The Wisdom of a Seven Year Old.

Over the last four years while trapped in a medical bubble, I have become ridiculously less aware of the world. I know it and I hate it. As it kicked off when I began travelling, I had no idea about the happenings in Turkey save a rough idea that some sort of riot had been happening. 

I met a seven year old with a Turkish mother and French father. They live in Istanbul. She speaks turkish and french. In an effort to remember some french, I made an effort to spend some time with her. With the brutal honesty of a french seven year old, she told me she understood some of what I said but not lots. She also told me how police shoot people in Turkey. Her parents say they are proud to be part of something so significant for their country. They mentioned the ongoing extensive amount of government media control and how when the protests began, one of the major tv stations showed a documentary of penguins. This was one of the young girl's favourite songs.

Embarrassed I knew so little about it, I went online and found this article.

http://www.guardian.co.uk/commentisfree/2013/jul/20/turkish-protests-enlightened-emboldened

Hopefully you find some of this as interesting as I did.

Mongolian Fooding

There are times in life you are sure that you have something in the bag. A few weeks ago, my friend Denbe came over with a pot of food for dinner. It was sheep's innards boiled with water and salt. The dish looked similar to a first year medicine anatomy lesson- all the body bits were in there. While I am willing to try many a new thing, this was slightly pushing my limits. So I suggested I make some pasta to make sure there was enough food. I made a fresh cherry tomato pasta with lots of garlic and oregano. In short, delicious. I presented it to my friend to be had alongside the innards. Sitting back to wait for the praise that was bound to follow, I was fairly sure it was going to substantially impress this friend and some others that had joined us. They tasted it, politely smiled and asked to be passed the innards. What?!?!?!?! resonated around my head as I tried to choke down another piece of rubbery kidney. 

If Mongolia has taught me one thing, taste is socialised. Mongolian food and I have not discovered a natural affinity for each other. But my Mongolian friends place their cuisine amongst the world's best. With most dishes consisting primarily of mutton, salt and flour, it is food that has allowed people to survive the harsh winters over hundreds of years and probably contributed to some outrageous cholesterol levels. The whitegoods, mentioned in early posts, also feature heavily. Cheese, Airag (fermented mare's milk), yoghurt and cream are offered to any household visitor. Said to cure most illnesses, markets have Airag stands to make sure it is readily available to the public. There is much ritual surrounding these foods. Firstly, there is the ready offering to household visitors. If any is dropped on the floor (a verifiable sin), the sinner must rub a little on their forehead. Milk blessing are undertaken daily with women tossing milk into the sky three times. 

One of the things, I do enjoy here is the generosity with which food is offered. When arriving into anyone's home the first thing done is that you are offered a seat and something to eat. This may the bowl of lollies every Mongolian home has. I refused to have one at mine due to the amount of black teeth children have and the fact I feared I would just eat them all. This lasted a week as I felt I was the worst host ever. The next thing you are offered is milky, slightly salted tea and then the whitegoods. This may continue to escalate until a full meal and the vodka arrives. This generosity historically allowed people to maintain the nomadic culture and easily travel across the country, ensuring every ger is a haven where food and shelter will be provided with a smile.

This generosity does mean no quick visits. I popped in to pick up something from my friend, Amgaa. Amgaa and I had been working together closely at the Hospital and he had taught me much about Mongolian medicine and it's politics. He had undertaken training in South Korea for a year and was relieved to return home to some good Mongolian food. Within two minutes of arriving at his apartment, I heard the line that often causes me concern, "Sarah, sit down, I will make you Mongolia's national dish." What followed was four hours of food and chat with others arriving. By the end, I left with the item I originally popped over for and a strengthened respect for the time Mongolians are willing to give to others. 

My friend, Denbe was determined to continue to teach me Mongolian food ways. She arrived a week ago, armed with Khuushuurr making ingredients. A Kuushuurr is the Mongolian equivalent of a samosa, a fried mutton pancake. As we were cooking in my kitchen, I was a bit cheeky and sneakily added garlic, ginger and cumin. We rolled out the dough, stuffed and fried it. The result was delicious and something I would be happy to find  at 3am after a night out. A bit of fusion and we both had a bit more appreciation for the other's cuisine.

Ger Grumbles

Part of the attraction of the sweet Ger lifestyle was experiencing a different way of living. A different way of living that is an unescapable norm for many in the world. One billion people in the world don't have access to safe water. While Mongolia's economically improves it status, infrastructure is lacking and there are many without running water at home.

Ger life had been going magically. I enjoyed the extra tasks I had each day. I felt like my home and I had established a symbiotic relationship that led to our greater good. There is a tap roughly 60 metres from my ger. Every morning I go, fill up my little white bucket and return for a bucket wash. I boil water every evening and let it cool overnight for the next day's drinking water. Washing dishes involving fetching water, boiling it and filling my dry sink. The dry sink is a setup with a small bucket with a tap above a sink that is manually filled. After finishing, any dirty water is then carted to a sink hole by yours truly. Washing clothes takes a bit longer and is a weekend activity. My handy shower bucket doubles as a manual, electricity free washing machine. My pit toilet now seems like a sensible option and my thigh strength has improved considerably. I am using less electricity and water than I ever have before. 

