Dr. A.Nota’s skilled hands help heal Mongolia

This is an interview with State Honored Doctor A. Nota, adviser to the Neurosurgeries Department at Achtan Hospital.

-How many years have you been working as a neurosurgeon?

-I have been working in this field since my graduation in 1968 from the now-renamed Health Sciences University of Mongolia. As I had no previous surgery experiences, I initially worked as a repairperson at the surgical faculty in my home province Bayan-Ulgii’s Ulaankhus sum hospital. 

My first surgery was an appendix removal surgery. As I performed the surgery independently, I lined up all my medical books and referenced them throughout the whole operation and was successful. Surgical equipment was abundant in the sum but white cloth and cotton were not as plentiful. 

During my one year working as a surgeon there, I performed 52 surgeries. Then in 1969, I was transferred to the General Hospital of the province, and after two years there I was the head of its surgical department. 

During my time there, I have performed many surgeries of the liver, intestine and stomach, bones, gallbladder and brain. I have also performed more difficult and complex surgeries like the skull. 

-When have you arrived in UB?

-After working at the General Hospital of my province for six years, I arrived in Ulaanbaatar and immediately transferred to the neurosurgical department.

A hospital’s quality is represented by its surgical department. My goal was to become a very good surgeon. I worked in Ulaanbaatar alongside my former teachers, and periodically, high-profile surgeons from Moscow would come and perform surgeries with us.

Soon I went to Russia to complete a specialized course in surgeries for two years at the Neurosurgical Surgery Study and Research Center of the N. N. Burdenko in Moscow. I returned in 1982 and joined the General Clinic of P. N. Shastin. I worked as the head of neurosurgical department for ten years and in 2007 I joined Achtan Hospital after working as an advisor for a few years. 

-You have introduced many new methods of surgeries to Mongolia. What has assisted you in this?

-Mongolia’s surgery sector began developing only recently. Surgical and diagnosis equipment are out of date and very old. In 1970s and 80s there were no computers and X-rays. We used to diagnose patients with the help of their veins. 

I think I learned so much while I worked with world famous Russian surgeons in Moscow. Then I travelled to Russia, Turkey, and Japan more than a few times to study and improve my skills as a surgeon. I read almost everything new available on surgeries and medicine. I used to and still attend various meetings and conferences concerning world healthcare and surgeries. 

I think that all my experiences and the instances when I had to perform surgeries in cooperation with foreign surgeons in Mongolia helped me introduce many different methods of surgeries and make contributions to Mongolia. 

Foreign surgeries cost anywhere from USD 30 – 60 thousand. There are people who can pay this much, people who can manage to pay it and also some people who has no way of paying this. So the goal I have put forward is to read and explore from books and always having a connection with foreign surgeons and stay up to date with every technology and methods made available in surgeries worldwide. My goal is to help improve and contribute as much as I can to Mongolia.

-Neurosurgery is considered to be a very complex surgery, what would you say?

-Yes, it is very complex. A neurosurgeon must have very elegant and careful hands, and also must know a lot about computer diagnosis. Third, a neurosurgeon must know the human nervous system inside-out. 

-You must have performed thousands of surgeries. Can you remember some of your experiences?

-I have performed surgeries on approximately 11,000 to 12,000 people. There were many difficult surgeries, unfortunate and stressful surgeries that left me depressed. During the Socialist Era, medical professionals were frequently called out to the countryside to provide immediate care. I was called out on emergencies 50 – 60 times per year. I believe it was the mid-1980s – the Ministry of Health awarded me and a few other doctors and medical experts for working in the countryside for an extended period of time: I worked 262 days out in the countryside that particular year. 

There was one woman in Moust sum who had just given birth but half her body was paralyzed due to a stroke. It was around 1983 – 1984. Travelling with a car was impossible beyond the sum as her home was located in the mountains. So I rode a horse there and once I got there I knew she had a stroke. I told the family that through a brain surgery, the blood could be channeled out of the brain to ease the pain. 

I reported the situation to the Ministry of Health and acquired permission from the sum’s hospital administration to perform a surgery. Accompanied by doctors and nurses from the sum, the surgery commenced. The sum provided us with all the required material and equipment.

The surgery ended and she regained consciousness and was able to move and even talk: it was a very successful surgery. We gave the word to the Ministry of our successful operation and told them that we require a helicopter to take her to the center of the province or, if required, to the capital city. They replied that we take necessary measures until they arrive. So we waited 2 – 3 days. Doctors were giving the patient shots and medicine. Horsemen and doctors would bring more shots and medicine from the sum. But the only real problem was that we needed specific sorts of medications and shots – which the sum did not have – that was required for this particular post-surgery patient. 

A few more days passed and there was no sign of the helicopter.

On the fourth day the weather got cold and a snow storm began. Medications and shots were running out. 

Our patient passed away 7 – 8 days after the surgery due to insufficient blood to the heart. During the subsequent autopsy we found that the brain had swollen, but it is normal; brain swells up after surgeries. 

There were no other abnormalities. I guess this is my only regret throughout my career: the fact that we could have prevented this. 

-Do you perform surgeries in Mongolia that are usually only performed in foreign countries?

-There are many people who approach us who have been planning to go to other countries for surgeries. 

We have performed many brain surgeries. 

But certain brain surgeries and artery surgeries cannot be performed in Mongolia. Nearly 80% of all surgeries can be preformed in Mongolia. The remaining 20% is still a very large amount. The required life support equipments and machinery for post-surgery patients are not available in Mongolia; in addition that the number of professional surgeons in Mongolia is too low. 

-You are the President of the Surgeons’ Community of Mongolia. How many neurosurgeons are there in Mongolia?

-Mongolia has 30 neurosurgeons. This is not enough for a population of 2.7 million people. The number of available beds is not even enough. There are always people waiting for beds. Some people even wait more than a month for a surgery. Our hospital does not have problems, we have 40 beds for surgery patients, but it is a private hospital: only those can afford the costs come to Achtan. Others who are not as fortunate wait in line at public hospitals. 

-Do you have any new methods of neurosurgery you are planning to introduce in the near future?

-There is one particular nervous illness that causes contractions and excruciating pain in the face muscles. 

The patients with this illness can no longer speak, as the face muscles are constantly twitching. I am planning to have a surgery introduced to Mongolia that treats this kind of illness. 

There is also one rather dangerous neurological illness called epilepsy. I am intending to introduce new surgery procedures for this illness, the ones that countries with more advanced neurosurgery sectors use. 

-For 44 years you have worked as a neurosurgeon. Have you ever thought of reducing your work pressure?

-I am 67 years old. Any surgeon’s ability and productivity to perform surgeries depends on three factors: accuracy and flexibility of hands and fingers, strong memory, and the general health of the surgeon. 

Right now I have no problems with my hands, they do not yet shake. My eye sight is good. Compared to my days before the age of 60, I get more tired when performing 6 – 7 hour surgeries. But my exhaustion fades away once the surgery is performed successfully and when the patient wakes up and is healthy. 

I think my body has gotten accustomed to being in a surgical environment and pressure; that is why, I think, I am able to keep going the way I do today. 

In present day surgeries, we have stopped performing brain and spine surgeries with the naked eye. I think that is why I moved from public hospitals to a private hospital, Achtan in my case. I guess I prioritized myself here – private hospitals promised me twice as much salary and also guaranteed me with the most advanced neurosurgical technology available. These high end technologies have become my primary tool to introduce new methods, procedures and techniques to Mongolia.

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