AT THE HOSPITAL SITE AGAIN

It's Saturday morning, and we're gathered in the dining room for breakfast. I enjoy catching bits of conversation here and there, as people discuss what they've been doing, and what they'll do today. Ray is feeling better, still no memory of the accident and his wrists are still very sore, but he's better. Bobby has been staying with him, but Ray says he's ready to go with one of the groups and be useful. Besides, he says, he doesn't think he wants to spend another day with his "mean nurse." This produces a round of laughter from those who heard him, and a grumbled retort from Bobby, which I didn't understand. Probably just as well. Those two are the best of friends, and the good-natured digs that fly between them are hilarious.

After breakfast, we're back in our vans and headed out for another day of work, each team going to their respective area of service. The construction team will do some more work on the buildings at Hongor, the humanitarian aid and elder care teams will visit more of the sick and needy in Darkhan, and our team is returning to the hospital grounds in Orkhan. We know there will be a large crowd waiting for us, because many people were given numbers yesterday, and asked to return today. We have no doubt that they will do so.

Sure enough, there is a long line of people waiting when we arrive. We go straight to our tent and begin. Things go pretty much the same as yesterday. We see several people who arrive wearing pajamas and robes. Obviously, they're patients from the hospital, who have left their rooms and come down to get in our line to be seen by the American doctors! This never ceases to amaze me. It's pretty humbling, too. These people trust us, and have such high hopes. They have no idea how limited our resources are, and how little we're actually equipped to do for them. I'm not sure there is a lot that we could do for many of them, even if we had them with us in America. A lifetime of wear-and-tear is not something that can be easily fixed. Still, they seem to go away happy. Perhaps just having someone to show some interest in them, and listen to them for even a moment, is enough to make them feel better.

It's hot. It's humid. The line is endless. Still, most of the people are so patient. Babies are well-behaved, and they are so very cute. Here's one little charmer whose mom had dressed her appropriately (no sweater):

SWEET LITTLE MONGOLIAN BABY GIRL

We continued seeing people, most of them with the same monotonous complaints, but occasionally we'd see something a bit different. There was a young girl, about 12, who had multiple warts on her hands. Probably fifty or more. She was very embarrassed about them, and tried to keep her hands hidden. Her mom was very concerned. We learned later that she was told by the doctor who saw her to just be patient, that in time they would disappear, being of a self-limiting variety.

Then there was the young deaf boy, about sixteen years old. He didn't speak, just sat and watched, eyes darting from one face to another, as though trying to gain some sense of what was happening around him. His mother said he could hear when he was a baby, and had begun to try to talk, when he lost his hearing. She wasn't quite sure what caused the loss, and said he never learned to talk after that. I had the impression that his attempts may have been discouraged, as they would have been largely unintelligible, and might have been embarrassing to his family. He did make a couple of guttural sounds at one point, and was waved into silence by his mother. No one seemed to speak to him, so he had little chance to learn lip-reading. They just made simple hand gestures to him, which he seemed to understand, and obeyed. Sit down, get up, come along. He gave the impression of mild retardation, though I'm not at all sure of that. There was also an air of confusion and bewilderment about him, that made me wonder just how much more intelligent and "connected" he would seem if he could hear and understand.

I've noticed that the people we're seeing here in the town are much less likely to be dressed in traditional Mongolian attire than those in the countryside. In fact, only the elderly seem to wear dels, and not very many of them do so. Everyone else dresses in a confusing mishmash of Western clothing. Here's an example:

THIS OLDER WOMAN IS WEARING A TRADITIONAL DEL.
HER DAUGHTER IS IN WESTERN ATTIRE.

Actually, this division in wearing apparel exists in the countryside as well, but there are some cross-overs. In the country, some younger people do wear the traditional attire, especially among the men, but I don't recall seeing anyone under the age of 40 or so in traditional clothing in town. It's really too bad, because the traditional garb is charming.

