Day 3 – 7/31/2019

Day #3 started with great weather for our walk to the hospital. We weren’t at the hospital very long, when Dr. Rita arrived. It was great to see her again. I gave a lecture to the nursing staff about Distraction and Comfort Hold. I reviewed all the supplies in the distraction kits that I brought for them to use with their patients. I also gave them the 2 vein finder lights that I had brought for them. They were so excited and amazed with the lights and how they worked. I also showed them some other supplies I brought and thought would be useful for them.

We went over to the lab and Dr. Sandler reviewed multiple smears on patients currently in the hospital. On the way to the lab they showed us the new helipad they have and are excited to be using sometime in the near future. We then went the Endocrine Department for lunch. It was another delicious meal.

We then headed back to the lab for Dr. Sandler to review some more slides. Then, back to the clinic to review the finding on the smears Dr. Sandler had reviewed with the clinic physicians.

We headed back to our hotel for a short time before heading out for what felt like the longest walk ever for dinner at BAEK HWA KOREA restaurant. The food was so tasty! We then started the long walk back to our hotel. The walk back didn’t seem that long… maybe it was the ice cream cone that I ate on the walk home. That is a wrap for today!

Dana

Day 2 – 7/30/2019

Day #2 started with our group being invited to attend the hospital’s weekly physician meeting at 8:30. At the meeting Dr. Sandler was presented with a Diploma of Honorary Professorship. We all knew that he was going to be honored at the meeting, but were surprised by the extent of the honor he received.

We then spent the day doing patient consults and reviewing the current inpatient cases. They currently have some really sick kids.

The hospital staff took us out to a great restaurant for dinner.  There was so much amazing food. Just when we thought dinner was done, another table full of food was brought out. We were so FULL!

The hospital staff presented us with beautiful gifts to thank us for coming to help at their hospital.

Dana

Eric’s update

Hard to believe that our week at the National Center for Maternal and Child Health in Ulaanbaatar is already ½ over. It has truly been a whirlwind. Seeing some of our previous recommendations implemented, and the wonderful care children with cancer are receiving is so rewarding. Of course, it remains a work in progress and there is a long way to go. One of the most exciting developments is that the National Cancer Center has new RT equipment and they are now much more open to treating the children. This has been such a big hurdle in the past as RT is essential to so many of our treatments. When we met with the oncology team and with Dr. Enkhtur, the Hospital Director there is a plan for development of a pediatric tumor board very soon. This will bring together various specialties involved in the care of our patients to discuss treatment planning together. We sometimes take for granted these kind of multi-disciplinary conferences and their importance, but finding the right time, day and location to get together specialist spread all over the city is indeed a daunting task.

It has been wonderful to have Dana and Larry here working with us. Dana gave an awesome lecture this morning on supportive care to the nurses and they just had question after question. Larry has been quite busy seeing children with a variety of endocrine disorders and giving lectures to the residents and endocrine team.

I was also very surprised yesterday to be awarded an honorary professorship at NCMHC. I know that this is a tribute to not only my work but to that of the many other colleagues who have joined our educational teams, to Wolfson Children’s Hospital and Nemours Children’s Specialty Care for their ongoing support of Jonathan’s mission and to our many supporters in the Jacksonville community.

Eric

Days 1 and 2, 2019

30 July 2019 – Days 1 & 2

We made it to Mongolia without any major travel issues.  The flights were indeed long, especially the 14 hour trek to Tokyo, but tolerable. And not even long enough to watch the entire Harry Potter series of movies (no, I didn’t try). 

My first two days at the children’s hospital have come and gone. Yesterday I met two of the three pediatric endocrinologists that work at NCMCH; the other is on maternity leave.  I toured the endocrine unit which shares space with nephrology.  I’m amazed at how large the children’s hospital is, spanning multiple buildings, connected by multiple underground tunnels.  

I was able to spend time with 4 patients, 3 of which were hospitalized (two with type 1 diabetes, one with Graves hyperthyroidism) and one outpatient, an 18 year old boy with severe short stature (only 56” tall) from hypopituitarism, not diagnosed until 3 years ago. Amazingly, he has been placed on growth hormone and has demonstrated some catch up growth. Plus, his growth plates remain wide open (they look like an 11 year old). He will be attending a university soon and, appropriately so, is anxious to go through puberty! 

The 15 year old girl with poorly controlled type 1 diabetes stopped checking blood sugars because she just got tired of doing them – really no different than many of the patients we see at home! But in Jacksonville and the rest of the U.S. and other developed countries at least we can rely on technology – continuous glucose monitors for example.  Not here, not yet. 

Today I met a 4 year old girl with precocious puberty and an almost 15 year old boy with diabetes insipidus and central hypothyroidism. I suspect he also has other pituitary deficiencies as well but time (and some additional testing) will tell.

The patients bring a bag full of written records, radiographs, MRI images, etc., wherever they go. The records follow the patients. At home we use an electronic medical record that can sometimes be shared from one organization to another. Most of the time, however, we struggle getting records from other physicians. Although the records they use here are paper based and simple, there’s something to be said for having them wherever they go, whichever specialist they see. 

I was able to do something I haven’t in a while: talk to patients and families (with the help of a translator of course) without concern for billing, time constraints, RVUs, and other logistic clinic issues that are not very relevant here. It was wonderful!

I look forward to seeing what tomorrow will bring. 

Larry

First Day at Hospital 2019

07/30/19

We just finished our first day at the Children’s Hospital. It was great to see familiar staff faces from last year and embraced meeting new faces today. Dr. Sandler and I rounded on all the inpatient Hem/Onc patients. We passed out bubbles to the patients while rounding this morning. We then went back and discussed some of the more complicated patients. Unfortunately, they currently have four patients on their service that have relapsed. They then provided us with a tasty lunch! We spent much of the afternoon, reviewing the current treatment protocols they are currently using for their patients.

We met with Dr. Shonkhuuz – Director General of the hospital. He talked about how things have been able to slowly improve with the help, teaching, and feedback from Dr. Sandler and his Medical Groups visits. He told Dr. Sandler that he would like for Dr. Sandler to give him feedback on the improvements that we feel are needed at the hospital at the end of our week at the hospital.

We then walked back to our hotel in misty rain and busy afternoon traffic. We were able to relax in our rooms for a few minutes, before heading out to dinner. When we headed out to dinner it was raining pretty good, but we braved it and walked to dinner in the rain. We had dinner which included lamb and horse, at “The Bull” a hot pot restaurant not too far from our hotel.

After a great meal we walked back to our hotel and called it a day! When I got up to my room, I took out my laptop out and started writing my blog post….I then woke up at !:30 with my laptop in my lap. Needless to say, I didn’t finish my post last night…but had a great, rewarding, and tiring first day! LOOKING FORWARD TO TOMORROW!

Dana

 

 

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