Field Report: Raising a hand to beat the odds — an early start

by Jean Shin, Board Member & Volunteer

‘You must experience the winter here,’ is what a local partner of The Denan Project (TDP) told me during my visit to Mongolia in July 2017. So, I thought I was being clever by picking September instead: not the tourist-friendly months of July and August, but safe enough from the harsh weather of its long winter. Well, let’s just say…I was only half right 😉

The snow-covered frozen ground near the Tariat Hospital in September

[This report was originally written during my visit to TDP’s project sites in Mongolia in mid-September 2018 in order to share the experiences with my fellow board members and other volunteers of TDP.]

Day 1: A Long Drive Across Frozen Mongolian Steppe

The long drive from the capital city Ulaanbaatar (UB as the locals call it) to Tariat started at 6AM, September 17. UB wasn’t fully awake yet — and neither was I. But I was looking forward to seeing the hospital staff in Tariat and Erdenemandal I met for the first time last year, and experience firsthand the progress they made past 14 months (and for the last 7 years since TDP’s arrival in Mongolia).

Just when I was about to reach my very limit and lean over to ask the driver about the cost of fixing the car’s suspension system, we entered Tariat. (Hooray!) Colorful roofs dotting the gray open field…gave me an instant relief — and made me smile.

Day 2: Promises Made, Promises Kept — and Renewed

doctor
Tariat Hospital’s Head Doctor Dr. Gereltuya is showing the mobile examination tools provided by TDP which enabled her team to provide medical examinations by visiting remote herding villages

Facing a compressed schedule for the day, we started early from our ger (yurt) camp and headed to the hospital to meet the staff and patients. Over a hot cup of kumquat tea (perfect for the cold morning!), the Head Doctor Dr. Gereltuya and her staff went over our regular metrics and new findings, such as how dental checkups revealed that 97% of the population have dental problems. They also shared their goals for the next 12 months. Among the topics we discussed, I was most impressed by how well the Tariat doctors are using the mobile examination tools we provided last year. They showed me medical reports generated from individual checkups. So far they provided baseline checkups for 900 people (measuring glucose, cholesterol, etc. for 18% of the total population), and are working to cover 60% of the total population (4,939) by the end of this year. This initiative will help them provide preventive cares, something that’s utterly lacking in many developing countries.

Another notable new initiative was their goal to become Brucellosis-free soum (district). Brucellosis is an infectious disease caused by a type of bacteria called Brucella that can spread from animals to humans, affecting many herder families. They’ve already examined 500 children ages 10–18, and treated 13 of them. Disseminating prevention information to herder families is a critical part of the initiative. As of now, there’s a vaccine for animals but not for humans. Every newborn animal will be vaccinated, and every animal will be tested but it’s up to the owner to put down the animals when they are infected.

A herder family leaving Tariat Hospital after a child’s treatment

Seeing how snow starts to fall in September, it was no surprise to Dick and I that the hospital is in need of a garage. But I was astonished to learn that they have to spend 40–60 mins just to de-ice the ambulance by burning firewood after receiving an emergency call. ‘Whaaat???’ was my response. That’s what they’ve been doing to cope with the winter temperatures that routinely dip below -40 ° (even -60 ° at some nights) without a garage. It was clear to Dick and I that we simply have to finance a heated garage for the hospital!

Walking around the ward, I saw what-felt-like a miracle. Yes, running water inside the hospital! The long-promised (and long-delayed) water was finally there, hot and cold, hooray! Now the government just needs to connect the hospital to the central sewage system so that they can have indoor toilets!
Tariat Hospital’s general doctor filling in for a pediatrician whose contract expired. The general doctor will be starting her pediatrician education from October 2019.

After the hospital visit, we went over to the Tariat school near the hospital. I had a keen interest in meeting some of the students in our Health Club, and possibly recruiting some more. The vibes inside the school and the dormitory were just what I was hoping to feel: bright, energetic and colorful. Maybe they were just being nice, but we did see all hands raised when we asked who would like to join the TDP Health Club 🙂


Meeting Tariat high school students and eyeing an opportunity to recruit them for our Health Club in the dormitory next door

Day 3 Big Changes. Small Details.

The next morning, we started even earlier to get to Erdenemandal Hospital. The district of Erdenemandal is a bit bigger than Tariat with a population of 5,644 (of which about 10% are under age 5). Although the hospital building is much bigger than that of Tariat, the outdated Soviet-era building was in much need of repair or rebuilding. I was excited to meet the hospital doctors and continue the conversation we started during my last visit.

