I recently traveled in the Russian Federation on a tour with my college alumni. I visited the emergency department of the largest hospital in St. Petersburg, the Elizavetinsky, and met with the director of the hospital. There is no formal training in emergency medicine or any certification of emergency physicians in the Russian federation. Their physical plants suffer from severe lack of funds for equipment and salaries. As a result, the health of the population has deteriorated, with falling population, birth rate, and longevity.