 Hello, everyone. Welcome to another edition of People's Health Dispatch. Today, we talk to Sopoja Faridze, a trade unionist and health activist from Georgia. The trade union Sopo works with is called the Solidarity Network. It's carrying out campaign for improving the working conditions of health workers, particularly nurses. She was also part of a research team that looked into the course and effects of privatization of healthcare in Georgia. We are going to hear more about the current situation in the health system in Georgia, the position of the health workers, and the possibilities of building universal healthcare there. So Sopoja, welcome and thank you for joining us today. Thanks for having me. Yeah, so I'd like to start with asking you to describe what's healthcare like in Georgia right now. So healthcare in Georgia right now is going through again another transition. It's been constant transition after transition. So it's quite expensive, relatively to the income people have, and it's underutilized. And government at one point was paying for full, it was like a full single payer system. And now, because private companies have taken so much of the government's money, they had to reduce it back down to targeted. And so now people are trying to figure out what does the government pay you know what percentage of say operation like I can tell you right now, one of my friends mom's friends mom is sick might need an operation on her heart. And she was trying to figure out like how much does she have to pay how much can the government subsidize. And so it's like, and then she's like, you know, worried like where's she going to come up with the 23,000 lari which like $1,000 which is a lot of money for people just to come up with right now. So it's it's it's become even more chaotic and one of the most expensive things in Georgia which has constantly the highest out of pocket costs is medicine. Um, that's good to know so it's reduced access increasingly reduce access to health care for everyone. Um, okay and you told me before that you grew up in the US can you explain a little bit describe a little bit what it was what health care after was like in the US and if you see any difference with Georgian health care system. Yeah, so until I was about eight years old, I grew up in the Soviet Union, so I have like Soviet Union health care until I was eight, and then I had us. And now I have Georgian health care so I have a spectrum, but really, as an adult is, I have never lived in a place where there was free health care, or that was something that I had access to personally. It's something that's always denied to me and something that I always think is like a privilege. And even me, knowing so much about health care working with nurses and understanding preventive care is so important. I still often do not get preventive care myself because it's still tied to costs. And until I always say like, unless I'm like dying I don't go to the doctor. So in the US I can give you an example of like when I was 17 I got into a car crash I was not driving my friend was. And my first instinct was because I've been told as an immigrant child was that health care is very expensive so like avoid all health care costs. I was like hid from the ambulance, because I thought that they would take me to the hospital and then my brother couldn't afford my medical bills so I was like literally had slammed my head, had a concussion. And like the first thing I thought of was trying to make sure I didn't go to the hospital because like my brother wouldn't be able to pay the bill. You know, I didn't know actually her insurance would pay and so on but still that would have taken like I didn't understand all that. And my first instinct was like, do not go to the hospital. You know we can't afford this bill and having it you know how I also had health insurance for years in the US but it didn't really cover most things like we pay three to $600 a month. And you still had to pay copay when you went. And that was even more expensive like with everything you need to get you still pay so much was always like why are we paying insurance we can never go to the doctor for real, because it's still additional costs that you dealt with, and also mental health I think I definitely had postpartum depression when I gave birth to my son, and I could not go to a therapist I tried I wanted to go I was very very sick like had such depression, and I couldn't go because we had a $500 deductible that means we first had to pay upfront at least $500 before the insurance would even cover any of the sessions. And so we didn't have like $500 because we're like really young just had a child. And so I couldn't get mental health I needed. And I was, you know, paying off me giving natural birth for like a year and a half we were still paying off even with insurance making monthly payments. So like, just really terrible experience mostly. Yeah, that that sounds stressful and terrible. Really. I mean, we would expect that you know country as rich as the United States would have discovered the social protection aspect I mean because it does. They do have the best healthcare in the world is just the social protection that's lacking. I heard people even would rather take Uber than call an ambulance. So I was saying, like, really, it's true. Yeah, yeah, of course, it's like $500 to $1,000 an ambulance something like that. All right. Okay, that is crazy. So are you saying like healthcare in Georgia and the US are kind of similar or it. I think it's better here. It's so poor, and in the government still does so much, you know, for its people comparatively to what it has us has, you know, is the richest