When done properly, international CME and other medical education activities can help share knowledge, foster cross-cultural understanding, and improve the care of patients around the world. But those of us who have attempted international medical meetings are only too familiar with the flip side of this romantic picture. Language barriers, cultural misunderstandings, differences in logistical expectations, and the frustration of trying to get your things through customs can all add up to a major challenge. Organizations that want to expand into new territories should be prepared with a lot of patience, an open mind, and a very good translator.

Russia Reaches Out

Eastern Europe, in particular, is undergoing a medical education metamorphosis. Emerging under new governments and new systems, many countries are refocusing their energies on improving healthcare for their populations. Russia is a great example.

Estimates of the number of physicians in Russia range from 680,000 to as many as 800,000, yet medical care in Russia remains quite poor. Most physicians are hospital-based, vastly underpaid, and rely on informal patient payments to make ends meet, according to World Pharmaceutical Markets, Version 2.0, a report produced by Espicom Business Intelligence, West Sussex, United Kingdom. Hospitals do not meet current standards for safety and infection control, and as a result, patients are often hesitant to go there when they become ill. Given this huge healthcare challenge, it's not surprising that Russia's population health remains significantly worse than most other European countries. Men in Russia had a life expectancy of only 58.9 years in 2004; women's was 72.3 years, according to the Espicom report.

Given the economic power of Russia, these numbers were of great concern to the Ministry of Health, which has recently taken several steps to bring Western-style medical education into the Russian fold, in the hope of improving patient care. A major strategy is to partner with well-established and highly respected medical education companies and associations in order to benefit from their expertise.

One of our partners, Universimed Verlags-und Service, a medical communications company in Vienna, was invited to support the development of medical education in Russia. Wolfgang Chlud, president, offers the following advice to CME organizations expanding into new territories. He stresses that local contacts are paramount to success in establishing a presence in any new market. “Each culture is highly unique, and it is difficult to accurately read the landscape through a foreigner's eyes,” he says. “Absolutely plan extra time and budget to go — and go often — to visit the people and places where you are contemplating starting up a new program. The investment upfront will be well worth it in the long run.”

Direct-to-consumer advertising of prescription medicine and most over-the-counter product advertising is strictly prohibited in Russia, so industry support for physician education is more readily available than in other countries. Be prepared, however, for some demanding requests for direct product exposure in exchange for commercial support. As in many countries, U.S. — style standards limiting funders' influence on content development simply do not exist in Russia. You will need to spend a lot of time educating your supporters about the need for unbiased program building. You might want to factor in some market research pre- and post-event to demonstrate the educational impact of your program for future prospects.

Exploring new markets is a fascinating way to expand your horizons and affect the quality of patient care around the world. Just remember that every country is different, that every experience has a silver lining, and that the logistical headaches and cultural misunderstandings you will most certainly have really are worth it.

Jennifer Goodwin is president of The Goodwin Group International LLC, a medical communications company in Arlington, Mass., that has a network of medical communication experts in 20 countries. You can reach her at jgoodwin@goodwingroupintl.com.

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