Top 20 Quotes of Mongolia Bound 2014

As we make our way home and reflect on our experiences over the past two weeks, we thought we would share with our Mongolia Bound readers a humorous glimpse of our travels and experiences. Each of the quotes listed below reflects either our individual personalities or aspects of our experiences.
20.  “Made you look!”  (Margie’s and Rita’s kids playing a favorite game by trying to get us to look at “spots” on our shirts, etc.)
19.  “Where’s the lecture hall?”  (Response: “Through the Tunnel of Death.”  See photo.)
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The Tunnel of Death leading from the children’s hospital to a separate building housing lecture hall, laboratory, etc.

18.  “Do you know where this word comes from?”  (Steve putting on his professorial role.)

17.  “Where’s John?” (Response: “He’s either taking a hot shower or shooting a photo.”)
16.  “Do you want red, white, champagne, or white and then red?”  (Steve asking the group about what type of wine they want for dinner, invariably followed by someone asking . . .)
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Cheers!!

15.  “How would you describe the body of this wine?”  (Steve’s response: “I’m not going to waste my time. This is crap wine.”)
14.  “What type of meat is this?”  (John asking about the salad at dinner at Khuduu Aral. The answer: beef tongue.  Alex and Cindy promptly stopped eating.)
13.  “It’s not as bad as Fly Camp.”  (All of us at different points comparing things to our first camp at Khuukh Nuur, which was swarmed with flies in biblical proportions.)
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Steve vs. flies at “Fly Camp”

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Sunrise over Blue Lake (Khuukh Nuur) at Heart-Shaped Mountain. This made up for all the flies.

12.  “There are no rules.”  (Steve describing traffic in Ulaanbaatar.)
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There are NO rules.

11. “Chuuka! Chuuka! Chuuka!”  (Our cheer after our amazing driver, Chuuka, had successfully forded a stream or achieved a 45 degree angle in the famous Russian van.)
10.  “Actually, it’s no good to drink.” (Doogii telling us not to drink the spring water–one day after we all drank it. See photo to see how the water changed color overnight.)
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Before: John takes a swig of water fresh from Auger Spring.

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After: Steve holds the bottle of spring water the next day. What were we thinking?

9.  “‘Camel’ is the marrow side of the bone.”  (Cindy, the hemonc, immediately able to discern the “camel” side of a sheep’s ankle bone. For centuries Mongols have used these ankle bones–with each side representing a different animal–to play a variety of games along the lines of checkers or jacks.)
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Anklebones.

8.  “Do you know that every day you produce 10% of your platelets?  Taking a daily aspirin irreversibly inhibits the function of the platelet.”  (Cindy to Steve when she learned that he takes an 81mg tablet of aspirin each day. )
7.  “Go with the flow.”  (What everyone who travels in Mongolia ultimately learns: you either become fluid or don’t make it.)
6.  “Where did all this water come from?  Is the raft supposed to fill up with water?”  (Cindy as she boarded our raft and noticed it filling with water. It turned out that the inflatable raft was designed to take on 3-4 inches of water.)
5.  “Doogii, do you know how to swim?”  (Steve asking a pivotal question of Doogii as we reach the middle of the Kherlen River on our raft and she informs us that this is her first time rafting.)
4.  “If you think that I have any control of this horse, it’s an illusion.”  (John on horseback.)
3.  “I enjoy looking at slides.”  (Cindy’s geek/researcher’s side coming out.)
2.  “It’s a beautiful stain.”  (See above. She’s referring to the stain labs make to be able to read slides.)
1. “Actually, it’s okay.”  (Doogii on innumerable occasions, but most memorably as she’s telling us that we are rafting without a guide and she has never rafted before and can’t swim. This became the saying of the trip, and it pretty much always turned out to be true.)
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Chuuka preparing to drive through deep water.

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Perhaps the only lawnmower in Mongolia.

On the way home – 2014 (John)

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Telling Jonathan’s story

It has been two years, Jonathan.  First time I went in 2012, I was inspired by your dream and wanted to be part of the team to live it out.  I went without knowing much about this country Mongolia that fascinated you, except that the people are traditionally nomads and their country neighbours my motherland. 