country in the world, yet doesn't take care of its citizens while Georgia, the past 30 years, and this I can do my study in a minute. Still tries currently at least this government has actually tried to prioritize health, but how can you have a functioning single payer and that's something that actually people in the US should think about. Most of the providers of health are private single payer ends up not working, because if they will just milk all the money they can raise costs have unnecessary interventions tests that you don't need just to get more money, because it's because you actually go to the doctor more so you don't get way more customers, it would meet they would have more you know interventions they don't need and and charge higher prices for it. That's an interesting thought. Yeah. So, you mentioned before that you live for a while in the Soviet Georgia. Give us some idea what was healthcare like back then. Yeah, so as my memories you know I was a child but all I remember as a kid was if I got sick a doctor came to my house like, I never went anywhere. So, it's it's interesting now but I had like, you know, really great, great life as a child you know, I got sick a doctor came to my house I remember getting in a flu or something. And they would come right away, you know, check my lungs and so on. I never had anything worse than a cold so of course everything was fine. And then one time I was poisoned like my whole family we ate some kind of canned fish and clearly it was like, had something bacteria and so we got food poisoning. And I remember as a kid being in the hospital for for a while. I remember how long. And that was like the only time I remember ever going to the hospital. And so everybody was at least like, as I recall taking care of not doing the research. So Union care was compared to now committed to actually caring for the for the people. It's a really different thing you have to think in a different way like the state and Soviet Union believes it's primarily responsible for its citizens. The state post Soviet Union believes that it's an individual responsibility, right. And of course everywhere we've seen this gone from more and more, you know, individual level of responsibility. And prevention, so preventive care. As a kid I do remember being in school and getting regular checkups. First and second grade, you know, because I didn't go anywhere else. I didn't go to any other school in Georgia. And so you had at every level so you had from birth to school to job, you had factory nurses and doctors so you would have preventive checkups all the time at every level. Military, you know, so everywhere you were at, you had a checkup and you had every single local neighborhood had a poly clinic. And these places, first, they would all share information with each other. And this poly clinic was your sort of computer chip of all of your health history. And if we look at some of the, you know, in almost every indicator that we, we looked at from Soviet Union until now has worsened from, you know, one of them is a cancer rate. Even if we took into account maybe different reasons why there might be more cancer now. The number one reason is that there's more cancer now than before is prevention, like cancer is something that could be completely like you don't have to die from it if you got it early. It's like it's preventable in the sense like you can check it early on. So if you have yearly checkups, you are going to catch it or even more frequently. And if you have a family history, which the poly clinic knows, and there's like, whole record of family record, you know, hope records and so on, of genetic, you know, markers, they also are maybe watching for it. So if like, say like my family, I know for sure, a lot of the men have died from prostate cancer. So I know that runs in my family. I don't know if any other cancer runs in my family, besides that. There'll be something that the poly clinic would know. And so the reason a lot of these factors, a lot of these health indicators have worsened is because there's no more preventative care. And because of general factors that leads social determinants what we call social determinants have worsened the pollution is worse food is worse, you know, in general life is much harder now. It's it's the entire understanding of health has changed. And what is the hospital in service of like, I will read you something. This is actually a really good indicator. We're talking about hospital beds, you know, it's like, so if the hospital bed is a source of income, then we have to consider that each added bed requires additional staff and additional infrastructure maintenance costs. And if the goal is revenue, then business takes into consideration the population's ability to pay. And in such a case, determining the optimal number of hospital beds is a relatively simple task, but one important drawback the health of citizens does not participate in the process anyway. Under the existing healthcare system the increase in beds is primarily due to the increase in payable demand. So, before their hospital beds, just in case and the biggest critique was you have too many hospital beds, but it was also because be able to have also for military use and for pandemics and also this idea that, it also emerged from the idea that in outpatient services right warrant the way people were treated, it was a way to be in the hospital way from your family in the sense that you've isolated any viruses and disease you had to help and cure it sort of old school way of of dealing with with sickness. And so hospital beds have been reduced or like reduced like you know IMF came in like World Bank and and