CHARITY ACTIVITIES
of
THE GENESIS ASSOCIATION
for 30 months - October 9th, 2001 - April 9th, 2004
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CHARITY ACTIVITIES
for 30 months - October 9th, 2001 - April 9th, 2004 |
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Short Background on Charity Healthcare Activities of Genesis
It is already eight years since the Genesis Association was set up (by an innitial financial support of Mr. Barend van der Vorm) and has been providing healthcare services to children lacking parental care, specifically children who live in special institutions: orphanages and special boarding schools/”internats” and Street Children’s Shelters of Tbilisi, East and South Georgia. The first provision of medical help by Genesis started within the framework of a “Doctors on Wheels” (funded by: Swiss Agency for Development and Cooperation Division of Humanitarian Aid and Swiss Disaster Relief Unit) project that used a modified Ford Transit vehicle with some basic diagnostic medical equipment. As a preliminary survey for selecting its target groups, the doctors of the association first travelled to all orphanages of East Georgia to identify those institutions which had the worst living conditions and medical services and, later, selected some of them for longer-term collaboration.
In October of 2001 (by financial support of Diakonisches Werk from Germany, Swiss organisation - Kirchgemeinde Audersihl and numerous in-kind contributions of medical equipment and consumable from Swiss citizens – raised by Mrs. Iris Bieder), after four years hard efforts of dealing with the state licensing obstacles, an Outpatient Charity Clinic was set up to provide children lacking parental care and, especially, so called street children of Tbilisi, with free of charge primary healthcare services. The provided range of the medical services at the Charity Clinic included consultations of a paediatrician, a general practitioner, a surgeon and a gynaecologist, facilitated by a minor (out-patient) surgery hall, a clinical laboratory and a day-time observation ward that is also capable of providing minor emergency aid. On a later stage there was a small range of diagnostic equipment, like ECG and Sonoscopy, added to make investigation and diagnosing of the children more efficient. Genesis purchased this equipment by its own income generated from charges for its medical services provided to other members of the community (see below). Another part of the purchase cost of the sonoscopy was covered by DIFAM-German Institute for Medical Mission.
The medical services provided at the Genesis Clinic are free-of-charge for the children from the orphanages and shelters, which are the focus group of Genesis’ charity activities (see more below). Poor members of society (especially multi children families, invalids and pensioners) who are unable to pay also receive free-of-charge consultations and investigations at the clinic, mainly on “Open Door” days. Genesis also covers the minor emergency needs of vulnerable members of the community who are unable to pay. The Genesis Clinic charges other members of the community for the medical services provided. These payments by the community are considered to be one of the elements of partial financial sustainability of the Charity Clinic - during the last year the income from patients fees covered all communal (electricity, water, heating) costs and a small part of the doctors salaries. The Target/Focus Group for the Charity Activities:
Network of Institutions helped by Genesis on regular basis The number of children living at shelters and orphanages of Georgia is approximately 3,500 all over Georgia. The Genesis Association provides 633 children leaving at nine different shelters and orphanages with regular medical care as well as with periodic general humanitarian aid to additional 236 children. Genesis currently provides regular comprehensive healthcare and other kind of support to the following institutions in East and South of Georgia: Orphanages:
1. Orphanage No. 1 in Dighomi district of Tbilisi – 109 children;
Street Children’s Shelters/Social Rehabilitation centres: 1. Beghurebi, run by the Child & Environment NGO in Tbilisi – 50 children; The Association has also provided non-medical support to the following institutions: 1. Children’s House in Lagodekhi, Khakheti region – 86 children; Profile and Size of Charity Focus Group of Genesis
There are no reliable statistics concerning these children. Genesis carried out a brief Survey on Social Backgrounds of the children from the shelters and the orphanages which are under Genesis medical care. (See attached Chart#1 & Chart#2 for more detailed information). The majority of the children living at these institutions have only one parent alive. A significant number of children, especially at those institutions which are located in the rural areas, are from large (with four and more children) and/or separated families which are unable to feed their children and send them to an orphanage instead. These children are taken home only for summer and/or winter holidays. In addition to these children and orphans (i.e. with both parents dead), the orphanages and city shelters hold children from refugee families (since there has been a large migration of refugees from Abkhazia and the South Ossetia to Tbilisi) and those who have handicapped parents. The children join these institutions at