Mongolian Surgery Training

Oyuunbold, Gaby, Tuya, Bolortuya, Ganbolor

How are Mongolian surgeons trained? After primary and secondary school, they enter a 6 year medical school program. Beyond that, they have a 1.5 year residency that was recently extended to 2 years . . . Yep, you got it – Not 5 years. 2 years! And these guys are sharp. For the limited resources that they have, these doctors know their stuff and are amazingly technically proficient. I cannot imagine a 2 yr training program. 

Enkhe explained to us that there is a significant generation gap between the senior surgeons and the young surgeons in Mongolia. It is hard for the younger surgeons to find mentors. The doctors we are working with are in their twenties and have only one more senior surgeon. We are trying to teach as best as possible - through translation. All of the surgeons are like sponges. So enthusiastic and eager - sometimes I feel like I don't have enough to teach them. And as expected, I am learning more than I am teaching. 

Ganbolor, Ganbot, Cody, Oyuunbold, Bolortuya

Reality Bites

So the reality is sometimes sobering. We are having a great adventure here in Mongolia; mostly because of the fantastic team of people I came here with and the beautiful, generous, and ambitious people we are teaching. But there are harsh realities. There are no chest tubes.

We have seen two significant chest trauma patients within two days here in Mongolia. One had a flail segment with four broken ribs after a car accident, and one had a 75% hemothorax after a drunken brawl. Two major chest traumas, zero chest tubes.  Each of these patients had a 12Fr suction catheter, placed about 3 inches deep in their pleural space, and that catheter was clamped. Intermittently, someone would take a syringe and manually evacuate what they could before re-clamping the tube. There are no chest tubes, and there are no pleura-vacs. We replaced one of these suction catheters with a nasal airway (larger bore catheter, more integrity to the plastic) and then we had nothing to attach it to. The doctors were able to find a pleura-vac at another hospital – but here, there are no pleura-vacs. Once the borrowed equipment arrived, and the nasal airway had been inserted, we had to find a suction device to attach to the apparatus – there are some of those around, but they are scarce and in demand – we used one anyway.

We have brought a dream package of things to this place. Generously donated fancy things like endoscopic staplers, and skin glue, disposable trocars, and endo-catch bags. We have brought all this with our fancy education and a team full of heart, but there is simply not a chest tube to be found. Not a pleuro-vac, not a Jackson Pratt drain, not even a sharp knife blade - the reality is sometimes sobering.

Dinner in Mongolia

We haven't really had dinner in Mongolia. It has been very busy at the hospital and our days have been very long. Two days ago, I got to do my first pediatric case - a 12 year old orphan with appendicitis. He had been brought 75km here to Choibalsan by a general practitioner. We all fell in love with him and i have decided maybe I should specialize in Mongolian orphan surgery. 

That's "Woman" in Choibalsan

Looking out the window of the plane I see only open spaces. It is the third time in about 20 minutes that I have glanced over, looking for a ger camp in the landscape. I haven’t seen any white dots in the landscape for those 20 minutes of flight. When one appears in the wide, green expanse, it appears tidy on the banks of the winding river below. Each ger, a perfect white circle. This is some desolate, remote territory.

We have landed in Choibalsan.

Christmas in Mongolia!

Today was like Christmas in the warehouse – opening all the new, generously donated Storz instruments, trocars, and telescopes. Cutting open the plastic packages made me a bit giddy – sparkling new toys. What silly children us surgeons can be. We spent the day sorting, and greeting new team members, and then packing it all to go. The duct tape duffel bag full of lap instrument trays and scrubs was a team accomplishment that had to be photodocumented. (me, Allison, Daniel) 

It's Midnight in Mongolia - Do you know where your daughter is?

We arrived in Mongolia around 1130pm local time. No problems with baggage and Ray immediately ran into a friend at the airport. Once our ride arrived, we had both a police and customs escort – which we thankfully did not need. Next stop, a storage warehouse. Yep. Midnight and we are off to a warehouse in Mongolia. The guard was sleeping when we arrived so we had to make a bit of a rucus before we could get into the compound. Inchee drove us around to the entrance of the large concrete building. Inside, it smelled like school. Middle school exactly – independence hall if you want me to be more precise, down by the science wing . . . excuse the Nether Providence middle school flashback.

The warehouse is quite an impressive scene. Stocked with surgical supplies of every variety. After a quick tour of the facility, we were off to the hotel, through the dark, quiet streets of Mongolia at sleep. 

Nothin' but Mutton . . .

One last blog and veggie burrito before i go! Word on the street is it is nothin' but mutton for the next 16 days . . . I brought lots of granola bars and oatmeal just in case.


My wise friend Kerri Reynolds recommended that I let everyone know how this adventure to Mongolia came to be. I like to tell the people at the hospital that my senior partner has had enough of my shenanigans and so he is sending me to Outer Mongolia. There is some truth to that :)


When I started the new year of my contract in Denver, I was fairly vocal about the fact that i wanted to use my vacation time to do service work. For my partners, that means longer stretches of every third night call and a willingness to allow me to be gone, far away, for weeks at a time. So to Steve, Saundra and Kristin - Thank You!!


Knowing that I was interested, Steve forwarded an email from The Swanson Family Foundation (http://www.swanfound.org/) They were looking for a surgeon to go to Mongolia in September (this is the part where he sends me to outer mongolia :) They had put out a post through the SAGES Global Affairs Committee (http://www.sages.org/projects/global_affairs/)  and through the American College of Surgeons Operation Giving Back (http://www.operationgivingback.facs.org/). Once Steve forwarded the email, and offered to cover my call - I sent an email back to Dr. Price (the medical director of the Swanson Family Foundation) and upon receiving all of the necessary documentation proving that I am a board certified surgeon, with a medical license and a passport - it was a done deal.


Financing is all personal but run through the foundation so it is tax deductible. (About $3000 but i will give you a grand total when i get back) Even if it wasn't run through the foundation, you can deduct money spent for medical service work. The foundation arranged all of my travel and accommodations. I was responsible for bringing only one checked bag and for bringing along some scrubs and white coats. Pretty low stress for me.


So that is how i wound up here, eating a veggie burrito in the SFO international terminal, waiting to hop a plane to Beijing . . .


Check out the links above if you are looking for service opportunities! Great Resources!!