The Institute for Health Policy Analysis, established nearly two decades ago in 1981, was originally administratively part of the Office of the Chancellor, Georgetown University Medical Center, Washington, D.C. Since its separation from Georgetown in 1990, it serves its traditional role as an independent 501(c) (3) not-for-profit institution. The American College of Physicians and the Institute for Health Policy Analysis established a partnership to develop and carry out the Eurasian Medical Education Program.

The Eurasian Medical Education Program

Beginning in 1997, the American College of Physicians committed itself to a partnership program with the Institute for Health Policy Analysis dedicated to professional medical education for the benefit of health professionals in the Russian federation. This program, known as the Eurasian Medical Education Program, is recognized as an opportunity for both academic and practicing physicians in the United States, trained in the disciplines of internal medicine, to enhance the level of technical knowledge of physicians in the former Soviet Union in contemporary methods of prevention and effective medical management of disease. The principal vehicle for this effort is exchanges of professionals in both directions. The effort is grounded in the concepts of continuing medical education as they are practiced in the United States and in other countries.

The Program

The program relies upon the voluntary contribution of both academically based and independently practicing physician internists in the United States who are willing to step out of their practicing mode from time-to-time and share their knowledge with colleagues abroad. Continuity of effort is an important element of this program

The Program’s principal clinical areas of interest were chosen to correspond to major components of the disease burden which contribute to premature mortality in Russia where basic medical intervention would be expected to bring about improvement in health:

• Cardiovascular disease - the detection and treatment of hypertension and the prevention of heart attacks and strokes.
• Control and treatment of TB and other common infectious diseases.
• Diabetes, its management and prevention of complications.
• HIV/AIDS, control, treatment and prevention.

American internists, expert in selected clinical fields, spend approximately one or two weeks with Russian colleagues in seminars, discussions and clinical rounds. To date, the Eurasian Medical Education Program has already reached directly over 6,000 Russian physicians in five regions of the Russian federation. Russian colleagues then impart that experience and knowledge to much larger groups of therapists (front-line practitioners, typically in polyclinics in the region) and general practice physicians during the regularly scheduled, Russian post-graduate medical education cycles. The American internists return during at least one of the periods of the training of the Russian practitioners. This pattern was chosen in order to derive the greatest amount of leverage or multiplication of effort from the program.

As a result of early experience, the program in each center now includes a combination of both the medical, scientific basis for treatment and prevention of disease, and a consideration of how to use resources effectively for screening and control of disease.

The educational effort, rather than standing alone, has been integrated into programs for the early and effective case finding and management of disease with emphasis on the opportunities for prevention -- continuity of care, patient education and patient compliance with treatment regimens. In brief, our effort in each center has become a combination of professional education and assistance in the design of disease control programs.

The program was instituted initially in the Russian federation in selected regions chosen according to the following criteria:

0. Recognized center of medical activity and appropriate location for continuing medical educational program.
0. Openness and desire to receive educational information.
0. Ability to disseminate the information to a larger cohort of practitioners.
0. Relatively unencumbered by inhibiting or complicating bureaucratic hurdles.

On the basis of these criteria, initial sites include medical centers in the following locations:

• Ekaterinburg
• Kazan
• Khabarovsk
• Tula
• Jewish Autonomous Region

Funding

The Subcommittee on Foreign Operations, Export Financing, and Related Programs of the Senate Appropriations Committee has supported the program in the form of report language for the past six years. Funding has come from the U.S. Agency for International Development, the Bill and Melinda Gates Foundation, the Rockefeller Philanthropic Collaborative, The Exxon Foundation, The Richard Lounsbery Foundation and the National Institutes of Health.

Cooperation with other programs

The Eurasian Medical Education Program of the American College of Physicians complements and cooperated with certain other health-related activities in the Russian Federation. Prominent examples are:

The American International Health Alliance

Program of Access to Quality Health Care

Open Society Institute (Soros Foundation) tuberculosis program in Russia

World Health Organization program for Tuberculosis in Russia

World Bank program for tuberculosis and HIV/AIDS in Russia

American Medical Association’s cooperative agreement with USAID toward certification of competency of Russian physicians

Future of Russia Foundation

Transatlantic Partners Against AIDS

Accomplishments

Since the inception of the program, we have interacted directly with nearly 8,000 Russian physicians in these Russian regional educational settings. Additionally, we have sponsored 10 groups of Russian physicians and health leaders to centers in the United States.

The Russian regions were chosen to exclude major population centers of Moscow and St. Petersburg, but to include regions having an academic medical center of substantial standing in Russia and because of expressed desire for this program from the political and professional leadership in each case. The principal regions served have been Tula Oblast, Tatarstan Republic, Sverdlovsk Oblast, Khabarovsk Krai and the Jewish Autonomous Region. Two of our hosts also serve as President’s Representatives for Health for two of the seven Federal Districts, and have requested our assistance in contributing to health in those enlarged regions.

It is rewarding that our hosts have incorporated the Eurasian Medical Education Program into the Russians’ own medical postgraduate education programs -- symptomatic of the strong relationships we have built with the political, academic and professional communities. Most of all, we have been able to demonstrate beneficial changes in physician practice patterns and benefit to patient health as a result of this program. These associations have been a function of the quality of the contributing talent we have enlisted and the continuity of effort.

Contribution

This program has made a substantial contribution and has brought credit to our foreign assistance activity:

We have enlisted some of our country’s finest medical-scientific talent who share their medical professional educational experience and do it with continuity over time. The contribution of the American visiting internists to this program is given pro bono. The monetized value of this contribution is of the order of $94,500/year. Over the period of the program, we estimate this amounts to $737,992.

• We have established strong and respected relationships with the political and health leadership in each region.
• We have demonstrated contribution to improving physician practice patterns and patient health.
• We have concentrated on those areas of serious disease most important in contributing to premature mortality in Russia.
• We have contributed to a process of re-professionalization within the Russian medical community.
• The program speaks directly to the issues concerned with economic security and maintenance of civil society and to President Putin’s expressed security concern for a rapidly declining population. It responds to the warning that Russia will not be able to achieve its full economic potential without improving the health status of its population.
• The program is responsive to President Putin’s strong plea for private interests to contribute to the social fabric of the nation.
• In brief, the program has served the finest tradition of professional collaboration toward the practice of medicine and betterment of health.

On a professional level, the program has resulted in evermore requests from our Russian hosts for cooperative efforts and professional exchanges.

As in the case of some other programs built around exchanges, such as the Open World Program or the Central European and Eurasian Law Initiative of the American Bar Association, important intangible as well as tangible benefits flow from these efforts.

Finally, in times of stress, programs and exchanges such as these, assume an even greater importance.

Regions Served by the Program

Tula Oblast

Sverdlovsk Oblast and the Ural Federal District

Tatarstan Republic

Khabarovsk Oblast and the Far Eastern Federal District

Primorski Krai

Yakutia-Sakha

Sakhalin Oblast

Jewish Autonomous Region