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Edward Chien - Medicine & Healthcare in Mongolia

Assisting in surgery

Who would have thought that a 4th year pharmacy student from the University of British Columbia would be assisting in surgery halfway around the world in Mongolia? In some minds, the two just do not add up. I have always wanted to be a surgeon. Becoming a pharmacist is a stepping stone in the greater scheme of ultimately becoming this health care professional. An outstanding résumé is needed in order to be admitted into medical schools in North America. The majority of applicants will have worked in a lab or a hospital and have done hundreds of hours of community service. A few will have traveled abroad (most likely to Africa or Central America) and volunteered in some sort of humanitarian project, such as building homes or teaching in schools.

Dressed as Mongolian Warriors at Kharkhorin

I did not want to do either; I wanted to be different. Not only did I want something that would give me more experience in the medical setting, I also wanted to do some traveling since this would be my last summer before I graduate and become a pharmacist. A lot of the volunteer organizations I looked into only offered simple hospital tasks (e.g. cleaning hospital beds, spending time with patients, job-shadowing nurses and doctors, and possibly observing surgery). Projects Abroad stood out from the other organizations because their medical placements are tailored to the needs of the volunteer, based on the volunteer's level of experience and interest.

Since Projects Abroad offers medicine placements in a vast array of places, deciding where to volunteer was not an easy choice. After talking to a friend who went to Mongolia for a similar volunteer placement, I was intrigued by the country and the experience she had. What also made Mongolia so attractive as a volunteer destination for me was that no one really knows much about Mongolia. I even had a few friends who asked me where Mongolia is (they thought it was in Africa!). As a result, the allure of this mysterious place compounded with my desire for adventure was enough to convince me to select Mongolia.

Me and Tom Pastorius

My placement at State Second Hospital turned out to be phenomenal. When I first signed up, I never imagined that my volunteer experience would be so stimulating. I assumed I would just be job-shadowing doctors, observing surgeries, and performing simple nursing activities. I never thought that I would be the assistant surgeon in a variety of different operations! I still remember the first day I assisted in an operation; it was only my second day at the hospital! Dr. Altan, one of my two supervisors, told me I would be assisting her in a benign tumor removal operation. I was nervous but very excited. Adrenaline was pumping through my veins. I had always wanted to be a surgeon but to be able to assist in an operation at this stage in my life, with no prior surgical experience, was totally unexpected. Dr. Altan was extremely patient with me. She taught me all the necessary procedures which had to be taken before a surgeon can operate; this included 10 minutes of hand washing and scrubbing, drying the hands and forearms with a sterile cloth, disinfecting the hands and forearms with alcohol, and finally putting on surgical gowns and gloves. I actually found the entire process to be a lot of fun since I was already starting to feel like a surgeon at that point.

As I walked into the operating room, I saw the patient lying on the operating bed. She had a massive golf ball-sized tumor on her forehead. Dr.Altan led me to where I would be standing, right beside the patient's head. I stood there with both hands wide open wondering what I should be doing. The nurse then handed me a pair of forceps with gauze clamped on. My role as the assistant surgeon in this operation was to dab blood away from the wound as Dr.Altan made her incisions to remove the tumor. The operation lasted slightly less than an hour. I was about to undress when another surgeon asked me if I wanted to assist him in another surgery. He was a urologist. Without hesitation, I gladly accepted the offer without knowing what I was getting myself into. The operation I assisted in next turned out to be a circumcision!

A typical day for me at the hospital would be to arrive at 8am, do quick rounds with the doctors in the surgery department, and then get dressed to either observe or assist in surgery until 2pm. Over the course of five weeks, I observed and assisted on a wide range of different operations. Some of the more interesting surgeries I observed were hysterectomies, tumor removals from inside the stomach, and laparoscopic colostomies. When observing any surgery, I would always be only a few inches away from the incision site, thus getting a clear view of everything that was happening. Staring into the abdominal cavity after an incision had been made for open colostomies (removal of the gallbladder through a single incision in the abdomen) and watching the liver and stomach pulsate to the patient's heartbeat were truly extraordinary experiences. Whenever I was the assistant surgeon, my tasks included using retractors to keep the incision site open so that the surgeon's view was not obstructed and to wipe away any blood.

My supervisors at State Second Hospital

Aside from being in the operation room at State Second Hospital, I also helped out at another hospital, State Third, to do some nursing work every Tuesday. Tuesday is considered a bad luck day in Mongolia so no operations are ever scheduled on this day. Therefore, I took the opportunity to help out in some nursing wards once a week. On one of these Tuesdays, I learned how to give different injections: intravenous (IV), intramuscular (IM), and subcutaneous (SC). It was great! On another Tuesday, I helped a nurse clean wounds and change dressings. The tasks I performed were always medically-related and I enjoyed this hands-on experience.

Before I left for Mongolia, I thought I would be at the hospital Monday to Friday and explore Ulaanbaatar during the weekends. My assumptions were completely wrong. Although Ulaanbaatar is a pleasant city to be in, words simply cannot illustrate how beautiful the Mongolian countryside is. On weekends, Projects Abroad would organize group trips. During my five weeks in Mongolia, they took us to Terelj National Park and the ancient city of Kharkhorin. After going to the countryside my first weekend, I made a pact to myself that I would go every weekend and managed to stick to it. Although Ulaanbaatar is an interesting city, one must definitely travel to the countryside and spend a night in a ger eating "authentic" Mongolian BBQ and drinking airag (fermented mare's milk).

Playing with Nomad kids

The most memorable weekend trip was the one to Kharkhorin. Although the city was only 400km away from Ulaanbaatar, it took us 10 hours to get there mainly due to the fact that we were off-roading in the countryside in a bus. We experienced one flat tire on the way to Kharkhorin. The journey back proved to be a lot more unique, with another flat tire, a broken axle and ultimately a dead car battery! Clearly, this weekend road trip was extremely exciting yet uncertain at times; however, like everything else in Mongolia, it was a once in a lifetime experience.

Another highlight of my volunteer experience was donating money to one of the many orphanages in Ulaanbaatar. After spending five weeks in Mongolia and seeing the large number of orphans in the country, I wanted to help. I had the chance to visit one orphanage in the countryside and the kids there were adorable. All they wanted to do was to hold your hand and say "hello" to you in English. Before I left Mongolia, the director of Projects Abroad took me to one of the orphanages that Projects Abroad is associated with. My final act in Mongolia was to use some of my money to buy antibiotics, which the directors at the orphanage desperately needed. I was extremely proud of what I had done and hope to continue to donate to this orphanage with the help of Projects Abroad in the future.

Preparing to give an IV injection

Going to Mongolia was the best educational experience that I could have asked for. I gained so much medical knowledge and hands-on experience within just five short weeks. Not only did I have a great time volunteering at the hospitals, I also had the exciting opportunity to travel to the countryside on the weekends, learn a lot about the culture, make a lot of new friends, and eat a lot of exotic and interesting things. I highly encourage anyone who is interested in traveling and volunteering in the medical field to consider Mongolia. It is truly one of Earth's last undiscovered majestic landscapes. If I had the chance, I would definitely go back to experience everything all over again.

Edward Chien

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