Mongolian Expedition: Tips for Visitors

Marc Shaw, FRNZCGP, FFTM, FACTM, DipTravMed

Mogolia. I couldn't believe that I was finally there. The Memsahib (my wife Lynne) and I had finally arrived in Ulaanbaatar (UB), a city still living on the dubious laurels of Genghis Khan. Compared to Beijing, the city was rugged and dirty and unkempt. The clear bright skies overlording the city and surrounding hills augured well for our upcoming expedition, the aims of which were becoming clearer now that we were there. Interesting, isn't it? You can do all the research for a trip but nothing beats getting there, smelling the air and experiencing the place and its people.

I am to be the team Doc for SES Expeditions, quite a well-known group operating out of the UK. We were in Mongolia to assist in digging fossils for a prominent Mongolian palaeontologist, collect rare plant specimens for a university botanist, and to track the route of the snow leopard in southern Mongolia.

It was at this stage of the briefing that Memsahib cautiously asked how high we would be traveling. `3,500 metres' came the reply from Simon, the gushing expedition leader. `Going to be bloody cold, about minus 10 C, and we won't have any water for showering or washing for four weeks.' Memsahib looked at me, daggers in her eyes and with a knowing `I TOLD you I didn't need to be here' look. `But', said I to Simon, `we can use wet-wipes to wash, can't we?' nodding to she-with-closed-eyes. I got a most strange look from the rest of the 15-person party. A sort of `and YOU are our doctor?' gaze.

Simon had just finishing addressing the group as to the risks and hazards of our anticipated travel south into the Gobi. Now, I have always wanted to go there; ever since W.E. Johns wrote a fine schoolboy book called `Biggles in the Gobi', which I read when I was eight years old. For me then this was a voyage of discovery and revelation, built upon childhood images. When I told the group this, they again stared at me. Memsahib told me to `settle down and check the medical kit.'

I obediently complied. Our kit needed to cover a wide variety of possible emergencies. I have to say that I spent much time in getting it right, yet having it contain appropriate meds for our trip. "Getting it right" is a much harder call than it would seem, for it is easy to include all that one `might need', much more difficult to be objective about an expedition's actual requirements. Obviously this latter is very dependant on itinerary and also on the health of the expeditioners. Our kit was compact, pretty inclusive and very practical and, like all medical kits, wasn't actually needed very much at all! There, I had ticked off `Part 1' on my checklist.

The kit was checked out, and so the next thing was to check out more specific local health issues. Over the last couple of years, there have been more and more folk going to Mongolia, so it is appropriate that `Part 2' of any expedition work-up includes LOCAL RESOURCES. To this end, I check out the medical services and resources in any area that I visit.

In Mongolia, the level of medical services provided is not up to western standards. In the countryside, outside of UB, medical care is very difficult to access. All Mongolian hospitals are very short of most medical supplies, including basic care items, drugs, and spare parts for medical equipment. Though having said that I visited a local hospital in Dalandzadgad (south of the country, in the Gobi Desert) where I was amazed at how well it WAS equipped. Nevertheless if a traveler needs to seek care in UB - and this generally goes for all developing countries - then several things should be kept in mind when dealing with local health care providers:

• There are generally no English speaking physicians or staff at any of the local hospitals or clinics. Many of the local doctors in UB were trained in the former Soviet Union, and therefore speak Russian. If you don't speak Russian or Mongolian, then an interpreter will need to accompany you to the hospital. When you're sick is NOT a good time to try learning a foreign language!
• Most Mongolian hospitals have not established fixed fees for foreign patients. To avoid being charged exorbitant fees for even routine care, travelers need to be advised to inquire about fees before services are rendered.
• Always telephone the hospital or clinic before visiting to be sure that it is open, that the proper staff is on duty, and that the hospital has the supplies and equipment to perform the desired service. Once again, no English-speaking staff will generally be available to answer your call, and hand gestures (with or without blood) don't convey well over the phone.

Recently an international clinic called the SOS Medica Mongolia Clinic has opened in UB. I visited this centre, and applaud its excellent amenities. Westerners living in the region are now starting to go there for routine medical care, but other than this facility, there are really only three others that are regarded at all in UB:

• Russian Polyclinic Hospital: This is the best-supplied and least crowded local hospital in Ulaanbaata. The staff is Russian, but some English is spoken.
• Hospital Number 2: The Mongolian-run Hospital Number 2 is the designated hospital for foreigners in Mongolia. It is generally considered to have the best care available in a Mongolian facility.
• Yonsei Friendship Hospital: This is a Korean-Mongolian outpatient clinic and has dentistry services as well. These facilities are designed to provide quality medical care at affordable prices to the local population and to foreigners. There are a couple of English speaking doctors.  

A cursory check-out of the pharmacy services in the city displayed that all types of medicine are in short supply, often unavailable. For travelers to the region, I would thus advise `Take your own medication, in fact double the amount just in case some gets lost.' On an emergency basis, some medicines may be available from the Russian Polyclinic or Hospital Number 2, but don't count on it!

Our expedition group had three interpreters and so my job in surveying our pre-travel organization was thus made much easier. We had catering for our group, so a diet that was acceptable to the expedition was essential. Before deciding this, the dietary needs of the group needed assessment: we had a diabetic and a vegetarian. Our expedition had good food planning for the trip. The food situation is improving in Mongolia, and the variety of food is increasing. In UB fresh fruit and vegetables, which used to be subject to seasonal changes, are now available throughout the year (imported from China by train). In the countryside, however, it is very difficult to find fresh fruit and vegetables, especially in winter. Beef, pork, mutton, lamb, and imported poultry are available. No `special cuts,' just a `cut a hunk' policy.

Got back to the hotel, initial surveillance for the trip done. Memsahib went to bed exhausted with all the walking. Before doing likewise, I got out my checklist: 1) I had prepared information for our group on what we were needing to take and plan for, 2) I had checked out the local medical resources in case of emergencies, and 3) I had determined that we had good food and nutrition for the trip. `Hot to trot,' we were ready to go into a region of history, survival and legend. But this is another story!

Marc is an Associate Professor at James Cook University, Townsville, Australia and medical director of WORLDWISE Travellers Health Centres, and WORLDWISE OnLINE Travellers Health Informatics in New Zealand.