certified questions and materials for Georgian doctors. This would not be unreasonable if the same request was not made a few years ago with no follow up. When the original request for Board Certified information was issued, the materials including books and study guides for Board certification of Surgeons were brought to TSMU, but nothing was ever done about it. What makes this time any different?     The same goes for the request made on all Georgians working in the healthcare in the US to come donate time and experience in Georgia. There was no system for this worker program in the past and there isn’t one now. If a doctor wants to come and help out in Georgian clinic, it is still up to him to find the clinic and arrange everything.  If anything, this meeting showed clearly that there are plenty of good ideas and ideology floating around, but not enough strategic plans to implement any of them. Let’s hope this was not just an exercise of public speaking, but a serious request for advice that will be heeded. But besides this skepticism there were many good points brought up at this meeting.
One such point was about Pharmaceuticals.
No matter how much I like walking into a drug store and buying just one tablet of headache medication, I really should not be able to buy penicillin just as easily. In the States if a patient is so sick that over the counter medication is not helping, the patient has to go to a doctor to get prescribed antibiotics. In Georgia anyone off the street can ask a pharmacist to suggest the medication. Everything is available at the local drug store. For someone who knows about medication or has family of professional doctors and can tell which medication to take it’s easy. But a lot of people don’t know if what they are buying is the correct medication for them. This doesn’t have anything to do with headache medications or flue medications. This is about prescription antibiotics. Like the ones being administered for TB (tuberculosis) which seems to be a serious problem for Georgian public health. That is not a number to sneeze at.  A doctor can correctly diagnose and treat the disease, but if not treated properly the wrong antibiotics build a resistance to TB. If Georgia is to contain any viruses and diseases form spreading, there needs to be a clear line between over the counter drugs and flue medicine. A pharmacist is not a doctor. Point taken! And then there were some ideas brought up that didn’t sit so well such as an unhealthy interest in turning to American style healthcare for a solution. In United States Health care is a very sour subject. Almost no one is happy with it and no one knows what to do about it. World Health Organization has ranked United States healthcare system at number 37. France is ranked number 1, while Italy is ranked number 2.  Funny enough when it comes to healthcare expenditure the US are number 2, France is number 10 and Italy is number 27. Mortality amendable index US is the last one the list. When sixteen other countries have improved by 16 % since 2000, USA has only improved by 4 %.  This is mostly due to half of the country being uninsured. Insurance costs are too high, and because the costs are too high and the insurance companies couldn’t care less, half of the country goes uninsured. With deductible costs going up and doctor patient care suffering under time constraints (it is common to wait an hour past your appointed time to see a doctor who keeps looking at his watch as he examines you) the ones who are insured are not faring much better.
As the Commonwealth Fund President Karen Davis has once said “While no one country provides a perfect model of care, there are many lessons to be learned from the strategies at work abroad”, which is why the Medea-2011 Conference presenters and speakers were interested in learning more about American healthcare system. Granted that healthcare system in Georgia is in serious need of a makeover (Georgia is ranked 114 by WHO), one would hope Georgian government would study how the countries that rate higher than 37 on WHO’s healthcare ranking are doing their job and at least consider adopting a more appropriate system for Georgia.
There were many more points brought up at the Medea-2-11Conference and most of them valid. In fact there were too many to write just one article about, so they televised the whole conference. The conference can be view on http://www.mdxp.com  And even if nothing comes of it, and I do hope I am wrong, it was an important meeting and people should get involved if they want to have a say in building a strategy for the healthcare system for Georgia.

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