We continued seeing people, and funneling them to the line waiting to get into the hospital building where they would see our doctors. The line was mostly outside, as it was so warm inside. At least outdoors, a vagrant breeze would pass by now and then. Here's a scene from inside one of the exam rooms:

DR. TOM, SEEING A PATIENT. DO YOU THINK IT WAS WARM
IN THE ROOM??

The picture above was taken by Barb, using my camera. She wanted to walk a few kinks out, and took the opportunity to get a few candid shots of our operation. I was glad she did. However, I wished for the camera at one point while she was gone, as a curious pig wandered into our triage tent, looked around at the people seated on the benches there, then turned and sauntered out again. My translators and I were about the only ones who seemed surprised by this. The waiting clients took little or no notice of the critter, and seemed mildly amused by the fact that I apparently found it to be unusual, to say the least. To my credit, I didn't jump up and shoo the pig away, but I did suspend my activity during its visit. At home, pigs just don't walk into a triage area unchallenged!

Lunch was at the little roadside cafe again. We had a sort of goulash of noodles and meat, and it was quite good. Hearty and well-seasoned, and I enjoyed it. I'm glad we didn't have what we had yesterday. That meal consisted of a slice of meatloaf (MUO, of course - meat of unknown origin), which would have been pretty good, except for the fact that an undercooked fried egg was plopped on top of it, covering the entire slice. I imagine that eggs are not plentiful in Mongolia, and that this was a choice tidbit, but after a couple of bites, I just couldn't eat any more of it. Had it been cooked thoroughly, it would have been a lot better, but not only was the yolk runny, the white was runny also. I like everything, and can eat almost anything, but runny egg white is just not something I choose to eat. Soft yolk, okay, but not clear whites. So I pushed the egg aside and ate the meat. I noticed the translators exchanging glances, like they couldn't believe I wasn't going to eat a treat such as that. Anyway, today the noodles and meat were really very good, and I went away well-fed.

In the original email installments, there is much more to this one, but as a blog, it grows too long. Therefore, I'm dividing it and the rest will appear later.

OUR FIRST DAY AT THE HOSPITAL SITE

Friday morning - today we will be going to a different site. We have our usual good breakfast - tea, bread and jam, boiled eggs, scrambled eggs, fried wieners, and potatoes. Also the good catsup. It occurs to me that perhaps the hotel would sell me some. I mention this in Badmaa's presence, and her face lights up in a huge smile as she tells me I am not to worry, that she will fix it! I don't doubt it for a moment. If anyone can make it happen, she can.

Stuffing ourselves into our vans, we settle in for the ride. We're going to the village of Orkhan, and will actually set up on the grounds of the little hospital there! This seems very odd. I try to picture a situation where a bunch of doctors and nurses from France, for example, would come and set up a clinic on the parking lot of one of our hospitals. Somehow, I just can't imagine it. Still, that's where we're going. It should be interesting.

When we arrive in the little town, before we even see the hospital, the idea seems a bit more believable. The town looks like a Mexico City barrio. Deplorable living conditions. Squalid buildings, corrugated tin shacks, rutted roads. Livestock roaming freely everywhere. Not a blade of grass to be seen. I'm amazed to even think that there could be a hospital here.

We arrive at the hospital, following a narrow, rutted road behind some buildings to get there. Through a gate, and we're on the hospital grounds. So are a couple of cows, but no one seems to notice. No driving around looking for a parking space here. Our vehicles are the only ones in sight, and have all of the half-acre or so of space in which to park.

We climb out of the vans and walk toward our big tent which has been set up just about thirty yards from the entrance to the hospital. One of our gers has been set up on a concrete patio area nearby. The Mustangs have worked during the night to get everything ready for us. Bless their little hearts! The ger will be the pharmacist's domain, and also contains our supplies of water. Bottled water, as usual, will be available to us in abundance. All we have to do is look a bit dry, and a Mustang appears with a bottle in his hand. What would we do without them?

There is a long line of people waiting for us outside our tent. We quickly set up an intake table, and the Mustangs begin to escort people in to get their registration card filled out. The clients are then seated on benches inside the tent, to be seen by Barb and/or myself. We resume our routine from the preceding days, with Barb mostly doing vital signs and me mostly getting histories, but sometimes we switch off, or sometimes we each do both processes to keep the lines moving. As soon as these things are done, a Mustang appears to escort the client over to another line, just outside the hospital entrance.

