Rehabilitation In The Land Of The Great Khaan

Working as a volunteer in Mongolia.

When I broke the news to my family that I had enrolled as a volunteer overseas, my father joked that I would probably get an invitation to work in some remote part of Siberia or some far eastern jungle. On both counts he has proved to be right!

My decision to work as a volunteer overseas had long been mulling inside me and now at the age of 56 (feeling more like 26) having qualified as a Manipulative therapist and an Acupuncturist I decided that the time had come when I needed to undertake a new challenge.

Within a few weeks of putting forward my application I had received invitations to work in Indonesia and Mongolia and this latter invitation was the most interesting as I would be working at the Shastin hospital, one of the largest in the capital Ulaan Baatar, as part of a medical team specialising in rehabilitation and I would be teaching the medical staff rehabilitation therapy and acupuncture. I therfore decided to go to Mongolia first and Indonesia in January.

I must admit I knew little about Mongolia apart from pieces I had learnt during odd moments of wakefulness at school, therefore, my knowledge centred on the military antics of Mongolia’s national hero Ghinggis Khaan, whose empire, at its height in the thirteenth century, stretched from Beijing to the Caspian sea and included most of China and Russia.

In the 17th century the Chinese Manchu dynasty had retaken power and controlled Mongolia until 1924 when, with the help of Russian communists, Mongolia gained its freedom from China in the form of the Mongolian Peoples Republic and came under Soviet influence for most of the remainder of the 20th century. This later period in Mongolia’s history saw major developments in Mongolia’s industry and infrastructure, overseen by a vast bureaucracy, directed by the political aspirations of the much larger and wealthier Soviet benefactor. A massive Soviet aid programme helped the Mongolian economy until 1991 when subsidies came to a halt as the Soviet empire collapsed. Mongolia now faced a precarious future and its subsequent struggle to remain an independent nation is truly remarkable, for with the withdrawal of Soviet aid Mongolia went bankrupt. Consequently it became totally reliant on international aid programmes for a third of its income and this situation remains the same today. Much of Mongolia’s survival is dependant on the voluntary contributions of wealthier nations and the voluntary work done by agencies such as International Health Volunteers.

In my case I paid all of my own expenses, including my flight and received no financial assistance. Having said this, I would add that the experience was worth every penny. My host during my stay in Mongolia was Dr Balja Avirmed who is the most highly qualified rehabilitation doctor in Mongolia and at the tender age of 30 carries much of the responsibility for advancing her country’s development in the field of rehabilitation medicine.

I had read that most hospitals and clinics in Mongolia are short of medical supplies and the thousand or so of its doctors are inadequately trained. Hospitals in the Far East are often described as unsanitary places by European standards and during my travels to the Far East I have seen many examples of this. I was therefore open minded about what was awaiting me in my new location but extremely impressed by what I actually witnessed at the Shastin hospital. Although Dr Balja frequently apologised for the antiquity of some of the equipment at my disposal, I felt that the levels of medical knowledge, range of treatment facilities and hygiene at the hospital were adequate. Furthermore, in my opinion, the hospital is perfectly capable of providing good medical care for most medical problems.

Patient care in the Shastin hospital is as good as I have seen anywhere in Asia and whilst fixtures and fittings may not come up to a European standard, the level of enthusiasm and consideration for patient well being is certainly equal to it.

From a European’s perspective I would always be cautious about undergoing any invasive procedure in any country in the Far East, especially Mongolia and China, where Hepatitis B is endemic. Consequently any traveller to the Far East should carry comprehensive medical insurance that gives access to a reliable blood bank and provides the facility for evacuation to a European hospital if necessary.

Away from the hospital the levels of health within the community seemed good and most of the Mongolian people I met seemed a healthy lot and at present unaffected by the plague of obesity that seems to be sweeping the western world. However, the average life expectancy for males is 64 years and for females is 69 years which does not compare favourably with European figures. This is probably due to the high levels of animal protein and dairy produce consumed in the average Mongolian diet. Mongolians are heavy meat eaters who particularly favour large quantities of mutton and dumplings in the diet. In a country that is exposed to sub arctic conditions for six months of the year, this need for fat and protein is hardly surprising and possibly explains why Mongolians appear heavier, taller and better nourished than some other Asian races that heavily rely on grain for their dietary needs.

