Zeno Group Blog

Our client today announced results for a very exciting medical prospect on the horizon for women’s health — the ability to definitively diagnose ovarian cancer, the deadliest of gynecological cancers, with a blood test. All of us women at some point in our lives worry and wonder, if we or someone close to us might have ovarian cancer. It’s a disease that is often asymptomatic; most women don’t know they have it until it’s in advanced stages, when the five year survival rate is just 23 percent. Imagine if along with her PAP smear, a woman could go to their OBGYN for her checkup, be tested for ovarian cancer and find it early when the survival rate is 94 percent. The future holds great hope for the diagnosis and treatment of cancer and this is just one example of what is on the horizon.

I have now returned to Washington, after a fabulous vacation in Montenegro. The trip has given me new perspective on several things. Mostly that we in the West take many things for granted. I had thought that before I left, but now I know that for sure.

Firstly, in the West when we say we lack resources we are generally talking money. In Montenegro they are talking both volunteers and budget. They have trouble getting volunteers for two reasons: because they have a law that requires them to have contracts with “volunteers” and because volunteers are seen as weird and unusual. I thought to myself the very idea of having a contract with volunteers is counter to the concept of “volunteering.” And because few volunteer due to the cultural legacy of socialism and the state taking care of everything, those who do volunteer are seen as unusual. We in the U.S. have a culture of volunteerism that we teach at the youngest of ages. It seems normal but we should know that it is not the norm in the entire world.

Secondly, in the world of health, we have many celebrities and role models willing to step up and discuss their illnesses and diseases. In Montenegro I was told that people do not discuss their illnesses, sometimes even with their own family. They stay close to home until they are well and do not discuss their issues with anyone, let alone go to a support group. We are lucky that more and more, role models and celebrities are willing to discuss their illnesses and give of their time to educate others. In addition, we have a support group for almost every disease that exists. For example, many breast cancer patients will walk around proudly with a bald head and have a choice of support groups to attend. In Montenegro you generally would not see bald heads out in the street and no support groups exist. To me it is very sad that people who are sick, who need support the most, have very few people to turn to due to stigma of illness.

Thirdly, while we sometimes get frustrated with our government and wish the outcomes of projects were different, we generally know the rules of engagement with the government. There are laws that exist for comment periods after a proposed rule as well as clear timeframes are established for feedback from the government. In Montenegro, hard working NGOs can submit comments to the government on an issue and may never hear back or have their comments acknowledged. That seems very frustrating. We think it is normal to have all these rules set up to promote public engagement and prevent abuse by government, it is not. Transparency in the U.S. is generally the norm, not the exception.

But mostly what I had taken for granted, is that in the U.S. generally if you work hard, you can be successful regardless of your family or connections. They of course help but I know I control my own life path, not my heritage and family name. It never occurred to me that because I was born to a certain family that my prospects were limited. My parents gave me self confidence and an education, and then I set on my way to build my life. In Montenegro an education and confidence does not appear to be enough.

I left Montenegro feeling hopeful that they will fully embrace democracy, with all the good and the bad it brings. I have to remind myself it has taken many, many years for our government and society to evolve and I have no doubt that Montenegro will, it’s just a matter of time! The importance of time should not be taken for granted!

I have now been in Montenegro for nine days and grow to love it more each day. I love the people, the beauty, the land and the heritage. Even though the people have been through many wars and political unrest, they remain happy. That may be because family is truly at the core of society. When I spoke with them about using celebrities as role models for public education campaigns, they explained that the best role model, especially for youth, are parents. I wish that were true in the U.S. It may be to some extent but not like here in Montenegro. As they become less isolated it will be interesting to see if that holds true. I hope so!

Today was another great day in Montenegro. I spent the whole day with healthcare groups including the Ministry of Heath and major NGOs. For the most part they deal with the same issues as we do in healthcare except our alcoholism problems are much greater as they do not consider it the forbidden proof. What is also different is that here sick are stigmatized and people do not discuss their sicknesses including breast and prostate cancers. Also, here they do not understand why people stigmatize those in the U.S. who have lung cancer. Here smoking is the norm and very accepted. I was asked today if there is really science studies that prove there is a link between smoking and lung cancer. After that question I realized some things are very different!

