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This morning I woke up a bit hungry since I've been eating a bit less than usual and devoured a protein bar I brought with me. I managed to get myself up early enough to get over to the department store to get a SIM card before heading over to SOS. SIM cards are fairly cheap here fortunately.
I caught a taxi this morning and had been warned to watch out for taxis ripping you off. I watched the meter and knew it was supposed to be 300 MNT/km. It started out OK but then I noticed the meter jumped drastically at one point. I was confused as to what had happened but suddenly it went from 400 to 4000 in a matter of blocks. I tried to ask him about this but he didn't speak any English. When we got to the destination, I told him the price was wrong and pointed to his odometer. He kept pointing at the meter and insisted I pay that amount. Since I wasn't 100% sure at this point that I was in the right, I paid the fare and left. There was no point trying to argue when there's not much I could do but walk away and I wouldn't do that unless I was absolutely certain he was scamming me. Once at the clinic, I asked about this and they said I had been ripped off. In Australian dollars, it cost me $4 instead of $1.50, so it's no real loss but rather it's the fact that you really do get scammed here and you will be scammed unless you stand firm and refuse. Its disappointing that the greed is greater than the desire to convey a good reputation of the people of Mongolia. With that being said, so far it's just been a small subset of people so now I've learned not to trust any taxi ever. Later in the day I was talking to my friend Luke who works at a mine here in Mongolia and he said that taxis often have a little hidden button on the steering wheel or on the gear shifter that can instantly add money to the meter. At least I learned this lesson early on.
Once at SOS, Dr. Gantulga was very nice to take me around to the various hospitals. We first went to Hospital 1 (Central Hospital). The corridors were crowded, there was no equipment except the basics, and the pride of the hospital, the MRI machine, had been broken for 3 weeks because there's no engineer here to fix it even though the part is here. We then went next door to the joint Korean-Mongolia Hospital and it was very clean and organised. It's a private hospital but the rates are still very low. For example, an FBC (CBC) is only about $1. An X-ray is $3. After this, we went to a district hospital in one of the outlying suburbs of UB and I found it very bare but much cleaner than the main hospital. There are only two wards there - internal medicine and neurology. Apparently this covers everything except for pediatrics. Internal medicine comprises anything "medical" while neurology comprises everything else from back injuries to strokes and psychiatric problems - all nerve-related in one way or another I suppose. Then finally we went to the local GP clinic in one of the outlying suburbs. I got to ask the local doctor some questions about what works and what doesn't work. Apparently, the way the system here works is that each suburb of is broken up into small subdivisions. Each subdivision has a government run GP clinic that has 2-4 doctors on staff most of the time. If someone gets sick, they must go to their local clinic (Hodo - sp?). There are basic medications available here but no labs. If the patient is seen to require further care, they're referred to their district hospital. Each suburb has a district hospital. So there are about 4-5 clinics that feed each district hospital. If the district hospital feels that the condition is serious enough to warrant escalation, then the patient is transferred to the central hospital. If the patient is a herdsman out in the country, they are allowed to go straight to the central hospital, which is partly why it is so crowded. All the city people must first go to their local clinic and do not have a choice of going to any other clinic unless they want to pay for it themselves. All medical services except for medications here are free. There are some exceptions but for the most part the government covers the cost.
From what it sounds like, I'll be going to the Emergency Center tomorrow to do some calls on the ambulance. Doctors are posted to the "Emergency Center" here and aren't tied to any one hospital. The Emergency Center just does central dispatch but is not a facility for treatment. Ambulances are staffed by a doctor and a nurse. There is no such thing as a paramedic here. It will be interesting to see the level of care and what happens.
I have to say that SOS has been absolutely fantastic in taking time out to help coordinate all this for me. They definitely have the best medical services in town for those who can pay.
Anyway, I got dropped off in the center of town towards the late afternoon and wandered back to the guest house. I decided I was running out of clean clothes and I needed to get some laundry done so I went to the store to buy some detergent. The stores are well stocked and clean, but this local supermarket belongs to the upscale department store so it's also probably the best one in town. I also found some good local beer on tap (for sale in bottles) so I picked up a litre. The total for all my stuff wasn't much, but at the store's exit, the people checking the receipt asked if I had received a "Monim" card (cash card). We couldn't really converse but they ended by keeping my receipt and walking off towards the store clerk. I left the store but what I think must have happened is that the checkout lady charged me for a cash card that I wasn't given so that she could keep it for herself. Though I did try to check my receipt, the ink was very faded plus it was in Mongolian so it made no sense anyway. So now I have to watch out at the store checkout too. Maybe next time I'll add it all up in my head for checking out and make sure that it's the right amount. It's a shame that there seems to be so much of this stealing going on here. I was really hoping that Mongolian culture would have a bit more integrity. However, I think (hope) this is limited to the city area and only certain people. Thinking back to New York, there are plenty of bad experiences that foreign visitors may encounter, but those responsible certainly aren't representative of Americans as a whole. So now my two things to watch are taxis and paying supermarket bills.