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2012 Mongolian Team

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With Candace’s and the boys’ great emotional support, I packed my bag and went!  I was blown away!!  I went home deeply inspired and touched.  I then understood why you were so fascinated about Mongolia!  The people there are so pure, content, positive, and happy.  Living their simple lives in the endless plains of the Mongolian Steppes, enjoying happy times with their family closely bound by their deep traditions in the warm gers, going through harsh winters with perseverance and strength, without fears… They have so much in common with you!  I was touched by their courage and strength to live… as nomads, as warriors against cancer.  I learnt the love that drives them to go on: the love of lives and nature; the love for their families.  I was moved by the innocent smiles that the Mongols patients had, even when battling life threatening diseases… just like you did.  I was touched by the love that the parents showed by being with them and holding them tightly… just like your parents did.  I learnt fatherhood at a deeper level when Steve was running around collecting Mongolian stones for you, and when he was praying in silence in Karakorum, and him turning your love into helping others.  I was inspired by the love of the doctors and nurses in Mongolia taking care of their little patients, even putting them before their own families… just like your doctors and nurses did.  I got to know two missionary families who went way way way before us to the Land of Blue Sky answering the Lord’s calling, taking care of Mongol children and being living testimonies of Christ’s love.  Two years later, these inspirations didn’t fade a bit; they only grew stronger!

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Bone marrow needles used by the hospital in 2012. They now use single use needles.

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A mother holding her child tight.

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Visiting with patient and her mother.

Thank you so much, Jonathan.  I would not have the opportunity to learn and experience all these without you.  Thank you for having such wonderful dream and letting us be part of it.  Jonathan, I thank our Father for giving you such a loving heart and being such strong living testimony of His love and sacrifice.  I can tell you that we made many friends in the Mother & Children’s Hospital and we are honoured to partner in battling childhood diseases in the U.S. and in Mongolia.  There are many things that we have learnt from each other.  We are making many changes to take better care of the patients entrusted to us because of you!  Although I may not be able to go back to Mongolia in the near future, I am forever bound with them via the friendship that is beyond time and space, just like ours. 

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2014 Mongolian Team.

 Please continue to watch over us and inspire us.  We are honoured to partner with you to do all these and I will continue to tell these amazing stories… all started by one child’s dream.  The time will come when we meet again and chat and laugh over our little travel stories in person (milk curds in coffee, fly camp, Russian van…), until then, take good care of yourself and your family.

Soccer Camp 2014: Under the Mongolian Sun

Mongolia is the least populous country on the planet (it is said that the horses outnumber the people 12 to 1), and in the vast steppes that comprise most of the country one feels the immensity of green space, as if one were sailing on a rolling sea of grass. But the sprawling, dusty city of Ulaanbaatar is quite another matter: there is virtually no green space to be found, and the few postage-stamp-sized playgrounds that dot the city–especially in the ger districts–are marred by mud puddles and rusting, decrepit equipment.
So when we offered the first soccer camp two years ago as a way to complement the medical team’s activities at the hospital, we did not realize that we were providing kids from both The Children’s Place orphanage and the nearby ger district a rare opportunity to play in open, green space. But the camp was so successful that, what began as the inspiration of a then-16-year-old Justin Sandler (Eric’s youngest) in 2012 has turned into an annual event carried on by members of Margie’s and Rita’s church as a ministry to local street kids.
The 2013 camp was again held at the 97th School, but for 2014 Margie decided to move the camp to a gorgeous, full-sized field located at the National Defense University–and closer to the ger district, so that more kids could access the camp.  With the children from the orphanage at their “Summer House,” a lovely country place donated to the orphans for two summer months a year, the 2014 camp would be three afternoon sessions geared toward older kids from the ger district.
Camp began on Monday afternoon underneath a bright blue Mongolian sky, with a dozen or more kids from the ger district participating, along with Margie’s and Rita’s kids. Under the watchful gaze of Boloroo, the young woman who runs the outreach ministry to kids in the ger district from Margie’s and Rita’s church, the kids skipped drills, chose sides, and jumped right into a game. Despite the heat–intensified by the artificial field-turf surface beneath us–the kids raced back and forth between the goals in a spirited match.  Across the street was a supermarket where Margie and I loaded up on water and snacks to keep the kids refreshed, and at the end of our two-hour session the manager of the field told us the kids could play for another hour for free.  Margie speculated that he made the gracious offer because he recognized the fact that these kids don’t have access to a facility like this and wanted to help out. By four o’clock the kids were worn out from the heat and the games, and Timuraa, who had picked up the kids in Margie’s old van, transported them back to their homes. Day 1 was a success.
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A young Messi shoots and scores.

