Doctors provide care in harsh Mongolian environment

Tendon Mondial IV, a combined Medical Civic Assistance Program (MEDCAP) in the Mongolian countryside, began with a two-hour flight into terrain so rugged, it took nine hours to drive 45 miles.
Last month the MEDCAP brought together military medical professionals from the United States and Mongolia.
The purpose of the mission was three-fold; train to provide medical aid in harsh, unfamiliar conditions; develop working ties with Mongolian military medical professionals; and provide free medical care to remote communities in the Mongolian countryside.
The group consisted of physicians, nurses, dentists, medics, surgeons, neurologists, an obstetrician/gynecologist, an optometrist, an ophthalmologist and, for the first time, veterinarians. The majority of the U.S. team was Army Reservists from the 5502nd U. S. Army Hospital (USAH), Colorado. Other members were from the 3297th USAH, North Carolina; the Alaska Army National Guard; and the 9th Regional Readiness Command (RRC) and Tripler Army Medical Center, Hawaii. The Mongolians were from the Mongolian Army and Border Guard.
To provide care to the maximum number of patients in different hospitals, the doctors were divided into a north team, a south team and a veterinarian team. U.S. doctors partnered with Mongolians who practiced the same specialty.
Each morning around 5 a.m., local drivers maneuvered the teams down bumpy two-track roads, across dried-up river beds, and over dusty hills to hospitals more than an hour away.
Once at their destinations, teams rushed into the hospitals to lay claim to a suitable work space and set up their equipment.
The doctors faced obstacles not found in hospitals in the United States. Most of the medical professionals work in large hospitals with bright lights and plenty of equipment, but came face-to-face with small buildings with little, if any, electricity.
Dentists, who rely on reclining chairs with swiveling lamps overhead, found whatever chair they could and a room with bright, direct sunlight.
“It took a day for the team to really come together,” said Army dentist Col. Jeffrey Astroth, from the 5502nd USAH. “We stumbled a little in the beginning… but the second, third and fourth days were really successful.”
Working together daily, they were able to learn together and give the best possible care to patients.
“We do these missions to try to help people, but it’s also a great way to develop relationships with our allied armed forces,” said Army Col. Dwight Shen, 9th RRC. “There was a lot of reciprocal teaching between the American and Mongolian forces.”
Astroth added, “It was great connecting with our Mongolian counterparts and with the locals, we’d say a few words to them in Mongolian as we treated the patients, and it made them feel a lot more comfortable.”
Some unexpected training came about when three cases of appendicitis were diagnosed in Bayanhayrhan. A team of surgeons, nurses and translators drove the patients an hour south to the Tudevtey hospital. By 3 a.m., they had successfully completed all three surgeries.
Mongolian surgeons performed the appendectomies, but U.S. Army Spc. John Westergard, a medic from the 5502nd USAH, observed the surgeries and learned, first-hand, some of the difficulties of the harsh environment created by the aged buildings and lack of supplies.
“We had to conserve water while scrubbing in because they don’t have running water,” said Westergard. “I’m not sure how the clothes were sterilized, and they didn’t put the patients to sleep, they just use a local anesthetic… they just don’t have the resources out here.”
Lack of electricity and modern electronic technology was another major difference. However, Army Lt. Col. Ruben Alvero, an obstetrician/gynecologist from the 5502nd USAH, brought a portable ultrasound machine that ran off a generator.
“I don’t have the ability to go to a good medical center because I live in a rural area where we don’t have sophisticated equipment,” Khajidma Jugder, a patient in Tudevtey said through a translator.
“I could not normally get this kind of medical treatment… especially free of charge, so I’m happy that the American doctors came out here.”
Byanbasuren Purevjay, who brought her 78-year-old father to the Tudevtey hospital for cataract surgery was surprised to see military doctors.
“When I got here, I found out there was an obstetrician/gynecologist with an ultrasound machine,” she said through a translator. “I was happy to be checked out by the modern equipment.”
Despite all of the obstacles the environment created, the teams accomplished their training goals.
“We demonstrated that American and Mongolian forces can work well together in austere environments,” said Shen, the mission’s officer in charge.
Furthermore, they treated more than 2,600 patients, exceeding their expectations by more than 500, according to Shen.
“We also successfully incorporated the first veterinarian team,” Shen said.
According to Col. John Belfrage, the veterinarian team leader, they examined more than 6,000 sheep, horses, dogs and pigs.
MEDCAPs are about more than training; they are also about helping people.
“America gave me a great profession,” said Astroth, “and I do these missions because I feel I have an obligation to do the right thing and help out where I can … I believe that’s part of what being in the military is about.”