Thursday, Sept. 17, 2010
The days have been full since we arrived, and while high-speed internet access has been easier than I expected at times, it is not always available when we might most like it. The hospital has good connections most of the time, but it is usually late when we are finished with work, and somehow the lines are turned off by that time.
Since the main intent of this trip has been to continue the education of local surgeons in the use of laparoscopic cholecystectomy, that has been the primary aim of all our activities. Where all of this technology fits into the big picture of medical care in Mongolia remains to be seen, and I have to be honest that there are more than a few times that I have my doubts. The Russians were the main influence here since the 1920s and while they have left (rather abruptly, I was told, one morning in 1992), their teaching persists in the leadership, both for good and for not so good. The main connection we have here, both as interpreter as well as for medical and logistical issues, is a very tall man, probably in his early fifties, who is an anesthesiologist and professor at the university in Ulaanbaator. He spent three years learning anesthesia in East Germany in the early 1980s, and later spent time in Arkansas doing additional training. He is clearly a very bright and delightful person, and it is through his eyes that I get to interpret what I am seeing. The cleanliness of the hospital, he says, is directly linked to Russian training. Surgical journals may be available on the internet, but they are expensive and mostly in English. Since only some of the younger individuals have learned basic English, it will always be a struggle for them to see what is going on outside of the country. Thus, medical missions such as ours will be the only source of new information that they will get for some time. Not surprisingly then, I found that the few words of Russian that I do know have gone a long way to bringing smiles to the faces of people around me.
Food has always been a good reason for me to travel, and I would suggest that there should be no illusions that just because the local customs and traditions might be different from elsewhere, that does not necessarily translate into something that is easy or even pleasurable. As one can imagine, this is not a very friendly terrain in terms of agriculture or of life in general, and so foods are quite limited. This is a meat-eating culture, and while we declined the opportunity last night to feast on a freshly slaughtered sheep, to enjoy intestine soup, a meal without meat is not a meal at all. Lamb and mutton are the most common of these, and while marmot seems to be the second most common of local meats, I actually did eat a stuffed cabbage yesterday for lunch that quite resembled beef and was really delicious. Mutton soup with vegetables (mostly carrots, a turnip or two, and some potatoes), mutton with rice and potatoes, mutton balls (not the anatomic ones!) with broth, mutton dumplings and mutton soup with noodles have been the mainstay of what we have eaten so far – is there a consistency to this? I hope that my coronary arteries do not start to complain. I have not even seen anything resembling the “Mongolian barbeque” that we think of from home, but I do think I will look forward to a scorpion kebab or two at one of the stalls near Wangfujing when I return to Beijing next week.
It is fall here already, and the few leaves that there are, are starting to turn. With very few trees around, even though they are mostly of the deciduous type, there is not a lot of autumnal color, and it seems that only the setting sun brings out a palette of visual variety to the landscape. The temperature is still comfortable during day, but drops precipitously at night, and I have taken to wearing my long underwear to bed. The streets are probably only half paved, and the sidewalks perhaps a third so. As we were crossing the street the other day, I noted that there was a pipe that seemed to serve as a culvert, through which snaked thick electrical cables whose insulation seemed to suffer the effects of exposure and age. Most of the people seem to live in compounds defined by five foot high walls made of concrete aggregate, within a combination of gers, frame houses, and housing composed of old, Russian railroad cars, derailed, and de-wheeled. Probably not surprisingly then, because of the relatively low height of the walls, there are no “extended security means” such as glass shards, applied to the tops of the concrete blocks. Extended families and resident dogs seem to complete the unit. A pack of 13 dogs barking in pursuit of something just passed under my window. Mostly people seem to dress in Western garb, and other than for height, look like everywhere else in Asia. There must be something in Mongolian genes or nutrition that breeds tall people, for it is not uncommon to see six-footers here at all. Occasionally, I see people dressed in dells, the traditional long coats with hats that bring a sense of difference to the area. Lastly smoking, which is so common elsewhere in Asia, is not so common here, and seems mostly to be among the urban dwellers rather than those few I have seen from “the country.”
I have made a few telephone calls during my stay so far, and it never fails to amaze me as to the technologic changes that we have seen in the past few years. ATM’s have completely replaced traveler’s checks, and internet, Skype or G-chat, and phone cards now are commonplace instead of aerogrammes or letters. Who ever goes to a post office to find a postage stamp or even postcards? There must be some who still do, but as a singular innovation, I think that email has changed the face of travel almost more than anything else.
Breakfast awaits, and we have at least four surgeries to do today: two pediatric hernias and two gallbladders. Let’s hope that all goes well for all.