Under the auspices of the International Children’s Heart Fund, Dr. A. Thomas Pezzella made his fourth trip in two years to Ulaanbaatar, Mongolia. While roughly the size of Alaska, Mongolia has a population of less than three million people. It is in the process of transforming from a totalitarian state to a democratic one and from a state-run to a free-market economy. Like its social and economic systems, its healthcare system is in flux. Government funding for healthcare is waning. While the government covers basic hospital and physician costs, individuals must pay for advanced surgical procedures, disposables such as suture, valves, drugs, and cardiopulmonary bypass components. Advanced graduate medical education does not exist. Foreign NGOs provide short-term education and training, but efforts are not coordinated.
Because Mongolia has a small population, there is only one established cardiac care center—Shastin Hospital #3. With the help and cooperation of a few foreign NGOs, particularly project Open Hearts and recently Samaritan’s Purse, the open-heart surgery program there is evolving slowly. Visiting cardiac surgery teams have been coming to Shastin Hospital #3 for the past ten years. A cardiac surgical team consists of ten to twelve professionals and performs five to ten procedures over the course of a week. During the visits, the engagement of the local host team is stressed. It is hoped that over the next five years, essential local personnel will receive additional training in anesthesia, perfusion, and critical care nursing.
The majority of cases seen at the cardiac care center involve rheumatic valve disease and congenital heart disease. However, as the population becomes more urbanized and the Mongolian diet becomes more westernized, coronary artery disease is becoming more prevalent.
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Interestingly, a few older cardiac procedures, including closed mitral commissurotomy (CMC), and surface cooling with inflow occlusion for repair of ASDs and small VSDs, are routine. In addition, a midline sternotomy with a gigli saw is typical. With the gradual improvement of the economy and health care system, the ultimate goal is a fully functional open-heart surgery center that performs 400-500 cases per year.
The open-heart surgery program in Mongolia has the following short-term needs:
Long-term needs include the strategic reorganization of the Mongolian health care system with the support of sophisticated/advanced medical care.
In addition to the support of the open-heart surgery program, help has been directed and is still needed in Thoracic surgery, especially in lung and esophageal surgery at the Mongolian Cancer Center, and tuberculosis surgery at the Infectious Disease Center. An Advanced Trauma Life Support (ATLS) training system is being implemented at the Mongolian Trauma Center.
Interested individuals or teams should contact Dr. Pezzella for additional information regarding future trips and initiatives.
