Mongolia

Letter from Dr. Gieser:

Cairo, Egypt

May 25, 2000

Mongolia is as far away as it sounds. We judge trips by the number of jumps it takes to get there. Europe is a 1 jumper. Our trips to India and Africa are big trips…2 jumps, usually with a stop in Europe. A trip to Mongolia is a 2½ jumper. There was a stop in Seoul, Korea and then a wait for a few hours to a few days while the winds over Mongolia quieted. Our wait was only six hours; some in our party waited five days.

Mongolia is twice the size of Texas and has 2½ million people. It is as empty as rural Montana. One-third of the population and most of the medical facilities are in the capital, Ulaanbaatar. Mongolia was a communist state for 70 years until a peaceful revolution in 1990. Communism left the country with a solid basic infrastructure of roads, hospitals, and railroads that are now crumbling after ten years of neglect. Missing are a work ethic, honest government officials, and the means of generating enough income to fuel a nation. A remaining jewel from the Russian occupation was a music school for 7-17 year olds that was started in 1937. The president at that time had a Russian wife who started the school. Six hundred children have regular classes in the morning and music in the afternoon. I visited six coaching sessions and watched very talented young musicians on both the usual instruments and Mongolian instruments. My favorite was led by a grand dame in her late 70’s from Russia, attired in a beautiful formal sweater, dark glasses, and a large black hat. Her young student played Chopin beautifully.

Part of my medical work was at the Vision Hospital, a joint venture with the city of Ulaanbaatar and the private philanthropic organization started by Howard Harper, a New Zealander we had heard about for years. He had started the Noor Eye Hospital in Kabul, Afghanistan. We spent six weeks there before the Russian occupation. I also examined and treated patients at Hospital #1, the main eye department in the country.

Marge painted a mural of Christ healing the blind man in the women’s ward of the Vision Hospital. The hospital is a nice two-story building that is clean and appears to be running cheerfully and efficiently. They see about 25 patients a day.

The mix of patients I saw at both hospitals was similar: neglected retinal detachments, blunt trauma, and Eales disease. There was almost no diabetic retinopathy; obviously the diabetics do not live long enough to get retinopathy. Macular degeneration was sparse. I have hardly ever seen exudative macular degeneration in Afghanistan, Mongolia, Pakistan or India. It may be related to their increased eye pigment. It is not the diet, which is vegetarian in India, mainly meat in Mongolia, with a small amount of meat in Afghanistan.

You are never too old to have a new and unusual incident during an operation. I had several: probes that didn’t work or were inadequate, delaying work by as much as six hours; having to tactfully cover for mistakes made by someone else; etc. Just before one interesting challenge of operating in an unusual operating room, I dropped my watch down the toilet, always a bad omen.

It is an uncomfortable feeling to see patients that are blind from problems easily treatable at home. Most of my time was spent examining patients with three great Mongolian colleagues and then discussing the cases. Each hospital had an indirect ophthalmoscope, standard equipment in the U.S. My main goal was to popularize its use. The knowledge base of my colleagues was not based on the controlled studies that we in our country love. "Interesting therapy" that would not be used in America was common.

After each procedure I performed, the family would track me down and give me a gift, sometimes tracking me to the restaurant or at our hotel. Caring for patients is a delight and privilege at home or abroad.

Mongolia is harsh for its underclass. The temperature dropped to -50 degrees last winter and the economy is limping along. The city is heated by a central heating plant. The passages from these steam pipes provide dark, warm, filthy underground shelters for the homeless. This group includes runaway children, alcoholics, and the destitute. It is an eerie feeling looking down a sewer hole and seeing a face looking back.

Marge spent time with many heroes that are helping with these sad folk. A couple from New Zealand, who had a runaway daughter years ago, are renting basement rooms in large apartment buildings that are safe, clean and supervised for these sewer children. A widow from New Zealand spends two weeks at a time living in prisons. At first she was rejected; her acts of kindness humanized the inmates. It is easier to ignore the sorry plight of prisoners when they are treated as sub-humans. Those on death row are treated so poorly they request death. Her entrée was to teach English to the guards. We also met a veterinarian from the United States who is very busy teaching Mongolian vets. Last winter about 1.5 million of Mongolia’s cattle died. A very thick layer of snow prevented foraging beneath the snow, but a major cause of death was over-grazing and parasites, both preventable. One shot of ivermectin, which costs 10 cents, given in the fall, will prevent many of the internal and external parasites. This shot decreases the lice in the cashmere goats and increases the coat by 15-20%.

