It’s hard to believe that a month has already gone by.  I am sure the month of April will be even faster than March and I will be home before I know it.  I apologize for not writing sooner, I have been under the weather the past few days but am finally much better.

Prior to getting sick, the pace of work was moving quite quickly for most of my projects.  I was going to meetings almost daily with the National Center for Communicable Disease, Health Science University here in Ulaanbaatar to discuss logistics for the Knowledge, Attitude and Practice Study, or meeting with the key stakeholders for the Community Awareness Project.  Needless to stay I have almost completed the study design for the Knowledge, Attitude and Practice Study thanks to the help of a researcher from Health Science University who will help translate the documents and carry out the study after I am back home.  I believe he will use this study as his master thesis. We will be getting ethical approval from the University IRB within Mongolia, which will enable us to publish results in the future and share that with you.  I have been told that things often move slowly compared to the states- but I am not personally experiencing that.  I have found that a lot of information is not widely shared between research institutions as it is in the states.  Many documents are only available if you have a connection with certain organizations. It is not as easy as going on google scholar and searching for a general topic and finding what you are looking for.  There is limited research available on Mongolia unless you are here and know someone doing the research.  This makes things very difficult for me as an outsider coming in to do research.  I have no idea what sort of research has been done in the past.  Thankfully, I have the expertise from local researchers as guides, but I could not imagine coming in without those resources.

Update on my projects:

So basically my projects revolve around the problem that there is a lot of hepatitis in Mongolia and a lot of that hepatitis leads to cirrhosis of the liver and liver cancer.  In Mongolia, 78% of liver cancer is diagnosed in stages three or four.  Much of hepatitis cases within the country go undiagnosed because the population is not aware of the disease, because testing is not readily available or because they do not know they could be at risk.  In order to change this within the population we are planning a community awareness campaign to encourage testing, treatment, and to educate the public on viral hepatitis so they know their options and have the resources to get tested.  It is an important public health issue for the country and will continue to be so until awareness of the issue is brought to the public.

In a meeting last week with the key stakeholders from the World Health Organization, the Public Health Institute of Mongolia, the National Cancer Center of Mongolia, Mongolia Broadcasting and National Center for Communicable Disease, I was able to hear ideas about the campaign and what it should look like (I understood some- most was in Mongolian but later translated back to me through coworkers).  This will ideally be a very large campaign throughout the country-talk revolved around a reality show, various communication messaging methods, and what we want the participants to get out of the campaign.  I am meeting with the representative for Mongolian Broadcasting to discuss the strategic planning and the communication messaging for the campaign tomorrow.  I am looking forward to have the experience working on such a large scale project.  It will definitely consume a lot of my hours – probably more than expected but will be very rewarding to see the results.

I have also assisted the World Health Organization with editing their translated subprogram on viral hepatitis.  This has been great exposure into their specific projects and goals for the coming year.  It was exciting to learn that FIRE was apart of some of their goals and projects to be carried out.

Thank you for taking the time and interest in my blog! Please feel free to ask any questions or leave any comments as you see fit! Sorry I do not have many pictures this round- work has not been very photogenic ??
One of the first ex-laps I did here in Kijabe was a planned gastrectomy on a 74-year-old female for gastric cancer. She was thin and frail and had progressive difficulty with eating for over a year now with resultant profound weight loss. I feared the worst when I felt her abdomen after she had been put to sleep; when she was fully relaxed, you could feel a large mass in her upper abdomen.
It seems to me that global surgery, or really any work in a resource-poor country, requires a different type of intelligence to be successful. Indeed, it requires ingenuity, the ability to think outside the box at nearly every level to make do with the resources available. This has been demonstrated to me over and over again for the last four weeks here in Kijabe, Kenya.

I am writing you tonight as I sit on my living room couch eating scrambled eggs for dinner after a full day of travel outside of the city.  Today, three new friends and I traveled to see part of the Mongolian health care system outside of the city.

To give you a little background on the landscape- Mongolia is divided into 21 aimags (provinces), which are further subdivided into soums (rural districts) and bags (villages or communities).  Ulaanbaatar for example is divided into nine districts all of which are divided further into koroos or sub-districts.  The Ministry of Health and Sports is responsible for all public health functions and oversees the management of all tertiary and secondary hospitals.