THIS IS THE LINE THAT GREETED US WHEN WE ARRIVED

Our doctors are inside the building. Rooms have been made available to them, and their exams will be done there. No gers this time, except for the pharmacy. The rooms are reasonably clean, and they are large enough, but there doesn't seem to be any a/c, and open windows allow flies in. The hallway is full of people and flies, probably at least forty men, women and children (I didn't count the flies), all seated on the floor or on the few chairs that are provided. They are not our clients, but instead are waiting to be seen by the clinic staff of the hospital. Interestingly, we learn later that many of these same people will come through our clinic as well.


PEOPLE WAITING TO SEE OUR DOCTORS - OUTSIDE THE HOSPITAL ENTRANCE

We have no little gray tent this time, but instead are permitted to use the restrooms in the building. One visit there, and I'm wishing for our little tent. I cannot believe that the stinking, filthy little closet in which I found myself was actually a hospital restroom. The floor was wet - just water, I hope - and there was no commode seat. No matter, I can't imagine anyone using it anyway. The sink was equipped with a faucet, but the broken handle lay nearby and there was no way to turn the water on. No paper towels, either, so if I had washed my hands I would have had to dry them on my jeans. Thank heaven for our liquid hand sanitizer.

A few hours later, on another visit to a restroom, an officious, uniformed staffer led me to another bathroom, and used a key from a string around her neck to unlock it. Apparently it's reserved for staff only, and I understood that it was a gesture of professional courtesy that I was taken there and permitted to use the facility. Inside, conditions were perhaps a little better than in the other restroom. At least the floor was mostly dry, and the faucet worked, but there were no towels. No matter, jeans work well when they have to. The staffer waited outside for me, and locked it again when I exited. I thanked her, and she smiled and nodded in a friendly manner. Pretty remarkable, really, when you think about it. She could have resented our presence, could have considered our visit to be a criticism of her hospital's services. Instead, in her way, she made me feel welcome.

For the most part, the folks we see are much the same as the country folks we've seen in the past three days. Most of these people are residents of the town, though not all. Some country people arrive as well - we see a few horses tied to the fence now and then. The complaints are much the same, though there is more evidence of the influence of the Chinese herbalists with these townfolk. I suppose the herbalists find it more profitable to hit the towns, where they can see a lot of people at once, instead of traveling from ger to ger in the country.

The efficient Bulgan, who seems to be everywhere at once - assisting and translating in the pharmacist's ger, serving as liaison between the hospital staff and our group, organizing our lunch plans - has decided to give the waiting people a number, so that they can come and go with a bit of freedom, yet not risk losing their place in line. This wasn't necessary at the river site, but seems to be a good idea here in town. The Mustangs are very good at using the numbers to help keep the line flowing in proper order.

In the early afternoon, as we're seeing people and getting them processed through as quickly as possible, we hear a minor commotion outside, and a large elderly man comes striding into the tent, via the side flap, rather than the door. There is a Mustang in hot pursuit, and the old man brushes him away as he would a fly. Our translators are quick to keep Barb and me informed of what's being said. The Mustang is pleading with him, explaining that he must have a number. The old man replies, "These are all the numbers I need!" and lifts the lapel of his frayed suit coat, displaying several shiny medals. One of the Mustangs examines the medals, and announces that they are medals of commendation from various military battles, that the old man is evidently a veteran of one of Mongolia's wars. He apparently considers himself a hero, though Goldie, my translator, tells me that some of the medals are of a kind that can be bought if one knows where to look for them.

At any rate, the old man seems to consider himself due a measure of extra respect, and since he's harmless, we decide to play along. The Mustang takes him to the registration table, and he is moved right on through. The folks outside the tent, who have been watching through the door, don't seem to mind. I would imagine the old man is well known to most of them, and in this country where age is held in great esteem, I'm convinced it would have been a mistake to try to make him conform to our procedures. We would have lost the respect and trust of the people waiting there.

