Hernia International Mission to Mongolia May 2015

Team members:

Surgeons:                    Trent Cross (Team leader)            Australia

                                    Mohan Jayasundera                Australia

                                    Hans Moser                            Germany        

                                    Jurgen Meyer                          Germany

                                    Markus Heiss                          Germany

Anaesthetist:   Peter Schuller                         Australia

Hernia International mission to Mongolia May 2015

This mission to Mongolia was a two part mission, with great contrasts in facilities and case mix. In the first week Trent, Hans, Jurgen and I travelled to Bayankhongor airmag, a rural centre around 15 hours drive from Ulaanbaatar. The second week was based at the Second General Hospital in central Ulaanbaatar, where we were joined by Markus who replaced Jurgen. The whole mission was co-ordinated by Enkhee, who not only provided all logistics support, but came with us on our long trip to Bayankhongor airmag, and ably helped us throughout the varied and challenging mission.

Bayankhongor is the administrative capital of the airmag (province), serving a population of 80,000 many of whom are rural herders. Although the distance from Ulaanbataar is around 700km, the journey across the empty steppe took over 15hours, arriving at around 2am.

However, the country side was beautiful in its barrenness, with the winter snows still melting on the grass steppe.

The local Hospital administrator and provincial governor both went to extreme lengths of hospitality to make us feel welcome. Some of the highlights include: a full traditional Mongolian concert performance in the concert hall, performed specially for the Hernia International team; Accommodation provided for us at the local hotel; Visits to the local Natural History Museum which specialised in the regional Gobi Desert flora and fauna; A grand dinner provided by the provincial governor in his private restaurant; and after our last day at the hospital, a huge traditional Mongolian feast in a yurt with the obligatory vodka toasts.

In the hospital we were provided with two operating theatres and divided the cases between the German and Australian teams.

The local surgeons were very keen to learn, and by the end of our week were performing most of the operations with our guidance.

As well as adult hernias, there was a large volume of paediatric cases, including many redo hernia operations and orchidopexies. The incidence of cryptorchidism seemed to be very high, perhaps due to the extreme cold endured over the winter! We were continually amazed at the stoicism and bravery of the local children.

Every lunchtime we were provided by an amazing assortment of different traditional Mongolian fare provided by the hospital kitchens. At the end of the week we were all fluent in the Mongolian and Russian terms for the surgical instruments and other important vocabulary!

After this busy first week, where we were humbled by the hospitality of our local hosts, we headed back to Ulaanbataar. Trent and Jurgen returned early, with Trent and Markus to present at the First Mongolian Congress of laparoscopic and endoscopic surgery. The remaining team members took a detour, visiting the Shargaljuut Sanatorium. This involved a 3 hour drive across the steppe on dirt four wheel drive tracks through pristine rural country side. The emptiness was punctuated by local herders and their yurts. We were lucky enough to visit one, as one of the herdsman was a relative of the driver, and were allowed to ride his horse and sample the traditional fermented cheese. The Sanatorium was definitely an eye opening experience, based around various hot springs which were used to treat an assortment of illnesses.

The second week at the Second General Hospital was a contrast in facilities and cases. The Hospital had been visited by previous operation hernia teams, and were particularly keen to learn more advanced techniques. Several laparoscopic inguinal hernia repairs were performed (both TAP and TEP), a giant parastomal hernia repaired demonstrating the Sugarbaker technique, as well as a wide variety of adult hernias. We were ably led by our team leader throughout this mission, which was definitely full of excitement and action!

Mohan Jayasundera

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