We met an ordinary looking, quiet nun who was not impressive at first meeting. All Sister Dominique did was take an abandoned city hospital with holes in the ceiling and turn it into a clean, sparkly structure that helps the poorest of the poor. The United States Ambassador talked the U.S. Corp of Engineers into replacing the roof and the windows of the second floor. The wiring and plumbing was completely replaced. The walls have been painted and the floors are new.

Frostbite and burns are Sister Dominique’s specialty and there is always a ward of recovering patients with missing fingers and toes. The drunks sleep outside in the bitter winter, getting frostbite, or fall asleep against steam pipes in the sewers, receiving burns. A room on the first floor is reserved for the street people to get showers and haircuts. The kitchen that had been a pile of garbage now serves 300 street folk a day. The secret of this gentle giant is four hours of prayer each day.

The national sports are wrestling, archery, and horseback riding. We flew into Ulaanbaatar with a team of wrestlers from China. John Peterson, the U.S. Olympic champ fifteen years ago, now works with Athletes in Action and Allie Sleiman, an American wrestler, was also in the group. Wrestlers are easy to spot, as their ears are thick from traumatic chondritis. The men were competing in a tournament of Greco-Roman wrestling, which is one of the styles used in the Olympics, in the wrestling palace, one of the few buildings in the world built for wrestling. Allie was using international wrestling tournaments to prepare for the Olympics. He had a small but vocal fan club…us. He got 4th place. The Mongolians are great wrestlers. We returned one week after the tournament and saw traditional Mongolian wrestling. The hall was packed and was as quiet as a tennis match. There is one weight class: heavyweight. The uniform includes large furry boots that go up to the knees, shorts that look like a Speedo swimming suit, and a small vest with long sleeves. There is no time limit. The idea is to force the opponent's knees or elbows to the mat. The match involves these two large buffaloes pushing each other around for a few boring minutes and then a sudden burst of activity with a flip or a trip and one of the giants is on the ground. A judge dressed in a long silk robe then places the victor’s hat on the champion. The hat looks like an igloo with a chimney on top. The winner then dances around the mat slowly waving with his arms gently flapping, representing an eagle. The winner and loser have the same expressionless face. Traditional wrestling was on television each night at 10:00 p.m.

The drama of our stay was a sinister plot to close down the Vision Hospital that unfolded during our stay. The licenses of Dr. Harper and an excellent English ophthalmologist were pulled for trivial reasons. The complaints of two unhappy patients were used by those interested in acquiring the hospital for their own activities. Dr. Harper was called to the police department, leaving his wife alone for many hours. After receiving harassing phone calls and on noticing a suspicious car in front, she crept out of the back door of her house and met us at a nearby restaurant, shaken by the experience. We were ready to move into her place or have her move into our hotel. As she was passing several thousand dollars to us under the table for safe keeping, her husband walked in to our cheers. The English doctor has fled the country. The outlook for the hospital is grim.

I spent several hours with my colleagues both professionally and socially. We learned about their families, hobbies, joys and sorrows. While talking about our trip to Romania when the dictator Ceausescu was in power and the hardships the people were experiencing at that time, one of our colleagues started crying. In 1992 there was not enough food even for the doctors and her malnutrition caused her to stop lactating, which was a difficult time for her baby.

We were treated royally, with one lovely meal after another. Our final celebration was in a Korean karaoke bar. First a Mongolian song, then our attempt at an American song. It was hilarious.

Once again, sharing ophthalmology has provided a chance to learn ophthalmology, geography, history and another culture. Best of all, our circle of unique friends has been expanded.

You never appreciate the blessing of living in America until you are far from home.

God bless America.

Cordially,

Richard G. Gieser, MD