Medicine & Healthcare in Mongolia by Venus Pang
Of all the volunteering opportunities I heard about in my first year at Queen’s University, several of which involved going overseas, Projects Abroad really stood out for me - it was the only one that offered a meaningful placement in medicine. From there, I chose Mongolia because I knew so little about this country; the mystery of its culture, geography and people intrigued me so much that I did not really know what to expect. Upon my arrival in Ulaanbaatar, I was definitely captivated: the city was a conglomeration of influences of a traditional Mongolian lifestyle, some remnants of Russian culture, as well as definitive western and Korean impacts.
The first day at my placement at Shastin (3rd) Hospital was busier than I had imagined. After a Projects Abroad staff member introduced me to my supervisor, a general surgeon, he immediately gave me a surgical cap and mask and took me to see an open cholecystectomy. As a first year science student with little hospital experience, I was thrilled to be seeing any type of surgery at all. One of the junior surgeons invited me to stand closer behind him for a better view and then proceeded to describe the whole procedure as the surgeons slowly removed the gallbladder from the patient’s abdominal cavity. After this surgery, one of the doctors told me to follow him down to the patient ward, introducing me to his patient, an 83 year old woman. As he examined her neck area, he explained to me that she had developed a lymphoma and would be going up soon to the operating room for its removal. The doctor asked if I would like to learn how to “wash hands,” and I nodded yes, not knowing exactly what I had agreed to.
We headed quickly to the operating room, where he taught me the elaborate process of hand washing and disinfecting, making sure that I was not to touch anything that had not been sterilized. As the nurse handed me a sterile cloth to dry my hands and helped me into my surgical gown and gloves, I realized that I would be assisting in this next procedure! After his preparation of the surgical drapes, he instructed me to place my hands on the woman’s neck area as he made a small incision. I remembering feeling shocked but excited, and the many lights shining on me and the heat of the room added more intensity to the atmosphere. It was a relatively simple procedure which ended after one hour.
Since the old lady was locally anaesthetized, she was awake during the whole procedure, and even gave me a thumbs up after the surgery finished – I felt both grateful and relieved. As I sat down to take a break, my supervisor returned and told me to watch his next operation, another open cholecystectomy. I later learned that this was a very common procedure in Mongolia, perhaps due to their diet, and during my stay in Ulaanbaatar I would witness more than fifteen cholecystectomies (only one that was performed laparoscopically) and assist in six more.
Every weekday I would arrive at the hospital around 8:30 am, and usually watch or assist in different surgical procedures. If there were no surgeries in the morning, I would head to the dressing room to help the nurse clean wounds and remove sutures. Most of the patients I saw did not know English and I did not speak Mongolian, but I learned to use body language as well as some simple Mongolian phrases in order to communicate. On other days, I followed another nurse and helped her prepare IVs and other injections for the patients; she taught me which areas on the arm to inject as well as how to insert a syringe into a vein.
One week into my placement, I was fortunate enough to meet one of the anesthesiologists in Shastin Hospital. He overlooked everything related to anesthesia in the operations of several departments including neurosurgery, and in addition to explaining to me the basics of anesthesia, he also took me to see several brain surgeries, including a hematoma and a brain cyst on a 3-month old baby. Another interesting operation that I participated in was an appendectomy on a teenage boy with acute appendicitis. I was also there for his diagnosis, as the doctor taught me how to palpate the patient’s lower abdominal area and distinguish between cases such as appendicitis and peritonitis. To my surprise, the emergency procedure was not performed laparoscopically, but rather open and without general anesthesia so that the patient was actually groaning and flailing his arms during the entire procedure, but this did not detract from the surgeon’s state of concentration.
During my stay, I also had a chance to work at the State Second Hospital. The medical equipment there was newer, and they had more doctors that were trained in laparoscopic surgery. At the Second Hospital, the first procedure I assisted in involved a post-operative abdominal hernia, in which I held open the surgical area with clamps and dabbed blood. Immediately afterwards two gynecologists, Dr. Basha and Dr. Bayra, motioned me to help them in a hysterectomy. The 45 year old patient had uterine myomas as well as an ovarian cyst, and the operation lasted almost three hours, and by the time it ended I was completely exhausted.
I think that my advice for any future volunteers would be to be engaged as much as possible, to ask questions, and to stay calm (even if the doctor nicks an artery!). As the doctors and nurses got to know and trust me, I was also allowed to do more during my shifts. For example, my job would be to hold clamps or dab blood in the first week, but by the second and third week I was allowed to cauterize bleeding vessels and also taught to do sutures on the skin. The biggest challenge for me at both hospitals was the major language barrier, but over time I was able to adapt and learn so much more than I ever thought I could have. All the things I encountered in Mongolia definitely do not fall short of a unique, rewarding and perhaps even life-changing experience, so I sincerely encourage anyone who has the chance to go for it!