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Reducing burns risk in Mongolia

Posted by Rebecca Dash on 30/09/2021 at 1:30 PM

Many people in Mongolia still live nomadically, as they have done for centuries, driving their herds across vast grassland ‘steppes’ and living in gers – big ‘tents’ made from felt tarpaulins and wood. Each ger is open plan, with a small kitchen, beds along the sides, and an all-important central fireplace for cooking and heating. In this way, it nurtures up to four generations of a family members, feeding them and keeping them warm in winter when temperatures often drop below -40˚C.

Despite such life-giving properties, these fires frequently cause very bad injuries, particularly among children. For example, contact with hot liquids amounts to well over half of all injuries to children in Mongolia. This is a global problem. Burns are a leading cause of unintentional, life-threatening injuries among young children around the world.

Anaesthetist Assoc. Professor David Pescod, has treated many burn injuries like this during his 20 years travelling to Mongolia with Interplast surgical teams. This excerpt comes from a recent interview where Assoc. Prof. Pescod shares his professional experiences and emphasises the need to do more to reduce the incidence of such preventable injuries.

If you’ve got someone who’s living remotely with no access to health care. Gets what could be a minor operation fix, but then doesn’t see a doctor for many years. In Mongolia, is that a big issue?
Yes, it is a big issue in Mongolia. The burns training isn’t there. The access to health care isn’t available. The burns then undergo contracture to where a simple burn on the wrist, which would be treated here, will undergo contracture and it will pull the whole wrist back to the point where the hand will be fused. And this is happening frequently in young children.

The burn rate in children in Mongolia is probably 1 in 3. Most of the burns occur because they are cooking on top of a closed fire, but the children are pulling down boiling water or boiling milk.

Can you explain a little about the living arrangements in a ‘ger’, and why that seems to compound this?

A ‘ger’ is a massive round tent which they can pack up in a day and put onto the back of their camels or their horses and move to another grazing field, but they cook in a closed fire. The fire is normally fuelled by dung because there’s no trees on the steppes, and the mothers cook in big open pots. Most of the diet is based around dairy or meat, and they boil up the milk. And then the children reach out and pull the pots down, and suffer dreadful burns, dreadful scalds. The nearest health access may be several days travel by motorbike away, and that would be to a small hospital, that may be manned by one doctor and two nurses, and then maybe another two days travel by jeep to get to a district hospital, and then several days to get to a tertiary hospital where they can treat a burn.

You’re one of the longest serving co-ordinators in Mongolia, so have you seen the Interplast system benefiting the people over 20 years?
Burns [treatment] in Interplast probably only started five years ago. Prior to that it was really anaesthesia strengthening. But the burns system, prior to COVID, was looking really encouraging. We’d been up to the far north, to Mörön on the border of Russia.

Dr Kirstie MacGill had trained a local surgeon there. She’d been back there twice, and he was very skilful. And the plan was, until COVID came, was to take him to Dalanzadgad, which is down south near one of the big mining towns, and have him mentor a surgeon under Kirstie’s supervision. I’d planned to train both those surgeons the following year or year after, then take those out to different spots and then train another four. Following this approach, looking at a 10 year program we’d expect to have a trained burns surgeons in every major hospital in every district in the country.

Is that still the ambition?

Yes. That is still the ambition, yes. And Kirstie is very ambitious to do that. And, it is easily, not easily, but it will be achievable. The Mongolian government has realised that burns is one of their major concerns. There’s finance from one of the foreign countries I think somewhere, might be United Arab Emirates. They’re providing money to build a burns hospital that’s half completed. And at that point, Interplast will be able to enter into a new hospital and provide a total service. We’ll be looking at setting up the physio, OT, surgery and anaesthesia. And also helping the hospital with how to manage a hospital infrastructure. It’s an amazing opportunity.

That’s part of Interplast’s role. It’s the bringing all the right components together and communicating with one another. When is the burns hospital likely to be completed? 
It was expected to be done two years ago. They’re fairly confident to have it finished sometime this year or early next year. With COVID there’s been several crises in Mongolia. They did a remarkable job until November keeping COVID out, but unfortunately they rely on transporting coal to China for most of their GDP apart from tourism. And COVID snuck back in through the coal mines.

 

Whilst challenges exist due to COVID-19, Interplast are continuing to work with our partners in Mongolia on burns prevention campaigns and burns care training via online education and remote mentoring.

 

Programs include Emergency Management of Severe Burns provider and instructor training, Interburns Advanced Burns Care training as well as online educational programs such as webinars, modules, training videos and mentoring sessions through our Telehealth approach.

 

Interplast is also working to develop a National Plastic Surgery Strategy and are supporting the Mongolian Society of Anaesthetists through the development of online education resources.

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