'MMM' Mini (Many) Miracles in Mongolia

In January 2009 Dean Walker, director of the humanitarian services vision initiative, told us there was a request for a vision project in Mongolia, originating from the welfare country directors, Elder and Sister Clark. Their email stated that they had visited several hospitals and the clinic of Dr. B. We reviewed the request and related our concerns to Dean Walker regarding Dr. B’s history of using donated supplies to her benefit, rather than serving the poor. He asked if we would communicate this to the Clarks and assist them in developing a vision initiative worksheet. This began a series of many emails back and forth from the Clarks to formulate a project.

We suggested they contact Dr. Chimgee regarding her feelings for what was needed in Mongolia. This was complicated by the fact that she was in England attending the “London School of Public Hygiene and Tropical Medicine” master’s program. This contact resulted in a long process of communication between the Clark’s, Dr. Chimgee and Roger to formulate a project. Dr. Chimgee’s request was for a fundus camera to take pictures of the retina for the diagnosis of diabetic retinopathy which was going to be her master’s thesis project.

Mini Miracle #1
We observed a major paradigm shift of the project from something of providing cataract supplies to a project that would provide long-term benefit of the incidence and prevalence of diabetic retinopothy in Mongolia. We felt this would provide a foundation for retinal diagnosis and treatment which currently doesn’t exist in the county. Things started to proceed in the right direction when a local retina specialist agreed to go to Mongolia and take his son, a medical student who was trained in retinal photography and fluorecein angiography.

Everything shifted to support this specific agenda for the project. Roger contacted retinal imaging companies regarding the best camera to obtain. Also, since a retinal specialist was going to be there, it was felt it was advisable to have him perform some retinal therapeutic procedures while he was there. Considerable effort was directed in working out the budget and list of supplies needed and coordinating this with Dr. Chimgee so Mongolian doctors and patients could be scheduled for training and treatment. Elder and Sister Clark made a number of contacts with individuals anticipating the arrival of the retina team.

Mini Miracle #2a & 2b
Unexpectedly, the retina specialist changed his mind and said he couldn’t go at that time. Roger contacted him to determine his level of interest in going at a later time, but he was evasive and talked in terms of moving the project up to a year later. This was communicated to Dr. Chimgee and the Clarks with very negative impact on all the efforts that had been put forth to put together this project. It’s interesting that during all this, I was either in Seattle or Alaska helping with new babies, Paul was scheduled to arrive home from his tour of duty in Afghanistan, and our Egypt trip had been moved to September because of the death of our host ophthalmologist, Dr. Saif, AND Roger’s work schedule was lightening up enough to allow a trip to Mongolia to be squeezed in.

Roger had a very strong prompting that this redirected project would greatly assist not only Dr. Chimgee’s current involvement with the Ministry of Health in coordinating NGO (non-governmental organizations) efforts for eye care in Mongolia and her master’s thesis, but it would establish a standard and database for diabetic retinopathy for a currently un-served segment of the population with serious eye disease. Establishing this database will create a focal point for future vision projects in the country.

Mini Miracle #3
My scheduled arrival from Alaska was delayed multiple times because of the eruption of Mt. Redoubt. I arrived back in Utah in a state of stress and mental exhaustion from this ordeal. Roger greeted me at the airport, gave me a big hug, and said, “Welcome home, don’t unpack your bags because we are going to Mongolia!” This miracle was that Roger didn't sleep on the couch for a week.

Mini Miracle #4
As essential part of the project was the training of Dr. Chimgee and others with the use of the retinal camera and fluorescein angiography. One option was to simply bring the camera components in their original shipping boxes to Mongolia and open them there with the plan to figure out how to assemble and use the camera. This option had many difficulties and would have provided less than optimal uses of everybody’s time. Roger had another epiphany regarding me. I was going to take the place of the trained medical student and be the subject matter expert for the imaging and angiography portion of the project. He spoke to his photography colleagues at the Moran Eye Center and asked if they would be willing to train me in the basics of retinal photography and fluorescein angiography. I spent about 3 days a week for about a month in this training.

Paula, Glen, Cyrie and Jim at the Moran Eye Center were so kind to provide me retinal imaging training. They even dilated their eyes and recruited others to join in so I could practice (I couldn't train on patients because I wasn't employed at the U). This picture shows Glen teaching me where to place the patients head, aligning the canthus of the eye with the markings on the chin rest.

 

A critical part was to have this camera delivered to the house and then meet the camera representative at the Moran Eye Center (thanks again to Paula for arranging a room to set-up the camera for the day) to have him show me how to put it together and become conversant with the software. I had the foresight to extensively document this process with photos with which I created a training manual. I can hear the collective sigh of all you kids saying, “here goes mom/Bev with her labeling fetish”.

