Day 7 Into our Trip -Jonathan

Day 7 into our trip, and day 4 at the children’s hospital completed! I continue to be amazed by this country, the city of UlaanBaatar and its people. Especially the people. At first they seem stoic but then you learn how open, caring and animated they can be. This was most evident as I met and began to work with the GI team at the children’s hospital. There are 6 GI physicians, each with their own well defined duties but working as a team to improve the care of their patients. The level of care is admirable considering the challenges they face: limited pharmacy formulary, limited laboratory and imaging (families must pay and go to a private adult hospital for a CT scan!), virtual absence of nutritional care, and a high  patient acuity level by the time they arrive at the only children’s hospital in Mongolia. Yesterday I met an infant with advanced biliary atresia who had to travel by car over 1000 miles to receive care. And these are but a few of the challenges that the dedicated staff face on a daily basis.

The hospital, with the exception of the new hem-onc wing is old and of Russian design. It is well worn and busy with narrow halls, low ceilings at times and buckled linoleum floors. It is however clean and appears efficient and orderly despite the high volume of patients.

The GI team is insular and eager to interact with same specialty colleagues. They presented troublesome patients daily, each time asking many questions about diagnosis and clinical care. The families themselves appeared very appreciative. My 3 lectures were well attended by the GI staff and residents, some lasting over 90 minutes.

As we begin to wrap up our clinical week and look forward to 4 days in the Gobi desert, I cannot help but think that this has been a profitable experience for all involved included the many Mongolian families that I have met. HI can only hope that the progress made and efforts expended will be ongoing and fruitful.

-Jonathan Evans

Photos from Day 1-4 at the Mother & Children’s Hospital

More pictures & posts coming soon! I promise!

-Sarah

(*All photos showing patient’s faces were taken with parental consent*)

Patients undergo all of their lumbar punctures and bone marrow aspirates while awake. For this procedure, Lindsay tucked herself into the corner and offered some pain relief via distraction.

Patients undergo all of their lumbar punctures and bone marrow aspirates while awake. For this procedure, Lindsay tucked herself into the corner and offered some pain relief via distraction.

The AMAZING Social Worker who has been our translator for the week. (Also, she does the job of about 50 people: Social Worker for 29 departments, including taking care of staff, coordinating volunteers, AND has taken on the role of developing a Child Life program at the hospital.

The AMAZING Social Worker who has been our translator for the week. (Also, she does the job of about 50 people: Social Worker for 29 departments, including taking care of staff, coordinating volunteers, AND has taken on the role of developing a Child Life program at the hospital.

Some of the nurses that were at Lindsay & Sarah's presentations.

Some of the nurses that were at Lindsay & Sarah’s presentations.

Lindsay introducing Child Life to the staff. This has been their first time ever hearing about the amazing resource that Child Life is!

Lindsay introducing Child Life to the staff. This has been their first time ever hearing about the amazing resource that Child Life is!

Sarah with the Hem/Onc nurses and residents.

Sarah with the Hem/Onc nurses and residents.

Lindsay providing some giggly distraction during an IV start.

Lindsay providing some giggly distraction during an IV start.

always gotta double check the chemo! ;)

always gotta double check the chemo!😉

Nurses here do their own type & cross labs.

Nurses here do their own type & cross labs.

Here, a nurse is mixing chemotherapy in their new safety hood! They didn't have this last year! This is such a good example of how this trip and how Jonathan is continuing to change lives here for the better.

Here, a nurse is mixing chemotherapy in their new safety hood! They didn’t have this last year! This is such a good example of how this trip and how Jonathan is continuing to change lives here for the better.

A neuro patient is excited to show Ethan her new toy.

A neuro patient is excited to show Ethan her new toy.

IMG_2398

LOTS of bubbles!

LOTS of bubbles!

Lindsay introducing bubbles to the inpatient children which started a discussion about utilizing deep breathing as a coping skill during painful procedures.

Lindsay introducing bubbles to the inpatient children which started a discussion about utilizing deep breathing as a coping skill during painful procedures.

Dad's know how to do their daughter's hair too!

Dad’s know how to do their daughter’s hair too!

Morning rounds involving the whole family.

Morning rounds involving the whole family.

A traditional Mongolian

A traditional Mongolian “dream catcher”

hide and seek!

hide and seek!

When we were in the Neuro area, Sarah found this curious little cutie.

When we were in the Neuro area, Sarah found this curious little cutie.

IMG_2311 IMG_2310

Dr. Sheth and Dr. Sandler collaborating about a possible new neuro-onc patient.

Dr. Sheth and Dr. Sandler collaborating about a possible new neuro-onc patient.

every chart has it's own flair

every chart has it’s own flair

IMG_2295

sweet sleep

sweet sleep

Getting a tour of the new hem/onc floor which includes a safety hood for mixing chemo and palliative care rooms.

