Gynaecology clinic lifeline for rural women in Georgia

“When we started doing mammograms, we discovered several cases of advanced breast cancer. Nowadays, that’s uncommon,” recounts gynaecologist Manana Vengrjhanovich.

Manana gives us a tour of the sparsely furnished clinic in Akhaltsikhe, a Georgian mountain town near the border with Turkey. One of the two rooms contains the region’s only mammography machine. This is where Manana and the others are responsible for a national screening programme for early detection of breast cancer. The other room offers just enough space for two desks and a gynaecological examination chair.

Despite the cold outside it is warm in here, though the woodstove next to Manana’s desk makes the air smoky.

Each year, between 1 200 and 2 000 women and girls receive free screenings and care here. Since 2002, the Democratic Women’s Organization (DWO)’s clinic has received support from Kvinna till Kvinna.

In this isolated Samtskhe-Javakheti region in south Georgia, many are subsistence farmers, surviving off pension contributions and remittances from friends and family abroad. There are major shortcomings in the local health care. Antiquated equipment, limited emergency care and a lack of specialists are just some of the reasons why many patients have to pay for an expensive trip to the capital Tbilisi instead when they fall ill.

STDs spread when men buy sex

Sexually-transmitted diseases (STDs) are one of the most common reasons why patients visit the DWO’s clinic. Often, the disease has already become chronic.

“Just the other day, I examined a woman whose untreated chlamydia had caused a serious infection of the uterus,” sighs Manana.

Many wait a long time to look for help because of the stigma that surrounds sexual and reproductive health and rights. The DWO works to change this by organising sexual education in schools and info sessions out in the villages.

The Samtskhe-Javakheti region lies close to the border with Turkey; because of the large number of men passing through the region as freight transport workers, the sex industry is booming here.

Manana explains how men buy sex, then go home to their wives and pass on STDs to them.

“STDs can even lead to violence. Symptoms are often more visible in women than men, so wives are often accused by their husbands of being unfaithful – and then abused in revenge,” says Marina Modebadze, head of the DWO. The organisation’s activities include running a shelter for women subjected to violence.

Home remedies to terminate pregnancies

As in other parts of Georgia, not many use contraception in Samtskhe-Javakheti. The consequence is high rates of teenage pregnancies, STDs and recurrent abortions. Abortion is a common and accepted way of ending an unwanted pregnancy here. But not everybody can afford a safe procedure.

“Abortions can be quite expensive. That’s why many women try terminating their pregnancy with home remedies, like drinking milk with iodine. That can cause bleeding and require hospitalisation, so if a patient doesn’t get help in time, the consequences can be serious,” explains Manana.

“There was a tragic case recently of a woman who died after drinking pure iodine to end a pregnancy. She had eight children,” Marina says.

The DWO travels the region to visit villages and hold info meetings about contraception. “While contraception may be expensive, it’s also a matter of attitudes. Some husbands have difficulties with their wife wanting to protect herself from further pregnancies,” Manana believes. As many men refuse to use condoms, the DWO suggests women use intrauterine devices (IUDs) instead.

Strategic efforts resulting in change

A great deal has changed in recent years, both when it comes to attitudes and women’s health. Besides running a clinic, the DWO also engages in political advocacy and awareness-raising.

In the past, some women were not allowed to visit the clinic, or they had to be accompanied by their father-in-law. Thanks to the DWO’s strategic efforts, the organisation now reaches more and more women who are controlled by their environment, including through home visits. By determinedly visiting villages, handing out brochures and in recent years even using social media, the clinic is now well-established. Today, it helps women who would otherwise have been left without care.