Tusheti, GeorgiaDuring the summer and early autumn, before heavy snow blankets the mountain peaks, Irakli Khvedaguridze gets to his patients on his white horse, Bichola. Later in the season, when the snow reaches too high for the horse to gallop, Khvedaguridze converts his shoes into skis, using a pair of sanded birch planks nailed with wide canvas. Once the snow rises above his knees, he can only travel on foot.
Regardless of the elements, he never visits a patient without first packing a knife, a box of matches, food that will last for at least two days, and a hunting rifle—along with his stethoscope and other medical supplies. Such is the life of this 80-year-old mountain doctor.
“Each time you step out, no matter the season or weather, you know that anything could happen,” says Khvedaguridze, a muscular man with milky blue eyes and a shock of white hair that protrudes from underneath a navy-blue baseball cap he is rarely seen without. “You might fall off a cliff, injure something. This is wild nature.”
Khvedaguridze, the only licensed doctor across nearly 386 square miles of mountainous land in this historic region in northeast Georgia, serves as a lifeline for the dwindling community of Tush people who remain in this remote area throughout the eight months of winter.
A few years ago, an intoxicated patient in the village of Omalo had to be airlifted to a hospital in the lowlands of Kakheti after he accidentally shot himself in the stomach with a hunting rifle. In the early 2000s, Khvedaguridze saved a boy’s leg after he trod on an unexploded mine.
More frequently, he tends to common ailments: shepherds with back pain, aging locals complaining of heartburn, or tourists who get into accidents. One summer, a Czech visitor was mauled by shepherd dogs while hiking. Another year, an American got sick from drinking water out of a stream.
In December, while paying a visit to his friend at a hamlet in a gorge dotted with a few wooden houses and a sheep pen, Khvedaguridze received a call from Georgia’s 112 emergency services about a man in another village complaining of a racing heartbeat and chest pains. He made the 7.5-mile trek by foot to reach the patient.
The next day, when the helicopter landed on the snow-laced pastureland of Kvavlo, the patient was lying face up on the ground. The tall, thin man in his early 40s was so inebriated his legs buckled as he was loaded onto the helicopter for transport to the hospital. Khvedaguridze also climbed aboard the flight to monitor and escort the patient to the hospital. The patient was released a few days later, and returned to his village. But alcohol poisoning sent him back to the hospital in January.
The doctor’s journey
In 1941, the year Khvedaguridze was born, sheep-keeping was the lifeblood of Tusheti. The twice-yearly transhumance—shepherds migrating their flock on foot down to the lowland pastures for the winter and back up to the highlands for grazing in the spring—was just another event in the Tush calendar.
Today, it signals the near-total departure of the Tush people to the lowlands for the winter, and their return when the Abano Pass—comprising winding, narrow, cliffside roads—reopens in spring.
Khvedaguridze lives in Bochorna, a village of a dozen houses high above Tusheti’s pine-filled Gometsari gorge. His two-story cottage is made from thin grey-brown slate and wood, and overlooks the wide, green valley. On the steep hillside below, some houses with rusted metal roofs speckle the grass beside the remains of stone towers long destroyed.
“My father, my grandfather, all my ancestors were born here,” Khvedaguridze says. “This area belonged to us.”
After graduating from the Medical Institute of Georgia (now called the Tbilisi State Medical University) in 1970, Khvedaguridze took his first job at a hospital in central Georgia. When the previous mountain doctor left Tusheti in 1979, he did one-month rotations there a couple of times a year. In 2009, he left his job as a neuropathologist at a hospital in Alvani, and the next year, instead of retiring, he took on the permanent post in Tusheti.
Khvedaguridze, who keeps his limited medical supplies—a stethoscope, pain killers, a suturing kit, injections for muscle spasm relief—in a German-made military first aid case emblazoned with a red cross, describes his profession as a “mediation between God and the sick.”
“For me, there’s no night or day,” he says. “If they call me to help someone, no matter the circumstances, no matter the rain, snow, day or night, I have to go. Even if I’m as old as 90, should there be people who need me, I will go to help them. It’s my duty.”
Mountain doctor treatments
Khvedaguridze’s 59-year-old neighbor, Elza Ivachidze, is among his patients. When she complained of shortness of breath and pain in her arm last summer, Khvedaguridze treated the symptoms with pain killers and an injection.
“He often gives old, traditional treatments, including herb teas and pears. It’s not always pills and antibiotics,” says Ivachidze, adding that she worries about what will happen once Khvedaguridze is gone. “He’s the oldest and wisest person we have. Who would replace him?”
During another medical excursion in August, Khvedaguridze saddled up Bichola to make his way over the mountain to reach the home of a shepherd, Rezo Partenishvili, who was experiencing agonizing back spasms for the third day and could not stand up, let alone walk his sheep onto the mountain for grazing.
On the descent an hour later, Khvedaguridze dismounted and soon three snarling Caucasian shepherd dogs alerted him that he was close to his destination. With the speed of someone a quarter his age, he dropped to the ground to snatch a handful of rocks to scare off the dogs but ultimately did not need to throw them.
At the sheep pen, Partenishvili, 39, was lying on a mattress of folded woolen blankets known as nabadi. He is one of five shepherds who graze the flock across the mountain. None of the others looked worried. Back pain, they say, is the most common ailment among shepherds. At this time of the season, they spend their days bent over, shearing the sheep.
In addition to back spasms, Partenishvili suffered from stomach cramps, diarrhea, and chronic sciatica. Khvedaguridze gave him a packet of pink pills to take with meals, then retrieved an injection with some red liquid from his bag: indomethacin to relieve the pain. Partenishvili muttered that he didn’t want it.
“Really? You’re telling me you’re afraid of such a small thing?” Khvedaguridze jested. He reminded Partenishvili that the other option was to stay in bed for a month unable to work. Partenishvili rolled over and pulled down his trousers for the shot.
As Khvedaguridze prepared to head back home, a man sitting nearby quietly puffing on cigarettes called out to complain about shortness of breath. “Get that cigarette out your mouth, then!” Khvedaguridze replied. The shepherd laughed but obeyed, throwing what was left of the cigarette into the fire pit in front of him.
Toward the end of the year, with the road now closed for two months, the mountain doctor’s birthplace is almost empty of both people and animals. The transhumance in October cleared the region of most sheep and their shepherds. Only one small flock grazed on a distant hill, and an old Jeep puffed out thick grey fumes before disappearing into the distance.
The arrival of snow quickly revealed the paucity of Tusheti’s infrastructure. Moving around demands sustained physical strength. Fetching water from the nearest tap or spring can take half the morning. With nowhere to get fuel, car journeys must be rationed. Military helicopters are used to deliver food and other necessities. Relatives in the lowlands prepare care packages for soldiers to deliver to family members up the mountains.
Loneliness can creep in from the isolation. “Sometimes I hear a wolf from afar,” he says. “That’s how I know there’s life out there somewhere.
An easier life would be possible elsewhere, but leaving Tusheti would sever Khvedaguridze’s connection to his ancestors’ land—and to his patients.
Despite his devotion, the day eventually will come when he can no longer handle it here. “I will leave,” Khvedaguridze says. “I don’t know if the next doctor will risk their life for this.”
Nadia Beard is a journalist and pianist based in Tbilisi. Follow her at @nadiawbeard.
Tomer Ifrah, born in Israel, is a documentary photographer. In the last decade he has worked in the post-Soviet countries as well as in Brazil and Israel on independent documentary projects and assignments for various international publications. Find more of his work on his website.