This journal will form an account of my October, 1999 trip to Tbilisi, Georgia, to work on improvements in the rehabilitation of amputees who are land mine survivors.
After we had seen all the amputees available that day, the men from the trauma center took me out for a supra, the traditional Georgian dinner. I had heard much about this event, but was really amazed upon experiencing it. Dinner is set much like a thanksgiving meal, with dozens of dishes for all to try, brought in courses of breads, salads, and various meat pies and dishes. My stomach was still turning flips, so I think I was not the most enthusiastic guest of honor, but I hope they’ll forgive me. Shortly after the start of the dinner, someone pours wine for everyone and nominates a tamada. For our dinner the director of the institute was chosen to serve this important role as toastmaster. Toasts are offered in a specified order, and then become more personalized in a time-honored tradition. The toasts take the shape of something in between a Jewish Passover seder and what we sometimes call “sentence prayers” where members of a group will take turns praying for whatever is on their hearts. The first toast is for the Motherland. I was the guest of honor for this meal, so first we toasted the Motherland America, and my hometown, “Nort Carlina”, Then we toasted the Motherland Georgia and each person’s village. I found it interesting that we usually call America “Fatherland”. Next was offered what the group declared was the most important toast, to each person’s parents. Special language was used for each person at the table based on whether their parents were alive or dead. It was explained to me that parents live in their children, and then again in their children’s children, so dead parents are considered “alive” in their offspring. The next toast was for peace, which is always timely here. Georgians have a proud history of defending themselves but never conquering others. Their country has been conquered and changed hands literally dozens of times, so they appreciate the presence and price of peace. Our more personalized toasts preceded these, since the tamada had only just met me and wanted to recognize me first. I was toast ed, as well as my work, my family, and just about everything about me in flowing language. The people waiting for my return in Atlanta were toasted, and then the success of my project. The tamada then toasted each of the people at the table. A special toast was offered to the only female at the table, again in poetic language, expanded to include all women, and I was told that Katia would be angry if I did not finish my glass of wine, ghvino. A word about their wine: they drink it by the gallon! Glasses are filled before each new toast, and usually emptied during. The wine was brought to the table in large glass pitchers that must have held several bottles each. I never drink wine, so I could not keep up. but did my best. I told them Katia would forgive me. I mixed in a few toasts of my own in turn, one for the men at the table who work in the trauma center. They work for paltry wages in terrible conditions with no equipment, working only from their desire to help others. I explained that physicians in America often start their career with a similar desire of philanthropy, but often lose this desire and work merely for the money or the status. I applauded their efforts and encouraged them to continue in their philanthropy despite the hardships. I also toasted the health of their patients, which prompted Paata to deliver a long and passionate speech about the importance of my work here. He brought up Maggie, the young girl I saw earlier that day, and said she was one of so many who have nothing here. He said that to his patients he is hope, and he is frustrated when he does not have the resources to help them. He is so grateful for my interest and hopeful that they might have proper, modern equipment to help people like Maggie. He said that to amputees and people like Maggie’s parents I am from God. I learned later that Paata has two daughters, 4 and 6, and I can see why he, like me, was particularly touched by the little girl.
Today, Tuesday, I saw a few more amputees and toured the trauma hospital. It’s a massive building made of plain blocks of poured concrete that is sparsely occupied, as most citizens cannot afford medical services. Room and board is 10 Lari a night, ($5) but the normal pension is 8 Lari a month ($4), so people either do without or pay a doctor for a house call, which is much cheaper. Equipment here was also quite old, although I did meet a surgeon who specializes in total hip arthroplasty, and his endoprostheses looked modern enough. He was full of questions about hip replacements, and I could offer little help. At the hospital I encountered more people with little odd jobs, like the woman who operates the elevator. It appears to be all she does, and we could not get on the elevator without first signaling her with a loud buzzer. She opened the doors for us, then pushed our floor button. (I was glad we only had to ride this elevator twice!) There is also an older fellow who stands in the parking lot and opens the gate for cars to come and go, and then closes it after them. He does not check for a pass or anything: any car can get in: he just opens and closes the gate all day I asked why they needed someone to do this, and why they even bothered closing the gate, and was told that this was an old Soviet custom “gate is always closed?” There are also these ubiquitous parking attendants. They carry around a small black and white stick, and I have yet to be in a parked car that has not had to pay a stick guy. At the market, at the restaurants, on the street, parked on aside walk, the stick guys are everywhere and seem to do nothing. They usually sit in a chair and walk up to cars as they leave to collect their coins. Even the most remote side streets have a stick guy Archil told me that this is a means to reduce unemployment and to give refugees something to do. I like this idea but I think it would be better if they actually served a purpose. This evening I walked around a bit on my own, taking some pictures of streets and people. I met a curious group of kids who giggled madly when I showed them their picture on the digital camera. I bought the girls some butterfly barrettes. The butterfly wings are on springs so they flap all the time; many girls here wear these. Cirls are usually quite done up, with their hate in some fancy do and wearing fancy skirts or dresses. They also look like they have makeup on, although this must just be the natural look of their faces. The boys dress a bit more slovenly, but then they are boys after all. The adults all take great pride in their appearance. They wear fancy leather shoes and clothes that are neatly pressed and stylish. They also all still stare at me. I don’t know why I expected this would have worn off somehow!
