Despite partial government funding for cancer treatment in Georgia, for society’s most vulnerable, the remaining costs can still be insurmountable. For one woman suffering from breast cancer, scraping together the money for life-saving treatment has been all but impossible.

Fifty-year-old Nino Beselia was diagnosed with breast cancer in 2017, but for two years she delayed getting the tumour examined for financial reasons.

‘Back then I didn’t realise it’s the most important thing. When I finally showed up in the doctor’s waiting room two years later, my breast was cracked and bleeding,’ Nino tells OC Media.

Nino now has stage IV cancer; she had her breast removed in a recent surgery but the cancer had already metastasised to her lungs and spine.

According to her, she needed ₾500 ($160) for the biopsy alone. A family acquaintance called the Chernovetsky Charity Fund which collected the money for her initial diagnostic procedures.

Altogether, the diagnostic procedures cost almost ₾1,900 ($610). Only then could she start chemotherapy and preparing for surgery, which is co-funded by the government.

The Ministry of Health’s oncological programme covers 70% of these costs, although in each case there are possibilities for full coverage. After receiving core funding from the ministry, a patient can proceed to the local municipality for the rest.

There is also a chance that the ministry will show a ‘gesture of goodwill’ — which happened for Nino’s surgery which the ministry fully covered.

‘In reality, patients never know upfront how much funding they’ll get,’ says Ana Mazanishvili, the director of Pink Space, a local breast cancer advocacy and support group. 

‘In life-threatening circumstances, it’s very depressing for them to sit and wait for the money,’ she tells OC Media.

‘Patients have no chance without them’ 

Nino and her family live in a garage that they purchased to save money on rent after finding out about her illness.

‘Now all four of us live here, in 15 square metres — we don’t have a bed so we all sleep on mattresses on the floor,’ Nino says.

Her eldest son works occasionally on building sites while her daughter-in-law had a job in a small office until recently, when it closed down. Her 17-year-old daughter is currently unemployed too. 

Overall, Nino says the monthly income of the family, including her social security benefits, is about ₾250 ($81).

When it came time to pay for chemotherapy, Nino was eligible for coverage of 90% of the costs, but the remaining 10% was still more than she could afford. As a result, her doctor substituted her chemotherapy medication with a lower-priced one — which Pink Space helped to pay for.

However, some vital treatments cannot be switched to cheaper versions, and Nino, who is currently in the post-surgery period, still has no means to afford them.

She has been prescribed shots of Herceptin and Perjeta, medications that target the HER2 protein, which causes the growth of breast cancer cells. HER2 occurs in just 10%–20% of breast cancer cases.

Tamar Esakia, an oncologist at the Todua Research Centre of Clinical Medicine in Tbilisi says that use of Herceptin and Perjeta is critical in HER2-positive patients — and has a direct impact on the quality and length of their lives. 

‘These are not to be skipped. Patients have no chance of surviving without them,’ Esakia tells OC Media.

While residents of Tbilisi are eligible for full coverage of Herceptin and Perjeta thanks to the local government, those outside the capital can only receive 80%.

Despite Nino’s socially vulnerable status, she has not yet met the 2-year minimum residency requirement for the full coverage of the medicine, which costs almost ₾5,000 ($1,600) per treatment.

‘I’ll be eligible only from next January,’ Nino says, ‘but I don’t have time. I might not make it till then.’

In addition to these costs, in August, Nino must undergo follow-up examinations after her breast removal surgery, which are not fully covered either — she’ll need to add another ₾107 ($35).

Battling cancer during a pandemic

Anna Mazanishvili says that it is common for women with breast cancer to refrain from examinations and vital treatments because of their financial situations. But according to her, the problem has become even more acute during the COVID-19 pandemic.

For Nino, a ban on public transport introduced as a measure to counter the virus meant it was difficult for her to attend her post-surgery doctor’s appointments.

‘We had to ask for taxi money from everyone we remotely knew,’ Nino recalls.

She had hoped to receive a ₾70 ($23) addition to her benefits that was announced in response to the pandemic, but it never materialised. She said she was told in the Social Service Agency that the first group to receive the help would be retirees.

The State Employment Agency, the body responsible for distributing these additions, told OC Media there was no age preference for the benefits but that Nino did not qualify because she did not score highly enough on their vulnerability assessment.

‘My doctors are excellent’, Nino says, ‘but they’re alone against the illness. Why doesn’t the government want to fight for our lives as they do? Life shouldn’t be a luxury’.

According to Mazanishvili, many patients who previously had the means to co-fund their treatment have lost their incomes as a result of the pandemic.

‘People were calling me every day saying they don’t even have money for food let alone medication. They’re telling me — “I want to live”. I’m sure if only the government was able to hear what I hear, they would support them’.

Mazanishvili created a petition for cancer patients to receive 100% financing for their treatment during this period. In two days, the petition was signed by more than 5,000 people and was submitted to the Health Minister.

However, the Ministry told OC Media there were no further changes planned to the oncological programme.

Meanwhile, Nino is still trying to get financing to cover the remaining costs of her treatment. 

‘It’s not just me, there are many in the same situation, but it’s like we don’t exist already. No one understands us — this feeling of the illness still being there, awake even when you sleep. Time is precious. It would be a great fortune to die fast.’

This article was prepared with support from the Friedrich-Ebert-Stiftung (FES) Regional Office in the South Caucasus. All opinions expressed are the author’s alone and do not necessarily reflect the views of FES.