HOME ON THE RANGE

When we first arrived at the remote site, there were no people waiting, which was a blessing. This gave our staff time to devote their attention to Smiley's knee, and gave Barb and me time to set up the benches and tables in our tent to our liking. As I've said, our location is beautiful, with the swift river flowing nearby, and the mountains in the distance, seeming to smile their approval of what we're doing. The free-ranging livestock makes an occasional appearance, with a few cows wandering by now and then. In the distance, a herd of horses can be seen, fording the river.

HORSES FORDING THE RIVER

The scene reminds me of an event from last year, one that will be in my memory forever. Toom Chris and I were sitting in our tent, taking vital signs on our patients, when we became aware of a thundering sound. It had started softly, as though in the distance, but we quickly became aware that it was coming closer, and we weren't sure just what it was. Then it dawned on us - it was hoofbeats. Many hoofbeats, and they were now very near. We jumped up and ran to the side of our tent, just in time to see a herd of 30 or 40 beautiful horses as they crested a nearby ridge, flowed over the top and came sweeping down the hillside off to our right, headed straight for our tent. At the last instant, or so it seemed to us, they veered off and continued their charge, straight up the hill behind the tent, over the top and they were gone, as suddenly as they had appeared. I didn't even have time to think about my camera, much less focus and shoot. I will always regret that, because it was a beautiful sight, albeit a bit frightening, and I'm sorry that I was unable to record it. The picture is there in my memory, though, and I'm grateful for that.

After a little while, a few people appeared, and then more, and more, and soon we had a long line waiting outside our tent. The Mustangs had placed a few benches inside the tent for the convenience of those who had been by the intake table and had received their registration card. There were a few more benches outside the tent, for those waiting to come inside. Those benches filled quickly, and soon there was a line of people standing as well. True to Mongolian nature, they waited quietly, maintained their place in line according to the order of their arrival, and things went smoothly.

There were no surprises. Based on my experiences last year, I was pretty sure I knew what to expect, and had filled Barb in as well, and sure enough, nothing had changed. A very high percentage of the people are hypertensive, many of them alarmingly so. Blood pressures of 200/120 are not unusual. Some of them admit to having been given medication for their blood pressure, but almost all will tell you that they "only take it when I need it." Need, apparently, is determined by the severity of their headache. Barb and I quickly teach our interpreters the little speech about taking the medicine all the time to keep their pressure from going up, and the girls faithfully repeat it to the patients when we say "tell them the blood pressure story", but we can tell from the expression on the people's faces that they aren't buying it.

There are a lot of factors at work here. Poverty is a big one. Most of these people can't afford to buy the medicines they need, and when they do manage to fill a prescription, they want to make it last as long as possible. They'll cut pills in half, or skip doses, or as so many do, only take it when they think they really need it. Another factor is distance. Remember how far we drove to get out here? Well, it's just as far for them to get into town to get medicine, and they don't make that trip very often. Many of them have no motorized transportation, and are miles from a road anyway. These folks live on the land, out on the steppes, at bare subsistence level. They raise and herd animals for food, using the milk and the meat to stay alive. A few have tiny gardens, and I suppose they buy a few groceries when someone makes a trip to town, but those trips are few and far between. Blood pressure pills just aren't on the top of their priority list.

Another big complaint is kidney pain. High blood pressure will beat up one's kidneys, and these people are chronically dehydrated, of course, so probably their kidneys aren't in very good shape. Clean water must be brought in, in many cases, and they just don't drink enough of it. There are some wells, and the nomadic families move from well to well, and I suppose there are some springs, but water doesn't just flow from a tap at someone's whim. The Mongolian word for "kidney" sounds like "poorrrr", with the r's rolled. It's one of the few words I learned in the language, and when a patient was telling Goldie (my interpreter) about his or her complaints, I could pick out that word and would write down "kidney pain" on their card before Goldie even translated it. Actually, we could almost have just written it down for everyone, because nearly all complain of kidney pain.