I had another fascinating conversation over dinner at Betsy’s. The clientele here are a global lot and as one might expect are full of interesting stories. For those folks travel is a practiced fact of life, and living abroad commonplace. “Expatriated American” become abbreviated in casual speech as “expat”. This evening I dined on Hungarian food with two attorneys, one currently from Prague, originally from Texas, and the other unable to pinpoint “home”. The homeless attorney was in customs law, so I was able to ascertain from him the reason for the Tbilisi airport security guard’s suspicions about the laptop I brought here. There is an import duty of 15% here, and although this is changing soon it does apply to computers. Also, if the item is to be used for commercial purposes a 20% VAT also applies. So, they could have legally charged me a hefty sum for the lap top, had I explained its destination more accurately I’ll add this to a growing list of countries where I have broken some sort of law before I’m scarcely out of the airport
I was watching a tennis match on EuroSport, but the TV is on the blink again. It’s maddening how often the signal is lost, several times throughout anything you watch. for several minutes each time. I don’t know if this is cable or satellite, but now the box has given up trying It flashes up a channel for a moment and turns itself off. I suspect that TV is the least of worries here, though. There was an article in yesterday’s paper that had an announcement that 4 more hours of electricity per day could occur this winter. Power and heat are routinely off for long periods in the winter, but the government is promising 12 hours a day this winter, if certain corporate partnerships work out. These outages are total blackouts, and I’m told there is just nothing for anyone to do during these times.
Back in Zürich, with prayers answered for another safe trip so far. I thought my layover was brief, but it’s over 3 hours (less, of course, than the 101 had on the way over). Yesterday I concluded a successful trip to Tbilisi. The first visit was back to the trauma center, where I collected some wonderful prosthesis materials from Paata, including a complete AK limb. This was far more than I expected to get, and I did not ask how he obtained these. Likewise, he did not volunteer the information. At any rate, these will be vital for my research back at Tech. No more patients were available today, so I said my goodbyes to the group and left for the Technical University. The parallels here with my Georgia Tech were unmistakable, with the English signs reading “Georgian
Technical University”. Perhaps this is the place to which people are referring when they call us “Georgia Tech University.” (This faux pas gets under many people’s skin among the Rambling Wreck.) The place was like so many here, expansive, dimly lit, and filthy. Winter break is from November to March to escape the obvious difficulties of teaching with neither heat nor lights. I met with Alex, director of the CAD/CAM Institute, and learned about his research. I explained the role of CAD/CAM in prosthetics to him, and he was not aware of this application. We proceeded to the NILC where I demonstrated the digitizer for the last time. I expected to demonstrate it once and be done with it. In the end I have demonstrated it 3 times and also applied it clinically. Alex readily understood the system and is eager to help with the project. I foresee his group as a valuable asset. This essentially concluded my work here, with everything on my list checked off. Archil took me to another of these odd 4:00 p.m. lunches that no doubt have contributed to my continued stomach ails. From there I went back to the hotel room for a couple of hours to pack and check out. My garment bag will no longer fold, as I could not get the prosthesis oriented such that the knee joint would flex in the right direction. Archil gave me a bottle of Georgian dry white wine (for Amy he says, as he knows I don’t drink much wine!), so I’ve assembled another plastic bag full of sundry gift items.
