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Georgia - Health and safety
With Dr Felicity Nicholson
Reform and privatisation of Georgia’s corrupt and run-down health service began in 1995; now a state medical insurance company and 12 health funds are funded by a payroll tax of 3% on employers and 1% on employees. The health service is still corrupt and run-down, but slowly improving as the economy recovers, though the share of GDP spent on health is still under 1%. Although British citizens are covered by a reciprocal agreement and need only proof of UK residence (ie: UK passport) for free treatment, they will still have to pay cash for drugs and many other services; as a rule US health insurance is not valid in Georgia without paying a substantial premium. Treatment is expensive (US$600 for a hernia operation), and even if you can pay for it there is a shortage of basic medical supplies, such as hypodermic needles, anaesthetics and antibiotics. Embassies have lists of good English-speaking doctors in Tbilisi.
You are advised to be up to date with vaccinations against tetanus, diphtheria and polio, now available as an all-in-one ten-year vaccine (Revaxis). You should also be covered for hepatitis A and very occasionally typhoid for longer trips and more rural travel. Other vaccines that may be advised include a course of hepatitis B and rabies vaccine. Hepatitis B vaccination is essential if you will be working in a medical capacity and is usually recommended when working with children. Having the pre-exposure rabies jab is particularly important as there’s a shortage of the rabies immunoglobulin used for treatment following bites, scratches or even licks from any warm-blooded mammal. The courses for rabies and hepatitis B comprise three injections over a minimum of 21 days (for hepatitis B you need to be 16 or over for this super-accelerated course), so you should go to see your GP or travel clinic specialist well in advance of your trip. Tuberculosis (TB) is common in Georgia with ≥40 cases per 100,000 population (Travel Health Pro, 2018). The disease is spread through close contact with infected sputum or through eating unpasteurised dairy products. Vaccination may be considered for those under 16 who are living or working with the local population for three months or more. Tuberculin-negative individuals under 35 years of age should be considered for vaccinating if they are at risk through their occupation. The vaccine becomes less effective with age, so vaccinating people over the age of 35 is considered only if they are at very high risk of disease.
Travel clinics and health information
A full list of current travel clinic websites worldwide is available on ISTM. For other journey preparation information, consult NaTHNac (UK) or CDC (US). Information about various medications may be found on NetDoctor. All advice found online should be used in conjunction with expert advice received prior to or during travel.
Georgia is in general a safe country, with too few tourists for them to be targeted by thieves. Abkhazia, which has effectively seceded, is a little more problematic, and with no diplomatic representation you are very much on your own there if you get into trouble. The bordering area around Zugdidi is also considered to be risky. South Ossetia is not only a problem politically, but crime levels are higher than elsewhere here too, partly due to the wide availability of guns; the same used to apply to Svaneti, where unwary tourists were almost routinely robbed until a few years ago, but this is now as safe as anywhere in the country. Nevertheless it is still probably wiser not to go walking too far outside Mestia or Ushguli without a local guide. Tusheti and Khevsureti are also safe – they were closed to tourists due to the Chechen war but there’s no problem now. In Tbilisi, you should take the same common-sense precautions as in any other big city.
There’s little public drunkenness in Georgia, and there are usually plenty of people on the streets, even late at night; however, there have been vicious muggings of foreigners, usually in the dark entrances to apartment blocks. Otherwise, there is some pickpocketing, particularly in the metro, but few other problems. The days of Kalashnikov-toting Mkhedrioni (political gangsters) running the whole country as one big protection racket are long gone!
Sexism in Georgia is as bad as anywhere in the world, but as a rule foreign women see only the positive, chivalrous side of the Georgian male’s world-view. In smaller towns and villages you may notice some stares and comments, but much less so than in neighbouring countries. There are some notable female politicians, notably Justice Minister Tea Tsulukiani, and three former foreign ministers, Tamar Beruchashvili, Salome Zourabichvili and Maia Panjikidze, and 39% of Georgia’s judges are women. Nevertheless, the proportion of women in parliament has fallen considerably from 30% in Soviet times, hitting a low of 5% in 2008 before recovering to 12% in 2016. In 2016 just 1.6% of local councillors were women, and not a single mayor. According to UN research, one in 11 married women in Georgia has been subjected to domestic violence; but the real number could be much higher as victims rarely speak out. Three-quarters of Georgian women believe domestic violence is a private matter and should remain within the family, and police refuse to get involved.
Despite the fact that discrimination against LGBT people is illegal, homosexuality is still viewed as a major deviation from Orthodox Christian values in Georgia – the Church itself is very anti-gay and priests have led violent protests against gay pride marches. In a 2017 survey, Georgia was rated as the world’s third-most homophobic country, with 93% of Georgians saying they would object to having a gay neighbour. In October 2017 there were protests against Guram Kashia, captain of Georgia’s soccer team (who plays for Vitesse Arnhem), wearing an LGBTQ armband as part of a Dutch Football Union pro-diversity campaign – but the same month the first openly gay candidate stood for Tbilisi’s city council (although she wasn’t elected).
As you might expect, attitudes are changing faster in the capital than elsewhere – thanks to dating apps and inclusive nightclubs such as Bassiani, gay people there can now be much more open and confident in their identity. Recent changes in legislation are due more to pro-Western alignment rather than any real buy-in by politicians. Nevertheless, there are a small number of pro-gay bars in Tbilisi, such as Success, Cafe Gallery, Salve and Divan. It is also normal for two men or women to share a room with each other.