About 60 kilometers outside Ulanbator (UB)  there is a small village or soum that has approximately 3,000 people.  We visited the hospital that serves this population plus the surrounding areas- mostly a primary care facility.  While there, we were able to speak to the director who gave us a tour of the facilities and answered our many questions.  The facility has 10 patient beds and serves in total patients within 102 kilometers around.  There is one doctor for about 3-4,000 people.  The majority of the illnesses that this hospital sees are respiratory (especially during the winter season Dec-March), heart disease, stomach issues, migraine and urinary complications.  This hospital is not allowed to deliver children unless it is an emergency- those mothers delivering are to go to the district hospital for birthing.  In the case of emergency delivery (which happened the week before we were there) doctors from the district hospital 60 kilometers are able to come to preform a C-section on the mother if necessary.  The hospital has no indoor plumbing- it is currently broken so patients have to go outside to the outhouses and water for hand washing is brought in.  This is something FIRE is hoping to help with in this location.

This hospital has a lot of success with local public health events.  In the event they had recently 7,000 people participated which is very impressive.  You can seem pictures below of the soum hospital below.

Triage location in the hospital

Vaccination Chart (The one on the bottom is in English) FYI this is what Mongolian Cyrillic looks like

The Pharmacy for the Soum Hospital

Maternity room

Today, we also drove further to a district hospital (Baganuur I believe) and were given a tour around a much larger facility.  The population of the city is approximately 30,000 and this hospital serves a total of 50,000 through neighboring soums.  There are a total of 216 beds and 315 health care workers within this hospital.

Because of the work we are doing on viral hepatitis, we had many questions about hepatitis treatment available at this hospital.  Currently, there are 15 people who are under hepatitis C treatment.  Patients are monitored by a specialist who tracks their viral load every four weeks (this is based on the Ministry of Health Guidelines in Mongolia).  Hepatitis C treatment for those not familiar recently is available and is extremely expensive.  Here, priority patients are those over 40 with highest viral loads. Many have to depend on family members or loans to receive the treatment.  This is a three to six month extremely costly treatment process. 

Based on a recent study done in Mongolia, it was approximated that the total number of hepatitis positive subjects is 379,427.  Within this same study, the incidence is higher in rural areas compared to the urban cities.  Mongolia has one of the highest incidences of hepatitis C in the world and it continues to be a pressing public health issue for the country.  Often times, the population does not go to the doctor unless they are showing severe symptoms of a disease and in the case of hepatitis C, it is often too late to be resolved.  In Mongolia, 78% of those with liver cancer are diagnosed within the 3rd or 4th stage of the disease.  

Thanks to vaccination law in Mongolia since the 1990s, approximately 96-97% of newborns are vaccinated for viral hepatitis so they likely will not face this issue themselves.

This district hospital mostly sees cardiovascular, respiratory, and urinary illness.  I was very impressed with the district hospitals public health programs.  In a separate building from the hospital there is an adolescent health program and reproductive health center where various information sessions are held about pressing and general health issues in the community.

Dialysis room

Outside of hospital

Public Health Center and Pharmacy for the hospital

In the district hospital we were able to see their medical waste management process- which involves burning their syringes, glass bottles and gloves a few meters away from the hospital building (see images below).  This is something FIRE is hoping to help with.

After all the hospital tours we went for Mongolian food – which was actually really good. Just a lot of meat – they claim that because Mongolians eat a lot of fatty meat they don’t have alzheimers? I am not sure if this is a real thing or not?

Then on our way back to the city stopped at the largest statue of Chinggis Khaan in the world.

So far, work has been great. I have made a lot of progress on the Knowledge, Attitude and Practice Survey and have recruited local students to help with the cultural aspects of this project.   I have really enjoyed myself so far.  I hope you enjoyed reading.  I appreciate you taking the time to do so! If you feel inclined feel free to leave a comment below! Have an awesome day!

Yesterday International Women Day was celebrated by giving cakes, sweets, flowers in appreciation of women around the country.  It kind of reminded me of Valentines day in the states- I was walking around towards the downtown square and passed countless men carrying flowers or cake boxes home. So naturally- I got myself a cupcake to celebrate :). It actually was pretty tasty! The day was also celebrated with no work- so I got a holiday on my second day.

I spent the holiday walking to the central square – Chengis Khan Square (once it reached 3 degrees outside). I promise I have never felt cold until yesterday.  I think it took about an hour to actually warm up after walking for 20 minutes.  I think it is supposed to warm up to the 30s next week so I am definitely looking forward to that!

Monday and Wednesday of this week have been mostly familiarizing myself with FIRE and what I am supposed to start working on here.  I mentioned briefly in the previous post that I will be working on a Knowledge, Attitude, and Practice (KAP) survey as well as helping plan for a community awareness campaign for Viral Hepatitis and liver cancer- two huge issues in Mongolia.  I have been familiarizing myself with the epidemiological features of the country through various documents given to me by mentors at FIRE.

