They live somewhere between inclusion and isolation – part of a community, yet apart from mainstream Georgian society because of the dreaded disease they bear. They are the patients of the Abastumani Tuberculosis Hospital, but, fearing the reaction of others, most prefer to keep that status a secret.
Many Georgians consider tuberculosis, a contagious bacterial infection of body tissues, a “prison disease,” say public-health advocates; or an illness born of abject poverty. The country experienced a resurgence of the often-fatal disease after the 1991 collapse of the Soviet Union, when armed conflict broke out and the economy and state-financed healthcare fell to pieces.
While the rate of infection has been falling steadily since then, Georgia still has among the highest infection rates in Europe (approximately 95.4 cases per 100,000 people, the WHO states). Multidrug-resistant tuberculosis, one of the most challenging forms of the disease, poses a particular risk.
To find help, scores of TB patients head to Abustamani, a village of less than 300 people, surrounded by towering mountains which form a relatively dry, largely wind-free “shelter” for those with TB.
Here, about a three-and-a-half-hour drive west from the Georgian capital, Tbilisi, stands the cavernous Abastumani Tuberculosis Hospital. Once reputed to be among the Soviet Union’s largest hospitals, it has been fighting for more than 90 years to give TB patients a chance at life.
In the early 1890s, Grand Duke Georgy Alexandrovich, a younger brother of Russia’s last tsar, Nicholas II, moved into a villa not far from the hospital’s later site in hopes that the area’s sub-alpine setting, climate and hot springs would help cure his tuberculosis. Abastumani consequently became something of a fashionable health resort.
Buildings from Abastumani’s Romanov era, bearing the marks of their age, still stand throughout the village.
The atmosphere of these structures, trapped between past and present, appears to fascinate some hospital patients, who can find their own lives put on hold for months or years at a time as they seek treatment.
A decrepit stone building, with peeling paint and un-weeded steps, the hospital, at first glance, could appear to many almost like a prison. “Put a mask on” are the words with which all visitors are greeted.
Inside, only 70 of the facility’s 200 rooms are in working order, according to Doctors Without Borders. Overall, it houses approximately 100 patients.
Despite access to advanced medication for treating tuberculosis, the patients’ experience is not easy. Frustration, depression and a sense of a loss of control are among the potential psychological effects of life with TB, according to one handbook for TB patients. Those kept in isolation can lose a definitive sense of time.
Fearing the stigma of TB, some, even when cured, do not disclose to others where they have been.
To try and express their emotions freely to the outside world, four patients at the Abastumani Tuberculosis Hospital have opted for photography as a form of communication. Over the course of six months, the average length of a tuberculosis treatment, they will use their mobile phones or a Sony or Nikon digital camera to focus on locations, all within range of the hospital, that resonate with them.
Their photos, part of a project called “My Micro Window,” will tentatively be exhibited in Tbilisi this December. Two of the photographers’ work is presented here.
Twenty-one-year-old Nino, an unemployed woman who declined to give her last name, has been a patient for the last seven months. She tries to understand the silence around her and learn what dignity can be derived from a solitary existence. What does it mean to be different? Does it lead to isolation and loneliness? She mostly looks to nature for the answers.
She is not alone. Twentieth-century Georgian poet Lado Asatiani, himself a TB patient, called a stream that leads from a hot spring near the hospital “the blue eye of life.”
Fifty-six-year-old social worker Kale Mantkava, who first came to the Abastumani Tuberculosis Hospital seven years ago after two unsuccessful TB treatments, recollects a patient similarly transfixed by Mikho’s Spring.
“He was feeling already very weak, but he still couldn’t stop going there because it was his favorite place. We found him dead in front of the spring one day. His body couldn’t fight against TB anymore to bring him back to the hospital.”
“[N]ow, we call it ‘the Death Spring,’” adds Mantkava, who, now cured, has endured tuberculosis for 30 years.
In Soviet times, the area, which included a fish restaurant, was full of life, he continues.
Despite its foreboding informal name, the spring remains a meeting place for both villagers and patients – in essence, a link between the two communities.
The question is whether, and how, more such links can be formed.