a very early age (3-4 years) from what is termed at Infant’s Houses where they are left as newborns or, sometimes – especially in the street children’s shelters – in their early teens. The current official estimate of the number of children living at these houses is approximately 3,500 all over Georgia. The Genesis Association provides 633 children from the above-mentioned organisations with regular medical care as well as with periodic general humanitarian aid to additional 236 children. During the last year, Genesis has started including elements of development approach into its charity healthcare activities. Genesis also plans to expand the range of its medical and non-medical support to these children in the nearest future (see below). Institutional arrangement and state financing of orphanages and shelters:
All orphanages and boarding schools are being governed and financially supported by The Ministry of Education. Street children shelters are coordinated and supported by Tbilisi Municipality. Monthly funding of orphanages per child is as follows:
The management of an institution has no right to re-allocate unused funds to another budget item! Monthly funding for Social Rehabilitation Centres/Shelters per child is as follows:
The children’s clothing, footwear and bed linen needs of the shelters are theoretically funded separately, but they have never received any funding for these needs since their establishment. Total state funding for “in-depth, on-site medical investigations” (screening investigation of all children of an orphanage/shelter by a group of general and specialised doctors) of all orphanages of Georgia in 2002 was equal to 100,000 Laris (41,000 Euros). The funding for any subsequent out-patient and in-hospital medical services for all orphanages and shelters was also 41,000 Euros during 2002. The “in-depth, on-site medical investigations”, which are funded by the state, are little different to the preliminary stage of the healthcare programme that Genesis carries out for each orphanage or shelter. However, in Genesis’ experience, those structures which are supposed to provide state-funded healthcare for orphans had never visited those orphanages which Genesis has been supporting the last 8 years – until, that is, Genesis brought children to the state hospitals for follow-up treatment of identified diseases. Subsequent to this, a group of doctors from the state hospital went to perform several unnecessary and incomplete screening examinations. It is possible that the purpose of these visits was to show that they are doing their job, in case Genesis should decide to apply for state funds for its activities. As a rule, these state medical institutions which are funded by the government select orphanages at random, are never consequent in providing services and, with the exception of surgical operations, hardly ever provide treatment to these children. The reasons for the inadequate implementation of the state funded healthcare programmes for orphanages and shelters of Georgia, as explained by implementing institutions/persons, are as follows:
In any case, the severe corruption and indifference that have become the norm in Georgia also affected the basic maintenance level and healthcare service quality for orphanages and shelters. With the new government and its anti-corruption policy, there is a hope that there will be more efficiency in the state funded healthcare system. However, considering that the state budget is permanently in deficit, there is a long-term need for Genesis to channel financial and other kinds of support for implementing projects which contribute to a better quality of life of children lacking parental care in our country. The Charity Healthcare Activities Provided by Genesis:
During the reporting period – in 30 months – on behalf of the children lacking parental care and living at nine special institutions (shelters and orphanages) that receive Genesis’ regular healthcare support, the Genesis staff organised:
There are Five Main Types of Charity Healthcare Activities that Genesis carries out on regular basis:
Activities Type I. Health Rehabilitation Programme for children from targeted orphanages and shelters This programme is implemented on the basis of the mutual agreement between Genesis’ staff and administration of an orphanage/shelter. It is built on preliminary observations and a brief assessment of healthcare needs of the children by both parties. A routine round of Health Rehabilitation programme consists of the following steps/actions: Step 1
In most cases the group of doctors consists of a Paediatrician, a Neurologist, a Cardiologist, a Surgeon, an Optalmologist, a Dermatologist (not always), an Endocrinologist, an Otolaryngologist and a Laboratory Nurse. The selected doctors are invited from different specialised medical institutions in Tbilisi. They are associated with Genesis and are available for Genesis’ charity examination site visits. At the beginning of the trip all doctors gather at Genesis office in Tbilisi. Genesis provides them with transportation and per-diems, covers their logistics and daily meal expenses. During the visits, doctors screen children’s health status on-site. For the majority of the children, recommendations are given immediately while the rest are grouped according to identified health needs which are analysed by Genesis’ staff for follow-up provision of investigations/better diagnosis, for in-hospital treatment and – sometimes – for surgical operations, etc. Genesis provides transportation for the children selected from the orphanages to all healthcare institutions where the investigations/treatment are being carried out, and back to their orphanage or shelter. Step 2
