Final Thoughts on the Trip from Dr. Michael Gayle

Following a busy and hectic five days at the hospital, the group made a four day visit to parts of Eastern Mongolia. On Saturday morning we met our tour guide and driver at the hotel and then headed out of Ulaanbataar on the East – West highway, part of the 3% of paved roads in Mongolia. Along the way we stopped at an ovoo, a religious site, used in worship of mountains and the sky as well as in Buddhist ceremonies but often are also landmarks. On the highway we stopped at a vendor who had some eagles that could be placed on our outstretched arms or  shoulders.

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We also visited a nomad family in their ger and were offered a drink of airag (fermented mare’s milk) and aaruul (dried curd). Soon we left the paved highway to start our many hours of roller coaster ride on miles and miles of unpaved dirt roads. We visited one of the handful of Buddhist monasteries left in Mongolia after the majority of monasteries were destroyed by the Russians. This was quite an interesting visit as we had to do quite a lot of walking and hiking to see all the unique historic monastery structures on this site. Our day ended when we reached our first camp site at the blue lake.
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That night I had an amazing time viewing stars where I was able to see and identify the Milky Way very clearly with my naked eyes for the first time. The next day we toured  the camp site which was a major area for Chinggis Khaan and the history of the Khaan dynasty.
The following day we headed for the Gun-Galuut Nature Reserve area. We drove through vast areas of steppe where we observed several herds of cattle, sheep, goats and horses. We checked into our ger camp site and our respective gers. The next day we went rafting which was quite relaxing. After lunch we went horseback riding on horses that were initially not interested in going more than at a trot. However, the horses became a lot more enthusiastic when we were heading back to the camp and sprinted all the way back.
The next day we checked out of our camp to head back to Ulaanbataar. We navigated our way along the unpaved dirt roads observing the beautiful landscape of Mongolia. We stopped at the massive Chinggis Khaan statue and museum. This was quite an impressive exhibit and is a major tourist attraction.
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Our final day in Mongolia was spent visiting the largest existing active Buddhist monastery, the Gandan Monastery, in Mongolia. Inside the monastery, there were numerous chanting llamas and we saw a towering 25 meter high Buddha statue. Our next stop was at the National Museum of Mongolia where we saw several historical artifacts on Mongolian history and culture. Our final day ended with some shopping.
This was quite an incredible and amazing visit to Mongolia. I believe our team made a significant contribution to the health care of the children in Mongolia and we all benefited from the experience.
I would like to personally thank Dr. Eric Sandler and the Baptist Health Foundation, in memory of Jonathan Soud, for giving me the opportunity to participate in this worthy project.
-Michael Gayle

Our Week in the National Center for Maternal and Child Health: Dr. Michael Gayle Reflects

We have been in Mongolia now for several days providing clinical care and teaching at the National Center for Maternal and Child Health in Ulaanbataar. My jet lag has improved and am finally feeling acclimated to my new time zone. Despite the language barrier I am feeling much more comfortable in the environment of the hospital and the city itself. I believe the warm and friendly nature of the Mongolian people has been a major factor. When Eric spoke with me about coming on this trip he told me It is likely the first time many of the people there will be seeing an African American. I am use to being the only minority in a room of people but not in a whole city.  I almost made it a week without seeing another African American but did ran into another AA in my hotel room. I was disappointed as I wanted to remain unique. I expected lots of staring and perhaps ensuing looks from the children at the hospital but so far the stares have been very minimal as I walk about the hospital.

I was very pleased to see that the 2 month old with the VSD and coarctation showing clinical improvement without surgery but I know he will have a poor prognosis without correction of this lesion. I continue to provide the PICU staff with daily teaching. They are very eager to learn and were ecstatic when I gave them a couple of critical care textbooks I brought for them. Despite their limited technology and equipment, they certainly do a very good job with what they have. The medical system here is modeled off the Russian medical system as all pediatric subspecialties are in Departments e.g Pediatric Intensive Care Department. This is quite different from our system in the USA and I believe the system here leads to fragmentation of care. I visited  their surgical pediatric intensive care unit which was staffed by pediatric anesthesiologist. After rounding on the unit I noted areas of care where multidisciplinary approach would serve the patients there better.

The mini symposium continues to be well attended. We have been very fortunate to have the assistance of several physicians acting as our translators and doing an excellent job at it. We have one more day of the symposium and expecting continued well attendance.

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The evenings continue to provide great opportunities for bonding of our group. We got exposed to some Mongolian folklore when we had dinner at a restaurant with live performance. It was quite a memorable experience listening to this very unusual “throat” singing. Very cool!!!. As the week draws near, I am looking forward to going to the country to experience more Mongolian culture but also to see the “real” Mongolia. I am especially eager to see the Blue Sky and view the Milky Way from this part of the world.

