First 4 Days at Mother & Child Hospital: Dr. Eric Sandler Shares

We have now been in Mongolia for 4 days. Sally and John and I have spent the last 3 days at the Women’s and Children’s Hospital. The staff have been so open and aprreciative of our visit. On first impression, the hospital is not much to look at from western standards. But as we learn more about life in Mongolia and particularly the medical care system we are all amazed at how much they are able to do for their patients with the limited resources that they have. The doctors have very little training (a H/O fellowship is 6 months) and even fewer resources. The list of drugs that they have to treat the patients is so limited and forever changing. All decisions about purchasing of drugs from manufacturers is made by the Ministry of health and the physicians and pharmacy submit a list annually, but have very little say in what is actually made available. Other medications must be purchased by the patient themselves and brought to the hospital. Still others (like dactinomycin), the family has to travel to Bejing to purchase the drug and bring it back to treat their child.


Clinic waiting area


Patient sleeping

There are usually 2 nurses on a shift covering up to 24 patients. They do everything- mix the chemotherapy, put in IV’s (no one has central lines), draw labs and run them to the laboratory, even do their own type and cross match for blood products!


Mixing chemo (with no protection)

Their diagnostic capabilities are very limited as well. They have no flow cytometry, cytogenetics  or immunohistochemical stains. Thus diagnosis is made by histology alone- so their is no way to tell T cell from B cell, or cytogenetic high risk vs low risk. They have 1 protocol for all children with ALL, one for AML and 1 for NHL. If a drug on that protocol is not available it is skipped (ie. no asparaginase for anyone). Supportive care is also very different as you might expect.  Bone marrow needles are these old metal reusable ones which one might see in a museum in the US (see below).



They have the same 10 needles for as long as anyone can remember and I’m sure they have gotten quite dull and hard (and painful for the kids) to use.

In addition, the health care system is very fragmented- the patients come from all over the country to Ulaanbaatar for care. Leukemias and lymphomas are treated at the Children’s Hospital but all of the solid tumors are treated at the National Cancer Center- more about this later. The neurosurgeons are at a different hospital, there is then a seperate ID hospital etc. We saw one patient yesterday with ALL who developed hepatitis (very common) after induction chemotherapy. He was transferred to the ID hospital for “treatment” and during that time received no chemotherapy. Now the leukemia is back and very resistant.


With a patient

My days have been spent meeting with the H/O team- physicians, fellows, and residents. They present each of the patients to us, we examine together and then we talk about how this patient would be treated in Jacksonville. We discuss and then in the evening we go back to the hotel and print out sample roadmaps etc to share with them in the a.m.

They have also presented to me a number of diagnostic dilemmas such as a set of twins with massive HSM, severe eczema and pancytopenia- BM done 3 times just show hypoplasia with no blasts or myelopdysplasia (tom we are going to look at the smears). We have had many great discussions and hopefully we are learning a lot from each other. I think that we have helped and I hope we can continue to do this on an ongoing basis.

So much more to discuss- but it will have to wait until tom.

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6 Comments

  1. Terry Humphret

     /  July 6, 2012

    Keep up this amazing work and mission. I am intrigued with each post and pic.

    Reply
  2. Dana

     /  July 6, 2012

    Wow!!! There are no words……..except, Wow..

    Reply
  3. Susan

     /  July 6, 2012

    This post humbles me and makes me grateful all at the same time. How much this westerner took for granted with her own child’s treatment. Impressed and proud for the team’s efforts to make a difference in the lives of these families!

    Reply
  4. Okefenokee Medical Society, Waycross GA

     /  July 6, 2012

    OUTSTANDING work, Doctors and team! Thank you for your blog posts. You bring honor to all those called to healing.

    Reply
  5. Karen Wolfson

     /  July 7, 2012

    Eric & team: I’m so thankful you are there! What beautiful children and families! Lots of work to do.

    Reply
  6. Eileen Connor

     /  July 10, 2012

    How amazing and awesome! Thank you for sharing. LOTS of prayers your way

    Reply

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