The children receive a broader medical check-up, including laboratory investigations, an ECG and Ultrasound scanning investigations, gynaecological investigations, out-patient surgical operations, etc. (Sometimes, instrumental investigations are carried out at the orphanage with the equipment which Genesis takes with, but having no portable ultrasound and with the existing high renting price many children who need only this instrumental investigation are brought to our clinic instead of being effectively investigated locally.) Step 3
Genesis pays for most of the in-hospital investigations and treatment of the targeted orphans, with the exception of surgical operations carried out by the state Children’s hospital #2 – in these cases Genesis identifies the needs for surgical involvement and catalyses free of change hospital admissions. Step 4
Step 5
All Five Steps of the Charity Health Rehabilitation Programme for each orphanage or shelter (mainly those ones which do not have regular access to medical services) may last for several months. In majority of cases these health rehabilitation programmes are being repeated at least once a year. The Specialised Medical Investigations (focusing on most widely spread and acute health problems ) are also carried out on-site to provide more specific investigations for health problems of the children (see below, Activities Type II). Regular provision of medical services to so called street children of different shelters and orphanages located in Tbilisi is achieved, mainly, by these children’s visits to Genesis Charity Clinic – when children come individually or in small groups. Activities Type II Specialised Medical Investigations On-Site When Genesis’ observations or screening investigations identify high incidence of a certain group of health problems among the children of a particular orphanage – or when requested by administration of an orphanage/shelter – specialised medical investigations are arranged by a team of doctors who specialises in that particular field. These investigations may have a primary or a follow-up character. In this context, the following Specialised Investigations were carried out at:
Doctors identified incidences of STD among children of the age 12-13. There were mentally healthy children from multi-children village families found among mentally disabled children – all studying the same simplified school program – as the parents of healthy children explain this is better than letting them suffer from severe lack of food. Child & Environment: on-site screening examinations by dermatologists, general and orthopaedic surgeons were provided for 70 children of the shelter. At Aspindza orphanage (with 100 children) and Lampioni social rehabilitation centre (with 45 children), where most children have tragic personal histories (see more about the Personal Stories of Orphans on GENESIS website), Genesis organised team of mental health professionals to obtain an in-depth assessment of their mental health status. As a result, a number of children with behavioural abnormalities, mood disorders/depressions and neurosis (including some severe cases) were identified. As a follow-up action these children have been provided with psychological treatment three times a week for a one-month period by a psychotherapist based at Ndoba (another NGO) - for this purpose they have been transported by Genesis. There was significant improvement of the children’s psycho-emotional health, but the treatment needs to be repeated several times and it is not always possible to find a good psychologist who is not busy with other projects within other institutions. In general, there is a severe lack of children’s psychotherapists/psychologists in Georgia, especially of those who can work with the type of children living at social rehabilitation centres and orphanages. To our surprise, it turned out that almost every shelter/social rehabilitation centre has a psychologist included in their staff but, as the directors explain, their knowledge is absolutely inadequate to the street children’s needs and their involvement cannot bring any meaningful changes to the children’s lives. Genesis plans to bring some solutions to this problem by mobilising and providing regular advanced specialised trainings to this specific staff of the shelters in coming future. (The relevant data have been included in Table #1) Activities Type III Daily Admission of Children lacking parental care at Genesis’ Charity Clinic
In addition, groups of girls come to a gynecologist with different infections. There are some cases of teenage pregnancy. These girls do not have appropriate education or information about contraception, nor can they afford it in any case. They know that Genesis Clinic does not carry out abortions, therefore the girls come when they plan to give birth to the child or have to do it when the pregnancy is identified too late. Genesis plans to develop more focus on preventive healthcare education on STDs and contraception for teenagers of the shelters and the orphanages to which Genesis provides regular medical care (see below in Activities Type IV).
