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.)
DSC_4300

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 . . .)
DSC_3751

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.)
DSC_2647

Steve vs. flies at “Fly Camp”

IMG_2099

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.)
DSC_3823

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.)
DSC_3133

Before: John takes a swig of water fresh from Auger Spring.

photo (1) (1)

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.)
DSC_3575

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.)
DSC_2603

Chuuka preparing to drive through deep water.

photo (2) (1)

Perhaps the only lawnmower in Mongolia.

On the way home – 2014 (John)

DSC_4478

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.

DSC_2904

2012 Mongolian Team

DSC_3389

The kids at Soccer Camp 2012 singing us a naadam song as thanks.

 

DSC_4477

On his way to the naadam horse race (2012).

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!

DSC_2625

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

DSC_2616

A mother holding her child tight.

DSC_3926

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.

DSC_4582

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.

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.  

DSC_4451

Peek-a-boo.

DSC_4273

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.

DSC_4105

Checking on newly diagnosed patient after her bone marrow aspirate.

 

DSC_4434

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. 

DSC_4457

Playing puppets with my new found friend.

DSC_4439

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.

DSC_3993

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.  

DSC_4265

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.

 

DSC_4421

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.  

DSC_4398

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

DSC_4401

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?

DSC_4130

Visiting with a Hemophilia patient.

DSC_4490

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.  

DSC_4500

With the medical team.

-Cindy Gauger       

 

Reunion of the medical teams (John)

After two years, I am back to the National Mother’s and Children’s Hospital!  The rooms and corridors may have changed, but the friendliness and hospitality of Mongols remain. I was completely overwhelmed and touched by my Mongol friends’ warm welcome, even the people that I had met only once or twice during my last visit!!

After a brief Meet’n’Greet with the Hematology/Oncology group with endless coffee, tea, crackers, and the famous dried milk curds (Cindy’s/Alex’s first), we started going through some treatment protocols.  It certainly was very exciting to see that many of our recommendations from our first trip were put into clinical practice, including drugs we recommend to put on formulary, bone marrow needles, and diagnostic machineries.  We were so excited, we wasted no time and started seeing patients.

DSC_3846

DSC_3838

Cindy and Alex get their first taste of airal (dried milk curd).

There are MANY major differences between Americans and Mongolians: geographic locations, cultures, faiths, languages, traffic patterns, diets, etc., etc. However, in the Hematology/Oncology wards, we are drawn together by the same calling to heal, to comfort, and to love.

DSC_3959

Entrusting the very lives of their most beloved children into the doctors’ hands, the parents’ eyes have the same mixed feelings of fear, uncertainty, and threads of hope… The same eyes that I saw two years ago.  The same eyes that I see back home in the US.

DSC_3880

Cindy rounding with a family discussing their young son’s diagnosis.

DSC_3894

Rita and Cindy discuss a babies symptoms.

DSC_3857

Oyunaa, Degii and Alex listen intently as Cindy reviews a case.

 

We see little brave warriors fighting for their lives receiving chemotherapy drugs that even adults fear.  We see a teenager girl broken into tears knowing that she needs to endure more vincristine infusions that cause her lots of pain with every dose.  We see families fight on with courage despite relapses, side effects, and failures.  We see worried fathers sitting at the end of the bed, wandering outside of the rooms sharing his deep love and concern in silence. We see mothers comforting suffering children with their loving arms and big hugs.  We see the same heroic stories beyond skin colours, cultures, and medical backgrounds back home and here in Mongolia.

DSC_3901

Cindy rounding really hard while John takes photos of the babies, the staff, the floor….

However, in the dark and partially ventilated Oncology ward, we also see angels in white coats who bring hope to every dark corner.  They may not be able to cure every patient, but I see the same hands of Mongolian and American doctors delivering not only the best skills in healing, but also care, comfort, and hope to the families they serve.  In their eyes, I see the same passion and determination to cure as possible. It is our honour to fight along side our Mongolian counterparts again to battle childhood cancers together.  May our busy week start!

 

Follow

Get every new post delivered to your Inbox.

Join 140 other followers