It's probably true that many of their kidney complaints are really something else, like back pain from their hard-working lifestyle. Also, the Chinese herbalist "doctors" come through periodically, and tell them they have kidney problems. They then proceed to sell them some concoction of herbs at outrageous prices. These herbalists offer all sorts of diagnoses, most of which sound ludicrous to us, but the uneducated country folk believe them, and will bankrupt themselves buying the "cures" the herbalists offer. Several women presented babies for our examination, telling us that the baby had "hot spots" on their head, and inviting us to feel them. Yes, in 85 degree weather, when the baby is wearing a sweater and a knitted hat, I would imagine his or her head would have some hot spots. We were also told by some mothers that their baby had a "sweating disease." Again, too much clothing in warm weather, but the herbalists had given their diagnosis, and the mothers believe them.

Tammy, in her role as doctor, met one patient who complained of kidney pain, and who showed her some large brown circles on his back, like brown bruises. Further questioning revealed that the Chinese "doctor" had applied hot cups to his back. They put fire in a specially designed cup, and place the mouth of the cup over the kidney area, and the resulting heat is supposed to draw out the bad spirits, along with the pain. Naturally, this burns the skin, even producing blisters, but the patient is convinced that he's being helped. I suppose the discoloration and blisters are evidence that the bad spirits have left. It's hard to believe that people can be fooled by such quackery, but they take it very seriously.

It's hard for me to accept that a country as technologically advanced as China can produce people like these herbalists, but it's true. Of course, money is the prime motivator, but there's something else. The Chinese still hold captive bears in tiny cages, and implant tubes into their gall bladders to drain the bile to be used as medicine. They traffick in all sorts of animal body parts - rhino horn, tiger paws and testes, and other things equally horrific. All these things are truly believed to provide strength, virility and health. So, I guess it's not surprising that they combine those shamanistic beliefs with the opportunity for financial gain, and the poor Mongolian herdsmen are the losers.

After a few hours of taking vital signs and hearing complaints of kidney pain, back pain, joint pain, heart pain and headaches, Barb and I began to turn our thoughts toward lunch! I had noticed that there was no food/supply ger like last year, and was wondering just how lunch was going to arrive, when someone came and told us we would be going off-site. We got in vans and traveled the rutted road back to the highway, and then stopped at a small restaurant about a quarter-mile from our turnoff. When I say "restaurant", don't envision Denny's or Outback. This was a small structure that looked more like a little house, with parking space for about six cars. The ubiquitous outhouse could be seen about fifty yards away, at the end of a little path.

We entered, and chose a couple of the ten or so tables inside. We quickly learned that we were going to share the tables with a legion of flies, and no one seemed to pay any attention, so we tried to ignore them, too. Now, this is not easy for me. My mother followed me around with a flyswatter when I was a child in the 40's, the polio years. She taught me to despise them, and I still do. It took an effort of will for me to overlook the fact that the flies which swarmed in the dining area had most likely visited the kitchen as well. However, the only thing I would hate more than flies, would be to offend my gentle Mongolian friends, so I just ate what was brought to me and kept quiet. The food was hearty and good, and I'm sure my mom would be surprised to know that I didn't sicken and die after eating food which had first been prayed over by the flies.

After lunch, we returned to the site and saw more patients. Same song, second verse. A constant litany of the same complaints, punctuated by the occasional arrival of some of the cutest little kids I ever saw. Here's one:

CAN YOU BELIEVE THOSE CHEEKS?

After a couple of hours, the line had dwindled, and soon we learned why. At some point, the word was put out that we would be leaving early, and people stopped coming, planning to come tomorrow instead. I don't know how the message is communicated, but they manage. I never heard drums or saw any smoke signals, but they still get it done.

We finished up, loaded into the vans, and returned to town. We went out to Hongor, the little village near Darkhan that is the site of the CTW compound. They told us that something special was going to happen that evening, and believe me, it did.

More tomorrow.....