Every young medical specialty has an origin story that sounds, in hindsight, too small for what it became. A meeting nobody photographed. A visit that was supposed to be brief. A relationship that started for reasons that had nothing to do with medicine at all, and only later turned into one. Georgia’s emergency medicine and clinical toxicology programs both have stories like that – and this July, at the Frontiers in Advanced Emergency Care and The Mediterranean Academy of Emergency Medicine Joint Congress in Tbilisi, you could see exactly what those small beginnings had grown into: two specialties standing on their own, sharing a stage, drawing physicians from across the region.
Much of that growth traces back to a long partnership with Emory University in Atlanta – training programs, research collaborations, a steady exchange of physicians moving in both directions between Georgia and the United States. But institutions don’t build relationships. People do, usually for reasons more personal than any grant proposal admits. We sat down with one of the people at the center of that story to ask how it actually started, what it took to grow a subspecialty here from almost nothing, and what he thinks Georgia still needs before that work is finished.
Ken Walker is an outstanding figure in advancing medicine in Georgia. He recognized the country’s potential at a time when Georgia was largely invisible on the global medical map. He planted the seed that allowed the later developments we’re enjoying today. How did that process unfold?
I think Dr. Walker’s greatest contribution was establishing a friendship between the state of Georgia, Emory University, and Georgia the country. By planting that seed, he started a tree that has grown and flourished; now you can see the fruits. Relationships between Emory faculty and Georgian physicians continue beyond his memory. These people are working together on projects far beyond internal medicine and infectious diseases – there’s public health, and most recently toxicology.
Clinical toxicology was the newest addition. I remember meeting Dr. Walker before his death, after I married my wife, Tamar Gabelaia. We discussed toxicology in Georgia and brainstormed several project ideas, though we never finalized any before his early death. When Dr. Walker died and the USAID grant that supported emergency medicine concluded, GEMPA – the group of emergency physicians in Georgia – remained. I saw an opportunity to continue the relationship in emergency medicine beyond the grant, to ensure Georgian physicians felt part of the Emory family in that specialty, and I added toxicology to that effort.
That’s how we sustained annual conferences. In 2015-2016 there was a large meeting organized by GEMPA, and the recent conference of similar size was notable for the significant clinical toxicology content. Our role with the Organization for the Prohibition of Chemical Weapons (OPCW) heightened attention to toxin-induced illnesses, which are especially relevant to Georgia given the Lugar Center and regional toxin hazards. The success and interest you see stem from those connections Dr. Walker initiated, which have continued and expanded after his passing, ultimately to improve the health of Georgian citizens.
It’s great to witness this continuity. Emory’s relationship with Georgia isn’t new – you’ve trained physicians and collaborated on surveys, such as the well-known lead-poisoning survey with UNICEF. What first brought you to Georgia? What initially piqued your interest?
My wife. I met her in Atlanta, we found many cultural similarities, and after we married I came to Georgia. My first trip here was with my daughter, who was less than one year old.
When you first encountered Georgia, what question came to mind – and after these years, has that question been answered?
When I arrived, my immediate question was: I’m a toxicologist, this is my home now – what’s happening with toxicology in Georgia? I wanted to understand the local situation.
I met excellent colleagues, such as Dr. Teimuraz Kubaidze and Dr. Otar Dikhaminjia, and learned about scattered lead case reports in the country. That led me to undertake an initial study. Looking back, the experience has been very rewarding – we contributed to an important project in Georgia and others contributed as well. Importantly, we’ve seen blood lead levels in children decrease, which gives me hope. I feel rewarded by that progress, but I also want to continue research to identify other hazards beyond lead that may affect Georgians.
There are substantial opportunities to improve public health in Georgia through toxicology. We were able to train Dr. Otar Dikhaminjia at Emory through the Fogarty program and the Center for Advanced Emergency Care; he completed a Level 3 certificate in clinical toxicology, received direct clinical supervision, and continues to collaborate with us. I hope more Georgian physicians will join this effort so we can expand clinical toxicology and environmental health in the same way we expanded emergency medicine.
How would you describe Georgia’s current standing in emergency medicine and clinical toxicology?
In emergency medicine Georgia has made tremendous progress: it advanced from having no emergency medicine training to establishing formal training programs. Emory trained some of the first classes, and now those physicians are training others. The number of practicing emergency medicine physicians is impressive – I don’t want to give an exact figure without confirmation, but it’s on the order of a hundred or two hundred. These physicians practice in hospitals across the regions of Georgia – from Samegrelo to Kakheti to Adjara – and that makes a big difference. When doctors dedicate themselves to the field and pursue continuous professional development, patient care improves. Many of those first classes are at this conference, which is a sign of success.
Toxicology is at a different stage. The first pioneer was Dr. Teimuraz Kubaidze; we are now developing a new generation of clinical toxicologists. The first Georgian trained at Emory, Dr. Otar Dikhaminjia, received American-style education that emphasizes clinical supervision and care as well as public health and education. There are other international education models, but our approach is the American model.
What are your future plans? Can you discuss any near-term steps – perhaps a toxicology center?
We hope to work with the National Center for Disease Control and Public Health to establish a Georgian National Poison Center that would include data collection, management guidance, technical consultation, public health interventions, and prevention. We also hope to partner with hospitals in Georgia – for example, Caucasus Medical Center – to create clinical centers of excellence for the care of poisoned patients.
Looking ahead, my immediate goals for the next five to ten years are to formalize Emory’s relationship with the National Center for Disease Control, deepen collaboration with the U.S. Georgia Poison Center, expand workforce development for clinical toxicologists, and use robust data collection to drive prevention strategies. This initiative is supported by the National Center for Disease Control under the leadership of Dr. Robi Selizuri, and we hope to play a meaningful supporting role.
