Excerpts from a Mongolian Mission Journal - Part 3

October 21st, 2010 | Comments POSTED BY: Ivan Shulman, MD, FACS FILED UNDER:

Monday, Sept. 13, 2010

It seems unbelievable to me that I am actually writing from Khovd, in the western part of Mongolia, on my laptop, in a hotel, looking out over the unpaved, dusty streets as the sun starts to rise on another day.  A woman is herding her cow through what serves as a parking lot in front of the hotel, by throwing stones at its rump, as a pack of a dozen large dogs marches around the corner, off to do some damage someplace. From what I saw yesterday, these are not your sweet household pet type dogs, but serious animals who contend with all manner of abuse, from wolves to other animals, as well as competition within the pack.  We are told to grab some stones if we are out walking and come across the dogs.  Life is not easy here.

We arrived in Khovd after our three-hour flight on EZNIS airways, on a propeller driven SAAB 380, crossing a goodly portion of the Gobi desert.  Deserts are obviously not all the same, as the dunes of the Sahara barely resemble anything I have seen of the Mojave, and this one seems to be widely varied as viewed from the air.  There are dune-like areas, with undulating sand banks, to those with vaguely greenish tint which I suppose are grasslands, to lakes, to smooth, Santa Fe stucco-colored sandy flats without obvious changes in elevation.  I was told it was going to be like arriving on the moon when we got to Khovd, and in fact it was. But I now realize that there are many places on earth that must then look like the moon, because it reminded me of the area around Tuba City, Arizona, a lot closer to home than the moon.  Certainly, as the day breaks and I look at the faces of people, the similarities between Mongolian and Navajo visages is quite striking.  Linguistically, of course, there appear to be no similarities, and if anything, one hears syllables that sound vaguely Korean. 

Our hotel is across the street from the hospital where we are working, and of the many hospitals that I have seen in developing nations, this one is about the cleanest yet.  People are constantly washing the floors, and there is no stench that one smells in the tropics.  The only odor one perceives is that of mutton being cooked everywhere, and occasionally, a homeopathic dose of germicide, kept in an assortment of glass bottles everywhere.  The stuff feels and smells like plain water to me, but who really knows?  Ultraviolet lights are turned on in the operating room for example, to help sterilize things. I was told yesterday that the water within the10 liter bottles kept corked in the room becomes sterile through this mechanism.  Interesting.  Intravenous solutions are made in the hospital in on- liter bottles, which are covered with a type of canvas, secured by colorful orange string.

…The young doctor on call, who had been part of the group who had been trained in laparoscopic cholecystectomy last year here in Khovd, had a patient who had been in a truck accident, probably with some broken ribs.  Over the next few days, he developed subcutaneous emphysema.  An unlabeled, unnamed, unoriented CXR was shown to us, which indicated that the left lung had completely collapsed.  The doctor had proposed to take the patient to the operating room to suture the hole in the lung.  The other surgeon in our group, a wonderfully warm and cheery 64-year-old man, has had many years experience working with Italian relief groups in places as disparate as Peshawar, Kandahar, Sierra Leone and Malagasy Republic, looked at me, and it was all we could do to slow down our words to suggest that perhaps placement of a tube in the chest emptying into a water seal bottle might be a better and safer alternative.  Of course, no such chest tube exists in the hospital, and so with the assistance of our anesthesiologist we fashioned one out of an endotracheal tube.  Finding a suitable water seal apparatus was not easy, and we considered cutting apart some strange drainage bottle we found that had been left over by a Swiss team some time ago.  In the bowels of some storage place a single Russian-made thick glass bottle with an appropriate cap was located. With additional tubing rigged from what we had, my colleague directed the Mongolian doctor as he placed this chest tube into the patient’s chest.  Sterile conditions are a relative term here, and it is frequently said, I have learned, that “clean is good enough.”  Maybe, but we offered some antibiotics to go along with what had been done so far.  After some more bleeding than we might have liked, the tube was repositioned and the expected bubbling came from beneath the water seal.  The fellow tolerated this all well, but it remains to be seen as how long it will take for this to resolve. 

Last night, we were taken to the ger of the family of a Kazakh man who is a feldsher, or village medic, about 20 km northeast of Khovd.  I am slowly learning the etiquette of Mongolian traditions, and now understand that what we have been calling a “yurt” is the Russian word for the Mongolian “ger,” and so now, I too shall try to use ger in my vocabulary.  The campsite was on the banks of one of the numerous rivers that traverse the area, and was as colorful as one could imagine, with cashmere goats, sheep, yaks, and a few cattle outside, and inside a warm and toasty comfortable homestead.  It was remarkably warm inside, and with all the Kazakh and Mongolian carpets lining the walls, two beds, a dresser, a wall of medals for horseback riding and family photos, and a central stove vented out the top. I can easily see how the winter can be survived despite the environmental challenges.  The feldsher also captures eagles for training, and we saw at least one nearby, looking well fed and content.  While we were there, a man came up on horseback, complaining of a headache.  Some potion was dispensed, and off he went.  Warm goat’s milk, fried biscuits, fried yoghurt cheese, tallow and yak butter were served, along with local watermelon.  This is not a low fat, low carb diet at all, but if one considers what is available, it seems to work for them over many years.  On the way back, we saw a herd of Bactrian camels (two humpers), and seeing them outlined against the grasslands, the snow covered peaks in the distance, and just the entire sense of foreign, I really did feel that I was on the steppes of Central Asia.  Where was Borodin when we really needed him?

I am off to help with surgery this morning, and need to get going.  I have been served a bowl of hot butter tea with rice, so I had better get my dose of calories early this morning.  A long day awaits.

73*,

Ivan

* “Best Regards,” per The National Telegraphic Review and Operators’ Guide, first published in April 1857.