Monday, April 7, 2014

B.Bolormaa: Instead of paying attention to District doctors, the ministry only thinks about higher level hospitals

Aside from the National Center for Maternal and Children’s Health (NCMCH) and District Children’s Hospitals, there’s hardly any hospital giving care to infants and children in Mongolia.

Since the Health Science University ceased doctor preparing classes in 1996, Mongolia is now limited in personnel for state children’s doctors.

Unlike adults, children are unable to state where and what is hurting. Becoming a children’s doctor is not a profession for everybody. One of the few doctors of this profession who graduated from the Children’s Faculty of the Medical Science University is B.Bolormaa. Throughout her career, she has built a reputation for protecting children’s health and giving her best effort in fulfilling her responsibilities.

She’s currently working as a doctor at Emuujin Children’s Hospital of the Bayangol Health Unit. This hospital is the sole children’s department of the District’s Health Unit. To learn more about the state of child health care in Mongolia, we spoke to B.Bolormaa, a Golden Stethoscope Medal recipient.

Have you done any other work besides your current profession?

Since 1990, I have worked in my profession nonstop for 24 years. From 1982 to 1984, I worked as an obstetrician in Bulgan Province. In the last 13 years, I worked as a children’s doctor at the Children’s Department of the United Hospital of Sukhbaatar District. Two years before transferring to Bayangol Province, I worked as an ICU doctor. People recommended that I work in the Children’s Hospital of Bayangol District. Our hospital began operating in June 1, 2013. Including the Head of the Department, there are five children’s doctors and around 20 staff in total. Since the workload is heavy for few doctors, I took dual responsibility of the ICU and Emergency Room.

Bayangol District doesn’t have a children’s hospital and children are examined in different district hospitals or private hospitals. Not many are familiar with your hospital. You don’t have the manpower to receive all the children of the district?

We have 35 quarters. Since the establishment, for around ten months, we have been accepting children of 7th, 8th, 13th, 19th, 20th, 22nd and 23rd khoroos of seven districts. This was due to their low capacity. Children aged from zero to 18 that are suffering from aggravated illnesses of respiratory or digestive systems are hospitalized here. Children in need of surgery or special health examinations are sent to level 3 hospitals. In times with little workload, we try to accept as many children as possible. Before 2014, we hospitalized and treated 590 children, after 2014, around 500 children came here. In the ICU department, we treat two to three children daily, during high-load days, five children and in a month, around 20 to 30 children are treated here.

In the last 23 years, there weren’t any children’s hospital established. Not just at a state level but also for Bayangol District, this hospital plays an important role for children’s health as there isn’t any for this district before. There used to be costly burdens when children of Bayangol District had to go to the NCMCH, Yarmag Hospital, Children’s Hospital of Songinokhairkhan District or private hospitals.

This hospital used to be a private house. The Minister of Justice Kh.temuulen fixed it for hospital purposes.

-Have you examined adults? It must be much easier than examining children?

-Children aren’t smaller versions of adults. Their body structures are completely different. Compared to adults, all of their organ systems aren’t completely developed and it’s hard to communicate. They cry for no reason and get fever for unknown reasons. Unless the mother defines these symptoms or pain, it’s difficult to know. In my opinion, it’s easier to examine children than adults. When adults come in pain, I can only think of giving them first aid. I instinctively know how children are feeling just by looking at them as I’ve worked with infants since my student days.

Apart from seasonal diseases, what kinds of illnesses do children get mostly?

