From Atlanta to Tbilisi

Transforming health care in the 'other' Georgia.

By Dana Goldman

Doug Ander

Emory physicians including Doug Ander (center) are training physicians and nurses in the Republic of Georgia based on successful medical and nursing education programs at Emory. 

Last fall, just as US presidential politics were reaching fever pitch, a small but important group at Emory was instead tuning into election results more than 6,000 miles away. In the Republic of Georgia, a country less than half the size of the state of Georgia, two million people had just gone to the polls in a parliamentary election. 

The results revealed a significant change in power. Doug Ander, professor of emergency medicine, knew this might mean going back to the drawing board. He was part of an Emory team partnering with the previous Georgian government on a new national training center for doctors. Would the incoming minister of health allow it to continue as planned? 

Around Emory, other faculty members asked similar questions about programs they had helped start in the former Soviet state. What about the continuing education programs for nurses, the initiative for emergency medicine, and efforts to modernize the country’s medical school curricula? At stake were health care initiatives to improve medical care throughout the country. After all, during the last 20 years, more than 125 Emory faculty members have worked to help that small country make big changes in its health care. 

In the months that followed Georgia’s fall 2012 election, the answers to Ander’s question revealed themselves. Professor of medicine Ken Walker has been spearheading Emory’s work in Georgia since the US Department of State first requested that the university help the country after the breakup of the Soviet Union. 

Walker is the founder and executive director of the Emory-Georgia nonprofit partnership, Partners for International Development (PfID). On trips to Georgia after the election, he met with new government officials. Afterward, he reported back to Ander and others. “The new team in the Ministry of Health is reviewing the plans and will come up with some minor additions and revisions, so they will feel it is their project. The schedule will be changed slightly. We don’t anticipate any major changes.” Faculty members breathed more easily: Emory’s work to improve the health care of millions could continue. 

It is hard to overstate the breadth and depth of PfID’s work in Georgia during the last 20 years. Emory professors truly have helped revolutionize health care in Georgia. Emory faculty have flown across nine time zones to conduct workshops on health care policy, perform trainings on health care administration, analyze health outcomes, and help Georgians lobby for and create health care reform. 

All this is possible because of Emory’s culture of collaboration and Georgia’s culture of learning. Says Ander of his Georgian colleagues, “They want to learn and want to be able to practice medicine well. The people as a whole there are incredibly friendly and open to learning new things and accepting new ways of doing things.” 

Tbisili

Georgia had no contemporary system for providing emergency medical care, so Emory faculty created eight-month-long miniresidencies in emergency medicine for already trained doctors, helped hospitals establish emergency departments, and successfully lobbied the government to recognize the new specialty in emergency medicine. Because of quicker diagnosis and treatment, the first hospital to create an emergency department watched as admissions dropped along with the length of hospital stays and costs. 

Soon after, PfID faced an unexpected test when tensions broke out between Georgia, the semiautonomous region of South Ossetia, and their neighbor Russia. Walker and his Emory colleague Archil Undilashvili were both in Georgia when the three groups began exchanging fire. They watched as doctors newly trained in emergency medicine cared for the casualties streaming into the capital city’s Central Republican Hospital. Undilashvili—a Georgian native now serving as PfID’s director of international programs— said it was clear that their work paid off. “Being next to the doctors and observing how they operated . . . and how the emergency room performed that had been organized with the help of Emory—that’s one of those moments that stands out for us,” he says. During that brief war, those new emergency medicine specialists treated hundreds of patients, with only a few deaths. 

Hospitals all across the country are now implementing emergency departments, and the fourth miniresidency program for emergency medicine physicians is now under way. 

Meanwhile, Georgia was updating its medical infrastructure rapidly, and officials realized they had a problem: most of the doctors in the country didn’t know how to use this new equipment and technology. “They decided every physician in Georgia—about 21,000—needed to have a course to improve clinical skills in the context of new infrastructure,” Walker says. “So the government came to us and said, ‘Will you be our partners?’ and we helped them develop a new national training center.” 

Why Emory? Ketevan Stvilia, a Georgian physician and the point person for PfID, says that government officials have taken notice of Emory’s long-term commitment to collaboration. “They decided to have Emory in charge of this new national medical center because of the good reputation and confidence that Emory can do it,” she says. 

Soon Walker had enlisted Ander, who also directs the Emory Center for Experiential Learning, for the effort. “It’s a group of doctors there who’ve been trained for the most part in an old Soviet system,” says Ander. “We thought this was a great opportunity to bring everyone up to the same level to practice 21st-century medicine.” 

Like his fellow Emory colleagues, Ander wants Georgian doctors to have modern skills and to be comfortable using advanced medical technology. But he also wants to offer Georgians a new model of teaching and learning. “None of us wants to sit in a lecture. The goal is not to just bring them up to par in their medical abilities but also in how they do their trainings in the future. The ability to work with simulators or actors playing the part of a patient makes the learning experience more vibrant, more active, and you get more out of it.” And, he says, there’s an added bonus to not using real patients while learning: “You can’t kill a simulator by accident.” 

At the heart of all of Emory’s work in Georgia is the goal of building knowledge within the country so that Emory can become less and less important. “The principle that’s been so important to us is to educate the people of Georgia so that from then on they can educate their own people,” explains Walker. With each project, Emory faculty train the first, pilot class. Then they hire promising Georgian graduates as the next trainers and move into support and consultant roles. 

“This is basically about taking a resource-challenged or developing country and helping them bring the standards of their lives up,” Walker says. “What we have focused on is educating people who can then continuously educate others.” 

And for Emory professors, that’s what they love about their work. “You always benefit from helping out in one way or another,” says Ander. “As an academic institution it’s part of our responsibility. That’s what we do in academic medicine. That’s our DNA.” 

Email the editor