Part of the challenge has also been to not look like a person without residence. Camping in the bush and on boats, I am comfortable living basically and consider any form of swim as a legitimate shower alternative. But I am not used to having look hospital presentable at the same time. Added to this pressure is the fact that Mongolians look look good, always. I needed to maintain my business and feel like I have been doing an above par job.

This romance of this symbiosis came to an abrupt holt when gastro arrived. I am normally completed immune to any disease that might possibly make me thinner. Except this one. Only lasting two days, gastro with a pit toilet when it is constantly raining and no running water in your ger is less than average. I did what any sensible human would do, curled up and died (well almost) but not before calling my mum to have a moan.

Hospital Blues

So the last few weeks at the hospital have had their ups and downs. The hospital services a region of about 100,000 people. It is missing what would be considered as fairly essential equipment back at home. No blood gas machine, limited imaging, limited treatments, even more limited pathology testing. Patients stay in small metal beds after walking up the stairs as there is no elevator. They bring there own food and linen. Nursing care is limited. Pain management non-existent. This results in a different practice of medicine. Doctors are left to guess patient's diagnoses, often unable to ever confirm via testing. It is frustrating for the Mongolian Doctors who are unable to fully utilise the knowledge for their patients. Even more frustrating for those who have worked in more developed countries and know how different things can be.

I have been rotating through several areas. ENT (Ears, Nose and Throat), Maxillary Facial Surgery (very fancy dentistry), Opthalmology (Eyes) and lots of Obstetrics and Gynaecology (lady bits). There have been some eye opening moments such as becoming acquainted with equipment that I wasn't sure existed past 1950. You know how cartoon doctors often have a headband with a big circular mirror on it? I was never sure what that was and never gave it much thought until I got here. Turns out it is a old school otoscope (ear checker) and muchin use in Mongolia. The user rotates the mirror over their eye so they can see through the whole in the middle. They then reflect a very big lamp onto the mirror and direct it down the ear canal where they are holding a small tube so the ear drum can be seen. Physics is not a strong point. I am frequently easily distracted during a pool game and mess up the angles. Anything that requires lining up light and bouncing it off way too many objects is not an instrument I am going to like using. Ever. At least my incompetence with this has provided much hilarity for onlooking doctors and medical students. While maybe not acquiring the most useful clinical skills, I have seen lots of advanced disease. This does take out much of the guess work. It is like playing Cluedo but instead of working out who the murderer is, they walk up to you and introduce themselves, possibly with an 'It was me. I did it with a candlestick in the Library.' t-shirt.

Today was sub par. A sick woman presented to the hospital a few days ago. She has been down in the very limited Emergency Ward. She has continued to deteriorate since arrival. Limited testing has made it very difficult to work out what is wrong with her. I popped into to see her this morning on arrival. She had gotten worse. Another key testing machine had broken and this limited our options even more. While I was there, she rapidly went downhill. I requested she was moved to somewhere we could resuscitate her if needed to be, thinking it was a bit odd this hadn't been done already. I would soon find out why. The patient crashed. I moved into resus mode. No one else did. It turns out resuscitation isn't a skill doctors here readily have. One other doctor knew how to perform basic resuscitation. The defibrillator then wouldn't work. The only instructions I could shout were in English. There were limited drugs on hand. With all these factors working against her, the patient passed away with all her family watching. To be fair, given her illness, I don't think caring for her in Australia would be easy either. But it is awful and unfair to watch people die because of lack of resources and education.

In Australia, we are currently in the process of deciding to send all asylum seekers offshore to Papua New Guinea. Regardless of what you think of asylum seekers (I am pretty sure no one risks their life and their families based solely on a desire for a free meal at the other end), they are people that sometimes have complicated health issues. PNG is a place full of people also with complicated health issues. This is combined with limited health resources and alternative governance. While there is no easy answer in the current debate, situations like the one above occur when stress is placed on a poorly resourced health system. Sure there may be legal opinion and polls that deign this not to be our nation's problem (the odd UN Convention may disagree with that). But supporting a decision that places stress on a poorly resourced health system and compromises the health of others is questionable at best. We have access to exceptional health care because we are born in a country that thinks that's important. Should the quality of your health care be determined by where the stork decided to deliver you?

Ger-ish Nights

Sleeping in my ger has been a delight. It reminds me of living on a boat, the tent billows in the wind and there also a breeze constantly drifting across the wooden floor. The rain hits the canvas at night and sends me to sleep. There is a cute mouse that pokes it's head in from outside and occasionally musters the courage to run across the floor. It will be considerably less cute if it gets into my food but until that day, cute away mouse.

