Sharing Duties and Improvising to Provide Care in Mongolia

A visit may last six minutes.  In the space of time it takes to brew a pot of coffee, Project HOPE volunteer certified nurse-midwife (CNM) Candace Duran of Gallup, New Mexico, and her Mongolian counterpart, OB/GYN physician Gandolgor Ulziinorov, have consulted with the patient, done a brief pelvic exam, written a prescription and provided quick follow up counseling.  In Mongolian. “We have a really good flow because we can tag team.  I might be putting my gloves on and she will start a visit.  Then she’ll catch me up on what the patient said and we’ll continue.”

Everything the patient says must be translated from the Mongolian language to English and the replies follow the opposite course.  Officially, Ulziinorov is the translator.  But on the first day of open clinic at Ondorhan hospital’s outpatient clinic– about five hours from Mongolia’s capitol– Duran learned about Ulziinorov’s qualifications and the expected work load, the pair decided it would make more sense to share duties…translator take the history while the Project HOPE CNM completed microscope sampling and prepared treatment protocols.

Eighty seven patients were seen by the team yesterday and they expect to see at least as many in each of the three remaining clinic days. The expedited work flow is part of the PACANGEL Mongolia mission launched by the U.S. Air Force with a target of over 6,000 patients in a six-day open clinic operated at two locations simultaneously.

Project HOPE volunteer Denise Barnes, also a CNM and her Mongolian translator– who she nicknamed “Nara”– made the same decision to share duties.  Assigned to B Team, which is operating two-day clinics back to back at three different locations, their approach means that while Nara is taking a history, Barnes– a self-described microscope fanatic– can be peering at a sample on a slide in order to zero in on an STD.  “Yesterday for the first time she was able to recognize Trichamonas, which she had never heard of,” relates Barnes, referring to a lesser known STD identified on a sample slide by the organism’s quick movements.  “Now whenever we see it we yell, ‘swimmers!'” “She’s not a trained interpreter so her brain has got to be hurting at the end of the day,” says Barnes.

The teams have had to improvise for supplies as well, using plastic bags on their exam tables instead of the standard roll of table paper and a sarong instead of a lap drape.  Duran worries what they will do when they run out of their short supply of disposable speculums and how they will compensate for the lack of lubricant.  “Thank goodness the women don’t expect the lubricant,” says Barnes, who, in lieu of cotton swabs to use for her slide samples has improvised with her gloved finger and a rolled piece of paper.

“It’s not ideal but it’s what we have,” says Candace, who hopes one day to be able to bring Ulziinorov to visit her clinic in Gallup.  “It’s just another opportunity to be around people who aren’t like me and learn some adaptability to situations.”