When he removes his coat to have his blood pressure checked, I can see that he would have had a very good build in his youth. He has the remains of well-developed muscles, and the set of his shoulders is still square, his bearing proud. It was a pleasure to show this old fellow some extra respect, and he enjoyed it tremendously.

OLD MAN WITH MEDALS

This grows too long, so will be continued in another blog, another day.

WE BID FAREWELL TO THE RIVER

Our vans bounce and jolt over the track out to the remote river site one more time. By now, even our first-timers have learned the "rhythm of the road" and are able to converse freely, or just enjoy the scenery, in spite of the sometimes bone-jarring motion of the vans. Of course, it helps that the ride is just not as rough as it was last year.

Arriving at the site, we see that there are already long lines of people, waiting to see the American doctors. The complaints are much the same as yesterday and the day before, and we soon settle into our routine. Translators at our sides, Barb and I extract as much information as we can, and get vital signs before sending the client on to wait in a line by one of the gers where the doctors are working. We have discovered that we can do things a bit faster if one of us does the vital signs and the other asks the questions about the client's history. Usually Barb does the vitals, and I ask the questions. We watch each other's line, and if one is getting an overload, the other will perform both functions until things even out again. It works well for us.

The complaints are much the same. High blood pressures, kidney pain, back pain, liver pain, heart pain, joint pain. A few more kids with "hot spots" on their heads. Drat those Chinese herbalists! Many folks complain of headaches, and almost without exception, they also have with high blood pressure. I know I've mentioned this before, but it's so prevalent with these people, and so dangerous, that I just can't forget it. So many of them do admit to having medication, but as I've said, they only take it when they think they need it, and their criteria for need is a splitting headache. We try to educate them in the brief moment of time that we have, but we can tell by their facial expression that they aren't listening. Well, at least we try.

If these folk survive their blood pressures long enough, their eyesight becomes a problem, just as it does for the 50-somethings at home. Near vision just deteriorates and they can't read or do any fine work up close. This could be a problem for a herdsman who needs to mend a harness or repair a hole in a ger. So, as we did last year, we have brought a supply of reading glasses with us, in various strengths. These can be obtained at the dollar stores back home, and for such a small price, they can make a big difference in the quality of life for these folks.

The doctors take great delight in supplying these glasses to the folks who need them. There are no eye charts or any other fancy equipment to determine the needed prescription. They simply hand the client a few pair of glasses, and let them try them on. They know they have the right prescription when the client's face lights up in a huge smile, and their voice rises in excited chatter. Dr. Ron fitted one gentleman with some glasses, and the man was so thrilled, he wanted his picture taken with his benefactor. To make it doubly gratifying for Dr. Ron, the man confided that he was a Christian, too. Here's the picture:

DR. RON AND MAN WITH NEW GLASSES

The people continue to arrive, on foot, on horses, in horse-drawn wagons, on motorcycles, by jeep, truck or car. The only conveyance I don't recall seeing is a boat, and with us being camped on the riverbank, I'm surprised that none came.

I'm always amazed at the nature of these people. Kind, considerate and unfailingly patient, they wait in the interminable lines without even a murmur of complaint. For the most part, they're waiting out in the sun. Our tent will only hold so many, so the others must wait outside until their turn comes. Still, they don't complain. Even the children are well-behaved and pleasant. They sit patiently on a lap, or on a bench beside their parent when there is room. Tiny infants who get hungry are casually but discreetly nursed, and rarely does one hear a baby cry. Diapers don't seem to be a concern. Often the babies are warmly dressed (too warmly, in many cases) but will be bare-bottomed. If they do have trousers on, there is usually no diaper underneath. Their caregivers seem to know when a disaster is about to strike, and simply hold the baby out at arm's length and the child does what Nature prompts. Any resulting moisture is quickly soaked up by the dry earth. If necessary, a little dirt is kicked over the deposit, and life goes on.

