Francesca Montalto (00:00):
Before we get started today, just a heads up, since the initial recording of this episode, the Georgian government has started administering COVID-19 vaccinations.

Speaker 1 (00:18):
Welcome to Sabin's Community Conversations on Vaccines presented by Immunization Advocates. In this episode, we are joined by Marina Shikhashvili, a primary care physician with 30 years experience in Georgia. Vince and Francesca talk to Dr. Marina about the impact COVID-19 has had on the medical community, the challenges of treating patients remotely in a pandemic, and how health workers globally can benefit from communication and community engagement skillsets.

Francesca Montalto (00:47):
Hi, and welcome to Community Conversations on Vaccines. I'm Francesca Montalto.

Vince Blaser (00:50):
And I'm Vince Blaser.

Francesca Montalto (00:52):
Now, Vince, I'm especially excited about this episode because my internet is actually working today. Hopefully, our listeners can tell, but last episode, I was having some serious issues with my wifi while we were recording, which prevented me from being able to see you and sometimes hear you. But, it's fixed now, which means I can fully engage with the amazing guest joining us today.

Vince Blaser (01:14):
Yeah, that's great to hear Francesca. It's amazing how much we're all dependent on technology these days. Well, I'm really excited as well. I'm really looking forward to our conversation today with Dr. Marina Shikhashvili of Georgia, to really talk about some of the issues that health workers, especially primary care physicians, are facing and communicating in administering vaccines.

Francesca Montalto (01:37):
Absolutely. And you know, in our last episode, we welcomed Dr. Naveen Thacker, executive director of the International Pediatric Association to give us a global perspective of vaccines and immunization, including barriers, such as communication, the infodemic and social inequity. Dr. Thacker also discussed IPA's recent global health initiative, the Vaccine Trust Project. Today, we have Dr. Marina here to give us a regional health worker perspective and tell us about vaccine access and demand in Georgia. So Dr. Marina, welcome to the show.

Dr. Marina Shikhashvili (02:08):
Hello.

Vince Blaser (02:10):
Dr. Marina, you have over 30 years of experience as a physician. We're curious - how did you become a doctor, and why did you decide to work particularly in primary care?

Dr. Marina Shikhashvili (02:22):
By basic education and pediatrician. After graduating from Tbilisi State Medical University, I started working as a district pediatrician at Children's Public Link. This is type of primary health care institution. A few years later, I moved to the secondary level and worked as a pediatrician at Children's Hospital. But since 1997, primary health care reform projects, too, have started in Georgia It was British now, or know how for the Georgian health project and primary health care development in Georgia. And, I was granted the opportunity to be engaged in those processes from the very beginning. It was really exciting in the ambition challenge and to be a pioneer in this process, developing family medicine in Georgia is big honor.

Vince Blaser (03:23):
Can you explain to us a little bit about Georgia's health system and how it works and, you know how that reform, what happened as a result of that reform?

Dr. Marina Shikhashvili (03:35):
So as I mentioned since 1997 begins developing family medicine in Georgia. Now we have a health system which has a primary care level and hospital level and these two levels connected with each other, But in our countrymost of healthcare organizations, facilities, they are private. Private medicare institutions, and also hospitals and financial. And also we have a health coverage program, universal health cover program, which support from our states. So it's a very complicated system.

Vince Blaser (04:26):
And are you, is the work that you're doing in family medicine, Is that private or public?

Dr. Marina Shikhashvili (04:33):
Yes. You see the state programs in primary care is free of charge; it's the state. But organizations are private.

Vince Blaser (04:45):
Okay. And, and so how are some of the family medicine, primary care physicians like yourself, how are you typically involved in talking to patients about vaccines and immunization?

Dr. Marina Shikhashvili (05:00):
Usually family physicians are encouraged to take a proactive approach to educate parents about preventive care measures, especially vaccination. It's the main duty of family med doctors at every well-child visit. Despite all the evidence regarding the effectiveness of vaccination, some parents may express concerns about having the children vaccinated. So primary care physicians emphasize the importance of vaccination to prevent different disease. The key off addressing any consent of parents are to listen more and to develop a communications style that is trust the base and science informed. Doctors and the nurses both should be involved in educated process of parents, unfortunately is there is a lack of nurses in Georgia and the majority of workload is shifted to doctors.

Francesca Montalto (06:04):
Dr. Marina you know, you talk about taking a proactive approach and communicating with patients. How has this been affected since the COVID-19 pandemic?

Dr. Marina Shikhashvili (06:14):
Oh, it's quite difficult to answer because COVID-19 vaccination is very the new for physicians and for patients also. Our country, we have not vaccines for today, and we are not starting a vaccination process.

Vince Blaser (06:36):
But maybe before we get into COVID vaccines, could you say how the pandemic, how this past year, since COVID-19 has come, has impacted your ability to have some of those conversations you have been talking about, that proactive approach you are talking aboutwith families about routine immunization.

Dr. Marina Shikhashvili (07:01):
This is of course not easy process and when we are doing child health, well-baby check visits all the way use always it's for education of parents, ensure them that immunization is the part of the prevention of diseases and to prevent own child or to prevent whole population. It's very important. And so we all the time, we are trying to use this possibility to educate our patients and families. We have some leaflets, also, some companies which were maybe from the TV. So it's quite wide job.