The more I trained, the more nervous I became. The Moran photographers constantly reminded me that retinal photography required extensive training and it wasn’t just a matter of ‘point and shoot’...and I quickly realized that after the first day of training. Paula told me she had 'conferred' with Roger at Ground Rounds one Wednesday, that I was being thrust into something very different than my nursing training. This added to my anxiety about being responsible for the operation and training of the camera and fluorescein angiogram. This miracle was that our marriage continued to survive during my weeks of training.I gained so much respect for the retinal imagers. Their wealth of knowledge and expertise were incredible.

Mini Miracle #5a & 5b
The day the camera components arrived at the house, Roger looked in the garage and said, “I can’t believe all those big boxes are the camera components.” I told him, “go look on the front porch; there are 4 more boxes”. There was a sudden sense of panic as we envisioned battling all this stuff through an 8000 mile trip to Mongolia.

I had to repack much of the equipment (thanks UPS) to satisfy weight and size requirements for 3 different airlines; Delta, Korean Air, and Mongolian Airlines. We researched the best we could by going to websites, phone calls and two visits to the airport to ensure we had the right parameters to pack the boxes. Unfortunately, we later learned nobody knew for sure…which came to a crashing near disaster at the SLC airport when they weren’t going to allow us to check the excess baggage because of oversize measurements. We were very lucky to have had Paul drive us to the airport and assist us with the baggage.

 

This miracle took the form of a Delta agent named Wesley H. who went far beyond his job description in helping us with our baggage nightmare. We left our cell phones home because of a lack of connections in Mongolia so I was running around to pay phones trying to call one of the kids to come back to the airport to pick up boxes that couldn’t be checked in. We thought being at the airport 3 hours early would be plenty of time to check in. We spent the entire 3 hours with the airline agent.

The agent suggested we change our itinerary to Korean Air all the way through. I tried calling the church’s on-call travel department (by now it was Friday at 6pm) to inquire whether or not this was possible. I finally got through to the church’s emergency travel agent who informed me it would cost $5000/per person to change our itinerary. Meanwhile, Roger was working with Wesley H. who was on the phone to Korean airlines to see if we could make an exception to their baggage requirement. At the last minute he found a Mr. Sho in LA who authorized the exception. At this point, we had 15 minutes before our flight was to depart.

I showed Roger the “El Paso shuffle” where we cut in front of the security line. Fortunately, a very good natured man understood our plight and didn’t protest. This miracle was when they closed the airline doors right behind us. We sat at this point exhausted and stressed as the plane took off not knowing if we could get the bags transferred to Korean airlines in Los Angeles for Seoul, Korea, or if Mongolian airlines would accept the boxes.

As the airplane took off into the sunset I had an overwhelming swelling of love in my heart for the charitable man I married. We shared this unique moment that gave us a glimpse of the eternities. Marriage is truly ordained of God and has the potential to bring ultimate joy.

Mini Miracle #6
We had made reservations at the transit hotel at the Incheon Korea airport. However, because of our baggage dilemma, we had to pick up all the baggage and therefore couldn’t re-enter the airport to stay at the transit hotel. This miracle was: our bags arrived in Seoul (thank you Mr. Sho).

Mini Miracle #7
We had to wait about 5 hours before Mongolian airlines ticket counter opened at 9am.

 

We held our breath and walked up to the ticket office (we were the first ones in line). We had a speech prepared as to why they should accept our bags because they were meant to help the poor in Mongolia.We were amazed how easy it was to check our over-sized, over-weighted baggage.

Mini Miracle #8
After we got the bags checked in, they told us to ‘take the shuttle to the section of the airport where we would board’. Exhausted and dazed, we made our way to where we thought we should be going. After walking about 10 minutes, I noticed there weren’t many people around. We approached 2 uniformed officers who didn’t speak English and they were of no help. Suddenly, an airport employee, driving a small transport vehicle appeared and asked if we needed a ride. We emphatically said “YES” because we were lost. Roger offered him a tip, but he refused. I remember looking into the young man’s eyes. His eyes were kind and pure. As he dropped us off at an elevator, I said to Roger, “we have just been in the presence of an angel”. Our eyes began to water with tears as we realized who was guiding us.

Mini Miracle #9
By this time we were very tired of going through so many security check points. As we passed through the final Seoul security point, we just plopped ourselves on the hard chairs, feeling relieved we were passed our troubles. I made a quick dash to the ladies room. I remember taking my time to wash my face brush my teeth, and put my hair in a ponytail. I casually walked out of the ladies room when suddenly I saw Roger/dad frantically motioning to me yelling, "Bev! Bev!" I hustled towards him. These were his words, "I LEFT THE LAPTOP BACK AT THE SECURITY CHECK". At this point, he got the famous 'Harrie eyeroll'.

