Mongolia is the most sparsely populated country in the world. The austere environment, lack of road building, and high percentage of nomadic people severely limits patients’ access to modern health care. Lack of trained human resources, supplies, and basic infrastructure posed significant challenges to creating sustainable modern surgical care.
In 2005, gastrointestinal diseases were the 2nd most common cause for inpatient morbidity with gallbladder disease representing a significant component While laparoscopic cholecystectomy had been introduced into Mongolia in 1994, by 2005, most patients did not have any knowledge about laparoscopic surgery or its benefits. Only 2% of the gallbladders were removed laparoscopically and only in the capitol city.
Dr. Sergelen, the chief of the Health Sciences University of Mongolia (HSUM) requested assistance in expanding laparoscopic cholecystectomy countrywide indicating that she thought the benefits of laparoscopic surgery were more important to people in a resource-limited country like Mongolia than in high-income countries. Over the next 9 years, the Dr. W.C. Swanson Family Foundation, SAGES global affairs committee, and the HSUM partnered to create sustainable laparoscopic surgery for all of Mongolia. This included team training of surgeons, nurses, anesthesiologists, scrub technicians, engineers, and administrators in the Regional Diagnostic Treatment Referral Centers. Advocacy through video, news reports, and meetings with the Ministry of Health were crucial in changing the perception of the patients and the local leaders.
Through didactic course work from the Fundamentals of Laparoscopic Surgery, introduction of FLS like skills training, hands on surgery, infrastructure development, support from industry and business, laparoscopic cholecystectomy is now performed nearly 80% of the time and in 19 of the 21 states with the Ministry of Health agreeing to fund the purchase of laparoscopic equipment for the remaining hospitals. Over 315 healthcare workers have been trained.
Laparoscopy has been an enabler to improve health care in general countrywide:
While there are many improvements to surgical care in Mongolia, a survey of doctors and patients feel that laparoscopy has been a central component to decreasing morbidity and mortality in surgical patients and is critical to expand further for continued improvements for healthcare in Mongolia.
Mongolia has become a prototype for health systems strengthening though laparoscopy that might be a model for improving healthcare in other low- and middle- income countries.
(Picture of representative surgeons from all our training sites taken at the Mongolian Surgical Society Meeting 2012: Dr. Sergelen is in the middle.)