Anyway, so I'm back at the guest house now and having a glass of this weird beer, "Gem" beer that's called "living beer", and the description said something about barley, hops, and fermented mare's milk. Hmmmm.... Anyway, it's better than Kahn Brau.
See ya!
For dinner, I decided to head back to the English pub since it's trivia night and there's not much else to do. The small place was fairly full when I got there. There was no one else I knew hen I got there except the owner with a broken leg. I got a quick dinner and wine just as trivia was starting. Since I didn't have a team, the owner and another guy who had just wandered in joined up with me for a three-person team. Though the owner didn't have anything to do with the questions, it was good that he was British because almost every question turned out to be about British history and popular culture, like "what's the nation's favorite pastime/national sport?" It turns out it's rolling cheese down a hill and chasing it!
Anyway, it turns out the other guy in the group, an American, is the defense guy at the US Embassy here. He had been out with the Russians all evening so he was showing the effects of all the vodka from earlier in the evening. We managed to do respectably in the end and it was good fun. About half-way through trivia, a few of the English students from last nights English Club turned up so it was great to chat with them.
One of the guys who I spent most of the time talking to told me a lot about Mongolian culture. For example, he said that the Mongolian women are notoriously possessive and violent towards husbands, and this combined with high rates of male infidelity leads to very high divorce rates here. He told me that the problems with pollution in the winter causing respiratory problems in kids goes back only to 2001. In 2001 there was a severe drought and most herders lost all their cattle and horses. To loose your cattle here is to lose all your money and food. To loose your horses here is to loose your transport. So with no transport, no food, and no money, all the herdsmen from the country had to move into the city. The sudden influx of people dramatically increased the amount of heating fires around the city as well as required the four electric plants here to run a lot more than usual. Plus there's the constant problem of smoke and soot inside the ghers from the coal fires. Smoking is also big here, and is of course allowed indoors, so when you put all this together it adds up to severe respiratory problems for most people.
I was also told earlier in the day that the most common medical problems here (aside from trauma) are renal disease, cardiovascular disease, and stroke. Most people have severe hypertension here and this very well may be a contributing factor for all of these conditions. Anti-hypertensives aren't used much here from what I can tell, and the diet is pretty poor in the city. In the country, the diet is almost entirely mutton and other types of meat. Everything is also very high in salt, which can't be helping much.
I also learned that Mongolians are very much like the Chinese and Japanese when it comes to issues of authority and questioning authority. In conversation, I had mentioned that it seemed that in the medical field, no one ever questioned superiors here or even dare to give any indication of disagreement. He said that in Mongolian culture one would never do this but couldn't really say why. This seems quite dangerous when people's lives re at issue. I think it's essential to have an open respectful dialog about any points of disagreement so that both the junior person can learn and so that the superior person can explain his/her line of thinking and back it up with facts and/or evidence. It's really a win-win situation unless it's a matter of an emergency where there's simply not the time for dialog.
Anyway, so towards the end of the trivia, three young women from Scotland came in and were chatting up another table of various guys, I think from Holland, the US, and somewhere else. When she was introducing herself to people, anyone who didn't automatically know who she was by her name was quickly informed that they ought to know, as she was the lead singer from a group called "The Rounders" and was apparently quite famous though I had no idea, nor really cared. She and her friends were in UB for a few days on holiday from Moscow. Though originally from Scotland, they went to Moscow for a semester of uni studies to learn Russian. This got the owner talking about celebrities in the bar, and unbeknown to me, Elton John's butler for 30 years was in the bar last night when the English club was there. And some evening before that, the Queen's head butler was in as well.
So it was quite an interesting time there. As soon as I headed home, I realized that things on the street looked a bit darker than usual. All the lights in the city had gone out except for a few of the main street lights. I think the only reason we didn't lose power in the pub was that it's actually in the bottom floor of an official building on the min square. Finding my way through a pitch-black guest house was a bit tricky. It's a good thing I brought my headlamp with me! Though I was going to ring Michelle on the computer but of course the routers are off as well and so there's no Internet. I was really hoping to talk to her, and I'm starting to miss home already. It's been great so far but I'm looking forward to getting back to regular life back home.
So here I'll say G'night again. I'm off to the ambulances tomorrow!
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