I have been in Mongolia for almost a week now and it has been amazing. After a 21 hour trip, I arrived in Ulaanbaatar around 10:30 pm. Thankfully, I was through customs with my luggage in about 10 minutes and didn’t have a long wait. I was picked up and delivered to my apartment where I met my roommate. She is a recently graduated veterinary technician from Nebraska and is finishing up a 3 month-long internship in the next week. I am going to miss her when she leaves!
The following morning (Tuesday), I was up bright and early – mainly because I only got 2 hours of sleep – after devotions, we went to the small animal clinic and we began our day. The most memorable case of the day was a little cat named Fluffy. Her owners noticed her having difficulty breathing for the last few days so they brought her in for an exam. She was found to have fluid around her lungs. I assisted the Mongolian veterinarian in thoracocentesis (removing fluid from the chest cavity with a needle). Later in the day, I learned that the clinic has an ultrasound machine, so we decided to take a closer look at the chest and see if we could see any heart problems since the fluid obscured the heart on radiographs (x-rays). What we saw changed everything. There was lot of fluid in the chest, but there was also fluid in the sac around the heart. I recommended a pericardiocentesis (removing the blood from around the heart with a needle) and it was agreed that this would be a good idea. I then learned that they did not know how to do this and would like me to show them. I am happy to say that my first pericardiocentesis was a success! I was able to drain fluid from both around the heart and from the lungs. Additional recommendations were made to the owner for care, but they decided to take her home and monitor her, even though there was a good chance that she would die. I have not heard how Fluffy is or if she is still alive, but I hope that she is.
On Wednesday, I met a wonderful woman, Ogi (pronounced Auggie), with two dogs, Sabu and Helga. Sabu is older and in wonderful shape, Helga is a 6 month old French Mastiff that has a premature physeal closer of the distal radius (the growth plate fused too early). I had one of the other doctors, Andrew, take a look at the radiographs and he is coming up with a plan to treat Helga over the next 6-12 months – most likely with external fixation to gradually lengthen Helga’s leg as she grows. We will see what can be done with the limited resources available. I have completely fallen in love with Helga. Ogi is also amazing and has offered to help me out with anything here in Mongolia. We exchanged information so we can stay in contact after we are done treating Helga.
Thursday brought a ferret into the clinic. Ferrets are not common pets in Mongolia and everyone looked at her with suspicion. It was exciting to meet her. She is about 2 years old and was never spayed. She has been in estrus (heat) for 2 months. Ferrets that are not spayed (had their ovaries removed) and are not used for breeding develop estrogen toxicity. The estrogen from their ovaries damages their bone marrow and they stop producing new red blood cells. Luckily, the treatment is to spay them. Usually, it is recommended to use hormone treatment or even blood transfusions to get them into a safer state for surgery, but we didn’t have those options, so we spayed her. She did very well in surgery – my first ferret spay – and looked good the next day as well, even though she was very pale (her hematocrit was only 22% before surgery). We were also able to discuss ferret behavior. The first time this little one came into the clinic, the veterinarian thought she was aggressive and attacking them, but it was only play behavior. Later that day,we had a veterinarian that used to work at the clinic, and has since started her own clinic, come in with a case – a husky puppy that had been hit by a car the day before. He had been diagnosed with a fracture femur (broken back leg), but had been doing well otherwise. When he came into us, he was having difficulty breathing. His heart and lung sounds were muffled on his left side and radiographs showed that he had a diaphragmatic hernia – his stomach was in his chest instead of his abdomen and it had displaced his heart and lungs. As the owners decided to have him euthanized, he died in our arms. I was allowed to do a necropsy, which although sad was amazing to see how a small hole in the diaphragm could cause so much destruction.
Friday, we performed surgery on a Pekingese that had been attacked by a dog the week before. She had multiple hernias, one contained the majority of her intestines that were outside of the body wall, but still under the skin. We had to remove the contents of the hernia pouches back into the abdomen, then clean the areas, repair the torn muscles, close the hernias, and remove the spleen that had also been damaged. It was a long surgery, but Bayaraa (pronounced ByRa) did wonderfully with me as her assistant. This was her first splenectomy (removal of the spleen) and a major trauma case. Choppa (not sure how it is really spelled) did great and went home that afternoon. We had another emergency case later in the day, a cat that was in dystocia (labor complications). The owner agreed to C-section and spay. None of the veterinarians I was working with had done a C-section before and one has not spayed anything either, so they had me do the surgery while they watched so they would know what to do in the future. The kittens were already dead and rotting, the mother cat was toxic. Surgery went as well as could be expected with rotten tissue that were falling apart. Sadly, The little cat did not make it. She died about 20 minutes after surgery was completed. I cried and mourned the loss of the cat.
This week has been filled with highs and lows medically, but I know that God has a plan in it all. I wasn’t sure if I was going to be able to do much here and really make a difference as I am just a regular doctor, not a specialist, not a genius. What I have found is that here, I am the specialist. There is no one else to go to with more experience. Although there is a veterinary school it is all book learning, there is no hands on teaching. There is not an emergency or specialty hospital near by…or anywhere in the country. We are the specialty hospital! I am thankful that Andrew is here to take care of the orthopedic (bone) problems as they make my stomach turn, but otherwise, I am currently the go to person for exotics, behavior, anesthesia, surgery, internal medicine, ophthalmology, dermatology, and the list goes on and on. I am thankful to have had such a well-rounded education and experience thus far. I am also thankful that I have not always worked in places that had every gadget and gizmo, the latest medications or diagnostic tests, because I have very few of them here. I have about 4 antibiotics, 3 anesthetics, 3 pain medications, and some deworming medications to work with. I have ultrasound and radiography, but I don’t have blood machines – we have to send them to the human hospital and wait a day or two for results which are not always accurate. There are cages full of dogs with diarrhea and vomiting, but the test to find out if it is parvovirus is too expensive for most Mongolians to afford. There is no true isolation to prevent spread of disease either. I am learning to practice with the basics again – focusing on my physical exam and reviewing the differentials for any case with a keener eye as I can’t test for many of them.
Outside of the medicine, I have met so many people – it is hard to keep all of the names and faces straight! I have started to learn some Mongolian, very slow going, but hopefully, I will have enough down to have a basic conversation soon. The food is nothing like HuHot, but it is very good. I don’t know that I have ever eaten this much meat and rice in 1 week before!
The best news of all was that as I was checking in for my flight leaving Chicago, my sister had her baby! Will was born at 3:07 pm in the UK. Congratulations, Kayla and Tom, and big brothers David and Trenton! Happy birthday, William!!
Please continue to keep in your thoughts and prayers: Mongolia, Kayla and William, the Mongolian people and the veterinary community, and me – that I can do the work that I have been sent here to do with the love and peace of Christ leading me each step of the way.