The first night in the ger though was a surprise. Returning from the Khorkhog, I was a little tipsy and keen to hit bed. I very elegantly walked into my ger, turned the light on and begun the bed proceedings. One thing I had yet to learn about Mongolian gers was that there is a no knock, just enter approach to visiting people. Within five minutes of returning home, I turned around to find my ger filled with my delightful Mongolian-only speaking neighbours, including their three year old grand daughter. There is normally pretty clear procedure on welcoming someone into your ger, even if they appear unannounced. Offer them tea, a variety of Mongolian dairy products and lollies. This is done with everyone, everytime and ensures there is no speedy popping in to borrow a cup of sugar. At this point, I was in no state to proceed with this protocol, I managed to smile a lot and find a clip on kangaroo for the three year old. They eventually seemed to believe I would survive there alone and bid me good night or in Mongol, bayartai. I recovered my poor form in the following weeks. I also got very good at locking my door as a wide range of surprise visitors continued to appear.

Khorkhog Times

My friend, Leah, has garnered many mentions in this blog so far but her partner, Andrew, has yet to feature. This is due to Andrew's first foray into running a Mongolian photographic tour with another friend, Batmaa. Andrew is an impressive photographer and writer. He has learnt over the last few years whilst crazy travelling the world. I'd give you a link to his site but you will continue to be disappointed with my photos from here on out so I might delay that. He has been taken a couple of Australian photographers around Mongolia, shooting the wild beauty on offer. Inviting Leah and I along, he had brought them back to our fair town for the night to experience a traditional Mongolian BBQ, a Khorkhog. 

  

A Khorkhog is an outside activity. Rocks are collected from a river and placed in a fire to heat up. Traditionally a goat would be gutted, the stones would be taken from the fire and placed inside the goat with vegetables. The whole thing is then cooked in the fire until deemed tasty. The modern day Khorkhog looked a little different. Instead of the gutted goat, the river rocks are heated and then placed in a pot (or metal milk container) with mutton or goat, veggies, water and salt. It then cooks away while participants kick back and enjoy the view.

For our Khorkhog, Batmaa's husband, Toggi took the reins. We had 4WD'd down to the river, scattering wild horses across the Steppes as we went. Toggi led us to collect and wash the river rocks. He then set about running his own cooking show as we relaxed with a few beers. The veggies (token) and meat were chopped and thrown into the pot with a little water and salt. The stones were piled in with tongs and the lid quickly secured in place.

When it was deemed the pot had hit tasty, it was taken off the fire. It's contents were emptied on the lid and the free for all began. The ribs are regarded as the tastiest morsel and soon everyone's fingers were covered in juices and the ever present animal grease. To finish the meal, the hot stones are taken from the pot and rubbed over the hands, or any other body part, to improve circulation. What is failed to be mentioned in this semi-romantic procedure, is that the stones are hot. Crazy, third degree burn hot. While the Mongolians sat there serenely with their stones, I am juggling mine back and forth, hoping the whole process finishes asap before blisters appear. 

With full bellies, we lay around the river grass and the vodka was passed around. It may sound that vodka is a constant in Mongolia and it is but it is about ritual more than alcoholism. After the Khorkhog, generally the most senior Mongolian male takes control of the bottle and passes the glass. He keeps the glass full and passes it with his right hand. You must receive it with your right hand and bring it to your lips. Here it is up to you, gulp or take nothing. It took me awhile to get the take nothing bit. The glass is then passed back to the man in charge with your right hand and the ritual repeated with the next person along. This continues until the bottles are empty.

The sunset was stunning. Mongolia definitely does a sunset. Armed with Vodka, I had hit the photographers for a free lesson and hopefully you will experience the benefits in the future. Feeling a little tipsy (hiccup!), we piled back into the old Russian troopy and I headed back for my first night in my ger. 

Khashah Dog

I want to introduce you to Khashah Dog. Mongolia has the most beautiful dogs. They are a genetically unique breed, can pretty much do anything from eating mutton fat to pulling sleds and have excellent, fluffy tails. I don't know enough about animal husbandry to tell you anymore than that. 

When in regional towns (aimags) or villages (soums), gers are generally located in a yard or a khahshah. These are owned by individuals. The ger districts, comprised of many khahshahs, have been rapidly expanding due to the impending end of a government policy that allows every individual to lay claim to a khahshah of their own.

A Khahshah normally has a dog to protect it. They wander wild and fend for themselves. For me, wandering scary dogs are a big deal because a dog bite would probably mean an eight hour bus trip to the capital for a rabies shot. Khahshah Dog terrified me the first night I met him, wandering in late with a friend. I obviously send the friend into the yard first as a sacrificial lamb. Fortunately, we both made it through safely. Since then though, Khahshah Dog and I have developed an active adoration of each other. I talk to him incessantly and throw him leftovers (he hates sushi). He sleeps next to my ger at night and follows me up the street.