Archil picked me up later and we went to “Jazz in Tbilisi “99”. This was one evening of a wonderful week-long jazz festival featuring musicians from around the world. The theater, normally for plays, was stately and ornate, and we had one of those stalls that reminded me of Lincoln’s box at Fords Theater. The music was first rate, first a guitar duo from the UK, and then four members of a quintet from America. The audience was appreciative. I’ve noticed they are very good at yelling “Bravo!” after a performance. They have just the right accent to pull it off. Also, one of their most common words does not cease to amuse me. Their word for “yes” is “ho”. They say it with that Yid dish-sort of gargled “H”, but it still makes me want to giggle. Sometimes they will agree with someone enthusiastically, as is “Ho, ho, ho” and you just can’t miss the Santa Claus com parison. At the concert people would occasion ally shout “Ho!” above the applause, and I’d just grin. I thought of doing it myself, but decided Archil might wonder what on Earth I was thinking. A famous Georgian pianist was due next, but it looked like the Americans were having so much fun they might never leave, so I decided we should go. I felt bad for making Archil miss the top billed act, but I had precious little sleep ahead of me. We settled up my accounts and I was back to the hotel and in bed by 11 p.m. with the alarm set for 3 a.m.
I woke up fine this morning, which is always a worry, and had everything together by the time Soso knocked on my door just before 3:30. We drove through town in the dark dead of night, and I once again marveled at his musical tastes. He spared me his tape this time. but turned the radio up nice and loud when a rap song came on. We had a couple of near misses in town, and then as we hurtled at 100 km per hour down a long, dark straightaway leading to the airport I realized my fist was clenched, palm sweaty and knuckles white. I was repeating to myself that surely I would survive this last car trip in this city, with so lit the traffic, and then we would scream by some Soviet military cargo van, just missing my inches, or we would plow through one of the few working red lights in town without a glance to one side or the other. Soso’s rap music did nothing to soothe me. I finally breathed again once we parked at the airport.
So, after an uneventful flight here I have said good bye to the Georgian Republic. I would have said good bye in Georgian, but I still have not mastered that word. The city has certainly impacted me and increased my awareness about conditions in different parts of the world. I met Tbilisi with constantly conflicting emotions. I was enamored by the city, her people, and their proud heritage. I admired their resilience through thousands of years of empires and rulers, and their great love for their motherland. Their hospitality toward strangers is unmatched, especially since they give out of so little. I was intrigued by Georgia’s independence, by the vestiges of Soviet life, and I marveled at this element of history I had heard so much about as a Cold War kid but did not ever expect to see firsthand. I was also on occasion disgusted by Tbilisi, by the hollow shells of buildings, the rubble and filth in so many corners, the kamikaze drivers with clouds of black and blue smoke trailing their bouncing cars, I was heartbroken by the healthcare system, antiquated but still unaffordable for the people who so desperately need it. Clearly this place was once a jewel, and I cannot figure out what holds it back from once again becoming a jewel. Perhaps it is inertia; there is so much that would need to be done toc lean the streets alone that it’s easier to toss another cigarette butt on the sidewalk than it is to pick up a discarded bottle. People seem quite aware of the problems, but do little to offer solutions. All the while, though, they press on in their humble and often noble tasks, and do not hesitate to walk an extra mile for you. I pray that this city might one day realize its great potential for the sake of its generous people.
I leave with newfound confidence in the amputee project. My strategy is to pursue training for the digitizer from two fronts: clinical and technical. Clearly the learning of the tool requires clinical experience that an engineer here would not have, but I don’t want the clinician using the tool to give up on it over what might be a trivial technical problem. The next step for this phase of the project is to somehow arrange this training. Obviously I need one more trip over here, but I’m sure I can figure out another means to disseminate the knowledge to the right people. The design of the prosthesis remains a tricky issue. The Swiss people seem to want to stay, and apparently view my project as their competition of all the free markets in Georgia where Capitalism does not work, prosthetics has to be the one where information is not shared because of competition, even at the expense of the patient! I never did speak with Miguel personally, as I was cautioned by the Ministry not to try this tack. The Swiss also threw another wrinkle in the picture by announcing that they will be completely changing the legs they make in about 6 months, with sockets fabricated locally as usual but components centrally fabricated in Switzerland. So, my design improvements are to be made on a moving target. I will try to get information on the new components; perhaps they are improved. My goal is to maintain the low cost of the current ICRC limb, and probably use the same materials, as the fabrication equipment is already in place, but try to make the limb more functional. If the new Swiss limb is more function, this would be wonderful. Before I proceed, then, I need to get a better handle on the future in this area. I have valuable contacts now and should be able to ascertain where things are going.
I am eager to get home and see my family. The trip has been long, but I sincerely hope it has a lasting impact for the people of Tbilisi.
Mark D. Geil, Ph.D.
Center for Human Movement Studies
Department of Health and Performance Sciences
Georgia Institute of Technology