Friday, August 29, 2014

New hospital to address Mongolia’s cancer crisis

According to the World Health Organization (WHO), Mongolians are investing more money in their health and consequently, living longer, healthier lives.

According to WHO, the probability of an individual living in Mongolia dying under the age of five, as of 2012, is 28 out of 1,000 births. This is down from 42 out of 1,000 births in 2006. The infant mortality rate has decreased from 44.6 to 19.4 deaths out of 1,000 live births between 1995 and 2010, just as the maternal mortality rate has dropped dramatically from 186.9 to 45.5 deaths out of 1000 in 1995 and 2010 respectively. Similarly, in 2006 the total expenditure on health per capita was 149 USD, but as of 2012 had more than doubled to 345 USD. The total expenditure on health was 5.1 percent of the gross domestic product in 2006, but has risen to 6.3 percent in 2012.

However, the increase in life expectancy and decrease in infant and maternal mortality should not overshadow more pressing concerns in Mongolian health and healthcare. Current research investigating the leading causes of mortality in Mongolia shows that Mongolians are now at a greater risk for lifestyle- and behavior-dependent diseases. WHO states, “The changes in Mongolian [health statistics] are reflected in the burden of diseases moving from communicable to non-communicable diseases. Leading causes of mortality are now circulatory system disorders and cancers.”

The result of a successful, national program of high immunization coverage and public awareness education has meant that infectious diseases have not been among the leading five causes of death in Mongolia since 1990. Instead, circulatory system diseases, cancer, and injuries have taken their place. Despite being the primary cause of death in 1990, respiratory system diseases have now fallen to fifth place. This is in contrast to a sharp increase in numbers of deaths from injury and cancer.

Mongolia’s rate of cancer is particularly worrying. According to WHO, cancer is a leading cause of death worldwide- accounting for 8.2 million deaths (approximately 13 percent of all deaths) in 2012. The most frequent cancers are lung, liver, stomach, colon, and breast cancer. In Mongolia, cancer accounted for eight percent of deaths in 1989, but was listed as responsible for 21 percent in 2010. This means that the rate of cancer in Mongolia is eight percent higher than the global average.

In addition, according to the World Cancer Research Fund, Mongolia has the highest rate of liver cancer in the world, 33 times greater than the rate in Russia. According to the National Cancer Registry of Mongolia, between 2003 and 2007, 17,271 new cases of invasive cancer were recorded (52.2 percent in males, 47.7 percent in females). Liver cancer was noted as the most common cause of death by cancer for both genders, with a rate that is approximately four times the global average.

Research suggests that this high rate of cancer is largely a result of life style. According to the second WHO STEPwise surveillance survey, conducted in 2009, 27.6 percent of the Mongolian population smoke, and 42.9 percent of the population was exposed to second-hand smoking at home. 38.6 percent of respondents reported consuming alcohol in the 30 days previous to taking the survey, and binge drinking (more than five drinks on one occasion for men, or more than four drinks for women) was 39.7 percent in men and 15.1 percent in women. The survey also noted that almost half (39.8 percent) of the Mongolian population is overweight, and 12.5percent are obese. Between 2005 and 2009, the prevalence of overweight and obese individuals has increased by 8.3 percent and 2.7 percent respectively. Manifold studies from various institutions all over the globe have linked the consumption of tobacco, alcohol, and excess body weight with increases in various cancers, thus providing a direct link between lifestyle choice and health.

To address the problem of cancer growth in adult Mongolians, opportunities are being pursued to prevent liver cancer through education of the dangers of excessive alcohol consumption, and the promotion of hepatitis B vaccinations. In addition, other forms of cancer common in adults, such as lung and cervical cancer, are being addressed through education of the dangers of tobacco usage and through increased access and affordability of pap-smears and other preventative, diagnostic gynecological care.

The risk of cancer and disease among children, however, is less the result of lifestyle and behavioral choices, and more frequently a consequence of insufficient access to adequate healthcare. According to a 2007 review of pediatric health in Mongolia, child deaths due to acute respiratory infection and diarrhea have decreased, whereas deaths due to neonatal causes and injuries have increased. Neonatal deaths, as of 2010, represent almost two thirds of all infant deaths in Mongolia, with 80 percent occurring within the first week of life. This is largely a result of insufficient medical treatment that is necessary in the crucial first weeks after birth.

