Инноваци - Шинэ Санаа, Шинэ Нээлт, 2008, 1(5-1)
What is the future for Mongolian healthcare?
( Шүүмж, эргэцүүлэл )
Товч намтар
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Доктор Бак Рашер нь Америкийн Нэгдсэн Улсын Арканзасын анагаахын сургуульд суралцаж төгсөөд Техаст хагалгааны дадлага хийсэн ба 2001 онд монголд иртлээ 1979 оноос хойш Арканзасын Жонесборо эмнэлэгт цээж хэвлийн судасны мэс заслын багийн ахлагчаар ажиллаж байжээ. Доктор Рашер өөрийн эхнэр Пэмийн хамт Монголд анх удаа 1993 онд ирж Эрүүл Мэндийн сайд Жигжигдсүрэнтэй нөхөрлөн найзынхаа хүсэлтээр УКТЭ-т сарын турш ажиллахаар болсон байна.
Доктор Рашер 1995, 1998 онуудад монголын мэс засалчидтай хамтран ажиллахаар айлчлан ирж байсан юм. Мөн Арканзасын Бернард эмнэлэгт 1994, 1996, 2004, 2006 онуудад монголын мэс засалчид дурангийн хагалгааны талаар суралцаж байжээ. 2001 онд доктор Рашер болон хатагтай Рашер нар 3 жилийн хугацаагаар Улаанбаатар хотод ажиллаж амьдрахаар нүүн иржээ. 3 жилийн хойно АНУ руу буцсаны дараа 2006-2008 онд УКТЭ-д ажиллахаар дахин буцаж ирсэн байна. Энэ хугацаанд доктор Рашер өөрийн найз нарын хамт Арканзасаас мэс заслын шаардлагатай тоног төхөөрөмж, эд материалыг явуулж орон нутгийн эмнэлгүүдэд тарааж байжээ. Тэрээр монголын 13 аймагт богино хугацааны томилолтоор ажиллаж байсан ба 2007 оны 10 сард клиникийн профессор цол хүртжээ. Мөн тэрээр хэд хэдэн уулзалт, зөвлөгөөнд илтгэл тавьж оролцсоноос гадна залуу мэс засалчдыг болон резидентүүдийг ерөнхий мэс заслын үйл явцад түлхүү хандуулан заавар, зөвлөгөө өгөн ажилласаар байна.
I am making some statements here based on a 14 year close working relationship with Mongolian surgical colleagues.
This began in 1993 just after the country became a democracy as Russia left its occupation here. As a surgeon myself, I have noted a considerable number of surgical improvements in equipment and in general skills especially in the city. This is mostly due to outside influences of both Christian and humanitarian organizations which have come to teach, to work cooperatively, and to share. However, some things have changed little and that would include the same old buildings, same old patient rooms, same old organization of departments and hospitals, and the same old lack of communication between health professionals.
This leads me to say yes, there are problems here, so let us be busy identifying them by making suggestions and then by finding solutions. Once identified, these problems may be addressed and progress will have a chance to occur.
First of the problems has to do with Laparoscopic Surgery. This is becoming the standard for the world in surgical care. It does not occur easily nor cheaply. Mistakes in surgery will happen so beware. Find and use the best possible equipment, get good experience by working with others who have been trained, and build a good reputation. Don’t take chances. Go slowly. It takes years to build this reputation yet only one unfortunate result can destroy it!!!
Secondly is the loss of revenue to foreign countries. Affluent patients have tended to go to China, Korea, and Japan for treatments when they can afford to do so. But I will assure you NO ONE wants to leave home if treatment of equal quality can be offered here. I would make the suggestion of investing in quality equipment, and you must retain qualified MDs in Mongolia. A foresighted Minister of Health would be invaluable if he could get the vision to use “lost funds” going to other countries to build the national public and private health system. This will take a special person.
Thirdly, I would identify poor quality of care as a big problem. As a solution, we can offer better training for doctors and nurses. Would you consider hiring larger hospital staffs since there are so many unemployed doctors? Better salaries for the medical professionals are a must to keep quality people in the field of medical care. Peer review of cases will keep people on their toes and can certainly be used beneficially to teach young doctors. Competition between hospitals is healthy as it only drives quality care upward in order to attract patients who should be given a choice of where they go. There should be more interdepartmental cooperation in hospitals because no one can be expected to know everything and we should share patients for the sake of better outcomes. Improving our facilities is a must and all this is to keep patients in Mongolia rather than to lose funds to other countries.