The Head Doctor (a surgeon) presenting how the surgical equipment TDP provided last year are being used

To my delight, the Head Doctor (who is also the hospital surgeon), joined by his staff, greeted us with a full slide presentation, detailing the surgeries he performed and how each of the medical equipment and supplies we provided are being used (surgical gurney, monitoring screens, etc.). We were also happy to hear that the hospital dentist was finally able to treat her patients (a total of 877 cases during the past 12 months) with the dental supplies we provided.


Erdenemandal Hospital’s dentist treating a boy for tooth extraction

After the staff meeting at Erdenemandal Hospital, we followed a local bagh doctor who’s making a house call to a herder family. Despite the apparent limitations (lack of medications, limited medical training, etc.), I was relieved to see how everyone, no matter where she lives, has access to free medical care.

Edenemandal’s bagh doctor (left, with a medical bag) visiting her patient living in a ger with her husband, daughter, horses and dogs

Day 4 Progress in Sight — and Fast Approaching

On the way back to UB from Erdenemandal, we stopped at Aimag Center (the capital city of the Arhangai province overseeing Tariat and Erdenemandal) to meet Dr. Gandiimaa, Director of the Arhangai Department of Health. Over the years of our partnership in the region, she became an ardent supporter of TDP initiatives and a great adviser. We were particularly thrilled to hear that due to recent improvements we’re making in Tariat and Erdenemandal, the number of patients coming to Aimag Center from those districts has drastically decreased. Furthermore, the success we’re making at Tariat Hospital is becoming an envy of other hospitals in the Arhangai province.

Back in UB, spending hours trying to iron out the details of our next budget year with Dick, before flying back to Munich, I couldn’t help but think how many high school students raised their hands to join our Health Club and get trained by our doctors. Facing a serious challenge in recruiting medical specialists to work in remote places like Tariat and Erdenemandal, it’s clear to me that we need to start getting more active in nurturing the local students, helping them get advanced education — and serve the community. If we can succeed in that initiative here in Mongolia, we can certainly try to replicate it in our other facilities in Peru and Ethiopia. And THAT is a wonderful reason for me to come back next year, and measure our progress with the students who raised their hands.


 

Where Herders Come for Healing

By Jean Shin, Board Member & Volunteer

Toilet paper? Check. Energy bars? Check. Cipro? Check. Email auto reply? Double check.

Packing light is something I already know how to do. But doing so with basic daily necessities, medicines, and clothing for multiple climates? Well, that turned out to be a rather distracting experience…at least that’s the only excuse I came up with while running for a long taxi line outside the Munich airport, trying to get back home to pick up my passport I forgot to pack. ‘There’s no way I’m missing the flight,’ I announced to the taxi driver. So it began on Jul. 5 – my first visit to The Denan Project (TDP) sites in Mongolia .

It’s not the mileage, it’s the connection.

After landing in Ulaanbaatar (the preferred spelling among locals) via Moscow and filling out a lost-luggage claim form, I was greeted with a news that Dick Young, the founder of our organization, was stuck in China and that his arrival time was unknown (something about his flight being cancelled, re-routed, reshuffled, etc.). Mongolia is not the farthest place I’ve ever traveled to, but definitely one of the places with the fewest direct connections.

Spending the eve of the Mongolian presidential election day in the heart of the capital city, I was trying to figure out why some of the street signs were still written in what-looks-like Russian Cyrillic. Right, the Soviet influence still remains in this country, sandwiched between Russia and China, trying to make their young market economy work.

Standing in front of a TEDx Ulaanbaatar poster against a backdrop of a new shiny building, I was reminded of my walks through Moscow and Shanghai…and some other cities in developing countries with similar shiny buildings in the making, Jakarta, Lima, Addis Ababa… ‘Let’s see how things outside the capital look,’ I murmured.

Economic and political participation of women.

Upon Dick’s arrival (about 30 hours after his departure in New York), the project team (including our local partners from Save The Children) met with the Mongolian Minister of Health Tsongtsetseg. Sitting across the table from the woman Minister and a room full of woman professionals at the same table, I couldn’t help but notice the stark difference from my visits to other TDP sites, especially compared to my meetings with an all-men group of elders in Denan, Ethiopia. As I walked back from the meeting – where the Minister awarded Dick with an honorary medal for TDP’s contribution to the wellbeing of people in the Arkangai province (about 700 km away from Ulaanbaatar) – I added this to my to-do list: google OECD’s report on women’s economic role and sustainable development. Read it again!

Nomadic living in urban ghettos—and in the Land of the Blue Sky.