Vince Blaser (07:54):
And what is, you know, both for you and other physicians and nurses you work with, what has this year been like for you personally?

Dr. Marina Shikhashvili (08:08):
Of courseCOVID-19 changed my everyday work dramatically as everywhere in the world. Primary health care system in Georgia transferred to remote model of working. We use very much remote consultation and this challenges me and also whole system. I'n my regular life without COVID, I was used to accessing health compliance based on my knowledge of the patient as well on my observation. What is seen and heard is vital. Non-Verbal communication, as well as physical examination, also, are essential tools for practice of family doctors. However, I need to make decision without seeing the patient. And now sometimes I have the concept regarding the compliance of the patient. For example, is phenotypic compliance due to the COVID-19 or could it be exacerbation? So it's quite difficult.

Dr. Marina Shikhashvili (09:21):
And an increase in the number of acute patients during the pandemic has resulted the reduction in the number of preventive visits to the clinic. We try to manage patients who also with the chronic diseases remotely, also very new. Also, I amI don't mention, but I am expert in Czech Caritas Project, which is about primary health care. And my responsibility in this project is to provide technical assistance, also conduct training for rural doctors all over Georgia, as a response to COVID-19, and also we are cooperating with the UNICEF to strengthen, the capacity of primary healthcare providers in delivery of postnatal and well-baby services and strengthening a maternal and child health or health component of the primary healthcare system, by actualization child development aspects. I'm also working as an invited lecturer of University of Georgia. This pandemic period challenge current healthcare system, both today's worker, and also next generation as lessons learned by the system where both organizational and medical in nature are of particular importance became the remote communication between the patient and the healthcare system.

Dr. Marina Shikhashvili (11:13):
The significant emphasis was put on preventative services and primary health care. People-Centered approach multi-sectoral collaboration and the the importance of constantly up-to-date evidence-based best practice, always three clear written protocols and procedures for success and based results were also highlighted. Also as a lecturer of University of Georgia, as I mentioned, I provide course research and communication skills. And this is very important to a career medical students with a general communication skills for consulting and educating patients and their familiesResearch on communication skills training suggest good communication skills.

Vince Blaser (12:13):
Looking forward a little bit. You mentioned earlier that that COVID-19 vaccines are not yet being rolled out in Georgia, but they will be soon you know, what are, what challenges are you anticipating with that in terms of communicating with patients? What do you need to best prepare for some of these questions and what's going to happen in the coming year?

Dr. Marina Shikhashvili (12:41):
The end of this coming year very dramatically change our work. COVID-19, it's quite new, you know, and of course vaccination and vaccines are very new. We have a to know side effects, effectiveness of this vaccine. But not just medical person medical staff, but the population, our patients also need whole information about this vaccine. So we have enough datas to explain them what it means or how it works.

Vince Blaser (13:23):
This past year, all over around the world, there've been a lot of honors for health workers. You see celebrities, people in music or movies honoring health workers. People have been giving lots of applause to health workers, writing messages, thanking them for all the work that they have been doing in fighting this pandemic. I'm curious how you feel about those honors. What are you hoping the public well, most do in response to help health workers end the COVID-19 pandemic?

Dr. Marina Shikhashvili (14:06):
This is this year and last year was very hard for healthcare workers. And in Georgia, also, a lot of doctors involved in this process we create here in our country. Now we call this remote clinics which helps people who stay at home who have COVID and stay at home with consultation and really a lot of cases our doctors manage at home. So of course, satisfaction from the patient was very high. And now we are trying to follow this by support of our organization, Czech Caritas in Georgia. We create a remote consultation for protocol in a remote consultation for children, for adults. And so it was also good help for family physicians and for primary care providers.

Francesca Montalto (15:17):
Do you think that after the pandemic, you'll still continue to use these new interventions, like remote...

Dr. Marina Shikhashvili (15:26):
Real remote consultation? You say remote consultation, it's very useful consultation. And we can use in, for example, in management of chronic disease, or sometimes in patient education part, for example, if patient has additional questions, they can contact with the family and with the doctors, and it should be not necessarily to go to the clinic and to see doctors. To use the remote consultation, it's also we will be good. Also nurses can use it a lot, so really very new, but very good communication, good communication skills. But it needs experience. It needs time.

Vince Blaser (16:16):
Dr. Marina, many of our listeners and Sabin partners are involved in global immunization programs and policy around the world. Thinking of all the health workers that you work with, what is your message to the international community about health workers needs this year in regard to vaccines and immunization?

Dr. Marina Shikhashvili (16:36):
Oh, okay. International community can deliver huge help in improving immunization program countrywide. And it can be by demonstrating the value of vaccines for the health of children and communities. Also highlight the need to build on immunization programs while addressing gaps, including encouragement of local governments for increasing investment in healthcare professionals. Motivation show that routine immunization is the foundation for strong health system and universal health coverage. Main key issue is communication and health education. I want to underline communication and health education, and there are no bounders for microbes and virus, therefore, every country and each citizen should be realizing the importance of vaccination. Each person is responsible not only for his own health, but also for the health of everyone. So this is a message that should always be heard this will be protect for from future pandemic.

Speaker 1 (18:09):
Thanks for listening to Sabin's Community Conversations on Vaccines brought to you by Immunization Advocates. For more information, visit immunizationadvocates.org,