Day 2 (Tuesday) saw another brilliant blue sky above us, and the campers had a slightly different flavor. All the kids from Monday were there, but several rough-looking teenagers joined us as well.  These teens have what Rita calls a “homeless lifestyle”–that is, they will spend weeks away from family, staying in friends’ gers, returning to the family ger for a short time, and then disappearing again for days at a time. “They’re depressed, so they drink, and that just intensifies the cycle,” Rita observes. Older and bigger than most of the other kids, these teens are tougher to control, and they are just more physically aggressive–with the younger kids and with each other. When you grow up in a home where violence is ever-present, you carry that anger and aggression into the outside world.
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The players at day 2 of camp. Note the long sleeves worn by some of the teens.

Nevertheless, here these teens are, wearing some of the only clothes they have–which means long sleeves in heat and sun that even at UB’s latitude are burning this Floridian.   But the teens, too, seem to enjoy the opportunity to run and play in an open space. Midway through the camp session, though, these four or five kids disappear, leaving us all to breathe a sigh of relief and yet to wonder why they departed so abruptly. But a few minutes later they return with a 1.5 liter bottle of what appears to be a soft drink from a local convenience store. Boloroo nonchalantly calls them over to her and asks if she can have a taste–she is cleverly making sure that no alcohol has been added to the cola. The drink passes muster, and the teens return to playing soccer. The field manager again grants us extra time to play, and after two-and-a-half hours of play in the heat we are all ready to call it a day.
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two young cheerleaders.

The third and final day saw fewer kids (and none of the teens), the blazing sun probably having scared some of the kids off. But we had a great group of about 15 kids who scampered about the field and played a high-scoring game. Meanwhile, I had noticed that the day before some of the kids moved off to the side and used a soccer ball to play volleyball. That night I headed to the State Department Store (a relic of the old Soviet system, with shopping bags that read “All Needs Are Fulfilled”) to buy a real volleyball, and I spent most of the day using the new ball to play “pepper” with a rotating group of kids who would tire of the soccer, play volleyball for a few minutes, and then head back to soccer. Since I have actually coached volleyball, I was able to give the kids some pointers–I just don’t know how often they will have a chance to play in the future.
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David challenges Emily.

As the camp drew to a close, Boloroo summoned the kids over to one of the few shaded areas of the facility–the team bench–and reminded everyone that the camp was a gift of God and invited all of them to the church.   Then we handed out the gifts I had brought–Hot Wheels cars, UF lanyards, seashells, and a few other trinkets, and the kids posed for one final photo with their gifts.
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The kids show off their gifts at the conclusion of camp.

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Boloroo holds forth at the conclusion of camp.

Though I finished the three days sunburned and exhausted, Soccer Camp 2014 was a resounding success. To be sure, I missed seeing the kids from the orphanage.  But through the efforts of Boloroo and others from the church (not to mention Margie’s daughter Emily), kids who might not otherwise have had the opportunity got a chance to run and play on a real soccer field in a fun and safe environment. They repeatedly showed their gratitude, and I know that Jonathan’s spirit lives on through events in Mongolia such as this.

 

Mother and Child Hospital – laughter is the best medicine.

It’s time to say goodbye to the smiling faces of the hematology/oncology team who have so graciously welcomed us during this week.  As I look back and reflect on my week at the Mother and Child Hospital, I have to say that I am taking home many heartwarming and fond memories from our time spent here. 

Degi, a pediatric hematology/oncology attending physician, met us at our hotel on Monday and escorted us through the maze of bustling traffic and buildings to begin our first day.  When we arrived that morning, there was a lot going on.  Patients, parents and siblings filled most of the beds and outpatient children were arriving to be seen.   We rounded as a team that day, which allowed me to gain a baseline understanding of the flow of the unit and what types of patients that they generally see.  

