Mission Mongolia
A group of L.A. Physicians Aids Pediatrics in a Pristine Land.
By Greg Goth

Mission: Mongolia.
Group plans educational trip to the pristine but medically challenged Asia
Country.A small group of Los Angeles area physicians with a taste for traveling off
the beaten path and a sense of mission will get to satisfy both impulses
this summer. A group of 13 doctors will be traveling to Ulan Bator, Mongolia, to conduct
a series of seminars, perform demonstration surgeries, and in the process,
learn about one of the world's most unique and untarnished cultures.

The program, conducted under the auspices of the Venice based Ulan Bator
Foundation, will be held July 8 through 21, with seminars scheduled for July
14 and 18 at the Maternal and Child Health Research Center in Ulan Bator.
Also included in the itinerary are excursions to the Mongolian countryside,
picnics, overnight stays in the Mongolian tents known as gers, museum
tours, and the opportunity to indulge in the national libation of Mongolia -
fermented mare's milk.

" I think the American physicians will be experiencing a very beautiful and
pastoral country," says Arnold Springer, Ph.D., the founder of the Ulan
Bator Foundation, "but beyond that, I think what they'll be feeling is a
great opportunity to create a classical demonstration project of how a
country's medical practice and delivery system can be radically transformed
in a very short period of time.

" Mongolia presents a great opportunity because of the high literacy rate.
They have a sophisticated professional class eager to get up to Western
speed. The country has 2.5 million people, so if you do an intervention in
Ulan Bator on pediatric healthcare, you can affect the course of pediatric
healthcare all over Mongolia."
Richard MacKenzie MD, director of adolescent medicine at Children's
Hsopital, will be leading the American medical delegation. Dr. MacKenzie
traveled to Ulan Bator in the summer of 1995 and performed a needs
assessment of the pediatrics facility then. He also met a young girl from
Mongolia who suffered from urinary incontinence and arranged for her life
transforming surgery here in Los Angeles.

The plight of the girl was brought to his attention via Wade Piston, LACMA's
director of public affairs, who received a call from Springer's assistant
looking for someone who could help. the girl and her mother traveled into
Ulan Bator from the Gobi Desert and met Dr. Mackenzie. they placed so much
faith in his abilities they ceremonially made him a part of their clan
before he arranged for the operation.

Dr. MacKenzie has continued his work to improve the fortunes of children and
adolescents in Mongolia. he says Mongolian doctors, due to the dearth of
current information and equipment, often perform procedures that Western
doctors halted years ago, removing entire kidneys in children with stones,
for example. Hospitals in Ulan Bator are on a par with many of those in
nations that are not leaving the Socialist sphere and re-entering democratic
society.

" Much of the equipment is vintage 1960's and 1970's, Dr. Mackenzie says,
" But it's in disrepair, and they don't have access to parts or technicians
to fix it. " The facility itself was one of bumpy, sloping floors. Every second light
bulb didn't work, or elevators didn't work." Ultimately, he says, "the sort of best vision would be that they would have a new children's hospital there, thanks to people like Arnold."
In the interim, however, Dr. MacKenzie hopes a regular regimen of
information in subjects such as general pediatric surgery, urology,
infectious disease, endocrinology, and adolescence will help raise the
general level of pediatric care in Mongolia.

One Mongolian physician, Enkhjargal Badamgarav MD, has spent the past
several months in Los Angels as a visiting pediatric clinician at Children's
Hospital and Cedar-Sinai Medical Center. She says the country's physicians
are eager to absorb any information the Los Angeles - based doctors can
impart.

The country's literacy rte is about 95%, Dr. Badamgarav says. In addition,
the nation's healthcare network, with smaller hospitals referring patients
to larger facilities, is already functioning.

But, Dr. Badamgarav says, there is still a long way to go. The infant
mortality rate has been reduced from 76 per 1,000 live births to 44 per
l,000 - but it's still relatively high, compared to nations with similar
gross domestic product figures and literacy rates.

" The big difference is high tech," she says. "We don't have much
information on current trends in the medical world. there are many
situations where you have to prioritize your patients and choose the one who
has more chance to survive."

While the dearth of state-of-the-art equipment is a handicap, Dr. Badamgarav
says the American physicians will also be able to hone skills that may have
dulled. " One of the negatives of high tech, people rely too much on technique and
computer, they seem to forget their own sense. they just go and pull from
the computer everything possible and make their diagnosis.

In Mongolia, there's nothing to look at except our textbook, which is an old Russian
textbook. I was the only person who had one English pediatric manual.
" They'll work in situations like old physicians, relying on their brain's
ability and their sense, which is really essential for any successful
physician. On top of that, Mongolia's a very beautiful country. It was
closed for 70 years. the whole environment is intact, people are very
natural. You can feel this close touch with nature, which makes people very
friendly. there's no rush or stress, or any emphasis on that."

Dr. Mackenzie says the relaxed unity of spirit is very noticeable.
" What impressed me the most about Mongolia was the enthusiasm of Mongolians
for their country," he says. "there's a certain spirituality to them, a way
of honoring the sky and earth without the intercession of gods."
Springer discovered the hidden treasure of Mongolia in 1990, "on a lark," he
says, while visiting Russia. A professor of Russian History at Long Beach
State, Springer returned from that trip impressed by the beauty of the land,
and was quickly given the opportunity to spread some good fortune.
" I had the good fortune of a bequeathment," he says. "the only stipulation
was I had to set up a non profit private charity. I thought it was good luck
I had gone to Mongolia, and decided to give the money back through a
foundation for Mongolia and West Los Angeles, create a synergy which could
work both ways. We have something to learn from light, space, air, and
horizon. We're Pacific Rim. We have to be looking out there.

" Meanwhile, there as this medical thing. I went back to Mongolia in 1992
and brought medicines. And that's when I got a letter about Ariunna, a
young girl who had really difficult problems. I thought, "I've got this
foundation, I'm supposed to help.'"

His assistance in obtaining the services of Dr. Mackenzie coincided with
arranging for the storage and transport of badly needed insulin from Project
Hope to Mongolia. " It was stored in a Mexican restaurant in a big walk-in freezer for awhile,"
he says. We just took it with us the next time we went. I thought we
should keep on trying to do something, and when I went back this past year,
I said, "Let's put together some proposals and see how the doctors here will
respond.' And they did, they worked hard. Everything's been really
positive. Everybody wants to help. Everybody's enthused by the prospects."
Springer hopes this trip is the first of regularly scheduled exchanges.

" We think his is the first year of a multi-year relationship in terms of
seminars," he says. "We'll be meeting after the seminars with all the
doctors in the Ministry of Health to assess what happened and to plan for
the following years in a systematic way."

Among the relationships envisioned are "sister hospital" ties, region to
region relationships, and enhanced communications.
" We think we can make some great breakthroughs and advances with just a
little bit of electronic communication to help with diagnosis," he says. He
also hopes Dr Badamgarav will be able to return to Los Angeles next year to
direct the exchange, which would include a training program in which
Mongolian physicians can visit Los Angeles for several months.

Dr Mackenzie says doctors who wish to join the excursion are still welcome.
though much of the seminar schedule in Ulan Bator itself is filled in, he
says there are still opportunities to disseminate expertise in regional
centers." You could make a great contribution in just half a day," he says.

LACMA Physician. Magazine of the Los Angeles County Medical Association.
March 3, 1997 Reproduced with permission of the copyright owner. Further reproduction or distribution is prohibited without permission.