Arjia Rinpoche, well-known to the public as the 20th Arjia Danpei Gyaltsen, a high Tibetan lama of Mongolian descent, has noted on his website ( that 86 percent of Mongolians who are diagnosed with cancer have terminal cases. Of these, most survive less than a year. Cancer is the second leading cause of death in Mongolia, and a large number of patients are children, in whom the incidences of leukemia, brain tumors, and osteocarcinoma (bone cancer) are higher on average than in other countries.

Additionally, the cost of health care is rising in Mongolia, largely a result of the post-Communist shift towards a market-driven economy. Cancer treatment is particularly expensive, due to the cost and inaccessibility of the necessary machinery and medicine, as well as the long-term nature of most chemotherapies and other cancer treatments.

In response to this need, Arjia Rinpoche and his colleagues have developed The Cancer Care Treatment Center for Mongolian Children. Rinpoche, who is also the director of The Tibetan Mongolian Buddhist Cultural Center in Bloomington, Indiana, USA, the founder of The Buddhist Center for Compassion and Wisdom in Mill Valley, California, and the founder of The Center for Compassion and Wisdom, a non-profit and non-government organization, has undertaken extensive efforts to raise funds and public awareness for the development of a new pediatric oncological hospital to serve the children of Mongolia.

Having investigated multiple pediatric cancer units in hospitals across the US, Rinpoche and his team convened with medical and government officials of Mongolia, and decided upon the current structure: a six-story building within the grounds of the Mother’s and Children’s Medical Center in Ulaanbaatar. Previously, this hospital had a pediatric oncology section; however, its small size prevented the dissemination of adequate medical treatment. In 2010, there were only 16 children being treated, and in 2012 the number was no more than 26.

The new pediatric hospital is comprised of the following: the basement and first floor contain advanced medical equipment, including an angiography machine, to diagnose and treat congenital heart disease, with plans to acquire a CT scanner and an MRI. The second floor is reserved for neonatal and cancer surgeries. The third floor is the neonatal intensive treatment unit with 25 incubators for premature newborns. The fourth through sixth floors contain the blood disease and cancer unit, containing 50 beds, and will provide all necessary conditions for children with cancer and other debilitating diseases.

The goal of the hospital is to address the key obstacles in child healthcare in Mongolia, namely: the care of prematurely born children, providing necessary surgical care and machinery for all cancers (in particular leukemia), providing bone marrow transplants, and encouraging international collaboration between hospitals in order to share developments, technologies, new strategies and resources. In addition, each room in the hospital is equipped with purified oxygen, a vacuum system, an air compressor unit, and an intercom installed into the walls. This allows for easier access to necessary medical equipment, without the need to transport these items between rooms.

Rinpoche also noted the importance of creating resources for palliative care, similar to the popular Ronald McDonald House in the Unites States. Long-term cancer treatment for children, Rinpoche remarked, is particularly difficult for families who do not live in the capital city. The financial and practical challenges of transporting a sick child between the city and the countryside in order to stay with the family between treatments impede the healing process. To address this, Rinpoche is planning the development of a second building, adjacent to the newly opened hospital, to accommodate families of patients. This building will have seven accommodation rooms and a conference room for visiting physicians and researchers to facilitate the exchange of information, and to allow easier access to doctors who come to educate and instruct the hospital’s staff.

The hospital, while independently funded, will be a government run organization. Rinpoche notes that many of the problems apparent in Mongolian government hospitals, in particular corruption and the lack of access to necessary and sufficient medication, will likely also be a problem here. He is working with his colleagues to address these issues, and thinking of importing medicine directly to the hospital from India. Similarly, the question of corruption looms large, and as such Rinpoche plans to hire staff specifically to monitor the importation of the medicine and the maintenance of the machinery, to make sure that nothing is stolen and sold on the black market.

The cost of this hospital is currently at 2.8 million USD, of which almost 2.6 million USD has already been raised. The funds have come from donations, predominantly from Taiwan, Hong Kong, Singapore, and the US, as well as from the European Mongolian Society and the Mongolian Society of London. In addition, all money from Arjia Rinpoche’s memoir, “Surviving the Dragon- A Tibetan Lama’s Account of 40 Years of Chinese Rule” has been directed towards the project. Rinpoche notes that the Mongolian government has promised 230,000 USD towards the project, but so far has only contributed half of that amount.

When asked about the opening of the hospital, the grand ceremony of which took place this Thursday, Rinpoche said, “It’s very exciting. It’s a very, very good thing. I’m very, very happy.”

After the completion of this project, Rinpoche plans to maintain his organization to oversee the functioning and development of the hospital, and then take a much deserved break.

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