also not just the World Bank really it's also like we have I we discussed like different levels of neoliberal militancy from slightly lower to really high to like a little bit but it's also this idea that one to please the reformers want to please and be very Western and pro-capitalist and so they would go above and beyond even private decision that was asked of them. Like, they wanted to be more more extreme than the World Bank told them which is crazy right. Yeah, post-Soviet world actually is is an interesting place where it's the World Bank is actually more progressive than the governments. They, the World Bank has to tell them to stop being too too free market you know. And so. So if you think of hospital beds as, okay so there's one understanding of okay maybe we have too many hospital beds you don't have enough money to take care of all this infrastructure decay and so on this this this argument okay we can understand that some level right. But when you look at hospitalization rates across similar countries. We see that Georgians are under utilizing them. So less people in hospitals that means that people are can't afford it. So they cannot stay long enough. So then you, then you do think in the capitalist logic which is, you know, you believe that, you know, healthcare is a commodity which almost all healthcare here thinks that then you think who can afford to be in the hospital, right, people who can pay. So I'm only going to have enough beds that people can pay so that also translates into everything else. Then where do you put the hospitals where do you invest in healthcare infrastructure. Do not invest in regions you do not invest in more areas you only invest that's why there's oversupply in like the city you know to really see where people have money there's oversupply of clinics of everything from restaurants to you know there's everybody makes everything in this one area, and then like the outer, you know, suburbs and poor areas and regions and mountainous areas are completely left without healthcare. So it's like, it's yeah it's it's a really terrible situation when you only consider really the cost. So then the state came in and 2013 was like okay will be the buyer, you know, and then we'll take will buy it. And this actually led to even more predatory behavior, because till 2013, it was just like free market, you know, you die you live based on how much you have now is it. And, and there was like some little bit of, you know, programs for the really really poor and so on that usually just covers very tiny parts of the population, because almost all of Georgia is very poor so it's really kind of need to cover the whole country. So the team, the state says okay will buy, because you know, you need to have a buyer and of course that increased people start going to the doctor more because they can go now for free. But that led to increase in the budget, or the demand for the budget, and then every single entrepreneur started thinking oh I'm going to start a clinic because I've guaranteed money from the government. So, so all these new clinics opened up clinics are probably would fail in a lot of ways. They're understaffed they don't have you know they're not like, they don't have the right inventory or anything else so expertise they're sort of unqualified in some ways. And so that led to also, I'm necessary medical interventions, because there's asymmetrical information like your doctor, I'm not so I don't know when I'm going to a doctor if he's lying to me is not. I know our nurses actually, you know, they have been telling me for years, and they, and they were the only ones who stood up and spoke about the mistreatment of patients on TV when nobody else would ever dare. And they said hey, like there was the thing where the government would pay for up to five days of hospital stay. So, they would bring someone in. And even instead of running tests right away to find out this person's actually like sick or was wrong with them to keep them in the hospital for five days, and then do the tests sort of towards the end to make sure they would get all the money from the government. There's like so many of these kinds of predatory fraudulent whatever I'm however you want to describe it just very anti social actions by the private sector, and Georgia has almost all private sector there's almost no public hospitals left or clinics. And so then the then the World Bank comes in again and says, you've been spending too much money on health, you need to change your single payer that's not working so sustainable. Then the government try to introduce caps on prices, and that led to more outrage by the private clinics and then they just start not paying the nurses. There's just so much and then COVID began. And I think COVID really hit home. I think COVID change a lot of things for the government. I believe that they started seeing things that everything led to the sort of chaos of the market doesn't work. They had to buy beds from the private sector. The private sector has been ripping them off like labor inspection did inspections and it was like over, I think 90% of the medical establishments were taking the money for COVID that was supposed to be for nurses and doctors and keeping it. Yeah, and happening also in other countries, even in the EU, and in my countries also like the government would incentivize the health workers but the hospitals are keeping it to make up for their loss of profit or something. And they're threatened actually to be fired if they don't give up this incentives from the government. That's what happened in my country, but it's not further discussed. So I'm glad in Georgia you're discussing about that.