Thursday, September 30, 2010

Playing an "Away" Game

Door to OR#1

Operating in a different operating room is like competing on the visiting teams field. You’ve got to make a quick assessment of the lay of the land and then play your game.  Things in the Mongolian OR’s were quirky but in general, I was pleasantly surprised by the resources we had available. When things weren't up to par, we had our own biotechnician, Danny, who made things work, like our very own personal "roadie." 

There were three general surgery operating rooms in the hospital. OR #1 was the largest with two big windows and two big OR lights. Unfortunately, when we arrived, there was only one functioning light bulb between those two large panels. Before our first cases, they found functioning bulbs for one light but one big light remained dark for our entire visit. The big windows helped in the daytime as the regular room lights were also missing bulbs. We relied on a back-up generator one day in Choibalsan and saw no interruption in power to the anesthesia machine, lights, or laparoscopic equipment in the room. We had a complete laparoscopic tower though the regulator on the CO2 tank was faulty and created a constant cricket-like chirp for two whole days of operating. Suction was also available but shared between the three general surgery operating rooms, the surgery ward, and the ICU. OR#1 accommodated a c-arm for intra-operative x-ray. This machine was 10-15 years old and required some work after our first series of cholangiograms provided a near white out image with the faintest hint of the biliary tree. Once it was adjusted, we had interpretable images.
No Bulbs in those lights. Eventually, we got the small one working.
Danny is checking out the lap tower. 
The anesthesia machine in OR#1
Big light, no bulbs.
The second general surgery room was smaller than my closet (I have a BIG closet but this room was still small) It fit the bed, anesthesia machine, bovie, and was filled when we brought in a laparoscopic tower and a back table of instruments. Lighting was again an issue and this room really only had one window. There was a small pass through to OR #1 which made it a good vantage point to spy into the action in the other room
Tight quarters in OR#2
The third room was about as big as OR #1, located on the opposite side of the hospital and was reserved for emergencies or infected cases. The anesthesia machine in OR#3 was not the most reliable.

Striking contrast to my new “home field” in Denver – with the state of the art Storz HD flat panels, fully integrated teleconferencing, video, audio, LED lights, even an integrated iPod dock . . . we are fortunate. But the stadium doesn’t make the team. Sometimes, I think we forget that. 

Tuesday, September 21, 2010

Anna Home

Sunday afternoon while Ray took Gaby to the airport, the team met up with Maarten (a dutch physician who volunteers in Mongolia, working with hospital administration) to go to Anna Home. 

Street children are a problem in Mongolia where abandonment is the most common reason children are left on their own. In the big cities (and small cities) of Mongolia, homeless children live underground where the steam pipes provide some heat. In Choibalsan, a karate instructor and generous soul - Boldsaikhan - began taking these children into his home. When he met Maarten in 2006, they worked together to found Anna Home; an NGO orphanage in Choibalsan. Currently 24 children live and thrive off of the street, in a safe and clean home. They have citizenship, healthcare, and go to school. They have a garden, chicken coop, soccer goals, computers, a fresh water well, and a loving home. 

We arrived at the orphanage and were met with smiles and enthusiasm. My camera got whisked away until i rescued it in the garden. I gave the kids my point and shoot for the remainder of our visit and this is the story they told . . . ALL of the pictures on this post are theirs. Even that sunflower - which is probably my favorite picture from the whole trip. 

please check out the Anna Home website if you want to learn more.
PS. I am sending them a digital camera when i get home - if anyone wants to chip in, we can send a few.

Goodbye Gaby

All of the team members in Choibalsan have left their families and jobs back home to come and serve in Mongolia. Getting two weeks off can be tough - and for Gaby, our surgical resident, it was impossible. She had to leave after one week with us to get back home to every other night call. Sunday after the museum, she left us. That is her, in the ambulance, heading to the airport. In some karmic twist of fate, Gaby's bag was lost when she travelled to Mongolia (it went to France). It then arrived in Mongolia with enough time for her to wear a few outfits and put it back on the plane. News from home is that Gaby's luggage was lost on the way back to the USA as well . . . 

We hope you got your luggage - and we miss you Gaby!!!! Love, Team Choibalsan


Statue remaining at ruins of Russian tank base
Team on the tank

Sunday we spent the day touring a few local sites which included the ruins of a Russian tank base and the Choibalsan Museum. We learned a bit more about the history of this city and this country and discussed how so much has changed since 1990 when the Russians withdrew from Outer Mongolia. When the Russians left, they left Mongolia with a huge gap in services and goods. They basically took their toys, and left. No more health care, no more food on the shelves, no more education . . . all the support that had been in place under communist rule was gone.  Our interpreter tells us of how life gradually changed for the worse, goods became scarce, and people changed careers in order to be able to find some work, somewhere. Doctors became business people and teachers creating a generation gap in the current medical system (see blog on surgical training). We had a patient who was an internal medicine doctor and went back to school in the 1990’s to become a school administrator and teacher. Apparently, these stories are common.

The Mongolian people have a fondness for the Russians that they do not have for the Chinese. The great wall was built by the Chinese to keep out Chinggis Khan (pronounced Chingus Han) It is the border separating Inner Mongolia from China. Outer Mongolia is the land north of Inner Mongolia and south of Russia that is also called just plain Mongolia. The geography can be confusing . . .

Jump Shot 
There is a rich history to this land. Prior to my trip, I read the book Genghis Khan and the Making of the Modern World by Jack Weatherford. It is a really well written account of the life of Genghis Khan and the extent of the Mongol empire, in its prime. I brought his second book: The Secret History of the Mongol Queens: How the Daughters of Genghis Khan Rescued his Empire; but I have not had time to read more than a few pages. Having read some of the history before I arrived has really helped me to appreciate the culture, and customs of the people. I am still in the process of learning about and understanding the complexities of modern Mongolian history but I have enjoyed picking up what I can from our translators Enkhe and Ooko. Again, learning more than I teach. 