Now this was no ordinary laptop. The church techy's had downloaded all the software to run the laptop based ultrasound probe. This was a critical part of the Mongolia project. The humanitarian project consisted of training not only the retina camera and angiography, but also the ultrasound unit. I was stunned as Roger/dad raced back to the security check point. I said a quiet prayer and waited. By the time Roger got to the security check, it had been about 30 minutes. The first person he came to, he asked about the laptop. The guard pointed over to a security desk. Roger asked if they had seen a laptop. The guard asked Roger to describe it. Roger said the label said, "The Church of Jesus Christ of Latter-Day Saints". The guard still looked a little skeptical. So, the guard produced it and Roger said, "let me show you that I can open it up with a password", which he proceeded to do. I saw Roger walking back with a big smile on his face with the laptop in hand. (I wonder if God rolls His eyes sometimes as He looks down upon His children).

Our flight from Seoul to Ulaanbaatar was uneventful. We were exhausted but happy we had finally arrived at our destination.

Mini Miracle #10
As we collected all of our bags and boxes in Ulaanbaatar and proceeded towards customs check-out, Dr. chimgee was standing there to greet us with two men in ordinary clothes. She introduced us to them and said they would help us through customs. We walked right through and none of the uniformed officers questioned us. I remember one female officer looking suspiciously at us but we continued walking while Dr. Chimgee led the way while the two other men helped push the 4 baggage carts. We've never gotten through customs so easily before. We were then greeted by Elder and Sister Clark and their warmth immediately touched us, and this would only become stronger as we served with them for the next week.

Mini Miracle #11
On Monday morning, we assembled the retina camera. My detailed assembly manual allowed this to proceed in a very smooth fashion (so haha kids, the laugh is on you for calling me the label lady).

 

The Canon representative in SLC included a power strip and surge protector for the equipment. All of us were very meticulous about ensuring all the voltage adapters were properly connected. We held our breath and plugged in the camera to the power strip and there was a loud pop and spark and smoke pour out. Our hearts sunk thinking that we had blown the camera electronics and our project was sabbotaged.

Dr. Buyan (Dr Chimgee's husband) took the plug and put it into a converter they had purchased. We then plugged the camera and it worked.We have no idea why the power strip blew and NOT the camera after being plugged into the same transformer. Any thoughts from you techy's out there? Nevertheless, we breathed a sigh of relief.

Mini Miracle #12
We were amazed at how fast Drs Buyan and Chimgee picked up the techniques of retina photography and angiography and ultrasound. Roger trained 51 doctors and residents. Roger performed and/or assisted other doctors in 65 ultrasounds. I introduced retina photography and fluorescein angiography to 39 residents or doctors . Sixty-four patients had fundus (retina) photography with 5 angiograms.

One patient, referred to ultrasound had a protusion of the left eye for several months. She came with a CT scan and reported a biopsy performed previously. She had been diagnosed with having an inflammatory condition of the orbit and the referring doctor wanted to inject cortisone into the orbit. The ultrasound showed a large orbital tumor which was most likely vascular and an injection could have caused serious bleeding with loss of the eye. We were informed that a orbital specialist was coming in another few months and we suggested she see him for surgical removal of the tumor.


Another patient was the father of a member of the church who was a judge in Ulaanbaatar. This patient had been advised to have laser treatment for diabetic swelling of the retina. A fluorescein angiogram was performed and showed areas of dead retina (ischemia) which would not be helped by laser treatment and in fact, would even be made worse by the destruction of this small amount of remaining retina.

 

So this second case and the four others involving fluorescein angiography demonstrate how important this technique will be to guide the proper treatment of patients in Mongolia with retina problems. This camera, so carefully carried to the doctors in Ulaanbaatar, will provide the basis to further develop retina diagnosis and treatment in a country that, to this point, had been without this technology.

The things we will most remember about our trip were these mini-miracles throughout our trip, the wonderful people of Mongolia and the dedicated couples that are serving each day in unfamiliar surroundings. These positives far outweighed the relatively minor annoyances such as Roger's/dad's bed bug bites and my swollen feet on 30 hour plane trip, wooden mattresses, brushing our teeth with bottled water and potholes that could swallow a tractor trailer.

 

It was humbling to be a part of training for doctors who so hungered and thirsted for knowledge and were so appreciative of the technology the church donated. We marveled at the dedication, goodness and warmth of our hosts, Elder and Sister Clark. The first stake was organized the week after we left. We were grateful to witness first-hand the growth of the church in that part of the Lord's vineyard.

MMM Pics...i have the wrong date, I still haven't recovered


MMM Many Mongolian Memories


I left Roger's lecture at Hospital #3 to explore the hospital units. This is a corridor in the vintage Russian-built hospital. It was haunting and it made me sad. It depicts the isolation of the country in terms of healthcare.

This child was so cute....I smiled.



FINALLY....THE END!