In the Spring-Summer of 2002 the day-ward was busy for 117 days when Genesis took over the treatment of a burned child (3rd A-B degree burn of 25% of his body) from the central hospital for burns. The boy was developing blood poisoning and there was no hope that he would recover without skin grafts. No shelter could pay for his long-term treatment, nor would any state institution assume the responsibility, either medical or financial. During this period the boy remained in the ward at night. His teachers and friends from the shelter Momavlis Sakhli have been actively helping Genesis doctors and were on duty at his bed for 24 hours. He was discharged completely recovered. All children living in Tbilsi’s street children’s shelters have a laminated card from the Genesis Clinic. The card contains the names of the contact persons at Genesis, the clinic’s phone numbers and a sketch map giving the exact location of the clinic. In an emergency, a child or whoever finds him/her unattended can immediately refer him/her to the clinic. The card also helps children to find us much easier when they have regular health problems. (See the statistics in Table #3 - Daily Admission of Children Lacking Parental Care at Genesis Clinic in Tbilisi and the Consequent Treatment Provided) Activities Type IV Primary Health Education Trainings/Seminars for orphans and their carers 1) Health Education Seminars for Children lacking parental care
To achieve a greater long-term impact on children’s health condition, especially in terms of prevention of illnesses, from the beginning of 2002 Genesis started providing primary healthcare education to the street children of the partner NGO’s sheltersdds. During this reporting period Genesis conducted seminars on following topics:
A seminar was prepared and given by Genesis’ Gynecologist to 16 children living rough on the street (not at the shelters) but supported and monitored by Child & Environment Some training materials were prepared by Genesis doctors, while other materials and the seminars themselves have been delivered out by invited experts from different healthcare institutions and NGOs. 2) Health Education for the staff of the shelters and the orphanages:
Health Education seminars for children and the staff of these institutions have, until now, been quite irregular, being carried out when deemed absolutely necessary to do so. Given the positive long-term impact on the children’s health expected from these activities, Genesis plans to make health education activities for children lacking parental care and the adults who are responsible for them a regular activity. Activities Type V Charity medical services to other vulnerable groups of communities
The Genesis Charity Clinic and the two PHC centres arrange periodic Open-Door Days for poor members of the community suffering from particular diseases (Heart and Vessels diseases, Endocrine diseases, Chronic diseases of Respiratory system; Ortopaedic problems, Gynecological diseases and infections, etc.) to receive free-of-charge consultations and related investigations. In the majority of cases, these free consultation/investigation days are accompanied by a relevant primary health education seminar/mini-lecture which is carried out by invited specialised consultant physicians. Current needs for maintaining Charity Healthcare Activities of Genesis Genesis considers it to be absolutely essential to continue Charity Healthcare Activities on behalf of orphans and street children:- at a minimum on the scale and scope that has been provided until today. Diakonisches Werk’s funding (9,065 Euros and about 2500 USD - equal to 24,681 Georgian Laris) for charity activities of Genesis helped us to maintain Charity Healthcare Activities (Type I,II, IV) of Genesis for 30 months. In April of 2004, this budget expired. Diakonishces Werk’s donation did not include any funding for the running costs of the Charity Clinic in Tbilisi. The running cots of the Charity Clinic (Activities Type III) have been partially covered by NOVIB’s funding as for a Primary Healthcare Centre of an urban type. About 25% of the expenditure needs have been obtained from community fees. Since NOVIB’s funding does not consider maintaining charity healthcare activities it is essential to raise at least a part of the running/operation budget of the Charity Clinic itself, in order to make it sustainably available for the children lacking parental care and other vulnerable groups of the community. It is also essential to have a budget for the small coordination staff of the Charity Programme of Genesis (see the essential budget provided) As for concerning upcoming development approach to healthcare activities of Genesis, specially the health education of children and their care takers, it is planned to maintain and expand following activities: 1. Preventive Healthcare Education for Children of these institutions – providing seminars on STDs, Healthy Life Style, Contraception and Family Planning, Rights of the Child, etc. In order to give a chance to these children to share and talk about their ongoing health problems more regularly, as a part of its daily activities, Genesis decided to set up a Hot-Line Health Telephone, that would respond to the children’s questions concerning their physical and psychological problems. 2. Advanced Health Education for medical personnel of the orphanages and shelters, especially of the local psychologists – regarding their skills for psychological rehabilitation of the street children, of the local doctors and nurses, as well as of the general carers; 3. Skill Raising Management Seminars for the Administration of these institutions – concerning: Project Cycle Management, Proposal Writing, Fundraising, Children’s Rights. Genesis is urgently looking for the new donations enabling to continue the provision of all types of the charity healthcare activities and any financial support whatever moderate will be strongly appreciated! Analysis of Genesis’ Observations I. Healthcare Activities: As mentioned above, Genesis has been carrying out charity healthcare actions for the last eight years. Usually, children appreciate our support. More than that, some of them even get upset if they are not being provided with the same type of medical services what the majority of children get (even if it is taking blood sample and causes pain). Children queue up for medical examination and never create obstacles for medical personnel providing the services. At the end of each on-site examination they get sweets and toys from Genesis staff.