My first week at the Shastin hospital was spent working with Balja in the rehabilitation centre, as part of a fifteen strong medical team, made up of doctors, nurses and physiotherapists.
During this initial period I treated about eight patients each morning. These seemed to be patient’s who weren’t responding to treatment, or patient’s who had reached a plateau in treatment. During this first week I dealt with a range of different conditions. These were musculoskeletal conditions, such as neck and back pain; neurological problems (especially those associated with stroke); physiological disease such as diabetes and cardio vascular disease; congenital deformities and growth problems and mental and emotional problems such as post traumatic stress, depression and anxiety. Balja translated for me and together we exchanged ideas and opinions and sought to tailor our treatment to each individual’s needs. There were a number of traditional therapies such as acupuncture, herbal medicine and massage that were available to patients, together with a range of physiotherapy modalities such as intereferential and ultrasound.

Traditional medicine is very popular in Mongolia and Balja believes that the 21st century is going to be a time when many of the traditions that have been around Asia for thousands of years will be integrated into modern medicine. She is trying to encourage scientific research throughout the world into some of the unexplained treasures of Traditional medicine. With this goal in mind, she has been helping the Health Sciences University of Mongolia to organise the first International Conference of Traditional Medicine, to be held this year, in Ulaan Baatar.

By the time I was into my second week at the Shastin hospital, I was in full swing and with Balja translating enthusiastically on my behalf I was treating patients all morning and teaching rehabilitation, maitland mobilisation and exercise techniques in the afternoon. My patient list seemed to grow by the day and now included some of the medical staff within the hospital. I accepted that some of this increase might be due to the novelty value of a European working in the hospital, but also believed that some of it was due to the excellent results I was getting.

By the beginning of my fourth and final week at the Shastin hospital, Balja and I discussed the progress of the patients I had seen to date and we were able to make some evaluation of my work during that period. Anecdotally, the results were excellent. Balja and I agreed that there is much that we learnt from each other. Her medical team have asked for me to return and I have agreed to spend another month in Mongolia next year.

On my last evening in Mongolia, Balja and her husband Amar took me to their favourite restaurant for a farewell meal. During the evening, Balja asked me what, in my opinion, was most needed in the hospital’s rehabilitation of patients. I tried to explain that sometimes things develop naturally if one builds on the resources one already has. In my opinion, in the field of rehabilitation, the most valuable resource lies within the practitioner. It is the compassion within the heart of that practitioner. I had seen that compassion in the hearts of all those practitioners I had worked with during my stay in Mongolia. I think Balja understood what I was trying to say.

About the author:

Article written by Richard Graham
Richard Graham began a career in health care as an exercise and fitness teacher. In 1989 he took up the study of oriental medicine and trained for three years as a shiatsu therapist. After graduating he went on to to train as an acupuncturist at the college of Traditional Acupuncture, Leamington Spa. Thereafter he continued his professional development at Leamington and also undertook postgraduate training at the Hangzhou college of Traditional Chinese Medicine, China, the Shizhen College of Herbal Medicine and the Northern Institute, Manchester.

His post graduate studies include physiotherapy, manipulative therapy and psychotherapy and in November 2003 he was awarded the qualification of Acupuncture Master.

Richard, has travelled extensively throughout the Far East and has written a number of articles on complementary medicine. In 2002 he became a member of International Medical Volunteers Overseas and has worked on projects in Mongolia and Indonesia. In 2004, His Royal Highness the Prince of Wales personally commended him for his work in the integration of western and complementary medicine. He currently works in private practice in Suffolk and teaches at the College of Traditional Acupuncture, which is affiliated to Oxford Brookes University.

He can be contacted at Richard@natramed.freeserve.co.uk

Author: Richard Graham
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