New Friends, Old Songs

Note to self – when forced to karaoke, “Sweet Caroline” is a sure thing. . . . After a day in the countryside, we made a quick turn around to head out to karaoke. The American group was pretty tired, sunburned, and somewhat reluctant but encouraged by the unflappable enthusiasm of our Mongolian hosts, we rallied in record time.
            I don’t karaoke. Repeat, I don’t karaoke . . . unless I am in a foreign country. Mexico, Fiji, and now Mongolia are the only three places I have ever subjected people to the off-key screeching usually reserved for the privacy of my car. There were a few hits, many misses, and lots of entertaining moments. (The photographic evidence of me actually singing has been destroyed and won’t be posted here!!) Highlights included the choreographed moves of Allison and Gaby; the Mongolian I.T. guy singing his heart out in amazingly good English; and the Mongolian surgeons belting out ‘classic’ Mongolian hits. Good times . . . “So good! So good!”

Dr. Harold Rust

Gaby and Allison "Like a Virgin"

I.T. Guy
Dr. Ganbolor

They are singing in Mongolian, I am mugging for the camera.
Ganbolor, Gaby, Allison, Vincent

Out on the Steppe

Our hostess in her ger. This woman trains horses and lives out on the steppe. 
The steppe
Daughter of the horse trainer
Allison and Oyuunbold's daughter (9m)
Saturday, our Mongolian hosts took us out to the countryside. On the Steppe, near the Kherlen river, we visited a traditional ger, “rode” horses, had a big Mongolian feast, played soccer (not me Dr. Parks, not me . . . ) and a little volleyball. It was a great day with the whole OR team outside under the “eternal blue sky” that is so sacred to the Mongolian people. 
Oyuunbold and his daughter
Un-hobbling the horse
Led around on a "wild" mongolian horse
Dr. Ray Price and Dr. Ganbat in the heat of battle
My one good shot

Monday, September 20, 2010

I Miss Beau!!

Every night, as the sun goes down, you can hear the packs of dogs barking in the city. There are dogs everywhere here – wandering the streets, behind the hotel, around the hospital grounds. Mostly, the dogs look healthy but every now and then, there is one with a lame leg or a matted coat walking down the street as best he can. 

Some are kept as pets like this one tied outside of the family house. 

We ran into this tiny puppy that kept trying to escape the yard as his owner unsuccessfully attempted to shoo him back in. 

I Miss My Beau!!

Children of Choibalsan

Saturday morning we got up early and walked through the city. Wandering from the town square near our hotel and the wrestling stadium, we walked up the small hill that is home to the vast majority of the population of Choibalsan. In neat rows, the dirt streets are orderly. Makeshift fences of every imaginable material hide so many stories . . . the family hanging their laundry, the woman tending her garden, the family getting ready to for an outing, the children feeding the dog, we peeked into many of these moments. But for me, it was about the children.

In the city center, there is a small man-made lake with a Buddha perched on an island in the middle. There we ran into these two young men and their big smiles.

Leaving the lake, I spotted this little guy who could not stop reading the label on this bottle – he caught me with those glasses, and that intensity. 

As we got further into the town, this guy quickly hid from our lenses after he gave us this perfectly framed shot.

Further on down the way these kids were playing with homemade swords but stopped when a young woman came by with her new baby. They briefly retired their battle for a curious look at the tiny bundle. 

On the next street, a young kung-fu fighter was showing off his moves. Little sister was trying to keep up but got distracted by the large puddle left from the morning rain. That was when the brother took her hand, and gently led her and her muddy face away and off down the street.

Everywhere you go, kids play like kids; kids smile, and hide, and explore, they splash in puddles and fight fake wars. Kids, being kids, as kids do. 

Sunday, September 19, 2010

Happy Birthday Uncle Friday

When we first arrived in Mongolia, we ran into a few intoxicated citizens and one of our Mongolian translators commented that “those guys have been celebrating Uncle Friday’s Birthday.” A little Mongolian twist on TGIF . . .

2 year old with Inguinal Hernia
Friday was a good day. I started off with an inguinal hernia repair on a two year old. He is a twin, and was the runt of the two. When he came to see us, he had a large hernia, conjunctivitis, and a generous fear of everyone American. No one on our team could get near the kiddo without him bursting into tears. He put up a fight for Dr. Rust and the team of anesthesiologists, but in the end, we won and fixed the hernia without much further drama. My next case was a laparoscopic cholecystectomy that ended up being a bear of a gallbladder buried in layers of fat. It took some time, but we won that battle too.

After Ray gave a few lectures, we reconvened for a photo shoot of epic proportion. With Gaby leaving Sunday, this was our last chance to assemble the complete OR team. Waiting on the surgical ward for the anesthesia team to wake the last patient, our countless cameras created a paparazzi caliber frenzy of flashes. We posed picture after picture and finally got a complete group shot. Mission accomplished, week #1 down, Happy Birthday Uncle Friday!!

The Complete Team

The Surgeons: Enkhe, Ganbolor, Oyuunbold, Suz, Bolortuya, Ray, Gaby, Ganbat

Thursday, September 16, 2010

"This is my Best Mongolian Birthday Ever!" - Gaby Vargas

Gaby blowing out candles
A few days ago it was Gaby's birthday. The fine Dr. Vargas reached the ripe old age of 32 here in Choibalsan and the Mongolian team bought her a birthday cake. Managing to keep it a surprise, we lit candles (in the OR) and sang after our last case of the day on Tuesday. It was a pretty special moment - and I am sure a birthday she will never forget!