But, as we mentioned above, our medical aid comes back to them at least once a year and every time it finds almost the same healthcare problems that during the last visit. In our understanding there are two major reasons for this: 1) Absence of Preventive Health Education for both the children and the staff of these institutions which we already discussed in Activities Type IV and in the previous section (see above) and
2) Inadequate Living Conditions to healthy development of a child. Visiting the orphanages and shelters on a regular basis, Genesis staff can see the real structure/causes of the identified diseases, both for somatic and for psychological ones. Depraved health status of these children - especially permanent infections of skin, respiratory, urinary and gastrointestinal diseases - is the direct outcome of malnutrition and intolerable living conditions: Irregular water and electricity supply, no bathing facilities and lack of hygienic consumable, no central heating, broken windows, broken desks and beds, permanent lack of appropriate clothing, footwear, linen and food – are common for the most of these institutions. Trying to evaluate acuteness of general/living conditions in each orphanage/shelter Genesis investigated these institutions and summarised the identified problems (see the Table#5 Communal/living conditions at the orphanages and shelters)
During the Health Rehabilitation Programme children used to be brought to the capital of the country which they had never seen before and having heard about upcoming trip they were happy and looking forward. But, until very recently, only impression they would get out of this trip was that of the Genesis Clinic and of other healthcare institutions. In some cases when they stay in Tbilisi overnight to continue their journey around the city hospitals the next day, they manage to rest before they travel back to their “ grey homes”.
While dealing with their health problems we should not forget that they are still children who expect a little bit more from out of a trip to the capital (regardless of whatever useful they consider it). Looking at their exhausted faces during the lunch at the Genesis office and at the end their journey to Tbilisi, we decided to combine every healthcare visit of a group of children from the remote orphanages to Tbilisi with some entertainment events (see more below).
II. Social Problems: Beside the common living/communal problems, these children exist in fear that the administration of orphanage/shelter will ask them to leave the institution when they become 16. Many of these children have no place to go, nor they have any working skills/profession to earn for living. The state does not provide them with any social security, stipend or logistics. If the child is lucky, he/she might be left at the institution for some common work. The vast majority winds up living in the streets.
Administrations of the shelters/orphanages try to arrange local workshops for the children to give them some common working skills which might save these children in future. All these workshops lack appropriate working tools and materials, good methodology. Lack of funding determines absence of good teachers, etc.
There is accidental incomplete support to these institutions from some donor organisations but no meaningful changes have taken during the last years – in many of them conditions have only worsened.
At the beginning, of its activities Genesis’ approach to the above situation was that it had a very concrete as well as demanding mission in dealing with the physical illnesses and diseases of the children, and hoping that the State, donors and other NGOs would deal with the more structural issues of living conditions, education, developing vocational skills, etc. However, the volume and complexity of the external support which the orphanages and the shelters have been receiving was far from being adequate for the proper development of these children.
Since very few appeared to improve their life quality and even less to provide any hope for future, Genesis started approaching its mission in more comprehensive way, including not only more development elements for its healthcare programmes, but also making the first very little steps aiming at the improvement of the children’s general knowledge of the outer world and their psychological adaptation, to development of their vocational skills, minor income generation activities, etc. - in which we need a support from the foreign community.
During the reporting period Genesis included as many elements as it could afford to respond to not direct healthcare needs of these children better.
Other Types of Non-Healthcare Charity Support provided to orphanages and shelters of Georgia by Genesis and the related Future Plans
I. Raising awareness and Entertainment events
In our opinion, it is essential to increase our work in this area, bringing more colours to their black-and-white lives. This would involve, e.g. arranging celebrations at the Genesis office on Christmas holidays, providing at least one theatre performance in their lives (possibly staged in the orphanages), cinemas, museums, etc. with a view to giving them some idea of the possibilities that exist, however remote. At the least, such a programme will reduce some of the institutionalisation that is evident in these children’s psychology, behaviour and aspirations and which serves as a background factor in maintaining chronic illnesses in most of these children.