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-Dr. Michael Gayle

The Teaching Begins: Dr. Michael Gayle Reflects

Another day in Ulaanbaatar brought new new experiences in and outside of the hospital. I brought the medical staff t-shirts I took from Jacksonville and they were very excited and appreciative. Did rounds again where I saw a 2 month old who was admitted the day before with a history of VSD. However, an echo performed there showed the infant also had a coarctation of the aorta. He was in respiratory distress and had evidence of poor perfusion. I suggested they tried some Prostaglandin but they did not have that medication in their hospital. The infant will require surgical repair very soon but sadly they do not do that type of cardiac surgery on children under 2 years.

I had my first experience giving a lecture to an audience that did not speak English and I did not speak their language. I had an interpreter but it still took twice as long to give the lecture due to the language barrier. I know I will have to make some adjustments to my presentations over the next three days.

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In the evening we went to a Mongolian restaurant where we had several Mongolian dishes including the “real Mongolian barbecue”. One thing I know when I get back to Jacksonville is that I will not want to eat any meat dishes for awhile.

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-Dr. Michael Gayle

First Day at the Hospital: Dr. Michael Gayle’s Experience

On Monday morning after getting only a few hours sleep, I went with the rest of the group to the National Center for Maternal and Child Health. At the hospital, we met with the lead physician there who will be in charge of our visit. In that meeting we received an overview of how pediatric care was delivered in the city and the other hospitals such as the cardiac, trauma, cancer and neurosurgery hospitals where children also received care.

After this meeting, the group was split up by speciality and we were taken to our respective areas in the hospital. Naturally, I was taken to the pediatric intensive care area. Adam who sometimes work in the PICU, also came with me. In the PICU we were met by the head of the  PICU who introduced us to the other ICU physicians. I gave them the several critical care supply items I took for them and they were all very grateful to receive them.

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In the PICU, I was struck by the open floor plan with patients very closely situated beside each other. I was told that this unit which was half the size of the unit we have at WCH, admitted about the same number of patients as we did in our PICU in Jacksonville which was twice the size. I then asked to do rounds on the 9 patients who were currently in the ICU. The patients in the unit at that time ranged in age from 3 months to 14 years. They all had diagnoses which we have seen in our PICU at WCH. After rounding I made the following observations and conclusions:

1. The doctors and nurses all appeared very dedicated and committed to their patients.
2. Families of critically ill patients were very grateful and appreciative of the care their children received in the unit.
3. Critically ill patients are similar across the world in spite of geography or ethnicity
4. The unit was lacking many of the modern high – tech equipment and devices we have at WCH for our ICU patients
5. We are very fortunate and blessed to have the resources we have and enjoy at our institution and the USA in general
6. It is important for physicians like myself to travel and share our expertise to developing countries

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I look forward to the sharing whatever information I have with the staff in the unit. I will be giving the first of several lectures on Tuesday.

-Dr. Michael Gayle

Providing Care to Critically Ill Children in Mongolia: Dr. Michael Gayle’s Perspective

About eight months ago Dr. Eric Sandler approached me about going to Mongolia with him in August. I told him I would think about it. Months went by and with my busy schedule I did not reflect on his request as I should have. However, by the time he asked me again, I had taken the time to reflect on making this incredible journey to a place I would not have envisioned going to. As a pediatric intensivist who trained and worked in a developing country, Jamaica, before coming to North America, I felt that I could make a difference. Critically ill children exist in every part of the world and I am sure I will be able to provide some assistance to the patients and physicians there.  This will be a challenging trip not only because of the very different culture that I will be exposed to but also working with the limited equipment and technology that exists in the hospital I will be going to.
I understand that the hospital, National Center for Maternal and Child Health, is the only pediatric hospital in Mongolia. Children are brought there from all over Mongolia and they do not have an established transport system like we have here. I am looking forward to providing some guidance in transporting critically ill children, giving lectures on critical care topics and also consulting on patients in their critical care area.
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This will be my first trip to Asia and am excited at the opportunity to visit a new continent. After watching a video on Mongolia by Globe Trekkers, I was somewhat apprehensive about visiting Mongolia. However, Eric Sandler assured me that we will have a more refined experience that what I saw on the video. I am looking forward to sleeping in a ger and seeing the sights and sounds in Ulaanbataar and other parts of the country.
This morning, I got up @4.30am and made it to Jax airport with all my three suitcases. Found out that weight limit per suitcase was 52 lbs. One of my suitcases was over by 8lbs. Luckily Eric was at the check in counter at the same time to take some stuff from me. I am taking several books and some medical supplies on the trip. Adam had us worried as Eric and I got to the gate before he did as he overslept. On to Atlanta we go and then to Seoul before we get to Ulaanbataar.
-Dr. Michael Gayle
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