I can't stress enough the innate courtesy and patience of these country people. I cannot recall one argument, one flare-up of temper, or a single incident of anyone making any demands on us. They simply wait their turn, follow instructions given by the translators or the Mustangs, and offer their very gracious thanks when they leave our area. Some have been turned away in the late afternoon and asked to return the next day, and they simply smile and agree, and come back as requested. We have no way of knowing how inconvenient this may be for them, but I'm sure it's not easy. Still, they do not complain or argue, they just do it.

It's true, they are receiving free services, and I'm sure that fact isn't lost on them, but I'm still impressed. Where I work back home, a lot of our patients are receiving free care, too, and I wish I could say their attitude is as gracious as that of the Mongolians, but it's not, in most cases. Some of the crankiest, most demanding, and heaviest abusers of our resources are those who are receiving free care. I have literally been cursed out by a new mother because her room was too small to suit her, and because we didn't have a free carseat to give her in which to take her new baby home. Here in Mongolia, we receive profuse thanks for a $1 pair of reading glasses. The contrast is glaringly obvious.

Toward the end of the day, as we were preparing to leave, a woman reappeared and sought me out. She had come through earlier in the day, and had returned, or perhaps waited somewhere on the site, to contact me when I was not otherwise occupied. Her request was simple. She wanted her picture taken with me. Imagine that! Naturally, I was glad to oblige, and handed my camera off to someone else to take the picture. After this was done, the woman very shyly took my hand, and in halting, careful English, she said, "Thank you. I want you to know, I am a Christian, too." Well, of course, this generated some excitement in me, and grabbing a translator, I managed to get more information. It seems she has been a Christian since 1996, and attends a small church located somewhere in the area. I never cease to be amazed at the golden thread of Christianity that is woven throughout this primarily Buddhist or atheist country.

LANNI AND THE WOMAN WHO HAS BEEN A CHRISTIAN SINCE 1996

The afternoon has ended, and the Mustangs are starting to tear down our camp. I really hate to see things dismantled, because we have been very happy here. Tomorrow, we will go to a different place, and I know by the nature of the location that it will not be as pleasant as our river camp has been.

We return to the hotel, and enjoy a good dinner. We have ice cream for dessert, and it's so good. The ice cream served here is creamy and delicious, and they put some sort of berry topping on it that's just delightful. Sweet and tart at the same time, and a wonderful contrasting taste to the ice cream. I wish I could get a jar of the topping to take home.

After dinner, a group of us gathers to go shopping. David Bass drives us in a van, dropping some off at the internet cafe, and taking the rest of us to the market. This market proves to be quite an experience. Affectionately referred to as "The Wal-Mart" by the Americans who live here, it's a big square building more or less in the center of town, and evidently is the only place to go other than the open market, which is another thing entirely. The building is about the size of a small Kroger store at home. There are a couple of swing sets and some resin chairs for sale outside the front entrance. Inside, there is a little bit of everything. The key phrase here is "a little bit." The linen department offers about six towels, a small stack of washcloths, and a few rugs. There are also several blankets, two of which are 100% cashmere, and appear to be of very good quality. They are not inexpensive, though probably much cheaper than they would be in the states. I considered one, but it was heavy, would take up a whole suitcase, and it was bright red. Okay, I'll pass on that.

Eloise and I continue to wander through the store, and we are very much impressed by the wide variety of things that are condensed into such a small space. There is everything from furniture to food, washing machines to jewelry. I'm looking for the Mongolian catsup I've learned to like so much, but can't find it. They have catsup, but it's Heinz! I can get that at home, for heaven's sake! Perhaps I'll try the tiny grocery near the hotel tomorrow. We do decide to buy a small package of washcloths - six in the package. They will come in handy back in our room, as only towels are supplied, and they're only replaced every other day, and then only by request! Eloise bought us each an extra towel earlier in the week. We plan to use them as backup, and then to leave them for the hotel at the end of our stay.

We meet David back at the front of the store, and get in the vans for the return drive to the hotel. It's really only a few blocks, and some of our folks have walked it. However, with my battered knee, I'm grateful for the ride. We go to our room, clean up and visit with other people for a little while, then head for our beds. As always, it's still light outside but we're used to it, and soon fall asleep.