We hope these relatively low-cost events would significantly support the recovery of their emotional health and reduce their feelings of isolation. These activities will need a small and flexible monthly budget for non-healthcare charity activities of Genesis that could be spent according to the upcoming needs (see the Future Budget for Charity Activities of Genesis)
II. Recreation Actions
Genesis connected Akhalgori orphanage with Sanatorium in East Georgia, Manglisi, which provided opportunity to 50 children from the orphanage to rest in the resort that is very suitable for respiratory diseases.
III. Periodic Humanitarian support from/through Genesis
But, any Humanitarian Aid in the form of in-kind contribution from foreign countries demands inadequately big volume of efforts to deal with the formalities at the customs and ministries and consumes time that could be successfully spent on more development activities. But once the Humanitarian Aid covers the needs which seriously affect the health status of the vast majority of children (like severe lack of winter footwear when children can not go out of buildings in winter, total absence of linen, when children sleep on bare grey matrases, etc.) Genesis can surely mobilise all its staff and time to distribute and monitor the provided aid.
IV. Minor Income Generation Support to local workshops
To motivate children to keep acquiring different professional skills (in tailoring, carpentry, painting, embroidery, etc) and to raise the awareness of the officials and the government, in April of 2003, Genesis organised an Exhibition/ Trade Fair of Hand-Made Goods in the hall of The Parliament of Georgia. Eight special institutions for children lacking parental care were represented at the fare. Hand-made goods sold brought total 1452 Laris income to different institutions. The income was distributed in such a manner that 30% was used to satisfy the personal needs of the child producing a good, another 30% went to buy the working material for a workshop, while the last 30% contributed to covering the common needs of an orphanage/shelter.
In coming future, Genesis would like to catalyse vocational skills development and minor income generating activities of the children lacking parental care. In this regard, we are looking for a flexible monthly budget for multi-purpose support in a shape of per-case funding for setting up/developing micro projects as follows:
1. Skills development and In-kind Support to Tailor Workshops of the shelters and the orphanages - almost all the girls at orphanages and shelters can tailor things, but because of lack of fabrics and other materials, they mainly create clothes for dolls. With some additional methodology, few additional machinery and supply of working material, this particular skill/habit could be transformed into a capacity to make clothes and linen for infants – based on the severe market needs, this could become quite a useful profession for the girls in future.
2. Support to the development/setting up of local Carpentry Workshops - some of these institutions already have carpentry workshops – with a better methodology and in-kind support they may advance quicker and make this activity their life-span earning skill;
3. Developemnt of Car repair Skills - considering the fast increase of number of vehicles in the cities and towns of Georgia, whereas the most of them are second hand ones imported from abroad (because of their affordable price), in our understanding, developing this particular skill would also strongly help the boys to survive in future;
4. Skills development for the Collection of Medical Plants and Breading Flowers - the remote orphanages are surrounded with the beautiful nature. In case if these children can recognise and correctly collect medical plants and learn how to bread flowers it may also become a good basis for their future earnings;
5. Any other small projects which would appear useful for the children and interesting for possible donors.
The small vocational skills development and income generating projects presented here have been analysed based in the light of the general institutional capacity of Genesis.
We would strongly welcome any in-kind or financial support
Thank you in advance for your time and possible support!
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Follow-up Out-patient Medical Services provided by the Genesis Clinic: Those children who are identified as needing deeper investigation/further treatment are transported to the Genesis Clinic in Tbilisi during the following 2-3 weeks.
Per-Case analysis (of the results of steps 1-3), giving final medical recommendations, securing necessary treatment: Genesis’ Charity staff categorises the results of medical services provided to the children of the selected orphanage both at Genesis clinic and at other healthcare institutions of Tbilisi.
Follow-up Hospital Investigations and Treatment obtained at other clinics/healthcare institutions: When necessary, the children identified for those investigations/treatment which are not available at Genesis Clinic are referred to different hospitals and clinics for broader and deeper diagnostic investigations (e.g. specific Lab. Tests, Encephalography, deeper ophthalmologic investigations, CT, Cardio ultrasound scanning, Dopplerography), different specific medical consultations, in-hospital treatment and/or operations.
Per-Case analysis (of the results of steps 1-3), giving final medical recommendations, securing necessary treatment: Genesis’ Charity staff categorises the results of medical services provided to the children of the selected orphanage both at Genesis clinic and at other healthcare institutions of Tbilisi.