Fourthly, there are becoming two distinct classes of patients in this country. The wealthy and the needy. Private hospitals are one way to serve the more affluent but that does NOT guarantee better doctors. I would make the suggestion to develop a private section of the public hospitals. This would allow the broadly trained teaching physicians who have good experience to have a private income and at the same time be available to help the needy patients of the country. It would be a way for the wealth of Mongolia to be put to use in helping to subsidize the healthcare for the poorer patients. It would seem that all parties would benefit from this if it is practical and possible to do so. This takes careful administration and budgeting and honest distribution of funds.
Fifthly, there is a terribly high incidence of liver disease in Mongolia. Too high. Most of this is a result of hepatitis but I understand there are efforts to immunize young folks against this problem at least for Hepatitis B. But the other type of liver disease is cirrhosis directly attributed to excess alcohol. How sad to have such a self-induced epidemic of liver disease! For these problems, I do not think liver transplantation is something we can do in the near future because of expense, sophisticated medical management needed, and simply put, a lack of healthy livers to transplant. I would highly recommend an emphasis on the prevention of liver disease by alcoholism. This is a national matter and should be countered with advertisement and training in schools.
The total number of small hospitals in the city seems to be excessive. This would call for reorganization by the government. I would not like to see anyone lose jobs, but I do not advocate continuing poor care in small hospitals. As mentioned above, there is a trend toward privatization but that does not guarantee quality care. Left to its own results, competition will close the doors of poor quality clinics and hospitals due to lack of patients and therefore lack of funds to keep them open.
The seventh problem I can recognize is the inadequate training of medical and nursing staff. The solution thus becomes a longer more intensive training, and I would certainly recommend some small pay during residency as these young doctors in training are working for the hospital. They need more broad training which demands longer times of residency service. There is a total lack of prophylactic health care in Mongolia and so it would seem reasonable to put more emphasis on general medical or family healthcare specialties for the next decade. Nurse training is also inadequate and this must be improved to allow for better patient care in hospitals especially at nights and weekends when medical personnel are away or resting.
Better communication in hospitals and between hospitals is my eighth recognized problem. Telephones in hospitals are limited to special offices and are not generally available. In my experience, most developed countries have a good phone system with hospital operators and paging systems to quickly and efficiently reach doctors who may be needed. There is also a poor arrangement for patients to get from the countryside to the city with health care needs. Too often a doctor goes from city to country with little to work with once there. This is a big multifaceted problem. I would even suggest the use of cheap digital cameras and laptop computers to link the specialists in UB with those special predicaments that occur in the country. Both pictures of patients and of X-rays can be quickly sent this way and should be able to quickly be seen and responded to. The whole point would be for there to be fewer complications occurring in the countryside.
The ninth problem is certainly a general lack of funds to do anything big. I would counter this problem with the solution of learning to NOT depend on Government. Let the “business of medicine” be the vehicle for the improvement of healthcare in Mongolia. In my western mind, there is no reason patients should not be expected to pay for the care rendered. It is essential they do so as it will allow for needed funds for purchasing needed equipment for the next patient. There will have to be a fair and equitable budget set up for such a practice but if there is no money, you can expect there to be no progress in medicine and a future of steadily declining interest in serving as medical professionals. Already we have medical classes of >80% females. This is a message to the Mongolia of the future. Listen.
My tenth problem is rather a list of problems just to mention the numerous other problems that will need some close attention at some point. I am sure there are others than these, but mercifully I will leave it with just the below stated ones.
- Sterilization techniques
- OR room ventilation (none presently)
- No colostomy supplies in hospitals/stores
- Transportation on Mongol roads
- Better elevators in hospitals
- More convenient family waiting spaces
- More utilization of Hospice organizations
- More complete service hospitals
- Too frequent changes in hospital and departmental leadership
- No central supply in hospitals (and little sharing between hospitals)
There are others I am quite sure and these each need individual attention. There is no shortage of problems here, but each problem is an opportunity. It is the management of the opportunities that will determine the future progress in Mongolian healthcare. I am not pessimistic. Progress is occurring and will continue. Be patient, but think aggressively toward your future. Many future lives will depend on the decisions you make now.
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