The State of Pediatric Neurology in Mongolia: Dr. Harry Abram Shares

I guess I still must have some jetlag as I am up and ready to go at 5:30 am.
The street outside the hotel, ironically called Peace Avenue (as it is anything but peaceful) is just now becoming congested with cars honking and kicking up the muddy water from last night’s rain.

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I have been kept busy everyday.  We walk 30 minutes up the hill every morning to the children’s hospital.  Once there I head off to the pediatric neurology floor.  When I arrive at 9:00 am, there is already a line of 15 anxious families patiently waiting.  I have been lucky to have a pediatric neurology resident with me the entire time, who speaks English well enough to translate.  This morning,  before  I saw my 1st patient, the Mongolian neurologists proudly brought me my first glass of airag (fermented mare’s milk) and anxiously waited for my reaction.  I managed to take a couple of sips before politely returning the glass.  I asked if I could take some home with me to take to my family and colleagues at work, but they said I would have a hard time with it in customs, so I left the jar behind.  They promised to bring me some ‘byaslag’ -dried curds from the same mare’s milk, which I should be able sneak home!

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With each patient,  the parents hurriedly walk in, holding their child in their arms.  One will carry a large plastic bag which contains a CT or rarely a MRI scan and their medical record-which is a small pamphlet of their doctor’s past handwritten notes (no EMR here!).   They quietly sit down at a small card table in the middle of large office space that 5 child neurologists share, no  examining  room or privacy.  Each family then explains the child’s problems to the neurology resident,  who then explains them to me.  Most of the patients are relatively complicated, with a  wide range of pathology: children with seizures of various types,  brain malformations, severe dystonia and several cases of kernicterus, which I have never seen before.   Many have cerebral palsy due to birth related complications.  Some of the diagnoses I don’t understand, such as ”hypertension of the brain’ , treated with ‘Russian medications’ to ‘increase cerebral blood flow’. Clearly they don’t have increased intracranial pressure and the medicines appear to be  various homeopathic vitamins.

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I am surprised at the number of children with MRI scans,  which cost the patient 200,000 tugrik (about $150) however that is still about a month’s pay for many families.  The EEG’s are of poor quality and difficult to interpret.    However, the most valuable ‘test’ for epilepsy has not been EEG’s and CT scan’s but cell phone videos of children having spells or seizures.  Some children clearly have epilepsy but others appear to have tics or night terrors but regardless of diagnosis, all are routinely treated with 10 days of admission and placed on phenobarbitol or valproic acid (plus the mysterious “Russian medicine).   Lots of education to be done!

I have been impressed with the Mongolian families, who diligently wait outside in crowded hall way for hours to spend 15 minutes with an American doctor, carefully listening to everything that is said, and quietly nod their head at the conclusion,  often after discouraging news.  All have been extremely thankful and appreciative of the visit.  I was touched as one family gave me a 20,000 turgik bill and a box of candy,  both given to the adjacent orphanage.

-Dr. Harry Abram

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5 Comments

  1. Terry Humphrey

     /  August 30, 2013

    Dr. Abram thank you for this insight. I know it is your desire to do more with less for our most venerable, children. May your works be blessed no matter the level.

    Reply
  2. Grace

     /  August 31, 2013

    Russian medicine – I wonder what that is. Thanks for sharing this

    Reply
  3. We love Dr. Abram. I read this update to our son, Luke, who is Dr. Abram’s patient. Luke said, “We are lucky to have Dr. Abram at our place. I love Dr. Harry Abram. I don’t want to give him yucky milk.” I agree, we are blessed to have Dr. Abram in Jacksonville!
    Love, The Akerstrom Family

    Reply
  4. Dear Dr. Abram
    I am lucky to read your impression about our Mongolian family. My name is Dr. Bayarmaa. Working in private hospital and doing sleep EEG. To improve our such an unusual situation we are providing epileptology and EEG course among neurology and neuropediatricians. If you are planning to come Mongolia could I have chance to meet with you.
    Here is my e mail: db_claudia @yahoo.com

    Reply

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