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Interview with Henry Debussmann, Medecins Sans Frontieres (MSF) volunteer to Abkhazia , Georgia , with GAA Intern Eka Paresashvili

March 5, 2004

Can you give us some of the details of your arrival in Abkhazia , Georgia ?  Where and how did you get there?  What was your assignment?  How long did you stay?

We first had training in the MSF office in Tbilisi , and then we took an eight-hour car drive to Abkhazia.  Most of the NGOs use car transfers.  Even if the border closes for political reasons, international organizations can go through. 

I was a logistician with Medecins Sans Frontieres, and I stayed in Abkhazia for 7 months.

Did MSF brief you about the situation before going there?  Did you find the situation different from what you had been told before arrival?

I got the best briefing in Tbilisi by the head of mission, who had been there two years.  He had been field coordinator in Abkhazia five years ago, so he really knew the context.  A local staff also gave a good historical briefing. 

I really went to Abkhazia with no expectations.  But still, there were some differences - mostly in terms of quality of life, which was much higher than I expected.  Security was also better than I expected. 

Who were the people you were helping there?  Were they Internally Displaced Persons or refugees? What was the breakdown in terms of age and nationality?

We were working on two major programs: one was a TB program in the capital city of Abkhazia - Sukhumi , and the Health Access Program, or the HAP program, that gave assistance to vulnerable people.  The recipients were often older people, but we also assisted orphans and destitute people.  The majority of the older population in the program were non-Abkhazi - Russians, Armenians, and Georgians, mostly.  Most of the Abkhazis had family and social networks left in the area.  The majority of non-Abkhazis in the program were elderly.  But I can not say for sure the percentages.

The criteria for getting into the program was linked to financial income, but also took other considerations like family support.  Some of the older people were receiving retirement income from the local government, but it was not enough to live on.

We had a home visiting program as well that made visits to mostly bed-ridden patients.  These people were mostly the older population.

How did you publicize your activities there?  How would people know about the availability of your program?

The TB program had radio and TV announcements to publicize it, but I don't know how the HAP program was publicized.  Also, our health staff and social workers worked in collaboration with the Red Cross.  The Red Cross had 18 or 19 thousand people registered with their food programs - they had four different programs.  So we cross-pollinated - recipients of the Red Cross program were automatically eligible for the HAP program.  They issued cards that would identify them as eligible recipients.

Local NGOs also would meet as a group to share concerns, and we would publicize through them.  We also had seven regional doctors, so those regional doctors got out the word in their areas.

What was your means of communication with the elderly?  What language did you use?

The ex-pats used English to talk to each other, but we had six or seven translators on staff.  The common language of the office was Russian, but I didn't speak Russian.  The translators would help us communicate with the local population. 

What were the basic types of services you provided to the people there?

We collaborated with the de facto Ministry of Health of Abkhazia to assist in several areas.  Most of our TB patients were in the National TB hospital including a few MDR (multi-drug-resistant patients).  We also had a TB program in a prison.  Within the TB program there were regional clinics to receive patients.  We had seven regional clinics in the seven sub-regions of Abkhazia.  For the MDR patients, we also helped them find housing and jobs after treatment, to integrate them back into the community.  Sometimes, it was a household's primary caregiver who was receiving treatment, so we would provide services for the family.

In the HAP program, we primarily gave assistance to the most vulnerable population. In the past, we donated medicines to regional hospitals, but that was phased back.  Now we just give to the city hospital and our regional clinics and to MSF pharmacy where vulnerable people with an MSF or ICRC card could receive drugs, and they could get check-ups in our clinics as well.  We also donated pain-relief medication and other supplies to the City Hospital surgery ward. 

Recently, we did a preliminary test project with cataract surgery, supplementing the ward's tools to give people the opportunity to see again.  We started a test run of 60 patients so far.

Our mobile team did door-to-door home visits to do patient follow-up.  Our social workers linked people with other organizations' services.  Also, if a patient died and had no family, we would help the hospital with the burial. 

Was the infrastructure terribly damaged as a result of the war?

The condition of the buildings certainly showed signs of deterioration from the war.  Also, after the war, a lot of people were reluctant to rebuild, so they didn't spend much energy on infrastructure.  So, we tried to make conditions more workable even outside of our mandate.  For instance, if we were working in a run-down hospital setting, we would only put our resources into rehabilitating the rooms we were working in even though these health structures were under the responsibility of the Ministry of Health.

Things are getting better now, though, and people seem to have hope. The UN is there now, and the German government provided several big grants.  There's a lot more money in the local economy than before, and people have access to construction materials they need to rebuild.  I was seeing optimism and a desire to rebuild.  Much harder was obtaining medical equipments, motors and other larger products.

Did you observe any types of mental disorders or trauma as a result of the conflict? 

Psychological distress was evident in a lot of people - you could tell people were still affected by the war.  People really tended to dwell on the past.  We recently were talking about getting a psychologist.  But I am not aware of the medications we had for psychological disorders.

What were some of the most pressing needs? Housing? Food?

I didn't see many homeless people in Abkhazia, although there may have been squatters, I don't know.  There were lots of empty accommodations, although they were not in the best condition.  But housing didn't seem to be a big problem.

Food wasn't scarce either - people tended to grow their own food on small plots outside the city. Abkhazia is a very fertile area, so food grows abundantly.  Almost everyone eats their own food, they don't necessarily have to buy it.

The people we assisted didn't have much income at all.  Orphans received 80 rubles a month from the local government, and pensioners received about 100-120 rubles a month - that's about 5 dollars.  Last September those rates were raised.  To put it in perspective, the average government salary is also only about 800-900 rubles a month.

Did you have any program for reuniting lost family members?

No, we didn't have any program to trace family members.  The seniors we worked with didn't seem to have much contact with families, but I can't say for sure.  It didn't seem that their children or relatives played much part in their everyday lives.

Did you have any program that would recognize the contributions that older people can make, to help them rehabilitate?

MSF didn't, but ICRC programs sometimes integrated older people into their programs as volunteers, to provide care for others.