Heading west from Ulaanbaatar, our 4×4 vehicle passed through some of the ‘ger districts,’ the Mongolian version of urban ghettoes surrounding the city center. Herders who fled the countryside, after having lost their livestock, were now stuck in the outskirts of the city with no running water, or proper sewage. Carrying all trappings of their nomadic lifestyle…but with no animals to herd, no fodder to harvest…

I was told that our drive should be smoother and faster than in previous years, at least for the first 1/3 of the journey, as more of the roads have been paved. ‘Hopefully not all the way,’ I murmured. I didn’t have to worry. The long stretch of paved roads, dotted with a few eateries and outhouses I didn’t dare to walk into, ended soon enough.

Then came something I’ve never seen before. Something I never had to describe before. A land of steppe and sky. Vast pastoral rolling grasslands…under a seemingly endless blue sky. I was beginning to get why Mongolians call their country the Land of the Eternal Blue Sky.

Low mountains started to dot the horizon…and I knew we were getting close to our destination Tariat, the second coldest place in Mongolia where winter temperatures routinely dip below -40 °C. Although my senses told me I was in an endless spread of temperate grasslands with grazing horses and yaks, I had heard enough about the harsh winters of the area to know that the July weather I was soaking in wouldn’t last much longer. In fact, that punishingly cold weather – in addition to the general lack of funds for heat and basic medical supplies – had a lot to do with why TDP came to Tariat in year 2011, and put a stop to the shortages that used to prevent the hospital from treating patients for 4 months a year.

Providing basic human services in developing countries.

So, how do you run a hospital without running water? The same question again. One of the first questions I asked myself while visiting our hospitals in Peru and Ethiopia. It’s a common problem that makes everything that much more difficult to handle – and those difficulties quickly add up. In fact, according to some stats, one-third of all hospitals in the developing world lack running water.

Beyond the glaring similarities across nations classified as developing countries, what I saw in Mongolia was distinctly different. In Denan, Ethiopia, our organization had to start from scratch (building the hospital from the ground up, trucking in water, etc.). In Uratari, Peru, the community rolled up their sleeves early on and built the hospital together brick by brick. In Tariat and Edenemandel in Mongolia, it became clear to me that it’s more about identifying the one last hurdle that prevented medical help from reaching the people in need.

What kind of last hurdles? Something I could only see by shadowing the doctors, meeting their patients, seeing the equipment and supplies they use, following the local doctors making house calls, etc.

Standing next to a young dentist, in front of a brand-new-but-never-used dental chair (a not-so-unique problem in many developing countries), I learned that with only USD1200 the dentist could get all dental supplies she needed for the next 4 months so that she could start taking care of her patients rather than waiting until January next year for the dental supplies, promised by the government, to arrive. In this case, that was the last hurdle. So, we resolved the issue then and there by allocating some of our leftover budget to the dental supplies.

Following a woman local doctor making a monthly visit to a herder’s family on a motorcycle, we learned that she ends up paying half of the motorcycle fuel costs out of her own pocket as the government’s fuel allowance covers only half of what she spends to cover the distance she has to travel every month. Having realized that the shortage is widespread and thinking that not every doctor would be able to make up the difference, Dick and I agreed to bring the issue to our board for next year’s budget.

Talking with a surgeon while shadowing doctors making rounds in Erdenemandal Hospital, Dick and I saw another hurdle we needed to address. The hospital has a surgeon who can perform a wide range of surgical operations, however the hospital has no anesthesiologist, limiting his scope to operations he can handle with partial anesthesia. Apparently there’s a nationwide shortage in anesthesiologists in Mongolia which makes it even harder for a remote hospital such as this one to recruit one. We left the hospital with a plan to provide extra incentives for a new anesthesiologist.

There lies the answer to the question I was asking while running back home to fetch my passport: so, what makes you think you will do more good by going there rather than simply donating that money? Why go there?

The answer? Because it matters. When the end goal is to get the care to the end recipient, we need to understand the entire flow. For many things, I prefer simpler answers. But what we’re trying to accomplish here requires understanding the complexity – and removing the barriers every step of the way. Besides, it’s in TDP’s DNA. We don’t just rely on secondhand reports. We go, inspect and improve.

Back in Munich, I find it easy to romanticize about the nomadic lifestyle I saw in Mongolia and to question the people who were abandoning their tradition and fleeing to the dismal life in urban ghettos. But ultimately, it’s their choice. And for those who decide to stay, I would like to think that they won’t be denied of the basic human care such as medical service. The children and adults who came to a neighboring ger and waited for their turn to see a visiting doctor…they are on my mind.