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.