These children are always accompanied by the Genesis Charity Healthcare Coordinator, with one or two members of the staff from a shelter/orphanage, and by Genesis semi-volunteers (mainly young doctors or nurses) who are paid very symbolic daily fees and who direct the children to investigation rooms and to doctors of different healthcare institutions, accompany them during the consultations and investigations, collect all data, follow-up hospital admission etc. Those children who remain for in-hospital treatment continue to be monitored by Genesis’ staff until their discharge from hospitals. Whenever investigations cannot be completed in one day, children stay in Tbilisi overnight.
Bodbe Boarding School: investigation and testing of all girls for STDs, and (since this institution principally provides living for children with moderate mental disability) psycho-neurological investigation of 101 children with the necessary follow-up treatment was carried out.
In addition to the scheduled health rehabilitation programme’s steps, the daily treatment of Children at Genesis’ Charity Clinic is the other major charity healthcare activity of Genesis from October of 2001. Children, mainly those who live at Tbilisi shelters come individually or in small groups (which they seem to prefer, presumably because it make the whole process less awkward for them), sometimes accompanied by an adult teachers or a guardian. In majority of cases they come with wounds (clean or infected), fractures, burns, bites, etc.- for minor but acute surgical procedures/operations. Planned, non-acute surgical operations are mainly provided during the health rehabilitation programmes. There are several cases when children come to have non-malignant tumours removed from the soft tissues.
The are numerous cases where staff from different shelters bring groups of children to Genesis Clinic for assorted health screening needs (e.g. anaemia, TB, Hepatitis,), for a paediatrician’s consultation during outbreaks of infections (common cold, flu, Measles, German measles, Infectious Parotitis, etc.), and in a number of cases it is necessary for them to stay in the day-ward for infusion therapy.
In the past, during 1997-1999 Genesis has been providing Emergency First Aid trainings to children and their carers at the orphanages and the shelters. Health Rehabilitation Programme of Genesis which brings groups of doctors back to the children every year, does not find any significant improvement in annual rate of morbidity of these children, since the structure/causes of these diseases remain the same.
Periodically, Genesis has been providing free-of-charge medical consultations and investigations to those families of Didube district of Tbilisi which have four or more children and are also classified as being poor (53 person). In addition, about 1500 patients who were unable to pay but needed emergency consultations, basic lab. investigations, minor surgical operations and other related instrumental investigations were also treated free of charge not only by the Genesis Clinic in Tbilisi, but also by two Primary Healthcare Centres (PHC) in Ortabatumi (Ajara Autonomic Republic, West Georgia) and Tamariani (Lagodekhi region, East Georgia) (see 
These two PHC centres which provide almost the same range of medical services as the Genesis Clinic have been set up within the framework of a project “Community Health Promotion Programme for Impoverished Population of Georgia” – Funded by NOVIB, The Netherlands organisation for International Development Cooperation. The communities served by these PHC centres usually pay for the obtained medical services, but the fees are very adequate to their paying capacity. Currently, the community fees cover not more than 10-15% of the total monthly running costs’ needs of these PHC centres.
As a final part of the charity health rehabilitation programmes, Genesis has begun arranging city tours in Tbilisi for the children from the rural institutions, taking them to, e.g., the zoo, city parks, museums – things which they had only ever heard about. Such visits seem to have a remarkable impact on the children when compared with the children from previous groups who left for their orphanages straight away and whose only entertainment was the hospital elevator (which really impressed them!). It would not be an exaggeration to describe these children as being exhausted and sad, especially when compared with more recent groups.
When available and if it responds to obvious and very acute needs of the majority of children at the targeted orphanages and the shelters, Genesis channels Humanitarian Aid/in-kind contributions to these institutions. In the reporting period, with the help of the Lions Clubs in Basel and Spiez and Swiss-Baltic Relief Committee, Genesis distributed warm winter footwear and winter clothes to its all target orphanages and shelters. (see the relevant 
As we mentioned above many of the orphanages and shelters already have some elements/small workshops often with incomplete machinery and tools for acquiring/developing working skills. Genesis contributed small amount of sawing and embroidery threads and embroidery samples books to young tailors of the shelters and orphanages – things which we could afford without a special funding
