Fox Chapel Physical Therapist Lectures in Country of Georgia

Fox Chapel Physical Therapy partner Christine Woods, PT, recently returned from the country of Georgia after instructing healthcare workers in modern physical therapy and rehabilitation practices.

Woods is a leading physical therapist in Pittsburgh with more than 25 years of experience and has lectured previously in the United States, but this was her first time presenting in a foreign country.

"Using an interpreter was quite a challenge," Woods said with a laugh. "But the lecture participants really welcomed the opportunity to talk with me about specific cases, and I got to learn a great deal about healthcare in Georgia."

Situated on the eastern shore of the Black Sea, in the valley of the Caucasus Mountains south of Russia and north of Turkey, Georgia is one of the former Soviet Republics. The country's independence was restored in 1991 after the fall of the Soviet Union, but years of civil war and economic strife followed as the nation struggled to transition from communism to a free market economy.

According to the World Health Organization (WHO), poor economic conditions are a major contributor to poor health among the Georgian population. The WHO estimates average life expectancy in Georgia to be 75 years for women and 67 for men; tobacco use is prevalent, cardiovascular disease, diabetes, and cancer are on the rise, and drug abuse, tuberculosis, and HIV/AIDS remain significant challenges.

Health service providers in Georgia, mainly non-governmental organizations, have developed solid hospice and palliative care, but are lacking in the components of preventative care, general wellness, and rehabilitative care that are typical in the United States. The Georgian government has made strides to expand healthcare services throughout the country in recent years, thanks in great part to First Lady Sandra Roelofs, a nurse by training. Under her leadership, the Cancer Prevention Center, a non-governmental organization, and Georgia's National Screening Center were formed to educate the public about the importance of cancer prevention and early detection.

Woods travelled to Georgia at the invitation of her longtime friend Mahnaz M. Harrison, who holds a Master of International Public Policy from Johns Hopkins University. Harrison received a Fulbright grant draft Georgia's first cancer control policy and has been working with the Cancer Prevention Center and National Screening Center since 2011. Through her research, Harrison discovered the shortage of prevention, rehabilitation, and patient rights and advocacy; she has launched programs and initiatives to address most of these shortcomings while working in the Georgian capital of Tbilisi, and developed an educational component for wellness programs that promoted healthy lifestyle choices and preventative care.

Harrison is concentrating on the epidemic of breast cancer, which is the leading cause of death among Georgian women. Nearly 50 percent of women in Georgia die of the disease within several months of diagnosis. Preventative activities such as monthly breast self-exams, clinical breast exams, and mammograms are not commonplace in Georgian culture, and Harrison and her colleagues are working to try to change that.

"Through education, we are trying to impart to Georgian women the notion that a breast cancer diagnosis does not need to be taboo and a death sentence if detected early and treated properly," Harrison said. She noted that while women in Georgia do have options for treatment, breast cancer survivors have few resources for social and physical rehabilitation because Georgia lacks a rehabilitation component in its educational curriculum.

This deficiency translates to both a shortage of providers of rehabilitative services and an absence of general knowledge among healthcare workers about some of the basics in rehabilitative care, such as wheelchair use and patient transfer techniques. To introduce rehabilitation, Harrison invited Woods to speak with nurses, home health workers, medical students, and Peace Corps volunteers in a diverse series of lectures held at the United States Embassy in Tbilisi and the Home Care Coalition, Cancer Prevention center, Tbilisi State Medical University, and Feristsvaleba Monastery.

Woods presented introductory information about physical therapy and its varied practice settings in the United States, as well as specialized topics like post-operative considerations, post-breast surgery exercise, exercise and cancer, wheelchair protocols, patient transfer techniques, gait training, amputee management, and skin care.

"It was so interesting to hear about their challenges, given that rehabilitation isn't a main component of healthcare for their population," Woods remarked. "I had a great discussion with a group of nurses about some common misconceptions about transfer techniques, like that you have to be strong to do them. I think they felt more confident knowing that anyone who is properly trained can successfully perform such a task without putting themselves or their patients at risk."

Woods described her experience as eye-opening, particularly regarding the differences between American and Georgian healthcare, from healthcare consumption and insurance to how patients are educated and informed about their treatments and prognoses. Harrison's research has revealed that Georgians pay nearly 70 percent of medical costs out-of-pocket, but the extent to which patients are informed about their courses of treatment is limited and there is little advocacy for patient's rights.

"Healthcare is a hot topic in the United States, but we don't realize how fortunate we are, both as clinicians and as patients," said Woods. "Providers have advanced training and ample opportunities for continuing education. Patients have access to the latest treatments and are well-informed about treatment options. As a culture, we're given extensive information about prevention and wellness. In Georgia, these things are all in development."

Two of the physicians Woods met during her lecture series have plans to open a multidisciplinary clinic that will include physical therapy and rehabilitative services.

"The American medical community has seen what PT can accomplish in helping patients restore function, improve mobility, and prevent future injury, which makes them healthier individuals as a whole," Woods noted. "It's great to see this being embraced in Georgia."

Woods holds a Bachelor of Science in Physical Therapy from Temple University and a certification in Manual Therapy from the University of St. Augustine. She has previously lectured on back pain, arthritis, and functional stability training. Woods hopes to return to Georgia this fall to work more extensively with medical students.