Getting a tour of the new hem/onc floor which includes a safety hood for mixing chemo and palliative care rooms.

The new play room in the brand new hem/onc floor!

The new play room in the brand new hem/onc floor!

IMG_2255

Some of the medical team collaborating about a post-op patient.

Some of the medical team collaborating about a post-op patient.

IMG_2249

PICU Nurses

PICU Nurses

Sarah & Lindsay with a new inpatient child after a delivery of goodies!

Sarah & Lindsay with a new inpatient child after a delivery of goodies!

Sarah speaking about the importance of pain management across all patient populations.

Sarah speaking about the importance of pain management across all patient populations

Mongolia Bound! Jonathan Evan’s Perspective

Mongolia Bound!   Bound being the word that should define our trip. No, I am sure that it doesn’t mean tied up and dragged by Eric S to the far reaches of our planet. Rather for me it means to have developed a bond with a land for which, at this point, I know little about. What will this bond mean to me? What will it mean to the people I meet?

I have been fortunate to have been placed in this situation before. Growing up as a minority in a culture that I was not born into and providing medical aid in impoverished Haiti come to mind. However, this will be a new situation for which it is unclear how well past experiences can prepare me.

Developing that bond will come at a price, the least being travel, the barriers of language and being out of one’s western comfort zone. The rewards however can be great: learning about a well rooted but mysterious (at least to me) culture, learning new customs, sharing conversations with people of different upbringings and perspectives. My curiosity about the “medical establishment” in Mongolia will further strengthen that bond. Does the medical profession view what we consider simple and common medical problems (e.g. chronic abdominal pain) and complex medical issues (e.g. chronic liver disease) the same way? What are the expectations of the patients and their families in regards to the medical care they receive?

As I explore these areas, and the others that will emerge once we are there, this bond will develop and strengthen. I am optimistic that it will be positive and durable on my end; hopeful that  it will be the same for the people who receive us.

Day Two – Ethan

Day 2 at the Women and Children’s Hospital.
     After getting a tour of the very confusing and maze-like hospital yesterday, it seemed a little bit more manageable today. This morning, I went on rounds at the Hem/Onc ward in the new building and saw several of the patients. It is amazing to me that the children were all so happy to see us and enjoyed playing with the toys that Lindsey, Sarah, and I brought. At one point while my dad was discussing cases with the Mongolian physicians, I poked my head into the hallway and saw that Lindsey and Sarah had gathered about 10 of the patients and were playing games, blowing bubbles, and bonding with the patients in the playroom. I must say, compared to what I have heard it was like when this project began 4 years ago, at least for Hem/Onc, the facilities have vastly improved. As a student, I learned what to look for as signs of disease and illness, and how to treat the different diseases which was all very interesting.
     After our lunch of chicken, rice, and beets, I sat in on Dr. Sheth’s lecture on seizures and my father’s lecture on Acute Lymphocytic Leukemia relapse treatment. I learned a lot watching the videos of different types of seizures and was really impressed by the Mongolian translator and the other physicians eagerly scribbling notes and asking questions. There were Mongolian physicians and residents from several different specialties, and I thought it was interesting that the Mongolian staff that was most engaged in the neurology and oncology lectures were the Cardiology residents that were able to attend.
The Mongolian physicians and staff have been so kind and appear appreciative of all the information and assistance that we are providing, but I worry about how much is being lost in translation, and what is not currently possible due to funding and availability.
-Ethan

Day One 2015 -Eric

Well we just spent our first day at the Women and Children’s Hospital. There have been some exciting changes since our last visit. The new oncology center has opened after several years of construction- it is really quite beautiful and well equipped. They even have a play room in the unit which is great to see. They also have several rooms which are devoted to the care of children post bone marrow transplant. The plan is that transplant will be done in the adult transplant facility (also a brand new program) and then transferred back to the children’s hospital for recovery. A scary thought since none of the current docs have any experience with transplant patients. I hope a plan will be developed for this transition. The other new and exciting thing is that starting in January, all the children with solid tumors, who are now taken care of at the National Cancer Center, will be cared for at the Children’s hospital. This is something we have been hoping to see for several years- but rather then a gradual transition, the plan now is for a complete change on January 1. The docs are excited but quite concerned as they have never taken care of any of these types of cancer nor do they know what the plan will be for more staff with a more then doubling of their patient volume. They are also very concerned about pathology support. It is both rewarding to see the small part we have played in helping to improve medical care for children here in Mongolia but also highlights the importance of keeping up our efforts to help.  This makes me more determined then ever to develop a more structured exchange system where we can bring the young oncology staff as well as pathologists to the US for 1-2 month observerships as well as have more frequent and consistent consultation by our team about diagnosis and treatment. 
 
To the Soud family- Jonathon’s legacy is clearly changing a small part of the world every day and thank you for letting us be a part of that legacy!
 
Eric
Follow

Get every new post delivered to your Inbox.

Join 150 other followers