In the afternoon I was able to follow one of the nurses as she went about her day.  It was amazing to see that they mix the patients’ chemotherapy right at bedside.  It was good to see that the nurses have implemented the recommendation from two years ago that they wear gloves during this process. They do not have central lines, so they must maintain peripheral IVs which can be challenging at times.  For the few patients that required new IVs during our rounds, family members often offered assistance and applied pressure above the desired site so that no tourniquet was needed.  We made several trips to the lab to drop off specimens so that tests could be run and so that blood products could be ordered.  These nurses work quickly and efficiently to deliver care to these adorable children.  

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Peek-a-boo.

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On Tuesday, we started our day with the news that two new patients had come in overnight and both would need bone marrow aspirations that day.  It was touching to see doctors and nurses utilizing the art of distraction, using stuffed animals and singing, to try to console the children as they were prepped for their (painful) tests.  Prior to their procedures, we gave both children Mickey Mouse necklaces, and it was touching to see the smiles our gifts brought to their faces.

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Checking on newly diagnosed patient after her bone marrow aspirate.

 

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She’s a lot happier the day after.

 During the course of the week I was able to spend a good portion of each day with the children.   One little girl refused to crack a smile while John and I made our “child life” rounds.  However, after we used stickers as an ice breaker, she smiled and then like a chain reaction her mom smiled.  We spent the rest of the day playing balloon volleyball and puppets with other patients as laughter filled the hallway.  Interacting with these children truly was one of my favorite aspects of this trip.   It is amazing that while we could not understand each other’s words, smiles and laughter needed no translation. 

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Playing puppets with my new found friend.

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She loved the necklace we gave her.

  - Alex Boddie  

Our introduction to Mongolian medicine (Cindy)

Although we had been prepared for what was to come, I will have to admit that the experience at National Center for Maternal and Child Health was both eye opening and rewarding.

To start our morning we make our way through the traffic, honking horns, broken sidewalks and dusty construction.  Once we arrive, we meet the oncology team to discuss new patients and events that occurred overnight prior to making rounds.  Dr. Sandler, I think they missed you; I tried my best to fill your shoes.  Although some physicians were on vacation, we were fortunate enough to have Degi, a fairly new oncologist, and Oyunaa, a pediatric resident, as part of our medical team who were able to translate.  Rita was also there ready and able to help as well, for which we are truly grateful.

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Examining a patient with Rita.

On our first day we rounded on every patient on the oncology floor.  A very full floor we must say.  There must have been 15 patients in house. There were plenty of teaching opportunities and discussion. Diagnoses included predominately ALL, but also AML, Histicysosis, Aplastic Anemia and a few Lymphomas.  The available chemotherapy drugs sound much better than years past, thanks in part to our previous teams’ recommendations.  However, there is more work to be done as it was quite heartbreaking seeing so many Leukemic relapses.  

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Discussing a patient’s case with the team.

With three to four patients in a room at times, it made no difference that there was no air conditioning – these children are so adorable and loving and quickly warmed up to Alex and John.  It was truly a heartwarming experience.  

Thanks to Dr. Sandler’s initiatives, I do believe that Hepatitis C PCR testing is under development.  On a bright note we were able to tour a new oncology building to be completed this fall.  The 2015 team should be quite impressed: Oncology alone will occupy 3 floors.  The cardiac cath lab will be located on the first floor.

 

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John, Alex and Degi mocking me as I worked hard to sign 100 certificates.

Our laboratory tour was quite impressive and afforded me the opportunity to view slides of a newly diagnosed patient.  I was excited to learn that flow cytometry is now available, at least on peripheral blood.  Acute Leukemia is now accurately diagnosed as pre-B ALL, T-cell ALL and AML.  A future goal might include the ability to perform Methotrexate levels so that high dose Methotrexate can be delivered.  

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With my anda (blood sister), Mongolia’s clinical pathologist.

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In my happy place. What a beautiful stain!

Lots of oncology, but hematology was not to be denied.  On day two I met an adorable little girl with 1% factor VIII, on weekly Advate prophylaxis!  However, we did learn that recombinant factor is in short supply and what a dream it would be for our Hemophilia Treatment Center (HTC) would be to “Twin” with Mongolia.  Missy, are you ready?

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Visiting with a Hemophilia patient.

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Discussing the clotting cascade.

The medical team remained eager to learn, always asking appropriate questions and very receptive to our input. It has been an amazing week, such wonderful people to work with.  I hope we can continue our Mongolian working relationship.  

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With the medical team.

-Cindy Gauger       

 

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