2) The Charity Healthcare Coordinator/Paediatrician has a separate room (attached/opening onto the big meeting room), arranged in such a way that she can receive the children for preliminary conversations and/or even medical examination before taking them down to the clinic.

The Coordinator is in charge of the following Charity Healthcare Activities of Genesis: a) organisation of periodic medical site visits to the orphanages and shelters, when we invite a large group of consultant doctors to screen children’s health problems and than follow-up the identified problems in step by step health rehabilitation actions arranged within our clinic or at other medical institutions, when necessary; b) preparation of the visits to our clinic by groups of orphans or street children for medical investigations/treatment or for preventive/diagnostic measures (often asked by the orphanages/shelters); c) the admission, examination and co-ordination of investigations/treatment of those orphans/ street children with acute or chronic health problems who need a doctor at any time and, d) organises educational healthcare seminars for these children.

Before the purchase of the office space she was sharing a room with a GP, often having to leave the room when the GP needed some privacy with his patient, and being unable to carry out her own job without permanent interference.

3) We have two office rooms now. In one of them the Administrator (Sandro) – who is now in charge of administrating the clinical activities of Genesis (organising smooth running of the Genesis Clinic in Tbilisi and two Primary Healthcare centres in the regions) – is in the same room with the Information Technologies and Publishing officer (as you know, periodically, we prepare and publish brochures for public healthcare education). There is a separate desk in the room with a PC for the medical staff of the Charity Clinic – our doctors can work with it at any time: search for new medical information by Internet, write some reports, etc.

4) Another smaller office room is where I have a desk. The room is designed in a way that we arrange all internal planning and evaluation meetings there and have enough space to receive the guests of Genesis for long conversations/discussions – a problem which was so acute downstairs.

5) A small room is now used by the Accountant and the Supply/Technical Maintenance coordinator:

all financial operations are carried out there with enough space for the relevant documentation to be kept in an organised form;

Developments in Charity Activities during the reporting period:
Quite soon after moving to the new office, the quality of organised charity actions increased significantly. In July, a series of investigations/consultations were carried out for children who do not even have a shelter to sleep in and live in the open. These are the most difficult children from the range of children we have ever dealt with. An organisation needs to be quite well organised to receive them in groups. The children are fed by "Child and Environment" in their day-care center, and the administration has been bringing them to us in small groups (5-6 children per day over two weeks) to identify their health problems. Some of these children have come back to us by themselves – sometimes even with their mothers. A few of these children inhale glue and have serious liver problems – until now, we could convince only one of them to start treatment, and we need to work more in this direction. These children will suffer most from the winter conditions, and it is very important that they have already learnt how to find their way to the Genesis Clinic.

It is important to note that during the summer months, a significant proportion of the children (those who are "social" orphans when the parents, often a single parent, can not feed them without an external help) living at the orphanages and shelters either return to their parents/guardians temporarily or these institutions move them to some summer sanatoriums, when possible (Genesis organised free of charge summer holidays for Akhalgori orphanage to Manglisi summer resort house this summer), so we have only been dealing with the so-called "hard-core" orphans and not-organised street children this summer.

As you know, we work with three street children’s shelters (Child and Environment, House of Future, Satnoeba) and three orphanages (in Dighomi (partly), in Akhalgori and in Bodbe, east Georgia). This autumn we are expanding our activities to a fourth newly-established shelter in Tbilisi called Lampari and another orphanage in Aspindza in south Georgia near the Turkish and Armenian borders – the Ministry of Education, which is in charge of coordinating the problems of these institutions, asked us to help this orphanage as one of the worst orphanages on their list (I think you can imagine its condition already). We might re-establish our medical activities (carried out in the past with the help of Iris Bieder’s fund-raising) for Epileptic children at Kaspi Orphanage, if we manage to raise enough funds for it, since there are at least 20 children who need periodic investigations and uninterrupted treatment for Epilepsy which is very costly.

For the autumn of 2002 Genesis will be providing regular healthcare aid to more than 600 children from the above mentioned orphanages, shelters and the day-care centre.

The following case may not have a direct connection to a report on our progress. However, since it happened very soon after you left Georgia, and it is a good example for how many things we need to be prepared for – even if they are not within our "official" capacities – we take the liberty of including it here.

About two weeks after you left we took a 13 years old orphan boy who lives in "The House of Future" (the shelter part of your group visited in Tbilisi) from the Central Burns Hospital to our clinic, under the responsibility of our GP/Surgeon. Both legs had severe third-degree burns that had been very inappropriately treated at the hospital – mainly because neither the hospital nor the shelter could provide the child with necessary consumables, medicines or appropriate hygienic conditions. Had he stayed where he was when our GP/surgeon was asked to give his opinion by the shelter’s director (who was worried that the treatment was making things worse rather than better), I do not think he would have survived at all.

When we moved him to us, he had a very high temperature, was completely immobile, and we had a very little hope he could be dealt with without skin transplants. Despite the difficulties in suiting an outpatient clinic to in-patient treatment, we were able to treat him successfully with the help of the children and the teachers from the shelter who stayed with the child on a rotating basis. He spent 3.5 months at our clinic, and was discharged in July. Two weeks ago he came to the new Genesis office by himself, for the purpose to start studying computers.

Some good news and concerns:
We received 9,000 Euros for the Genesis Charity Healthcare Fund from Diakonisches Werk. Plus, a part of VAT tax paid by us (2,500 USD) during the previous years, while setting up the clinic, was refunded to Genesis by the government and we added it to the same Fund. These funds were very timely, since we did not have a specific budget for site visits by group of doctors, charity health rehabilitation actions, investigation of charity patients at other hospitals when investigations that are not available at our clinic are needed, and (mainly) for the medicines prescribed. Neither the orphanages nor the children’s parents (when they exist) can cover these costs, especially for seriously or chronically ill children.

The decision of Genesis and its donors was to set up the Charity Clinic in such a way that fee-paying patients, who attend our clinic and pay for visits to a doctor and/or investigations would support our charity activities financially. Unfortunately, the day when our tax system will agree to give tax breaks/benefits for charity structures does not seem close, and we still lack some good qualitydiagnostic equipment to attract enough fee-paying patients to promote self-financing quicker. However, I am convinced that, like almost all charity medical institutions, we will not be able to achieve complete financial self-sufficiency in the foreseeable future and therefore will need the help of Donors for many years to come.

In addition, the children need not only a better health care, but also a better nutrition, warm clothing, an education that will enable them to be employable and to survive in the future. Enough work to keep Genesis and several other NGOs busy in Georgia!

We are in the process of accomplishing the set-up of another Healthcare Centre in East Georgia. The Pintzgauer which will be left with this Centre has been used to carry the construction materials and workers from Tbilisi to Lagodekhi, where it is located. The Novib funding included some fuel costs, but I do not know how to run this vehicle later and Lagodekhi is not as mountainous as Ajara. We are considering converting this Pintzgauer to LPG gas, which we are told might be technically possible.

The third Pintzgauer, which we left at the Genesis Clinic will help us to reach orphanages that no other car can reach in winter, and for scheduled diagnostic investigations of remote villages in the high Caucasus in summer, as even Pintzgauers cannot can not reach those villages in winter because of too heavy snow and avalanches. We had this charity action planned for five villages of Svaneti for this Summer, but could not do so as the delays in the purchase of the office and the completion of the follow-up arrangements left us with too much work to finish during the Summer. We hope to carry out this visit to Svaneti the next summer.