Recently, the American, non-profit, philanthropic organization, Global Healing, provided us a wonderful opportunity to improve the quality of blood banking and transfusion medicine in the country of Georgia. Over the past decade, this former Soviet Republic has fallen on hard times, such that its medical community has been largely unable to provide adequate care to its population. As is often the case in such situations, a disproportionate amount of the suffering has been borne by the children of Georgia, many of whom lack even the most basic preventive healthcare, let alone access to more specialized treatment.

Owing to this, in 1994, Georgian cardiac surgeon, Dr. Irakli Metreveli, approached Global Healing's founder, Jo Ann McGowan, to ask if she would help establish a pediatric cardiac diagnosis, surgery, and treatment center in the capital city of Tbilisi. Jo Ann had just spearheaded a similar project in St. Petersburg, Russia, and the St. Petersburg facility already had become a crown jewel in the Russian pediatric healthcare system.

Not surprisingly (to those who knew Jo Ann), she agreed to this newest request without hesitation and, thanks to the unflagging efforts of herself, several Global Healing colleagues, their Georgian medical partners, and many pediatric cardiac surgery specialists from around the world, this small but promising facility opened on September 16, 1996. Sadly, Jo Ann lived long enough only to see the initial fruit of her efforts, as she died unexpectedly on October 5, 1996. However, her legacy was so profound that, soon after her death, President Shevardnadze renamed the facility the Jo Ann Medical Center (JAMC) in her honor.

Since opening, the JAMC has been the site of over 600 lifesaving surgical procedures in which well trained, Georgian surgeons have corrected a variety of congenital cardiac defects. By all accounts, it has been one of the most successful medical projects in the history of this country. Moreover, thanks to the seeds sown by the many volunteers involved in this project, coupled with the high quality of the Georgian medical staff who work there every day (and the support of Minister of Health Dr. Avtandil Jorbenadze and Georgian President Eduard Shevardnadze), it now is a self-sufficient entity.

Jo Ann Medical Center Cardiac Intensive Care Unit

As successful as the JAMC has been, though, its weak link was its reliance upon blood supplied by a number of local, government-sanctioned "blood stations". These facilities have demonstrated many weaknesses in their ability to provide safe blood to Georgia's patients. For instance, until very recently, they did not reliably test a large portion of the blood supply for HIV-1/2 and the hepatitis B and C viruses. Moreover, most of them continue their routine use (and repeated reuse) of ostensibly sterilized glass bottles and needles, and their solicitation of paid "donors" (i.e., "sellers"). For these and related reasons, we knew we had to come up with a better alternative, since the needs of our patients demanded no less.

Global Healing began its fundraising efforts to establish a new Georgian blood bank in late-1998. However, because of many bureaucratic hurdles, we were prevented from doing any formal work on this project within Georgia itself until October of 1999, when we made our initial scouting trip. During this 10-day trip, we worked on a number of tasks. These included: setting up our infectious disease testing equipment (which had been donated to us by Organon Teknika) and training our Georgian colleagues in its use; creating a preliminary blood bank computer program; providing daily lectures on all major aspects of transfusion medicine; scouting out potential locations for the new blood bank; and meeting several times with the Ministry of Health to review the project. This reconnaissance mission, which set the stage for everything we have done since, made us fully aware (not that we didn't already have a strong inkling) that, in order to establish this blood bank, we would have to overcome a number of obstacles.

First, we needed to identify and hire a medical director who would perform at a very high level. To that end, we looked for someone young, intelligent, and hardworking, who had not yet been overly influenced by the existing system. After some initial missteps, we found that person in Dr. Levan Avalishvili, a local intensivist/hematologist with seven years of experience at the local Institute of Transfusion Medicine.

Next, we had to find an appropriate site on which to build our blood bank. For political and economic reasons, it was not possible for us to operate in a location within the city's center (our original wish). Rather, we were required to keep things on a smaller scale. And, so, we decided to build the blood bank within the JAMC itself. In hindsight, we realize that this was the best possible primary site for our blood bank, as its proximity to the JAMC's patient wards has allowed us to establish the beginnings of a much-needed transfusion service at this flagship hospital. This was very important, as the red cell compatibility testing methods historically used by Georgian hospitals - even at the JAMC (until recently)-have been of sub-optimal reliability, at best.

Emergency entrance to the Jo Ann Medical Center

In order to build our blood bank, we needed to create plans and solicit funds for the renovation. Neither of these tasks - particularly the former - was an easy one, as Georgian healthcare-related building requirements are comprised of an amalgam of ponderous, often inconsistent and outdated regulations that seemed designed more to impede progress than to serve and protect patients and medical workers. Still, after a great deal of negotiation with the City Department of Sanitary Control, by January 2000, we had tenable architectural plans in place for our 540-square-meter facility. Moreover, around this same time, an anonymous U.S. benefactor provided us the funds to renovate the space.

Next, we hired a local contractor and simultaneously began the: (a) renovation, (b) collection of equipment and supplies, and (c) formation of the Georgian blood bank staff and the U.S. training teams. These went successfully (albeit, "(a)" and "(b)" required a great deal of time and effort) and, finally, by September, 2000, the renovation was complete; and we were able to begin full-scale training.