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.
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.
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!