Today in Montenegro I realized a few fundamentals about campaigns whose goal is to change behavior that I have taken for granted: keep campaign messages simple, the need for campaign longevity (we cannot change behavior in 1-3 months), and who delivers the messages is important. Many of the organizations I met here have very good intentions but forget these three fundamentals, in particular longevity. Many of America’s most famous campaigns such as MADD, Click It or Ticket, and Smokey the Bear, have been going on for many years. Here, due to lack of funding, the longest they do a campaign is three months and then are left wondering why they do not make an impact. I am hoping that I have convinced them that doing less campaigns, but those they undertake they do for longer, may be a better route to go. Only time will tell and I know all my new friends will keep me informed of progress!

As I told my embassy contact yesterday at lunch, I do think this is a very exciting time in Montenegro! They are on the verge of becoming a full democracy but are not quite there yet. They have not figured out how to leave their socialist ways and embrace what a democracy means, but I feel soon they will. The government is still reluctant to fully communicate with the public, transparency does not quite mean what it means in the U.S. (not yet) and they do not have experienced people to communicate with the public as they did not really need to do that ever before. But imagine living in a country and watching it transform like Montenegro is at the present time. Especially being one of the younger generation and pushing for change through their civic activities? Very exciting and I cannot wait to return in 5-7 years and see how far they will have come! It is really fascinating to watch if nothing else!

I have finished my first day of meetings with two government agencies and an NGO. Montenegro being a democratic country early in development, they seem to be over complicating the art and science of communications. They have elevated communications to rocket science and are analyzing it as if they are studying data from the moon! What I plan to tell them is that they need to stop being afraid and strategically start engaging with their stakeholders, one of the most important being the citizens of this country! In my opinion it is better to communicate and make some mistakes than to keep the public in the dark about what their government is doing. We will talk tomorrow about how to do that and gain the trust of the public. We will also talk about the role the media can play in helping them. We hope they will take some of what I say and move forward.

I just arrived in Montenegro today after a 15 hour trip here through Vienna. To my surprise the country is much more in a state of early development than I would have thought. There seems to be construction everywhere. From what I can tell thus far the biggest problems they have are widespread smoking (everyone here does and I mean everyone!), no respect for traffic laws and especially pedestrian crossings and environmental issues such as throwing trash on the ground. I will work with the government and NGOs to help them better communicate with citizens on these issues and more. This will not be easy as they do not value the environment and health the same way we do. At least not yet!

I have spent the last week intensely working to get ready for my trip to Montenegro on behalf of the State Department. I will spend five days working with the government of Montenegro and emerging NGOs to help them develop strategies for civic engagement, how to better educate the public on health, traffic and safety issues and how and when to lobby decision makers. These are many things we take for granted in this country. Civic engagement is a right that is demanded. Buckling up and slowing in school zones is expected and we have financial penalties if we do not. Lobbying and how to influence decision makers is an industry and an art. In developing democracies these are works in progress. Perhaps we should not take these for granted and embrace what we do have? Follow me on my exciting journey and we will learn together first hand what the barriers to successful social marketing and public affairs are in a developing Eastern European country.

It has become more than clear that the controversy with screening will not cease. This week, the U.S. Preventative Services Task Force added fuel to the controversy by advising against regular mammography screening for women 40-49 years of age, provide mammograms only every other year for women between 50 and 74, and stop all breast cancer screening in women over 74. Soon after that statement was issued many including Komen, American Cancer Society and the American College of Radiology, issued statements against this new recommendation.

As I wonder why this controversy is heating up now, I wonder if it is all due to the renewed emphasis on cost-cutting measures and getting our country’s health care budget under control? Or is it that we are finally realizing that we need more research to understand why even though we have early screening guidelines for many types of cancer we are still losing many of our loved ones unnecessarily? I think that many of us can agree that we need new and improved tests to detect cancer at an earlier stage and there are many in the works but not approved yet. But until we improve on what we have are issuing conflicting guidelines by prominent health organizations really going to save lives and improve care or just create more stress that leads to even more disease in this country?  I believe the argument for delaying testing by many is that there is no proof that testing in younger patients has saved lives. But I wonder if I wait until 50 to get a mammogram, and then at that point I am told that I have cancer and its advanced, how I will feel about having waited? I personally would rather endure the yearly mammogram than have the uncertainty and regret later. This is of course a personal decision with perhaps no right or wrong answer but I am certain of one issue: creating confusion in the minds of Americans will not lead to better outcomes.