On Monday we met with the World Health Organization Representative in Mongolia (FIRE has a strong relationship with WHO) which was very informative towards future project plans for the organization.  For those interested in the epidemiological features of the country, I will attach a document with descriptives to this blog (click on interested)- be sure to check out this information from WHO.  I will keep you updated on the progress of each project.  I will be apart largely of the planning for each project- I have a goal of piloting the KAP survey before I leave.  I am planning to coordinate with other Public Health Students here in Mongolia so they can implement the final KAP survey.  I am very excited about this opportunity to collaborate and learn with local students!

*if you click on the blue underlined words it will take you to a link with more information about what is mentioned 

My Living Room

Walking towards my apartment after getting groceries

Walking near city center on International Women Day

City Center

Travel helps me better understand and appreciate the world around me.  Public health has become my passion. Follow me as I learn to bring the love of travel and public health together through my Master of Public Health field experience in Ulaanbaatar, Mongolia.

This adventure will begin on March 2nd as I begin my two day trek from East Tennessee State University to my temporary home for two months.  There will be many lessons learned, knowledge gained, and many pictures to share with you throughout this experience.  I look forward to sharing this journey with you.

"One may observe in one's travels to distant countries the feelings of recognition and affiliation that link every human being to every other human being." – Aristotle

At the age of nineteen I scribbled this quote on the inside cover of a journal I kept while interning at an HIV/AIDS clinic in Kampala, Uganda - a one month experience that I, in my naïvety, had assumed would shine light on answers to the world's problems and provide me with direction in my future studies and career choices. Not so shockingly, I returned home with more questions than answers about the all-too-exhaustive list of social injustices in this world and how I could possibly play a role.
The Aspen Institute, an educational and policy studies organization based in Washington DC, holds a monthly speakers luncheon for Congressional staff interested in the various topics related to foreign assistance. Its mission is to foster leadership based on enduring values and to provide a nonpartisan venue for dealing with critical issues.

Hello Friends and Family,

I have never been so thankful for a shower! I am happy to say that after a two day journey and a lot of jet lag I have made it to Ulaanbaatar, Mongolia.  I arrived late last night around 3AM here to meet wonderful hosts who welcomed me to this beautiful city.  I can honestly say I had no idea what to expect, or what it would look like coming in. I feel very comfortable here so far and have enjoyed walking (not too far) around my apartment.

It is quite cold here, around 7 degrees Fahrenheit today- it sounds terrible, but honestly with a warm jacket, boots, and sweater you are good to go.  My apartment is great- it has everything I need including a washing machine and microwave which is awesome! These are things I was not really expecting- I feel like my hosts are giving me the royal treatment! Any issue (which was really minor- lack of running water at first) were solved within a few hours thanks to my hosts.

Who are my hosts you ask? I am interning with Flagstaff International Relief Effort (F.I.R.E) and my future coworkers come Monday have been helping me get around and comfortable with the area.  I am staying near the City Center- close to Chinggis Khaan (yes, we say it wrong in the states- I had no idea until yesterday) Square and have any amenity I could need at my finger tips.

I begin work on Monday.  I am set to work with F.I.R.E and the World Health Organization (WHO) on a planning project for community based education for viral hepatitis and liver cancer- two large health problems for Mongolia.  Mongolia has the highest rate of liver cancer and viral hepatitis C in the world as well as one of the highest rates of hepatitis B.  The liver cancer rate alone is six times higher than the international average.  This high rate is often due to late diagnosis of viral hepatitis and other related liver diseases such as cirrhosis.  78% of liver cancer patients are not diagnosed until stage III or IV and 85% of liver cancer patients die within one year of diagnosis according to the Center for Health Development in Mongolia, 2014.  The goal of this project is to raise awareness and influence change by directing the general population on testing and treatment.

In addition, I will be helping with a Knowledge, Attitude, and Practice Assessment with WHO and the National Cancer Center.  I am definitely looking forward to each of these projects and will continue to share throughout the two months I am here.

Feel free to leave any comments and questions you may have! I would love to hear from you!

The picture above is near my apartment.  I am staying to the right behind the crane.  The first building you see on the right with the cars in front is a shopping center right across the street from my apartment.

Since the 1990's, the U.S. foreign aid budget has helped cut global poverty in HALF. Yet, foreign aid comprises less than 1% of the entire U.S. budget. Foreign aid isn't just a humanitarian cause - when global health improves and poverty is eliminated, citizens of the U.S. benefits from greater global security and a thriving global economy.

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