Common diseases include aggravated illnesses of respiratory and digestive systems. In connection to this, children’s respiratory and immunity system are not completely developed, cold and flu are dominant in the winter and digestive system illnesses in the summer. Middle schoolers are hardly hospitalized, mainly children aged from zero to five. Apart from seasonal diseases, recently, swelling and chronic inflammation of the anterior tonsillar pillar became common for children. This is due to not providing health care for children to grow healthily. In other words, it’s connected to tooth decay and dental cavity. In recent years, young mothers are packing readymade products for their children’s lunch which is absolutely incorrect. During our days, mothers packed homemade lunches, different depending on each day and month and we had healthy shining teeth. Chronic inflammation of the anterior tonsillar pillar is a dangerous illness that may harm joints, the heart and kidneys. If your child has had a sore throat, rest them in bed until their fever has cooled down and treat them for 10 to 14 days with additional treatment for immune system. In Mongolia, mothers stop giving treatment or attention to their child after two to three days. This doesn’t completely heal, instead, it does the opposite and aggravates it. Disease sets in children aged from zero to five, that’s when they are to be treated for 14 days. This way it’ll cure completely. If children keep on getting ill when their immune system is getting better, it means that they have incorrect eating habits.

There are significantly fewer children’s doctors in Mongolia. Young doctors get depressed and reject their profession as the workload is heavy and has low salary. What is needed to increase interest in this field?

It was good when there was the Children’s Faculty in the Medical Science University. From the beginning, they made students love this profession and prepared them well. This class was ceased in 1996 and students wanting to become children’s doctor had to only study medicine for four years then attend a postgraduate training for two years. It’s very difficult to become a children’s doctor. It requires expertise in all areas. It’s a given that uneducated young people who haven’t learned to work in pressure get depressed. Most importantly, the workload is heavy. When doctors of other departments have high salaries, the ministry of the sector and related organizations have neglected us. Due to this, it wouldn’t be surprising for young doctors working in this profession for a short period to evade it. People who have worked all their life in hospitals are capable of enduring this. We had interns working in the United Hospital of Sukhbaatar District as well as here. After a month or two, they would get depressed and say that they want to quit. It’s a given. District hospitals have too much workload. The ministry only thinks about higher level hospitals instead of paying attention to the lack of district doctors. We attend training courses after being begged and pleaded. Only those who have basic education, love the profession and can dedicate themselves to become children’s doctors.

Lately, the NCMCH have been training children’s doctors. Before this, this field was abandoned.

In your opinion, how satisfactory are the skill and knowledge of Mongolian children’s doctors?

There are many capable doctors who have worked for many years, mainly in the children’s department. Their skills are exceptional. Out of five doctors working in our hospital, three have degrees, one is young and the other is an experienced doctor who studied and worked in the USA for many years. It’s a different case for doctors who’ve just graduated.

Diseases that mainly affect adults are affecting younger people. Why do you think this is?

These diseases are tuberculosis and diabetes. They occur to those who got these illnesses when they were young. It’s important that children are raised up healthily. They say that they have base diseases, rickets and intracranial pressure. However, their parents don’t even know what sorts of diseases they are.

From many years of experience, I’ve noticed that children from ger districts getting rickets are comparatively low. They are always getting out and communicate well with nature. Mostly children who live in apartments are hospitalized. Rickets is a condition that affect bone development due to deficiency of vitamin D. It’s common for children with rickets to have bad memory, small build, bad digestive system and frequent joint pain. Instead of saying your child has rickets or intracranial pressure, mothers need to get at least some medical knowledge.

There are criticisms that many doctors have started running private hospitals in recent years and have started treating public work indifferently. What’s your though on this matter?

Doctors can’t last for long in a situation where they’ve worked for many years with insufficient wages. We cannot blame those who’ve opened private hospitals due to this reason. It doesn’t mean that we can’t accomplish our private work without neglecting other jobs. If they are indifferent, then it’s a violation of doctor’s morals.

When will the Children’s Hospital of Bayangol District start receiving all the children of the district?

Starting next year, expansions will be made. The proposal to increase 35 quarters into 135 to 150 quarters was supported by the state. By 2015, we will have a big children’s hospital and start receiving children of Bayangol District. Although we have little capacity, we are equipped with all necessary equipment for emergency services, ICU and hospitalizing. In ICU rooms, all beds have monitors, respirators and IV fluid therapy equipment. All emergency room equipment meets the standards. Other district hospitals do not have modern equipment like ours. We have equipment from Germany, Japan and South Korea.

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